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Objectives. We assessed the impact of health literacy and acculturation on oral health status of Somali refugees in Massachusetts.
Methods. Between December 2009 and June 2011, we surveyed 439 adult Somalis who had lived in the United States 10 years or less. Assessments included oral examinations with decayed, missing, and filled teeth (DMFT) counts and measurement of spoken English and health literacy. We tested associations with generalized linear regression models.
Results. Participants had means of 1.4 decayed, 2.8 missing, and 1.3 filled teeth. Among participants who had been in the United States 0 to 4 years, lower health literacy scores correlated with lower DMFT (rate ratio [RR] = 0.78; P= .016). Among participants who had been in the country 5 to 10 years, lower literacy scores correlated with higher DMFT (RR = 1.37; P=.012). Literacy was not significantly associated with decayed teeth. Lower literacy scores correlated marginally with lower risk of periodontal disease (odds ratio = 0.22; P= .047).
Conclusions. Worsening oral health of Somali refugees over time may be linked to less access to preventive care and less utilization of beneficial oral hygiene practices. [Am J Public Health. 2013;103:1516-1523. doi:10.2105/AJPH. 2012.300885)
Among refugees newly arrived in Massachu- setts, oral abnormalities are the most common health problem in children1 and the second most common problem in adults. One major determinant of oral health disparities is access to preventive and restorative dental care.2 Other determinants include oral hygiene prac- tices and diet.2 Linguistic and cultural factors may play important roles in determining access to oral health services as well as personal oral hygiene practices, and limited literacy skills have been hypothesized as a likely barrier to better oral health outcomes.3
Health literacy, reflecting an individual's capacity to obtain, process, and understand basic health information and services, affects a variety of determinants of oral health and is thought to play a pervasive role in all aspects of health care and oral health status.3'4 Inade- quate health literacy has been associated with a long and growing list of adverse health outcomes.5 Inadequate literacy has been asso- ciated with limited access and utilization of care,6'7 poor clinical outcomes,8 hospitaliza- tion,9 and mortality.10 However, the relation- ship between health literacy and oral health has never been studied in a...