Investigating the Complex Relationship Between Adverse Childhood Experiences and Oral Health-Related Quality of Life

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dc.contributor.advisorLykens, Kristine A.
dc.creatorKabani, Faizan A.
dc.date.accessioned2020-05-15T14:07:38Z
dc.date.available2020-05-15T14:07:38Z
dc.date.issued2017-05
dc.description.abstractDental caries is one of the most common chronic disease in children and continues to be a significant global public health concern. Evidence indicates that chronic diseases, and adverse childhood experiences (ACEs), have destructive impacts on overall quality of life, health outcomes, and health care expenditures. The ACE investigation identified cumulative dose-response relationships between ACEs and development of diverse health and social consequences later in life. Research is scarce on investigating causal pathways to facilitate contextualized public health interventions addressing this seismic threat. Data was utilized from the 2011-2012 National Survey of Children's Health, inclusive of ages 1-17 for dentate status. The dependent variables identified untreated oral health care needs and preventive dental utilization. The key independent variable, ACEs, included exposure to parental death, parental divorce, parental incarceration, mental health illnesses, domestic violence, neighborhood violence, and racial discrimination. Exogenous variables included age, sex, race/ethnicity, number of children in household, socioeconomic status proxies, health insurance status, and presence of special health care needs. Path analysis, a special subcomponent of structural equation modeling was utilized to explore direct, indirect, and mediating causal pathways. The data, when adjusted for complex survey design, proportionately represents children in the United States. The results of the adjusted logistic regressions revealed ACEs demonstrating varying magnitudes of significance across diverse racial and ethnic profiles. Exposures to parental divorce and parental death particularly exhibited critical magnitudes of influence. Adjusted path analyses demonstrated alternative family structures contributing a mediating role between ACEs and oral health-related quality of life (OHRQoL). In keeping with the Pareto Principle, exposure to certain ACEs, namely parental divorce and parental death, potentially introduces more profound social and health-related consequences later in life. Moreover, invocation of Occam's razor, can assist in theorizing that exposure to alternative family structures (i.e. via parental divorce and/or parental death) initiate a concatenated deteriorating domino effect sequela of secondary ACEs. Therefore, contextualized interventions should prioritize psychotherapeutic child, marriage, and family counseling services improving the home, as an enabling environment, to potentially minimize detriments of ACEs on OHRQoL.
dc.format.mimetypeapplication/pdf
dc.identifier.urihttps://hdl.handle.net/20.500.12503/29842
dc.language.isoen
dc.subject.meshOral Health
dc.subject.meshQuality of Life
dc.subject.meshAdverse Childhood Experiences
dc.titleInvestigating the Complex Relationship Between Adverse Childhood Experiences and Oral Health-Related Quality of Life
dc.typeThesis
dc.type.materialtext
thesis.degree.departmentSchool of Public Health
thesis.degree.disciplineHealth Management and Policy
thesis.degree.grantorUniversity of North Texas Health Science Center at Fort Worth
thesis.degree.nameDoctor of Philosophy

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