Residential Rurality and Oral Health Disparities: Influences of Contextual and Individual Factors

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine
contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle
behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage,
telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel
statistics for categorical variables were applied to explore conditional independence between both health access and individual
factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate
the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter
(24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health
disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common
among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings
suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related
to better access to oral health care and improved lifestyles in both rural and urban areas.