Our study revealed a significant black-white gap in the use of preventive care among children under-five, and these results are in consonance with other reports in the literature, further confirming the notion that race/ethnicity remains an important marker for underutilization of preventive care services. It does appear that current efforts and resources have proven inadequate in addressing the black disadvantage consistently reported by studies because this racial group still lags significantly behind relative to their white counterparts. Augmentation of infused resources as well as prioritizing subgroups of black children that depict higher-than-expected levels of nonuse of preventive care will enhance the effectiveness of strategies that aim to narrow the racial gap.

We also observed a trend between preventive care use and age of the child. The component of preventive care utilization that accounted for this relationship was a dental visit since the immunization component displayed almost a flat association with age. Previous investigators have also detected the same direct relationship between child’s age and the probability of a visit to a dentist. In an analysis restricted to components of dental care, Macek et al. in 2001 reported a low level of diagnostic and preventive care use among 0-18-year-old children (39.3%). Similarly, in a cohort study of 0-3-year-old children followed over time, only 2% had a dental visit by one year of age, 11% by two years of age and 19% by three years of age. The increasing trend with age is consistent with the findings of our study.
levitra plus

Interestingly, our results also demonstrated that maternal characteristics (e.g., age and education) influenced the receipt of preventive services by children. Very few studies have examined the influence of maternal characteristics on pediatric use of preventive care. In a recent study that investigated the association between maternal characteristics and vaccination among children aged 19-35 months, the authors found that children of mothers who were black, of low education and who have had multiple children were more likely to be undervaccinated. In a similar analysis focused on the receipt of recommended well-child and dental visits among children younger than 18 years, it was observed that higher rates of dental visits correlated significantly with older parental age and high parental education. The same study also noted significantly low visit rates among children of black parents. These reports are in agreement with our findings.

While the direct association between level of maternal education and receipt of preventive care use by the child can easily be explained, the pathway through which older maternal age mediates enhanced pediatric preventive care utilization is not so obvious. It has been reported that adolescent mothers tend to have a lower level of prenatal care when pregnant, and adequacy of prenatal care improves with increasing maternal age. Earlier studies have also observed that children of mothers who have delayed prenatal care are at a high risk for not receiving an adequate number of well-child visits by age two. It is, therefore, reasonable to speculate that influential factors that interact with maternal age to determine access and use of health services during the period of gestation still play a similar role during the childhood years. With increased age, people tend to be more educated and informed. This will determine their inclination toward use of healthcare services not only for themselves but for the children under their care as well. However, even after accounting for the effect of education in the adjusted model in our analysis, maternal age still portrayed a significant relationship with preventive care use among children. For policy purposes, even though age cannot be modified, it is important to recognize young maternal age as a risk factor for lower level of pediatric preventive care utilization. Therefore, care providers and those involved with provision of preventive care may need to focus more attention on younger mothers in a bid to improve utilization of preventive health services by their children.
viagra plus

A unique feature of this study is the finding that the insurance status of the mother is also a predictor of pediatric preventive care use. It is well known that children who have health insurance coverage are more likely to have access and to utilize health services. It is poorly known, however, whether coverage for the mother would enhance the use. Interestingly, both public and private insurance coverage demonstrated the same level of prediction. This finding bears an important implication on current public policy concerning insurance coverage for the mother. It suggests that the effectiveness of ongoing programs that target highly needy children through insurance coverage (e.g., the state-run SCHIP programs) can be strengthened by extending the same coverage to their mothers or by instituting a parallel insurance coverage programs for their mothers.

A number of potential limitations to this study deserve mention. In constructing the composite variable for preventive care use, we could not differentiate between preventive versus acute or emergent dental care. It is noteworthy that the American Academy of Pediatric Dentistry (AAPD) and Bright Futures recommend two dental visits per year commencing at age one, but we decided to lower the inclusion criterion to a single dental visit since that is more likely to be the common practice. Despite these potential shortcomings, our analysis provides useful information, especially for constructive national debates regarding the extension of insurance coverage to mothers of disadvantaged children—a step that will enhance pediatric preventive care use. seroquel medication

Finally, the study findings clearly demonstrate that dental visit was a more sensitive parameter for pedi­atric preventive care than immunization coverage, and a yearly dental visit commencing at age one could be a valid and reliable preventive healthcare indicator.