Multilevel Drivers of Oral Health: Psychosocial Stress, Health Behaviors, and Neighborhood - ABSTRACT Oral health is essential for the overall health and well-being of adults, yet oral diseases remain prevalent within this population. It is estimated that 90% of United States (U.S.) adults aged 20 to 64 years have experienced dental caries, and nearly 60% of adults aged 65 years or older have periodontitis. Adults of Central and South American ancestry, in particular, experience notable differences in oral health outcomes, including the highest prevalence of periodontal diseases compared to their counterparts. Research exploring the reasons for their increased risk of oral diseases has often focused on acculturation—broadly understood as the process of adopting to U.S. societal norms, practices, and behaviors. However, such cultural explanations that emphasize individual-level adaptations tend to overlook broader upstream influences that contribute to oral health challenges over the life course and across generations. Therefore, the purpose of the proposed study is to examine how everyday experiences shaped by upstream psychosocial factors influence oral health among adults of Central and South American ancestry. To advance this undertheorized area of research, this project will leverage electronic dental records to examine the association between perceived exposure to psychosocial stress and both clinical and self-reported oral health, while evaluating differences by biological sex, behavioral risk factors, and neighborhood-level economic conditions. The knowledge generated from this study will advance understanding of the mechanisms by which broader upstream contextual factors influence oral health. This study is novel in moving beyond individual-level frameworks to focus on broader systems and conditions that shape access to and outcomes in oral health. Findings will contribute to advancing the goals outlined in NIDCR’s 2021-2026 strategic plan goal to improve scientific methods for understanding and addressing variation in dental, oral, and craniofacial health and disease.
