Altruism in Dental Students

7/25/2019 Altruism in Dental Students

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PART I: ORIGINAL PAPER

Altruism in Dental StudentsDaisy Carreon, MPH

Pamela Davidson, PhD

Ron Andersen, PhD

erry Nakazono, MA

Abstract:Altruistic dentists play a central role in treating minority populations, the poor,the uninsured, and those living in underserved communities. Tis study examines actors

associated with graduating dental students altruistic attitudes. We use a nationally repre-sentative dataset, the 2007 American Dental Education Association Survey o Dental SchoolSeniors (n53,841), and a comprehensive ramework to investigate individual, school, andcommunity characteristics that may influence altruism. Student characteristics were themost significant predictors: women, Arican Americans, Hispanics, Asian/Pacific Islanders,and students with low socioeconomic status expressed greater altruism than their counter-parts. Tese results inorm dental educators and administrators to expand efforts to recruitunderrepresented racial/ethnic and low-income students into dentistry. Additionally, weound that students with altruistic personalities attend schools where the social context ismore accepting and respectul o diversity. Tis suggests that schools can promote altruism

in their students by creating a positive culture and environment or diverse populations.

Key words:Dental education, altruism, access to care.

M illions o Americans are unable to obtain quality dental care services needed tomaintain a healthy mouth and body. Although oral health is integral to overallhealth and well-being, an estimated 25 million individuals reside in areas lacking

adequate oral health care services according to Oral Health in America: A Report of

the Surgeon General.1Te access to oral health care crisis is most evident among low-

income and racial minority populations.2,3Arican Americans, Hispanics, and Ameri-can Indians and Alaskan Natives generally have the poorest oral health o any racial

and ethnic groups in the U.S. and are less likely than Whites to utilize preventive and

specialty dental services.1,4,5

In response to a call by the U.S. Surgeon General to improve the dental saety net

or the nations underserved and disadvantaged populations, Te Robert Wood Johnson

MS. CARREONis a doctoral student in the Sociology Department, University of California Irvine andResearch Associate on the National Evaluation eam (NE) for the Dental Pipeline Program, UCLA

School of Public Health. DR. DAVIDSON is Associate Professor, UCLA School of Public Health andCo-Principal Investigator on NE;DR. ANDERSENis the Wasserman Professor Emeritus, UCLA Schoolof Public Health and Principal Investigator on the NE; MR NAKAZONO is a Programmer Analyst


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57Carreon, Davidson, Andersen, and Nakazono

Foundation (RWJF) and Te Caliornia Endowment (CE) unded a five-year initiative.6,7

Te programPipeline, Proession, and Practice: Community Based Dental Education

(Dental Pipeline Program)had three major objectives: (1) increase the proportion o

minority and low-income students in dental schools; (2) provide didactic and clinical

training or students to care or diverse and disadvantaged patients; and (3) establish

community-based clinical education programs to provide dental students with 60

days o experience in a patient care environment. Fifeen dental schools o the 56 U.S.

accredited dental schools received RWJF or CE grants to implement the program. A

description o the selection criteria or the schools is provided elsewhere; 7it included

a multi-stage application process and site visits to the schools. A complete description

o the evaluation and outcomes o Dental Pipeline Program is also available and was

recently published in a special report.8

Several o the Dental Pipeline schools successully increased the recruitment and

retention o underrepresented racial/ethnic and low-income students and integratedcommunity-based dental education curricula to prepare their students to treat under-

served patients.6,8Tese efforts should result in immediate and long-term reductions

in access disparities. Previous studies ound that dental students rom racial and ethnic

minority backgrounds and rom lower socioeconomic status are highly motivated to

provide care to underserved populations.913Hispanic dentists are more than twice as

likely as non-Hispanic U.S. dental graduates to practice in heavily populated Hispanic

ZIP code areas;12Arican American dentists are more likely to provide care to uninsured

and Medicaid beneficiaries than Whites.13

Te academic community has an important role in addressing oral health caredisparities, as recognized by the Institute o Medicine.14On the other hand, economic

incentives underlying dental practice continue to discourage providers rom practicing

in community clinics, government, and public health settings. Considering the lim-

ited unding available to support the dental care saety net, some dentists will have to

provide care to those who cannot pay by volunteering their services. However, recent

studies on dental students suggest their desire to enter dentistry is largely motivated

by proessional and financial expectations.15,16Qualitative data collected on 35 gradu-

ating dental students suggested a strong emphasis on financial benefits, job security,

flexibility, and independence or choosing the dental proession.15Similarly, a survey

o 160 medical and dental students at one university ound dental students were more

likely than medical students to be motivated by actors related to status and security

and the nature o their occupation.16Additionally, dental students were shown to be

less motivated by altruism than medical students, and findings show they become less

altruistic during school.17

An understanding o dental students attitudes toward serving low-income and

minority communities is needed because it represents a predisposing actor that will be

required to build an effective health care inrastructure to meet the oral health needs o

all Americans. Moreover, in light o the recent studies suggesting the dental proession

is headed toward sel-service rather than altruistic public service, this study attemptsto investigate the determinants o dental students altruistic attitudes. Currently there


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58 Altruism in dental students

during dental school in order to build a dental workorce responsive to societal and

community needs.18,19Not surprisingly, altruism has been shown to be significantly

correlated with dental students preparedness to care or underserved populations20

and plans to serve underrepresented communities.911Graduating dental students with

altruistic attitudes had greater intentions to serve minority communities, low-income

amilies, people living in rural areas, the medically disabled, and the rail elderly. 911

Assuming altruism correlates with uture practice, findings rom this study will inorm

workorce planning in the dental sector. Dental educators will be better inormed about

the characteristics o individuals predisposed to serve the public and society. In addi-

tion, insights rom this study may be useul or reducing access disparities to types o

care other than oral health.

Tis study addresses three research questions: (1) Which demographic characteristics

are associated with altruism in dental students? (2) Do community and dental school

characteristics influence altruistic attitudes in graduating dental students? and (3) Didthe Dental Pipeline Program affect the altruistic attitudes o graduating dental students?

Altruism, or the purposes o this study, is defined as a selfless concern or the welare

o others. Te term was first coined in the 19th century by French sociologist Auguste

Comte and is generally considered the opposite o egoism.

Measurement model. Figure 1 presents a measurement model to investigate ac-

tors that significantly influence the altruistic attitudes o dental school seniors. Tese

include predisposing characteristics, such as sex, age, race/ethnicity, and other social

and economic actors. I ound significant, these student characteristics should be

considered by dental school recruitment committees interested in improving accessto care or underserved and low-income populations. Other variables considered in

this study include those measured at the school and community levels. Once students

enroll in dental school, educators have the opportunity to raise awareness regarding

access barriers and population oral health needs. Dental school characteristics, such

as the belies and attitudes held by the student body as well as the extramural clinical

rotations program may be associated with socializing students to provide some level

o charity care upon graduation. For example, there may be specific attitudes related to

dental care practice held by the student body, such as low entrepreneurial motives and/

or high service orientation that will either heighten or maintain student enthusiasm

or public service during school and upon graduation. We also explored the effects

o the Dental Pipeline Program in the 15 intervention schools that received RWJF or

CE grants versusthe other accredited U.S. dental schools. Finally, our model suggests

altruism might be influenced by the community context where the dental school is

located. For example, students in dental schools with greater percentages o Arican

Americans and Hispanics living in the surrounding county are expected to be more

altruistic because they have greater exposure to underrepresented minority groups,

which in turn, would influence their ideas regarding access to oral health care.

Methods


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School Seniors. Te ADEA survey is administered annually to graduating seniors in

all the accredited U.S. dental schools.21Te ADEA survey collects inormation aboutsocial and demographic characteristics, educational financing and debt, reasons students

Community Characteristics

Schools community (county-level)

% African American or Hispanic % Low-income

% Education less than high school

% Immigrant

Dental School Characteristics

Educational program (school-level)

Pipeline school status

Private/ public Number of weeks in extramural

rotations

Cultural and social environment

Extramural rotations were positively

experienced

Altruistic

Dental

Graduates

Student Body Characteristics

Attitudes (school-level)

Entrepreneurial scale

Service orientation scale

Contextual Variables

Students Predisposing Characteristics

Demographics (student-level)

Sex Age

Race/Ethnicity

Marital Status

Parents annual household income

Parents educational attainment

Figure 1. Model or predicting altruistic attitudes o dental school seniors.


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inormation to assess community-based dental education (recruitment, curricular

revisions, and extramural clinical rotations).

Te overall student response rate in 2007 was 86%. For two o the schools, Boston

University and University o Maryland at Baltimore, we used ADEA data rom 2006

because the response rates or these two schools were low in 2007. We used data col-

lected rom 3,841 students in 52 dental schools or this study. A detailed description

o the ADEA survey is provided elsewhere.21

Altruism. Although this survey is not solely about altruism or other attitudinal val-

ues, it does include items that can be used to construct a measure o altruism. Altruism

was constructed rom the ollowing questions: (1) access to oral health care is a societal

good and right; (2) access to oral health care is a major problem in the United States;

(3) assuring and providing care to all segments o society is an ethical and proessional

obligation; and (4) everyone is entitled to receiving basic oral health care regardless o

his or her ability to pay. We took the means rom these our items to create the finalaltruism scale ranging rom 1 (strongly disagree) to 4 (strongly agree).

Tind, Atchison, and Andersen22 ran a actor analysis on selected student belies

using the 2003 version o the ADEA survey data and ound that these our items loaded

highly on a single actor, measuring a construct they called social consciousness. We

confirmed their study by running a actor analysis using the ADEA 2007 data, finding

that these our items clearly defined a single actor. We also conducted a Cronbachs

alpha reliability test to assess how well these our variables measured what we believe

to be a single construct (altruism), producing a high reliability score o 0.83; a value o

0.70 being the minimum or items to be used in an instrument.23

Tese actor loadingsalso make conceptual sense: concerns about societal problems o access to health care

indicate unselfish concerns or the welare o others. Moreover, a person interested in

helping others even when no benefits are expected is ofen regarded as altruistic. 24

Student, dental school, and community covariates. At the student level, we tested

demographic, socioeconomic, and attitudinal characteristics o dental school seniors

collected in the ADEA survey. Age (at the time o graduation rom dental school) was

a continuous variable, ranging rom 23 to 51 years. Race/ethnicity was classified into

our categories: (1) Arican American, (2) Hispanic, (3) Asian/Pacific Islander, and (3)

non-Hispanic White. Te ADEA survey also includes Native American/Alaskan Native

ethnicity. Because a majority o the schools recruited no Native Americans/Alaskan

Natives, they were excluded rom this analysis. Marital status was a dichotomous inde-

pendent variable coded as married and not married. Additionally, we had two indica-

tors o students socioeconomic status: parental income and parental education level.

Parents household income was divided into less than $30,000; $30,001 to $50,000; and

greater than $50,001. Fathers and mothers educational attainment was dichotomized

into high school diploma or less and at least some college or higher.

wo scales, developed previously by Tind et al.,22 were constructed rom the

questionnaire and used to measure student body attitudes toward social service and

entrepreneurial orientation. Tese scales were based on actor analyses o nine itemsregarding choosing dentistry as a career. Students responses to these items were


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(high). Te social service scale was constructed rom three items, which loaded highly

on one actor: (1) service to others, (2) service to my own race or ethnic group, and

(3) opportunity to serve vulnerable and low-income populations. Te entrepreneurial

scale was constructed rom two items: (1) opportunity or sel-employment, and (2)

high income potential.

Dental school characteristics also included ownership o the school (private or public).

Additionally, schools were categorized to reflect status related to the Dental Pipeline

Program; this variable reflects three programs: National Pipeline (RWJF), Caliornia

Pipeline (CE), or non-Pipeline school.

Students also evaluated the clinical training programs at their respective dental

schools. For example, students recorded the number o weeks they spent in extramural

clinical rotations (ranging rom 020 weeks) and assessed whether the extramural clinic

sites provided positive experiences (ranging rom 1 [strongly disagree] to 5 [strongly

agree]). Te students evaluations were averaged across each o the schools and thenreassigned to the individual students. Lastly, we used a variable that measured the dental

schools aggregate cultural and social environment: Te cultural and social environment

of your school promotes acceptance and respect of students and patients of different races,

ethnicities, and cultures. Level o agreement was measured using a our-point scale

ranging rom 1 (strongly disagree) to 4 (strongly agree).

Te community-level variables represent the environment surrounding the dental

school and were generated rom the 2000 U.S. Census, including percent o the popula-

tion that were Arican American or Hispanic, percent o people living below 200% o

the ederal poverty level, percent o people with less than a high school education, andpercent o oreign-born people. Since the students have exposure to the community, we

expect these population characteristics will influence their altruistic attitudes.

Analysis. We regressed the independent variables in two stages. In Model 1, we intro-

duced only the student-level variables to identiy the student characteristics significantly

associated with altruistic attitudes. Next, we introduced student body characteristics

and dental school and community-level variables to examine the extent to which the

contextual environment influences altruistic attitudes. Te best-subset approach was

used to select the predictor variables in the models. Tis method involves examining

all models created rom all possible combinations o predictor variables and selecting

the best model(s) based on a selection criterion, such as a residual sum o squares.

Several different measures are available to select the best model; we used the smallest

AIC (Akaike inormation criteria) and the smallest Mallows C(p) criteria.23Te results

o the best-subset model were then used in multivariate linear regression model. SAS

and SAA statistical sofware were used to process and analyze the data.2526

Results

Descriptive analysis. able 1 describes the sample characteristics. Overall, there were

more male than emale students and most were not married. Te mean age o the studentswas 28 years. Most o the students were White, approximately one-ourth were Asian/


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Table 1.

DESCRIPTIVES OF STUDENT, DENTAL SCHOOL,AND COMMUNITY CHARACTERISTICS

Independent Variables % or Mean (Standard Deviation)

Student Characteristics

Sex (%) Male 553.7Female 546.3

Age 28.0 (3.5)

Race-ethnicity (%) White 564.0Asian/ Pacific Islander 525.1Hispanic 55.5%Arican American 55.4

Marital status (%) Married 556.3%Not married 543.7

Parents annual household income (%) .$50,001 578.7$30,001$50,000 510.9,$30,000 510.4

Fathers educational attainment (%) Some college or higher 577.7No college 522.3

Mothers educational attainment (%) Some college or higher 572.1No college 527.9

Contextual Characteristics

Student Body Characteristics

Entrepreneurial scalea 4.3 (0.1)

Service orientation scalea 3.5 (0.2)

Dental School Characteristics

Pipeline school status (%) non-Pipeline school 570.1National Pipeline (RWJF) 518.5Caliornia Pipeline (CE) 511.4

Ownership (%) Public 557.0Private 543.0

Cultural and social environmentb 3.2 (0.2)

Number o weeks in extramural rotations 7.3 (3.2)

Extramural rotations are a positive experiencein your educationb

3.8 (0.4)

Community Characteristics

Percent Arican American or Hispanic 36.4 (17.6)

Percent low-income 33.8 (6.7)

Percent education is less than high school 15.8 (5.1)

Percent oreign-born 16.1 (10.3)

Dependent VariableAltruism Scalec 3.0 (0.6)


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o athers and 72% o mothers had attended some college education or higher. Te

altruism scale or all students in the sample yielded a mean score o 3 and a standard

deviation o 0.6.

Bivariate analysis. able 2 displays correlations between the dependent variable and

each o the covariates. Among the demographic variables, women, non-Whites, and

unmarried students reported more altruistic attitudes. Higher percentages o students

had altruistic attitudes i their parents household income was below $30,000 and i

their parents did not attend any college. Age was not significantly associated with our

altruism scale.

Among dental school characteristics, schools that were part o the National Pipeline

Program had more altruistic students. In addition, schools scoring higher on the service

orientation scale and whose graduating students elt their schools cultural and social

environment was accepting and respectul o diverse groups and perceived extramural

rotations as good experiences were positively associated with altruism. None o thecommunity characteristics were significantly associated with altruistic attitudes.

Multivariate analysis. o identiy the significant predictors o altruistic attitudes

among dental school seniors, we conducted multiple variable regression analysis

(able 3). Model 1 included student-level characteristics and the best-subset regression

technique chose sex, race/ethnicity, marital status, parents annual household income,

and mothers education. Findings indicated that women were more altruistic than men

(regression coefficient o 20.15) and Arican Americans, Hispanics, and Asian/Pacific

Islanders were more altruistic than Whites (with regression coefficients o 0.26, 0.19,

and 0.10, respectively). Additionally, students who came rom low-income households(parents making less than $30,000 annually) were more altruistic than students rom

higher-income households. Students who have mothers with low educational attain-

ment (no college education) were also more altruistic than students whose mothers

have a college education or more. Tere were no significant differences between age,

marital status, and athers educational attainment.

Model 2 included variables constructed at the dental school level, and the com-

munity level, as well as at the student characteristics shown in Model 1. All o the

student variables, regardless o whether or not they were significant in the first model,

were included as candidate variables. Te best-subset statistical technique chose eight

best predictors or the final model, out o a total o 17 candidate variables that were

initially screened by the model. Consistent with Model 1 findings, women, Arican

Americans, Hispanics, Asian/Pacific Islanders, and students with low socioeconomic

status expressed significantly greater altruistic attitudes than their counterparts. Among

the dental school and community characteristics, an especially important finding was

that contextual predictor o altruistic attitudes was the schools environment promoting

acceptance and respect o diverse cultures.

Discussion

Te literature within sociology, social psychology, economics, and political behavior


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Table 2.

CORRELATIONS BETWEEN ALTRUISM AND STUDENT,DENTAL SCHOOL, AND COMMUNITY CHARACTERISTICS

Student characteristics Coefficient

Male (re 5emale) 2.146***

Age 2.002

Race-ethnicityArican AmericanHispanic

Asian/Pacific Islander White

.093***

.070***

.057***2.129***

Married (re 5not married) 2.058***

Parents annual household income (re 5 .$50,001) $0$30,000 30,001$50,000

.064***

.010

Fathers educational attainment (re 5no college) Some college or higher 2.036*

Mothers educational attainment (re 5no college) Some college or higher 2.051**

Contextual characteristics

Student body characteristics

Entrepreneurial Scalea 2.006

Service orientation Scalea .070***Dental school characteristics

Pipeline school status (re 5non-Pipeline school) National Pipeline (RWJF) Caliornia Pipeline (CE)

.045**2.004

Private school (re 5Public) 2.005

Cultural and social environmentb .103***

Number o weeks in extramural rotations 2.018

Extramural rotations are a positive experience in your educationc

.062***Community characteristics

Percent Arican American or Hispanic 2.010

Percent low-income (FPL is ,200%) 2.001

Percent education less than high school 2.020

Percent oreign-born .016

*.01#p,.05**.001#p,.01***p,.001aMean scale at the school level, with 1 low to 5 high.bMean scale at the school level, with 1 strongly disagree and 4 strongly agree.cMean scale at the school level, with 1 strongly disagree to 5 strongly agree.RWJF 5 Robert Wood Johnson Foundation


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le3.

EARR

EGRESSIONOFSTUD

ENT,DENTALSCHOO

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DCOMMUNITYCHARACTERISTICSFORALTRUISM

Model1

Model2a

Coefficient

95%CI

Coefficient

95%CI

ntCharacteristics

(ref5female)

2.15***

(2.192.11)

2.14***

(2.182.10)

b

b

ethnicity(ref5W

hites)

nAmerican

.26***

(.17.36

)

.23***

(.14.33)

nic

.19***

(.10.28

)

.17***

(.07.26)

/Pacifi

cIslander

.10***

(.05.15

)

.11***

(.05.16)

ed(ref

5notmarried)

2.03

(2.07.01

)

2.04

(2.08.00)

tsannualhouseholdincome(ref5.$50,001)

$30,00

0

.08*

(.01.14

)

.08*

(.01.14)

,001$

50,000

.01

(2.06.07

)

.00

(2.06.07)

rseducationalattainment(somecollegeorhigher)

f5no

collegeeducation)

b

b

ersedu

cationalattainment(somecollegeorhigher)

f5no

collegeeducation)

2.05

(2.09.01

)

2.05*

(2.10.01)

(Continu

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66)


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le3.(continued)

Model1

Model2a

Coefficient

95%CI

Coefficient

95%CI

ContextualCharacteristics

ntBod

yCharacteristics

preneurialscalec

b

eorientationscalec

.08

(2.04.20)

alScho

olCharacteristics

neschoolstatus(ref5non-Pipeline

school)

ionalP

ipeline(RWJF)

.05

(.01.12)

ifornia

Pipeline(CE)

2.04

(2.13.04)

eschool(ref5Publicschool)

b

raland

socialenvironmentd

.39***

(.25.53)

berofw

eeksinextramuralrotations

b

muralrotationsareapositiveexperie

nceinyoureducatione

b

munity

Characteristics

ntAfricanAmericanorHispanic

b

ntlow-

income(FPLis,200%)

b

nteducationlessthanhighschool

b

ntforeign-born

b

ant

3.10***

(3.043.1

6)

1.57***

(.912.23)

p,.05

#p,.01

001

tisticsforModel2:R250.0562;AIC5

5735.6

ariablewasnotincludedinthemodel.T

ebest-subsetregressionprocedurewasusedtochoosethevariable

sinthemodels.

scaleattheschoollevel,with1lowto

5high.

scaleattheschoollevel,with1stronglydisagreeand4stronglyagree.

scaleattheschoollevel,with1stronglydisagreeto5stronglyagree.

Confide

nceIntervals


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raised by generous parents rather than sel-centered parents. Other research has shown

having high sel-esteem, competence, and moral development, and greater sensitivity

to social norms are related to altruistic behaviors. Additionally, people high in altruism

also see helping situations as more rewarding and less costly than those low in altru-

ism. Tere is agreement among social scientists that gender differences derived rom

societal norms ascribed to males and emales generally result in the more nurturing

social perspectives and roles that emales requently embrace. Lastly, helping behavior

has been shown to increase with age, perhaps due to increased capacity to empathize

with others.27

Although altruism is ofen thought to be an essential attribute o health proessionals,

to date little empirical research has been conducted in this area concerning oral health

proessionals. During the past ew years, however, studies conducted by the Dental

Pipeline Program National Evaluation eam have reported that altruistic attitudes are

significantly associated with practice plans upon graduation, preparedness to care ordiverse populations, and positive attitudes towards extramural clinical rotations.911,20,22,28

A complete description o the methods and data sources used by the National Evalua-

tion eam are provided elsewhere.29In this study, we examined the predictors o dental

school seniors altruistic attitudes using data rom the ADEA Survey o Dental School

Seniors and a set o contextual variables.

Our results suggest individual-level predisposing characteristics, such as sex, race/

ethnicity, and socioeconomic status are most highly correlated with altruistic attitudes.

Tis is in line with a previous study conducted by Coulter et al., who compared altru-

istic attitudes o medical, law, and business students rom one Caliornia university.17

Teir findings also showed that emale students (in comparison with male students),

and Arican American and Hispanic students (in comparison with White students) had

more altruistic attitudes. Our study ound that Asian/Pacific Islander dental students

also scored high on the altruism scale than Whites. While our study ound no signifi-

cant differences related to age among dental students, Coulter et al.s study showed age

was negatively associated with altruism. Additionally, our study revealed students with

indicators o low socioeconomic status (low amily incomes and low parental educational

attainment) were also more likely to express altruistic attitudes. Moreover, we ound

that students with altruistic attitudes attend schools where the social context is more

accepting and respectul o diversity, suggesting the school culture and environment

can promote altruism.

o begin to address racial/ethnic disparities in oral health care access, our findings

suggest dental schools should continue to expand their recruitment efforts to enroll

qualified underrepresented minority, emale, and low-income students to dental schools.

Te growing body o evidence suggests that dental care access will improve in uture

years by virtue o their leadership and service. In the past several years, Dental Pipe-

line Program schools have been quite successul in increasing enrollment o Arican

American, Hispanic, and American Indian students.28 Our results also support the

holistic review process, also known asfull file review, emerging out o the Dental Pipe-line initiative in schools such as University o Connecticut and University o Caliornia


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involvement and service, and interest and experience in providing care to vulnerable

and disadvantaged patients.

Furthermore, we ound more students with altruistic attitudes attend schools where

the culture is more accepting and respectul o diversity. Improving the diversity climate

in the academic setting requires the recruitment and retention o underrepresented

minority students and aculty and interactions between students and aculty and com-

munity leaders rom different racial and ethnic backgrounds.18,19,30Since we analyzed

only cross-sectional data or this study it is unclear whether the more altruistic students

are attracted to dental schools with this type o social and cultural environment or

whether the students are changed and socialized by these schools to embrace altruis-

tic attitudes. Tus, a limitation o our study is the cross-sectional nature o the data.

We cannot posit causality with certainty given our research design. Moreover, socio-

behavioral research is needed to establish whether altruistic attitudes actually result

in practice decisions to improve access to oral health care or underserved patients.Future studies should approach these research questions using a systems approach that

examines individual, delivery system, and policy-level variables that may significantly

influence a dentists ability to improve access within the structure o the existing U.S.

dental care delivery systems.

Acknowledgments

We want to acknowledge John Gutierrez, Jia Bai, ram Le, Marissa Opilas, and Shirin

Shahedi or their contributions and the American Dental Education Association orproviding survey data o dental school seniors. We are also grateul to the Robert Wood

Johnson Foundation (Grants #045592 and #58942) and Te Caliornia Endowment

(Grant #20031951) or supporting the work o the Dental Pipeline Program National

Evaluation eam. Tis study was approved by the UCLA Institutional Review Board.

Notes

1. U.S. Department o Health and Human Services. Oral health in America: a report othe Surgeon General. Rockville, MD: U.S. Department o Health and Human Services,

National Institute o Dental and Cranioacial Research, National Institutes o Health,2000. Available at: http://silk.nih.gov/public/hck1ocv.www.surgeon.ullrpt.pd.

2. Dasanayake AP, Li Y, Chhun N, et al. Challenges aced by minority children in obtain-ing dental care. J Health Care Poor Underserved. 2007 Nov;18(4):77989.

3. readwell HM, Northridge ME. Oral health is the measure o a just society. J HealthCare Poor Underserved. 2007 Feb;18(1):1220.

4. Nqui EM, Flores G. Unmet needs or specialty, dental, mental, and allied health careamong children with special health care needs: are there racial/ethnic disparities?J Health Care Poor Underserved. 2007 Nov;18(4):93149.

5. Doty HE, Weech-Maldonado R. Racial/ethnic disparities in adult preventive dental

care use. J Health Care Poor Underserved. 2003 Nov;14(4):51634. 6. Formicola A, Bailit H, DAbreu K, et al. Te dental pipeline programs impact onaccess disparities and student diversity. J Am Dent Assoc. 2009 Mar;140(3):34653.


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8. Leviton LC. Foreword. Evaluating the dental pipeline program: recruiting minori-ties and promoting community-based dental education. J Dent Educ. 2009 Feb;73(2Suppl):S57.

9. Davidson PL, Nakazono , Carreon DC, et al. Practice plans o dental school gradu-

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