Community Firearm Violence and Dental Care Use in Middle Adulthood

Prior research links violence inside the home to reduced dental care utilization, yet little is known about how community firearm violence affects dental care behaviors. The current study used data from wave V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), linked to census tract-level fatal and nonfatal shooting data from the American Violence Project for the 100 largest cities in the United States. The analytic sample included 1925 respondents aged 33-42. The primary outcome was self-reported dental care use in the past year. Firearm violence exposure was categorized as 0, 1, or 2 + shootings in a respondent's census tract over a 2-year period. Logistic regression models were used to estimate the relationship between shootings and dental care use, adjusting for individual sociodemographic factors, prior dental use, violence exposure, and contextual variables including poverty and dentists per capita. Respondents exposed to multiple shootings had significantly lower odds of past-year dental care use (OR = 0.625, 95% CI: 0.418-0.934) compared to those with no exposure, after adjustment. These findings provide new evidence that suggests exposure to neighborhood violence may reduce dental care use, net of key confounding variables. Public health and dental initiatives may consider violence exposure when designing interventions to increase care utilization.