Pathways Mediating Immigration and Utilization of Dental Care in Children

Timely dental care is essential for children's health and development, yet disparities persist, particularly among immigrants and children of immigrants. This study examined how children's and their parents' immigration status affects dental care utilization, considering social capital and material hardship as mediators. Using 8 waves of the National Survey of Children's Health from 2016 through 2023, we analyzed a nationally representative, pooled, cross-sectional survey sample of 274,302 children in the United States aged 2 to 17 y. Latent variables for social capital, material hardship, and socioeconomic status (SES) were constructed from factor analysis of observable indicators. Multivariable structural equation models simultaneously included child and parental immigration status as exposures to assess pathways linking immigration to dental attendance and receipt of preventive dental care. We compared models with mediation versus confounding by SES. Results indicate that social capital is a primary pathway through which immigration status reduces dental attendance. Social capital mediated the effect of being a foreign-born child in both the mediation-by-SES and confounding-by-SES models (odds ratio [OR], 0.74; 95% confidence intervals [CI], 0.64-0.86). Similarly, social capital mediated the effect of having foreign-born parents in both models (OR, 0.59; 95% CI, 0.46-0.76). Comparing the pathways of the 2 exposures revealed heterogeneity: direct effects (i.e., those not mediated by social capital or material hardship) were stronger than mediated effects for the child's immigrant status, whereas mediated effects were stronger for parental immigrant status. Our findings remained consistent when assessing receipt of preventive care as an outcome and also when carrying out sensitivity analyses comparing the pre- and post-COVID-19 periods. These results highlight social capital as a potential target for future research into reducing dental care disparities among immigrant children. Improving social networks, community engagement, and access to supportive resources may potentially be a viable way to promote equitable utilization of dental care.