North carolina child health assessment monitoring program

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The Provider Monitoring Webinar Project is a follow-up to workshops that were presented in February to introduce the new process and tools for routine provider monitoring that went live on March 1.

The webinars address important aspects of the process in greater detail than was possible during the statewide workshops. Provider agencies will also use the tools as part of their internal quality assurance process. The webinars can be used as a self-audit to ensure ongoing compliance with the regulatory requirements that are the focus of the routine review.

The webinars are broken into modules. School days missed by study children for reasons related to dental care: North Carolina Child Health Assessment and Monitoring Program, The results of multivariate analyses examining school absences resulting from dental pain or infection and routine dental care are shown in Table 2.

Having public assistance or no health insurance was related to absences caused by dental pain or infection. Uninsured children were more likely than were those with private insurance to miss school for dental pain, but they were less likely to miss school for routine dental care.

Children with good, fair, or poor oral health were nearly 3 times more likely than were children with very good or excellent oral health to miss school as a result of dental pain.

Black children were less likely than were White children to miss school for routine dental care. The variables associated with poor school performance in the multivariate analyses Table 3 included gender male , race Black , grade in school 6—12 , parental educational level high school , health insurance public , and special health care needs. Mediation analysis results revealed that school absence related to dental pain was not a mediator between oral health status and poor school performance; rather, we found an association between oral health status and school performance independent of absence related to dental pain.

Ellipses indicate information that was not included. Policymakers and legislators frequently use the association between poor oral health and school attendance as an advocacy talking point; however, the commonly used US school attendance data emanate from the s and are outdated.

The 2 new questions we added to the oral health section of CHAMP assessed the number and cause of school days missed because of routine dental visits and dental problems, providing novel data to clarify the association between school absences related to dental care and school performance. Our first 2 aims were to document school absences related to routine dental care and those related to dental pain or infection. In the NHIS data set that produced the commonly cited 51 million hours 13 of school missed annually for reasons related to dental care, survey participants were asked to recall the amount of time missed in a specified 2-week period.

As noted by Gift et al. State requirements in North Carolina mandate a minimum of school days and school hours per year 5. According to the most recent data, the population of school-aged K—12 children in North Carolina is 1 Using the minimum school time figures and extrapolating our sample of children to represent the entire population of children in the state, we found that 3 school hours were missed as a result of routine dental care and that hours were missed as a result of dental pain or infection.

Keeping in mind that most children attend school for longer than 5. Nevertheless, according to these extrapolations, North Carolina schoolchildren missed more than 4 million school hours for reasons related to dental care. These findings underscore the likelihood that school absence is not a stand-alone factor in considerations of school performance, providing further evidence that children experiencing pain or infection may have a diminished educational experience because their discomfort may inhibit their ability to perform well while at school.

Our third aim was to assess the extent to which children's oral health status is related to school attendance. The literature is outdated relative to school time missed for dental reasons.

This finding supports the hypothesis that children with poor oral health are more likely to experience pain or infection that may have a negative impact on school attendance.

Our final aim was to examine the extent to which children's oral health status is related to their school performance. Although evidence exists that chronic illness can interfere with children's success in school 8 , 9 and that dental caries may put them at a disadvantage for their overall development, 10 , 11 a relationship between oral health status and school performance has not been previously reported.

Poor oral health was related to a higher likelihood of poor school performance in our multivariate analyses. We estimated logistic regression models excluding health status and school absence variables to account for the potential for these variables to be highly correlated. Even when the school absence variables were excluded, there was still a relationship between poor oral health and the likelihood of poor school performance. Furthermore, without the health variables in the model, we found a relationship between poor school performance and absence related to dental pain or infection.

These results show a negative impact of poor oral health status on a child's school performance with or without school absence variables in the model. A child missing school as a result of dental pain or infection also had a negative effect on school performance.

Our mediation analyses revealed that school absence resulting from dental pain was not a mediating variable in the relationship between good, fair, or poor oral health status and poor school performance. Although missing school because of dental pain may have an impact on performance, there appears to be something fundamental in the relationship between oral health status and school performance independent of attendance.

This finding suggests that a child with poor oral health is at an increased risk of having a diminished educational experience. We hypothesize that a child with poor oral health is more likely to have pain or infection that not only leads to school absences but also detracts from his or her ability to perform well whether present in school or studying at home. No cause-and-effect relationships can be inferred from our cross-sectional data.

Also, because CHAMP is a telephone survey, the sampling frame is restricted to households that have a telephone. Research has shown some differences in households with and without a telephone. For example, individuals with low incomes and those living in rural areas are less likely than are their counterparts to live in a household with a telephone. Another potential limitation is that the CHAMP school performance and dental health variables are subjective measures; however, published data support the strength of such subjective reports.

For example, Talekar et al. The strengths of this study include the wealth of child health information available in CHAMP and the detailed questions regarding oral health and school performance.

The new questions we added to the oral health section directly assessed the number and cause of missed school days secondary to routine dental visits and dental problems, helping to clarify the relationship between school absence and performance, a concept not previously examined in the United States to our knowledge. Our study provides updated information on school absences for dental care.

We found that children missed an average of 0. To further evaluate school absences related to dental care, one needs to consider not only the average number of days missed but the impact of absences.

Finally, it is also important to consider the mechanism by which children's oral health status affects their school performance. Children in good, fair, or poor oral health were more likely to perform poorly in school, suggesting that dental disease may adversely affect children's performance independent of school absences.

Altogether, our findings suggest that improving children's oral health status may be a vehicle to enhancing their educational experience. The North Carolina Child Health Assessment and Monitoring Program data have no identifying information, are anonymous, and are available in a public use data set. National Center for Biotechnology Information , U. Am J Public Health. Stephanie L. Author information Article notes Copyright and License information Disclaimer.

At the time of this study, Stephanie L. William F. Jonathan B. Bhavna T. Pahel was with the Cecil G. Jessica Y. Corresponding author.