Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
5-2026
Committee Chair or Co-Chairs
Dr. Nathan Hale
Committee Members
Dr. Casey Balio, Dr Ying Liu
Abstract
Introduction: U.S. adults with diabetes are at increased risk of oral diseases compared with adults without diabetes, yet they are less likely to visit a dentist. Prior studies have examined individual and geographic determinants of dental care utilization, but evidence on broader policy factors is limited. This study addressed this gap by examining state policy environments associated with dental care utilization and opportunities within the Rural Health Transformation Program (RHTP) to integrate oral health into primary diabetes care.
Methods: A mixed methods approach was used. Aim 1 involved a cross-sectional analysis of the 2024 Behavioral Risk Factor Surveillance System data, utilizing a nationally representative sample of adults aged ≥ 18 years with self-reported diabetes. Guided by Andersen’s Behavioral Model, associations between a past-year dental visit and contextual, individual, behavioral, and health status factors were examined, with rural-urban residence as the key independent variable. Survey-weighted descriptive, bivariate, and multivariable logistic regression analyses were conducted. Aim 2 involved a descriptive policy analysis using the Rainbow Model of Integrated Care.
Results: The analysis included 63,384 U.S. adults with diabetes; 62.6% reported a dental visit in the past year. Utilization was lower among rural than urban residents (55.7% vs. 63.1%), and rural residence remained associated with lower odds after adjustment. Differences were also observed by sex, education, income, insurance status, smoking, routine medical care, foregone medical care due to cost, and Medicaid expansion status. Compared with adults residing in very early expansion states, those in non-expansion states had lower odds of reporting a past-year dental visit. Among rural residents, those in states with limited Medicaid adult dental benefits had lower odds than those in states with extensive benefits. Policy analysis indicated that RHTP funds could support strategies including mobile dental clinics, teledentistry, community-based dental access points, workforce recruitment, health information technology, and payment reforms.
Implications: Dental care utilization among U.S. adults with diabetes is associated with multiple individual, geographic, and policy factors, with persistent rural disparities. Findings support broader insurance expansion, stronger adult dental benefits, and integrated rural care strategies. The RHTP presents opportunities to strengthen access to oral health care within primary care settings.
Document Type
Dissertation - embargo
Recommended Citation
Toitole, Kusse Koirita, "Contextual and Individual Factors Associated with the Receipt of Dental Care Among Adults with Diabetes in the U.S. and Implications for Policy and Practice" (2026). Electronic Theses and Dissertations. Paper 4699. https://dc.etsu.edu/etd/4699
Copyright
Copyright by the authors.
Included in
Dental Public Health and Education Commons, Health Services Administration Commons, Health Services Research Commons, Other Public Health Commons, Rural Health Commons
