A mediation analysis study: The influence of mothers' dental anxiety on children's dental utilization among low-income African Americans.

OBJECTIVES: The aim of this study was to test a hypothesized mediation model to explain associations between mothers' dental anxiety and children's dental utilization through the mothers' own dental utilization.

METHODS: Two hundred and fourteen low-income African American mothers with young children (age 31-59 months) completed a study questionnaire which assessed (i) mothers' dental anxiety; (ii) mothers' dental utilization (seeing a dentist at least once a year) and (iii) children's dental utilization (at least one non-study-related dental visit during the 36-month study period). The hypothesized mediation model consisted of these three elements with both a direct path from mothers' dental anxiety to children's dental utilization and an indirect path from mothers' dental anxiety to children's dental utilization through mothers' dental utilization. Mediation analysis with bootstrapping was conducted to test the hypothesized model.

RESULTS: The mediation analysis indicated significant total effect of mothers' dental anxiety on children's dental utilization. The standardized total effect of mothers' anxiety on children's dental utilization was -0.172 (SE=.084, P=.041), and the standardized indirect effect of mothers' anxiety on children's dental utilization mediated by mothers' dental utilization was -0.069 (SE=.039, P=.076). The direct effect from mothers' anxiety to children's dental utilization was not statistically significant (P=.261) after adjusting for the mothers' dental utilization.

CONCLUSIONS: In this low-income African American sample, there was a trend for mothers' dental anxiety to be associated with children's dental utilization indirectly through mothers' own dental utilization, while the direct influence of mothers' dental anxiety on children's dental utilization was not seen. This suggests that mothers' dental utilization might explain how mothers' dental anxiety impacts children's early dental utilization.