Dr. Angelia Paschal of Mississippi University for Women Speaks to

By Megan Driscoll

Dr. Angelia M. Paschal What's your educational background and how did you become interested in health research?

Dr. Paschal: My educational background is in the social sciences: I have a bachelor's degree in psychology, a master's in counseling and a doctorate in sociology.

I first became interested in health research after working at a mental health facility. The majority of my caseload at the time was made up of low-income children and teens. Despite the emotional and mental health problems these children experienced, I saw that there were other factors affecting their health, including economic, cultural, social and political issues. After this experience, I decided to pursue a degree in a research-related discipline that would allow me to further examine these issues. In fact, my doctoral degree is in sociology with an emphasis on the sociology of health and healthcare (also known as medical sociology).

I then went on to work with the Master of Public Health program at the University of Kansas in Wichita, which furthered my interest in health research. Public health is a multidisciplinary field, including individuals from medicine, sociology, psychology and other areas. What I liked about public health is that it's very 'applied' in nature, allowing me to use my sociological interests and research in a way that actually effects change among individuals and in communities.

E-P: In addition to your research, you teach at the Mississippi University for Women (MUW). What types of classes do you teach?

AP: At the MUW, I teach graduate courses in health education and undergraduate courses in public health education.

E-P: You recently received a grant to research oral health among uninsured children in the U.S. Please describe this project.

AP: Dental caries (tooth decay) is the most prevalent chronic condition among children, with severe medical complications associated with minimal dental care and treatment. While dental caries and subsequent tooth loss can be prevented, affordable dental insurance and accessible dental care services are significant issues for many economically disadvantaged families. Despite the availability of dental coverage through public programs such as Medicaid and SCHIP, access to dental services remains low for many.

The purpose of my study is to increase understanding of how uninsured, racially and ethnically diverse children and their families access and use dental care and/or dental insurance, and to identify and explore potential strategies for improvement in access to and utilization of care. Specifically, we will analyze data collected from surveys, the children's dental charts, follow-up structured interviews and focus groups with parents. Long-term, we hope the findings will be used to increase access to dental care services among uninsured children and influence public insurance policy.

This study is innovative in that it will follow up on a difficult to reach population following a community intervention associated with the topic of oral health. This study is also significant in that it uses community-based participatory research methods to focus on an important health issue - oral health in uninsured children. The findings will contribute information to help providers improve practice and access, promote increased health and dental care services in safety-net clinics, and stimulate further studies, targeted health/dental interventions and policy changes.

E-P: Your past research has also looked at issues concerning oral health among medically disadvantaged populations. Can you explain what 'medically disadvantaged populations' are and how prevalent these groups are in the U.S.?

AP: Medically disadvantaged populations are typically those groups or communities that show disparities in health and/or in healthcare. Health disparities are population-based differences in the prevalence or incidence of disease, disorders, mortality, morbidity and/or other adverse health conditions. Healthcare disparities tend to relate to the inequalities we seen in access to or quality of services. Those showing the greatest health and healthcare disparities tend to be low socioeconomic populations, racial and ethnic minority groups and rural-base communities.

E-P: What are some of the oral health challenges facing uninsured Americans?

AP: The main oral health challenge for uninsured Americans is having access to dental care services when needed. Adults that lack insurance tend to lack the resources needed to pay for dental care services. Therefore, they are more likely to incur oral health problems including toothaches and pain, dental caries and gum disease.

While many uninsured children might be eligible for Medicaid or other state-based services that would make it possible for them to access dental services, many of their parents are not accessing them. Understanding why this is the case and what could be done to address this issue is part of my current study.

At the same time, there is a group of children who would not be eligible for public assistance, but whose parents still aren't able to afford dental care services for them. For instance, these might include children of the working poor. Again, oral health problems and having access to appropriate services would be a challenge to these children and their families.

E-P: Are there organizations devoted to helping overcome these challenges? If so, what kind of work are they doing to increase access to oral healthcare?

AP: Uninsured adults are typically at a disadvantage when it comes to accessing dental care services. Unless they are eligible for a state or federal resource such as Medicaid or Medicare, there aren't many public options. Fortunately, in some communities there are organizations and safety-net clinics that provide affordable dental care. However, these are limited and do not exist in all communities.

As for uninsured children, many are eligible for Medicaid, SCHIP and other state or federal sources that provide dental coverage. Similar to adults, there are also some community organizations and safety-net clinics that provide affordable services. Yet many children and their parents are not aware of such services, and the services do not exist in all communities. In most communities, there is no particular organization devoted to helping people overcome these challenges.

E-P: Based on your research, what do you think absolutely must happen in order to increase access to healthcare for uninsured Americans?

AP: First, greater awareness of affordable dental care services in communities is needed. Increased promotion of these services is critical. Many resources exist, but many families are not aware of them.

Second, greater partnerships among educational, health and dental, social services and city council entities are needed to address the problem as a community. The Give Kids a Smile (GKAS) project in Kansas is a great example of how a stable, strong coalition of such partners could work together to provide much needed dental care to uninsured children. Community efforts can be powerful. They fill in the gaps where public assistance is not available or is inadequate.

Finally, policy changes might be in order. The link between oral health and general health is strong enough to warrant greater attention and resources to this need, especially among children.

E-P: What advice would you give to a college student who is interested in doing research or other work to help increase access to healthcare?

AP: What oftentimes sustains research is a genuine interest and passion for the topic at hand. For example, working to increase access to healthcare involves being committed to addressing the needs of the disadvantaged. More and more research is showing that collaborative, community-based efforts can be effective at addressing such needs. Therefore, being interested in and open to working with various partners, learning from them and sharing each other's expertise and resources would be instrumental to doing research in this area.

E-P: Finally, I'd like to give you the opportunity to share anything you'd like about your research and teaching as well as the state of healthcare in the U.S.

AP: When working with medically disadvantaged or hard-to-reach populations, one of the approaches I use in research when possible is community-based participatory research (CBPR). CBPR requires that the researcher involve the target group or representatives of that community as true and equal partners. The target group should be involved in the research project at every step. Previous studies have shown that while this approach might be labor-intensive, and that 'control' of the research project is shared, the final product tends to be more relevant and effective. CBPR has been especially critical to the success of the Kansas-based coalition's efforts in addressing the oral health needs of uninsured children, and I continue to employ this approach when feasible.

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