Utilization of Prepaid Dental Health Care By Students in Health Professional Schools DONALD W. LEGLER, DDS, PHD, MICHAEL L. HUGHES, DMD, AND EDWIN L. BRADLEY, JR., PHD
Abstract: Utilization of prepaid dental health care was studied, involving health professional students in an open panel program at the University of Alabama Medical Center. Major barriers to treatment were eliminated and optimal conditions for utilization established. Annual utilization ranged from 44-61 per cent during the period extending from 1969-70 to 1975-76. The majority of enrollees treated sought care from the Student Dental Health Plan (SDHP) clinic, rather than
69:1017-1020, 1979.)
Introduction
Methods
The dental health care delivery system in the United States faces at least two major issues. The first of these involves the rapid growth of dental health insurance and the implications this holds for dental practice. In 1965, only 1.6 per cent of the civilian population in the United States was covered by private dental insurance. By 1975, this had increased to 16.2 per cent. The proportion of dental costs covered by private insurance rose commensurately, reaching nearly 14 per cent of all consumer expenditures for dental care in 1975.' This investigation relates to the issue of dental health insurance by providing data on the management and utilization of a prepaid dental health program. The issue of demand is addressed more tangentially in that the enrollee population is composed of students in the health professions who are expected to be more health-oriented than the average individual. Virtually all external barriers to the receipt of dental care were eliminated. Therefore, the assumption can be made that the degree of utilization by such enrollees can be closely associated with maximum demand for the age group.
In 1963, a program was initiated to demonstrate the feasibility of a dental prepayment plan designed primarily for students attending the health professional schools of the University of Alabama in Birmingham. The entering class of the School of Nursing constituted the first group of enrollees.2 Entering classes of the Schools of Medicine and Dentistry were incorporated into the plan by 1966, with students in the School of Optometry following in 1969. The entire student bodies of these four schools presently comprise
From the School of Dentistry and the Department of Biostatistics, University of Alabama in Birmingham. Address reprint requests to Michael L. Hughes, DMD, School of Dentistry, University of Alabama, University Station, Birmingham, AL 35294. This paper, submitted to the Journal August 25, 1978, was revised and accepted for publication February 26, 1979.
AJPH October 1979, Vol. 69, No. 10
from private practitioners. Thirteen per cent of recent graduates presented for treatment at least once each year during their tenure as students, 57 per cent sought
care in more than one year, and 24 per cent did not seek care at all. It was concluded that factors other
than cost, accessibility, and educational level operate
to prevent total utilization of prepaid dental health care in a young adult age group. (Am J Public Health
the enrollee population. The population is comprised of individuals in the age group of 18-26 years, an adult age group which normally exhibits high dental treatment needs. Enrollment of these students in the Student Dental Health Program is compulsory under University policy. The Student Dental Health Program (SDHP) is an open panel, prepaid dental health care program. There are two components of this program which operate independently. A group practice component located in an attractive self-standing facility at the University of Alabama Medical Center provides on-campus treatment. Alternatively, students may elect to seek treatment from private practitioners of their own choice. Through either component, students are afforded the same coverage and opportunities for treatment. The on-campus SDHP facility and general philosophy of the program have been described previously.3 At present, a premium of $48 is paid by all enrollees, which covers the cost of treatment for a 12-month period. All diagnostic, pre1017
LEGLER ET AL.
ventive, restorative, and surgical dental care is provided with the exception of orthodontic therapy, fixed and removable prosthodontic appliances, and elective oral surgery such as impacted third molar removal. Each entering student must furnish evidence that he/she has received a dental examination and that all necessary dental treatment has been performed prior to admission. The SDHP facility, convenient to all UAB schools, is open evenings for maximum accessibility. Students are seen by appointment except in cases of emergency for which staff members are readily available on an on-call basis. Every effort is made to encourage use of the program, whether on campus or through private practitioners. Students receive a descriptive brochure at the time of admission to their respective schools and an explanation of the program during freshman orientation. Clinic charts are maintained for all students in the program. Data for analyses were taken directly from these records and summarized in Figure 1 and Tables 1-3. Statistical comparisons were by means of the Chi square statistic for two-way tables.
z W :D
1200
LLJ
CC 100000 Results The progressive increase in enrollment in the SDHP is shown in Table 1; by 1975-76 enrollment had increased to 1,618 students, representing the total student bodies of the four health schools. During the early years of the program extraordinary efforts were made to ensure utilization.4 These efforts included weekly appointment reminders, personal contacts with students to make appointments, charges for broken appointments, and administrative pressure. Findings show that 81 per cent of enrollees in 1963-64 and 97 per cent in 1965-66 utilized the program either at the SDHP group practice facility or from a private practitioner. In 1966-67, a laissez faire policy was adopted and the mandate to seek care was eliminated. This resulted in a significant drop in utilization (X2ldf = 62.14, p < 0.001) to a low point of 44 per cent by 1973-74, when compared with the other three years of this study. During the entire period from 1969-70 to 197576, utilization ranged from 44 to 61 per cent. The 61 per cent level represents the maximum response in utilization that was observed employing all reasonable means of encouragement short of required attendance. Figure 1 shows the relative distribution in the numbers of students who seek treatment from private practitioners,
4800 2600-
01 1969-70 71-72 73-74 75-76
ACADEMIC YEAR FIGURE 1-Relative Distribution of Students Seeking Care from Private Practitioners (PP), Group Practice (SDHP), or Remaining Nonusers.
the SDHP faculty, or who remain as non-users. The proportion of students electing to utilize the open panel provision
TABLE 1-Utilization of Prepaid Dental Program during Academic Years 1969-76, University of Alabama, Birmingham
1018
Year
1969-70
1971-72
1973-74
1975-76
Total Numberof Enrollees Number Utilizing Program % Utilization
862
1252
1620
1618
489
615
721
994
57
50
44
61
A18PH October 1979, Vol. 69, No. 10
UTILIZATION OF PREPAID DENTAL CARE TABLE 2-Differences in Utilization of Prepaid Dental Program by Health Professional School in 1973-74 and 1975-76, Alabama, Birmingham
University of
Number Seeking Treatment By Source* Total Number Enrolled
Per Cent Utilization
Number Treated
SDHP Clinic
Private
School
1973-74
1975-76
1973-74
1975-76
1973-74
1975-76
1973-74
1975-76
1973-74
1975-76
Dental Medical Nursing Optometry
247 479 808 86
271 406 828 113
125 236 325 35
141 229 558 66
51 49 40 41
52 56 67 58
117(94) 189 (80) 226 (70) 25 (71)
130 (92) 156 (68) 405 (73) 53 (80)
47 (20) 99 (30)
8(6)
11 (8) 73 (32) 153 (27) 13 (20)
10 (29)
*Figures in parentheses indicate per cent seeking treatment.
has increased proportionately to those seeking treatment at the SDHP facility. Utilization by health school is shown in Table 2. The year of lowest total utilization, 1973-74, is compared to the most recent year showing a higher utilization (1975-76). From the low point of 1973-74 to 1975-76, the last year for which complete data are available, utilization of the SDHP increased significantly for nursing students from 40 per cent to 67 per cent (X2ldf = 121.5, p < 0.001), for optometry students from 41 per cent to 58 per cent (X2ldf = 6.13, p < 0.03), and for medical students from 49 per cent to 56 per cent (X2ldf = 4.49, p < 0.05). During this period, utilization by dental students remained relatively constant at 51-52 per cent (X2ldf = 0.10, p > 0.70). Nursing students are currently the heaviest users when compared to the other three schools (X2ldf = 25.40, p < 0.001). On the basis of these data it would appear that chronic underutilization is not characteristic of any one of the professional schools. The data in Table 2 also reflect an analysis of the open panel provisions among those students who chose to utilize the SDHP in 1975-76. Medical students showed the greatest preference for private practitioners, with 32 per cent seeking care outside the SDHP clinic, as did 27 per cent of the nursing students and 20 per cent of the optometry students (X22df = 4.06, p > 0.10). Only 8 per cent of dental students were treated by private practitioners in 1975-76. Of the entire enrollee population, approximately three-fourths (744) elected to seek treatment at the SDHP clinic. The attendance history of senior students who have been in the program since their first year in professional school is shown in Table 3. Although the adage "'see your
dentist twice a year" has been ingrained in the American public, and the value of health service should be apparent to all enrollees, only 13 per cent of enrollees presented for treatment at least once each year during their tenure as students; 57 per cent sought care in more than one year. Twenty-four per cent of the students did not present for treatment at all during the entire length of their educational program.
Discussion The design of the Student Dental Health Program provided for the removal of two main barriers to the receipt of dental health care, i.e., cost of services, and accessibility. A third barrier, lack of health education and motivation, was minimized since enrollees were presumably more health-oriented since they were in training for careers as health care providers. Despite the removal of these barriers, utilization of the program peaked at a level of 61 per cent over the seven-year period of the program when participation was not mandatory. Although various predictions have been offered about the cataclysmic effects of a national dental health insurance plan on dental care delivery, these data suggest that utilization would not be overwhelming in the 18-26 year age group. Data provided by other investigators for various age groups support this observation. Barenthin reported the results of a local survey involving a community of 21,000 people in Sweden.5 In a representative sample interviewed in relation to their receipt of dental care in 1974, the first year of national dental insurance in Sweden, approximately 42
TABLE 3-Attendance History of Dental Program Enrollees Graduating in 1977
Those seeking care in every year Those seeking care in > one year,
Number
%
Total Enrolled
39 132
13 44
299 299
56
19
299
72
24
299
but < every year
Those seeking care in only one year
Those not seeking care in any year
AJPH October 1979, Vol. 69, No. 10
1019
LEGLER ET AL.
Schoen reported annual utilization of a dental plan, involving both a capitation group practice and an open panel, to be at a level of 48.2 per cent when based upon all of the 323 enrollees. Utilization of the group practice component was considerably higher, however.6 Leverett, et al, noted utilization in a multi-state company dental plan to be at an overall level of 49.6 per cent in 1964.7 Comprehensive dental care was available under the plan to 1,896 individuals who comprised the study population. Utilization by males in 1825 year age range was 32 per cent, compared to 49 per cent for females of the same age. Utilization of prepaid dental care as low as 19 per cent has been reported for persons in the 15-24 year age groups in a community wide plan,8 and 23.3 per cent in persons covered by a commercial plan provided as a company fringe benefit.9 In the latter case, despite comprehensive provision of services, utilization ranged from 16 per cent in 1962 to 24 per cent in 1967. At least one program has exhibited utilization comparable to that reported in our study. This involves the Dental Health Care Plan provided to employees and dependents of the American Dental Association, which reported utilization rates of 60.6 per cent in 1965, 57.2 per cent in 1966, and 68.1 per cent in 1969. Presumably, these individuals were dentally oriented, and a comprehensive program of benefits was provided.'0 The findings summarized in Table 3 relative to enrollee attendance history were unexpected with respect to the number of students who never sought care through the SDHP clinic or private practitioners. The observation that 24 per cent of these graduates did not use the program would suggest that non-users in any given year tend to be non-users in other years as well. The 1977 graduating students were
enrolled in the program from 1973-1977, a time frame that included both low and high years of overall program utilization. Although barriers of cost, accessibility, and lack of appreciation for health care were eliminated for the study population, other factors such as psychological factors, patient busyness, and lack of perceived needs may also be important determinants in the utilization of prepaid dental care.
REFERENCES 1. Mueller MS: Private health insurance in 1975; coverage, enrollment, and financial experience. Soc Secur Bull 40: 3-21, 1977. 2. Pelton WJ: Student dental health program of the University of Alabama in Birmingham: I. The influence of dental treatment on DMF rates. J Am Col Health Assoc 17: 325-331, 1969. 3. Pelton WJ: A plan for a student dental health program at the University of Alabama Medical Center. Ala J Med Sci 2: 216220, 1965. 4. Pelton WJ, McNeal, DR and Goggins, JK: Student dental health program of the University of Alabama in Birmingham: IV. Enrollment and utilization. Ala J Med Sci 8: 283-287, 1971. 5. Barenthin I: Dental insurance and equity of access to dental services. Community Dent Oral Epidemiol 4: 215-220, 1976. 6. Schoen M: Observations of selected dental services under two prepayment mechanisms. Am J Public Health 63: 727-731, 1973. 7. Leverett DH, Hooper SD and Russell WN: Variations in utilization of a multi-state company dental plan. Am J Public Health 67: 1173-1178, 1977. 8. Nikias MK: Prepaid dental care: patterns of use and source of premium payment. Am J Public Health 59: 1088-1103, 1969. 9. Mulvihill JE, Bear WS, Dunning JM, et al: Utilization of a prepaid plan of commercial dental insurance. J Pub Health Dent 32: 187-196, 1972. 10. Bureau of Economic Research and Statistics, American Dental Association: Use of the American Dental Association dental health care plan during 1966 and 1969. JADA 81: 723-728, 1970.
I Conference on Airborne Contagion in Humans, Animals and Plants The New York Academy of Sciences is sponsoring a conference on "'Airborne Contagion in Humans, Animals and Plants," November 7-9, 1979, at the Barbizon-Plaza Hotel in New York City. The conference will focus on the changing concepts of airborne contagion, cover the history and epidemiology of airborne contagion, and will consider new agents for which airborne transmission has been documented. Sessions will be devoted to specific agents such as fungi, bacteria and viruses; airborne infection in hospitals will also be discussed. While there is public awareness and great emphasis on chemical pollutants in the environment, microbial pollutants with higher morbidity have not been adequately appreciated. This conference aims to describe and collate information on agents which can be airborne pathogens for humans, animals and plants. Methods of intervention will be proposed and evaluated. For further information, contact: Conference Department, The New York Academy of Sciences, 2 East 63rd Street, New York, NY 10021. (212) 838-0230.
1020
AJPH October 1979, Vol. 69, No. 10
Abstract: Utilization of prepaid dental health care was studied, involving health professional students in an open panel program at the University of Alabama Medical Center. Major barriers to treatment were eliminated and optimal conditions for utilization established. Annual utilization ranged from 44-61 per cent during the period extending from 1969-70 to 1975-76. The majority of enrollees treated sought care from the Student Dental Health Plan (SDHP) clinic, rather than
69:1017-1020, 1979.)
Introduction
Methods
The dental health care delivery system in the United States faces at least two major issues. The first of these involves the rapid growth of dental health insurance and the implications this holds for dental practice. In 1965, only 1.6 per cent of the civilian population in the United States was covered by private dental insurance. By 1975, this had increased to 16.2 per cent. The proportion of dental costs covered by private insurance rose commensurately, reaching nearly 14 per cent of all consumer expenditures for dental care in 1975.' This investigation relates to the issue of dental health insurance by providing data on the management and utilization of a prepaid dental health program. The issue of demand is addressed more tangentially in that the enrollee population is composed of students in the health professions who are expected to be more health-oriented than the average individual. Virtually all external barriers to the receipt of dental care were eliminated. Therefore, the assumption can be made that the degree of utilization by such enrollees can be closely associated with maximum demand for the age group.
In 1963, a program was initiated to demonstrate the feasibility of a dental prepayment plan designed primarily for students attending the health professional schools of the University of Alabama in Birmingham. The entering class of the School of Nursing constituted the first group of enrollees.2 Entering classes of the Schools of Medicine and Dentistry were incorporated into the plan by 1966, with students in the School of Optometry following in 1969. The entire student bodies of these four schools presently comprise
From the School of Dentistry and the Department of Biostatistics, University of Alabama in Birmingham. Address reprint requests to Michael L. Hughes, DMD, School of Dentistry, University of Alabama, University Station, Birmingham, AL 35294. This paper, submitted to the Journal August 25, 1978, was revised and accepted for publication February 26, 1979.
AJPH October 1979, Vol. 69, No. 10
from private practitioners. Thirteen per cent of recent graduates presented for treatment at least once each year during their tenure as students, 57 per cent sought
care in more than one year, and 24 per cent did not seek care at all. It was concluded that factors other
than cost, accessibility, and educational level operate
to prevent total utilization of prepaid dental health care in a young adult age group. (Am J Public Health
the enrollee population. The population is comprised of individuals in the age group of 18-26 years, an adult age group which normally exhibits high dental treatment needs. Enrollment of these students in the Student Dental Health Program is compulsory under University policy. The Student Dental Health Program (SDHP) is an open panel, prepaid dental health care program. There are two components of this program which operate independently. A group practice component located in an attractive self-standing facility at the University of Alabama Medical Center provides on-campus treatment. Alternatively, students may elect to seek treatment from private practitioners of their own choice. Through either component, students are afforded the same coverage and opportunities for treatment. The on-campus SDHP facility and general philosophy of the program have been described previously.3 At present, a premium of $48 is paid by all enrollees, which covers the cost of treatment for a 12-month period. All diagnostic, pre1017
LEGLER ET AL.
ventive, restorative, and surgical dental care is provided with the exception of orthodontic therapy, fixed and removable prosthodontic appliances, and elective oral surgery such as impacted third molar removal. Each entering student must furnish evidence that he/she has received a dental examination and that all necessary dental treatment has been performed prior to admission. The SDHP facility, convenient to all UAB schools, is open evenings for maximum accessibility. Students are seen by appointment except in cases of emergency for which staff members are readily available on an on-call basis. Every effort is made to encourage use of the program, whether on campus or through private practitioners. Students receive a descriptive brochure at the time of admission to their respective schools and an explanation of the program during freshman orientation. Clinic charts are maintained for all students in the program. Data for analyses were taken directly from these records and summarized in Figure 1 and Tables 1-3. Statistical comparisons were by means of the Chi square statistic for two-way tables.
z W :D
1200
LLJ
CC 100000 Results The progressive increase in enrollment in the SDHP is shown in Table 1; by 1975-76 enrollment had increased to 1,618 students, representing the total student bodies of the four health schools. During the early years of the program extraordinary efforts were made to ensure utilization.4 These efforts included weekly appointment reminders, personal contacts with students to make appointments, charges for broken appointments, and administrative pressure. Findings show that 81 per cent of enrollees in 1963-64 and 97 per cent in 1965-66 utilized the program either at the SDHP group practice facility or from a private practitioner. In 1966-67, a laissez faire policy was adopted and the mandate to seek care was eliminated. This resulted in a significant drop in utilization (X2ldf = 62.14, p < 0.001) to a low point of 44 per cent by 1973-74, when compared with the other three years of this study. During the entire period from 1969-70 to 197576, utilization ranged from 44 to 61 per cent. The 61 per cent level represents the maximum response in utilization that was observed employing all reasonable means of encouragement short of required attendance. Figure 1 shows the relative distribution in the numbers of students who seek treatment from private practitioners,
4800 2600-
01 1969-70 71-72 73-74 75-76
ACADEMIC YEAR FIGURE 1-Relative Distribution of Students Seeking Care from Private Practitioners (PP), Group Practice (SDHP), or Remaining Nonusers.
the SDHP faculty, or who remain as non-users. The proportion of students electing to utilize the open panel provision
TABLE 1-Utilization of Prepaid Dental Program during Academic Years 1969-76, University of Alabama, Birmingham
1018
Year
1969-70
1971-72
1973-74
1975-76
Total Numberof Enrollees Number Utilizing Program % Utilization
862
1252
1620
1618
489
615
721
994
57
50
44
61
A18PH October 1979, Vol. 69, No. 10
UTILIZATION OF PREPAID DENTAL CARE TABLE 2-Differences in Utilization of Prepaid Dental Program by Health Professional School in 1973-74 and 1975-76, Alabama, Birmingham
University of
Number Seeking Treatment By Source* Total Number Enrolled
Per Cent Utilization
Number Treated
SDHP Clinic
Private
School
1973-74
1975-76
1973-74
1975-76
1973-74
1975-76
1973-74
1975-76
1973-74
1975-76
Dental Medical Nursing Optometry
247 479 808 86
271 406 828 113
125 236 325 35
141 229 558 66
51 49 40 41
52 56 67 58
117(94) 189 (80) 226 (70) 25 (71)
130 (92) 156 (68) 405 (73) 53 (80)
47 (20) 99 (30)
8(6)
11 (8) 73 (32) 153 (27) 13 (20)
10 (29)
*Figures in parentheses indicate per cent seeking treatment.
has increased proportionately to those seeking treatment at the SDHP facility. Utilization by health school is shown in Table 2. The year of lowest total utilization, 1973-74, is compared to the most recent year showing a higher utilization (1975-76). From the low point of 1973-74 to 1975-76, the last year for which complete data are available, utilization of the SDHP increased significantly for nursing students from 40 per cent to 67 per cent (X2ldf = 121.5, p < 0.001), for optometry students from 41 per cent to 58 per cent (X2ldf = 6.13, p < 0.03), and for medical students from 49 per cent to 56 per cent (X2ldf = 4.49, p < 0.05). During this period, utilization by dental students remained relatively constant at 51-52 per cent (X2ldf = 0.10, p > 0.70). Nursing students are currently the heaviest users when compared to the other three schools (X2ldf = 25.40, p < 0.001). On the basis of these data it would appear that chronic underutilization is not characteristic of any one of the professional schools. The data in Table 2 also reflect an analysis of the open panel provisions among those students who chose to utilize the SDHP in 1975-76. Medical students showed the greatest preference for private practitioners, with 32 per cent seeking care outside the SDHP clinic, as did 27 per cent of the nursing students and 20 per cent of the optometry students (X22df = 4.06, p > 0.10). Only 8 per cent of dental students were treated by private practitioners in 1975-76. Of the entire enrollee population, approximately three-fourths (744) elected to seek treatment at the SDHP clinic. The attendance history of senior students who have been in the program since their first year in professional school is shown in Table 3. Although the adage "'see your
dentist twice a year" has been ingrained in the American public, and the value of health service should be apparent to all enrollees, only 13 per cent of enrollees presented for treatment at least once each year during their tenure as students; 57 per cent sought care in more than one year. Twenty-four per cent of the students did not present for treatment at all during the entire length of their educational program.
Discussion The design of the Student Dental Health Program provided for the removal of two main barriers to the receipt of dental health care, i.e., cost of services, and accessibility. A third barrier, lack of health education and motivation, was minimized since enrollees were presumably more health-oriented since they were in training for careers as health care providers. Despite the removal of these barriers, utilization of the program peaked at a level of 61 per cent over the seven-year period of the program when participation was not mandatory. Although various predictions have been offered about the cataclysmic effects of a national dental health insurance plan on dental care delivery, these data suggest that utilization would not be overwhelming in the 18-26 year age group. Data provided by other investigators for various age groups support this observation. Barenthin reported the results of a local survey involving a community of 21,000 people in Sweden.5 In a representative sample interviewed in relation to their receipt of dental care in 1974, the first year of national dental insurance in Sweden, approximately 42
TABLE 3-Attendance History of Dental Program Enrollees Graduating in 1977
Those seeking care in every year Those seeking care in > one year,
Number
%
Total Enrolled
39 132
13 44
299 299
56
19
299
72
24
299
but < every year
Those seeking care in only one year
Those not seeking care in any year
AJPH October 1979, Vol. 69, No. 10
1019
LEGLER ET AL.
Schoen reported annual utilization of a dental plan, involving both a capitation group practice and an open panel, to be at a level of 48.2 per cent when based upon all of the 323 enrollees. Utilization of the group practice component was considerably higher, however.6 Leverett, et al, noted utilization in a multi-state company dental plan to be at an overall level of 49.6 per cent in 1964.7 Comprehensive dental care was available under the plan to 1,896 individuals who comprised the study population. Utilization by males in 1825 year age range was 32 per cent, compared to 49 per cent for females of the same age. Utilization of prepaid dental care as low as 19 per cent has been reported for persons in the 15-24 year age groups in a community wide plan,8 and 23.3 per cent in persons covered by a commercial plan provided as a company fringe benefit.9 In the latter case, despite comprehensive provision of services, utilization ranged from 16 per cent in 1962 to 24 per cent in 1967. At least one program has exhibited utilization comparable to that reported in our study. This involves the Dental Health Care Plan provided to employees and dependents of the American Dental Association, which reported utilization rates of 60.6 per cent in 1965, 57.2 per cent in 1966, and 68.1 per cent in 1969. Presumably, these individuals were dentally oriented, and a comprehensive program of benefits was provided.'0 The findings summarized in Table 3 relative to enrollee attendance history were unexpected with respect to the number of students who never sought care through the SDHP clinic or private practitioners. The observation that 24 per cent of these graduates did not use the program would suggest that non-users in any given year tend to be non-users in other years as well. The 1977 graduating students were
enrolled in the program from 1973-1977, a time frame that included both low and high years of overall program utilization. Although barriers of cost, accessibility, and lack of appreciation for health care were eliminated for the study population, other factors such as psychological factors, patient busyness, and lack of perceived needs may also be important determinants in the utilization of prepaid dental care.
REFERENCES 1. Mueller MS: Private health insurance in 1975; coverage, enrollment, and financial experience. Soc Secur Bull 40: 3-21, 1977. 2. Pelton WJ: Student dental health program of the University of Alabama in Birmingham: I. The influence of dental treatment on DMF rates. J Am Col Health Assoc 17: 325-331, 1969. 3. Pelton WJ: A plan for a student dental health program at the University of Alabama Medical Center. Ala J Med Sci 2: 216220, 1965. 4. Pelton WJ, McNeal, DR and Goggins, JK: Student dental health program of the University of Alabama in Birmingham: IV. Enrollment and utilization. Ala J Med Sci 8: 283-287, 1971. 5. Barenthin I: Dental insurance and equity of access to dental services. Community Dent Oral Epidemiol 4: 215-220, 1976. 6. Schoen M: Observations of selected dental services under two prepayment mechanisms. Am J Public Health 63: 727-731, 1973. 7. Leverett DH, Hooper SD and Russell WN: Variations in utilization of a multi-state company dental plan. Am J Public Health 67: 1173-1178, 1977. 8. Nikias MK: Prepaid dental care: patterns of use and source of premium payment. Am J Public Health 59: 1088-1103, 1969. 9. Mulvihill JE, Bear WS, Dunning JM, et al: Utilization of a prepaid plan of commercial dental insurance. J Pub Health Dent 32: 187-196, 1972. 10. Bureau of Economic Research and Statistics, American Dental Association: Use of the American Dental Association dental health care plan during 1966 and 1969. JADA 81: 723-728, 1970.
I Conference on Airborne Contagion in Humans, Animals and Plants The New York Academy of Sciences is sponsoring a conference on "'Airborne Contagion in Humans, Animals and Plants," November 7-9, 1979, at the Barbizon-Plaza Hotel in New York City. The conference will focus on the changing concepts of airborne contagion, cover the history and epidemiology of airborne contagion, and will consider new agents for which airborne transmission has been documented. Sessions will be devoted to specific agents such as fungi, bacteria and viruses; airborne infection in hospitals will also be discussed. While there is public awareness and great emphasis on chemical pollutants in the environment, microbial pollutants with higher morbidity have not been adequately appreciated. This conference aims to describe and collate information on agents which can be airborne pathogens for humans, animals and plants. Methods of intervention will be proposed and evaluated. For further information, contact: Conference Department, The New York Academy of Sciences, 2 East 63rd Street, New York, NY 10021. (212) 838-0230.
1020
AJPH October 1979, Vol. 69, No. 10
