Psychosocial factors included maternal selfreportsof depressive symptoms, parenting stress,and social support. Depressive symptoms wereassessed using the Center for EpidemiologicalStudies Depression Scale (CES-D), a reliable andwell-validated 20-item scale with standard scoringwidely used in research to assess depressivesymptoms in the general population (31). Adummy variable was created and coded ‘1’ formothers scoring 16 or above, the standard cutofffor identifying individuals at risk of depression(32). The Chronbach’s alpha for the CES-D in oursample was 0.89. Parenting stress was measured bythe average score of six items from the ParentingStress Index (PSI), a standard measure of perceivedstress in the caregiver role (33). Mothers respondedon a scale from 1 ¼ ‘never’ to 5 ¼ ‘almostalways’ to items such as ‘having too little time tospend by yourself’ and ‘child gets on your nerves.’The alpha reliability for this scale in our samplewas 0.76.Social support was assessed by whether or notmothers responded positively to being asked ifthere was someone they could count on to: (i) runerrands, (ii) lend them money, (iii) watch theirchildren, and (iv) lend them a car or give them aride if needed (15–17). Dummy variables for eachof the four specific types of support were created.All analyses included standard sociodemographicvariables, including the mothers’ age (continuousvariable), education level (coded as completinghigh school or more), annual household income(categorized as <$10 000 as the reference, $10 000–19 999, and ‡$20 000), and household size (continuousvariable). The child’s age, dental insurancestatus (1 ¼ insured), and dental visit history(1 ¼ past visit) were examined as well.
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