Objectives: Exploring the association between neighborhoods and caries could provide a way to address oral health inequalities from a population perspective by developing multilevel oral health community interventions. This study examines neighborhood effects on the severity of caries among African Americans. Methods: A multistage probability sample of African- American families living in the poorest 39 Census Tracts in Detroit was conducted. This study used cross sectional data on 1021 caregivers obtained in the first wave of interview and examination in 2002-2003, collected by the Detroit Center for Research on Oral Health Disparities (NIH/NIDCR Grant Number U-54 DE 14261-01). Multilevel analyses focused on 27 neighborhood clusters and involved a combination of individual (level-1) and neighborhood data including Census and geocoded information (level-2). Results: There is significant variation in the severity of caries (DS scores) among low-income neighborhood clusters; however, the magnitude of this variation is less than 3%. On average, 36% of the neighborhood level variance in caries severity was explained by level-2 predictors. Direct effects on caries severity, after accounting for individual risk factors, were observed with the number of churches and grocery stores in the clusters. Lower DS scores seem to be associated with an increasing number of churches in neighborhood clusters even after accounting for individual risk factors. Individual predictors such as age, socioeconomic status, total sugar intake, oral hygiene and oral health self-perception explained approximately 15% of the caries variance within the neighborhood clusters. The great inter-individual variability in caries is still mostly unexplained by classical risk factors for this condition. Conclusion: Neighborhoods contribute something unique to the oral health status of caregivers, beyond their own socioeconomic position and individual risk factors. Multilevel interventions are necessary to reduce disparities among African-Americans and churches may offer a promising venue in which to conduct these strategies.

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