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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.119495v1 98/6/1101    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Sanders, A. E. Articles by Sohn, W. PubMed PubMed Citation Articles by Sanders, A. E. Articles by Sohn, W.

Anne E. Sanders, PhD, MSocSc, MHEc, Sungwoo Lim, MA, MS and Woosung Sohn, DDS, PhD, DrPH

At the time of the study, Anne E. Sanders was with the Australian Research Centre for Population Oral Health, Adelaide, and the University of Michigan, Ann Arbor. Sungwoo Lim was with the Detroit Dental Health Project at the University of Michigan, Ann Arbor. Woosung Sohn was with the School of Dentistry, University of Michigan, Ann Arbor.

Correspondence: Requests for reprints should be sent to Dr Anne E. Sanders, School of Dentistry, University of Michigan, 1011 N University, Ann Arbor, MI 48109-1078. (e-mail: aesand{at}umich.edu).

Objectives. To better understand the trajectory that propels people from poverty to poor health, we investigated health resilience longitudinally among African American families with incomes below 250% of the federal poverty level.

Methods. Health resilience is the capacity to maintain good health in the face of significant adversity. With higher levels of tooth retention as a marker of health resilience, we used a social–epidemiological framework to define capacity for health resilience through a chain of determinants starting in the built environment (housing quality) and community context (social support) to familial influences (religiosity) and individual mental health and health behavior.

Results. Odds of retaining 20 or more teeth were 3 times as likely among adults with resilience versus more-vulnerable adults (odds ratio=3.1; 95% confidence interval [CI]=1.3, 7.4). Children of caregivers with resilience had a lower incident rate of noncavitated tooth decay at 18- to 24-month follow-up (incidence risk ratio=0.8; 95% CI=0.7, 0.9) compared with other children.

Conclusions. Health resilience to poverty was supported by protective factors in the built and social environments. When poverty itself cannot be eliminated, improving the quality of the built and social environments will foster resilience to its harmful health effects.