Table 1.

Mechanisms That Connect Unemployment to Preventive Oral Health Care Utilization

	Direct Effects:	Indirect Effects:
	Act Only on the Unemployed Individual	Act on Those Economically Connected to the Unemployed Individual
Impedance mechanism	Cell I	Cell II
Individuals want to utilize preventive oral health care services, but are impeded from doing so.	Utilization of preventive oral health care services by unemployed individuals is impeded by unemployment through: (1) the loss of employer-sponsored dental insurance; and/or (2) the reduction of overall financial resources, making out-of-pocket care, transportation, and childcare too expensive.	Utilization of preventive oral health care services by those economically connected to an unemployed individual is impeded through: (1) the loss of employer-sponsored dental insurance from the unemployed individual; and/or (2) the reduction of overall financial resources, making out-of-pocket care, transportation, and childcare too expensive.
Distraction mechanism	Cell III	Cell IV
Individuals have access to preventive oral health care services, but are distracted from utilization of those services.	Individuals lack the time, energy, or attention to utilize preventive oral health care services due to their own unemployment.	Individuals lack the time, energy, or attention to utilize preventive oral health care services due to: (1) the demands of an unemployed spouse, partner, or friends; and/or (2) excess demands on those left working; and/or (3) concern about one's own possible pending unemployment.

Adapted from Catalano et al. (2003).