Oral Health Advocates in Public Housing Abstract Dental caries is the most common, chronic disease of childhood, is increasing in prevalence and disproportionately affects individuals who are financially disadvantaged and from racial and ethnic minority groups. Given the chronic nature of dental caries, clinically based preventive and restorative care alone will be inadequate to decrease disparities in ECC prevalence. Instead, we posit that a multimodal communitybased approach, which addresses the chronic, infectious and multifactorial nature of dental caries, will be more effective than behavioral counseling and the chemotherapeutic effects of fluoride, either alone or in combination. A successful community-based multimodal intervention will incorporate these strategies, but will also need to equip caregivers with the skills to become involved in the prevention and management of ECC as well as to foster community and environmental support for decreasing ECC risk factors. Similar strategies have been applied successfully to a variety of chronic diseases such as asthma, diabetes, and depression, with most studies showing significant short and long term effects. This project, using community based participatory research principles to decrease disparities in early childhood caries, extends the work of the ongoing partnership of the "Center for Research to Evaluate and Eliminate Dental Disparities" [CREEDD], the CDC funded "Partners in Health and Housing Prevention Research Center" [PHH-PRC], the Boston Housing Authority (BHA) and the Community Committee for Health Promotion (CCPH). This approach is synergistic not only with the goals of all partners, but also with the goal of our campus wide clinical and translational science institute, particularly the CTSI's focus on community involvement in research. In order to facilitate the ongoing collaborative working relationships with the public housing communities and other partners, Dr. Henshaw, the project PI will serve as the specific key person responsible for the project's coordination with community partners. Dr. Henshaw has successfully served in this role for the past 2 years, during which time the research team has collaborated with the public housing community through conduct of pilot intervention studies, participation in community committee meetings, special community sessions and events, and the conduct of focus groups to obtain community input in all aspects of the proposed research. The work will build on the Expanded Chronic Care Model, and will test if a community-based multimodal intervention will reduce the 2-year ECC incidence of children aged 0-5 living in public housing developments. The intervention combines evidentiary components (motivational interviewing delivered by oral health advocates, oral health assessment and referral, care management and community health promotion) and a unique delivery setting (public housing). We hypothesize that because of the counseling activities, the experimental group will not only be more likely to reduce individual behavioral risk factors for ECC, but will be more likely to access both primary dental care and the community-based fluoride applications that will be available at both the experimental and control sites, leading to a greater incidence of ECC reduction in the experimental group.
The specific aims of the proposed research are to:
Specific Aim 1 : Determine if a multimodal intervention (oral health assessment and feedback, fluoride varnish application, motivational interviewing delivered by oral health advocates and a community-based oral health promotion program), built upon the chronic care model, can reduce incidence of ECC compared with a matched control group that receives dental screening and fluoride varnish application alone.
Specific Aim 2 : Determine if the multimodal intervention can reduce ECC behavioral risk factors in the domains of tooth monitoring, oral hygiene and dietary practices compared with a matched control group that receives dental screening and fluoride varnish application alone.
Specific Aim 3 : Evaluate facilitators and barriers to the multimodal intervention in public housing sites. This study is well poised for dissemination and will utilize process-related project findings from years 1-4 to conduct targeted expansion in years 5, 6 and 7 in which implementation will occur in 3 housing authorities located in New York, NY, Washington, D.C. and Columbus, OH where similar advocacy models are in place. Ultimately, this work could be disseminated through the Boston Housing Authority's network of nationwide contacts and could potentially improve the oral health of over 500,000 family households and over 1 million children living in public housing.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Specialized Center--Cooperative Agreements (U54)
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Special Emphasis Panel (ZDE1-MS)
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Boston University
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