Despite advances in population-based interventions to prevent dental caries, the prevalence of ECC in children is increasing and disproportionately affects children from racial and ethnic minority groups. ECC is a significant public health problem in American Indian/Alaska Native (AI/AN) children: it's highly prevalent, more severe and occurs earlier in the lifespan compared to other race/ethnic groups in the US. This underscores an urgent need for effective, culturally- appropriate oral health promotion, disease prevention and treatment programs for AI/AN children. This project, uses community-based participatory research principles and takes advantage of the strengths of the partnership among the California Tribal Epidemiology Center and the California Dental Support Center, both housed at the California Rural Indian Health Board, and the Center to Address Disparities in Children's Oral Health at the University of California, San Francisco. We will implement an innovative storytelling intervention to prevent ECC by partnering with tribal organizations in three areas in northern California and by specifically targeting mothers because they influence ECC risk factors earliest in the lifespan. The purpose of this research is to develop and evaluate a culturally-tailored intervention that incorporates key oral health messages in the indigenous practice of storytelling intended to provide education on ECC risk factors and promote positive oral health behaviors. The proposed intervention includes a story told by a traditional storyteller indigenous to California in a talking circle format. The primary research question to be answered is whether this culturally- tailored, novel intervention is a feasible and acceptable one for improving knowledge, beliefs and behaviors regarding ECC among self-identified age 18 and older AI/AN pregnant women or mothers of children aged 0-71 months. The secondary research question is whether positive effects can be detected from the intervention and the specific aim is to document the effects of the structured intervention for increasing knowledge, beliefs, and positive oral health behaviors through pre-test and two post-test surveys. Outcomes will be assessed immediately after the intervention (post-test 1) and 6 months later (post-test 2) to examine maintenance. This project is important because it will help inform future intervention studies that may include both oral health promotion and clinical interventions for families and their communities to reduce ECC in AI/AN populations.

Public Health Relevance

Among American Indians/Alaska Natives, Early Childhood Caries (ECC) begins at younger ages, is more frequent (68% in 2-4 year olds compared to 11% in the general US population;DHHS, 2000) and presents itself more severely than other US populations. The proposal implements a storytelling intervention to prevent ECC by partnering with tribal organizations and by specifically targeting mothers because they influence ECC risk factors earliest in the lifespan. If storytelling in a talking circle format is feasible and acceptable by this target population, then this culturally-appropriate strategy can be further extended to families and the community to promote oral health.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Exploratory/Developmental Grants (R21)
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Community-Level Health Promotion Study Section (CLHP)
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Nowjack-Raymer, Ruth
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California Rural Indian Health Board
United States
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Heaton, Brenda; Gebel, Christina; Crawford, Andrew et al. (2018) Using Storytelling to Address Oral Health Knowledge in American Indian and Alaska Native Communities. Prev Chronic Dis 15:E63
Heaton, Brenda; Crawford, Andrew; Garcia, Raul I et al. (2017) Oral health beliefs, knowledge, and behaviors in Northern California American Indian and Alaska Native mothers regarding early childhood caries. J Public Health Dent 77:350-359