Oral Health Advocates in Public HousingAbstractDental caries is the most common, chronic disease of childhood, is increasing in prevalence anddisproportionately affects individuals who are financially disadvantaged and from racial and ethnic minoritygroups. Given the chronic nature of dental caries, clinically based preventive and restorative care alone will beinadequate to decrease disparities in ECC prevalence. Instead, we posit that a multimodal communitybasedapproach, which addresses the chronic, infectious and multifactorial nature of dental caries, will bemore effective than behavioral counseling and the chemotherapeutic effects of fluoride, either alone or incombination. A successful community-based multimodal intervention will incorporate these strategies, but willalso need to equip caregivers with the skills to become involved in the prevention and management of ECC aswell as to foster community and environmental support for decreasing ECC risk factors. Similar strategies havebeen applied successfully to a variety of chronic diseases such as asthma, diabetes, and depression, withmost studies showing significant short and long term effects.This project, using community based participatory research principles to decrease disparities in earlychildhood caries, extends the work of the ongoing partnership of the 'Center for Research to Evaluate andEliminate Dental Disparities' [CREEDD], the CDC funded 'Partners in Health and Housing PreventionResearch Center' [PHH-PRC], the Boston Housing Authority (BHA) and the Community Committee for HealthPromotion (CCPH). This approach is synergistic not only with the goals of all partners, but also with the goal ofour campus wide clinical and translational science institute, particularly the CTSI's focus on communityinvolvement in research. In order to facilitate the ongoing collaborative working relationships with thepublic housing communities and other partners, Dr. Henshaw, the project PI will serve as the specifickey 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 teamhas collaborated with the public housing community through conduct of pilot intervention studies, participationin community committee meetings, special community sessions and events, and the conduct of focus groupsto obtain community input in all aspects of the proposed research. The work will build on the ExpandedChronic Care Model, and will test if a community-based multimodal intervention will reduce the 2-year ECCincidence of children aged 0-5 living in public housing developments. The intervention combines evidentiarycomponents (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). Wehypothesize that because of the counseling activities, the experimental group will not only be more likely toreduce individual behavioral risk factors for ECC, but will be more likely to access both primary dental care andthe 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 proposedresearch are to:
Specific Aim 1 : Determine if a multimodal intervention (oral health assessment andfeedback, fluoride varnish application, motivational interviewing delivered by oral health advocates and acommunity-based oral health promotion program), built upon the chronic care model, can reduce incidence ofECC compared with a matched control group that receives dental screening and fluoride varnish applicationalone.
Specific Aim 2 : Determine if the multimodal intervention can reduce ECC behavioral risk factors in thedomains of tooth monitoring, oral hygiene and dietary practices compared with a matched control group thatreceives dental screening and fluoride varnish application alone.
Specific Aim 3 : Evaluate facilitators andbarriers 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 toconduct targeted expansion in years 5, 6 and 7 in which implementation will occur in 3 housing authoritieslocated 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 nationwidecontacts and could potentially improve the oral health of over 500,000 family households and over 1 millionchildren living in public housing.
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