Coordinated Oral Health Promotion (CO-OP) Chicago

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The Coordinated Oral Health Promotion (CO-OP) Chicago studies [UH2DE02583/UH3DE025483] were funded by the National Institute of Dental and Craniofacial Research (NIDCR) as part of a consortium to develop and test interventions to reduce oral health disparities in children. The resulting CO-OP Chicago Trial is a health disparities cohort of 420 very young children and their families. At entry into the trial, the mean child age was 21.5 months old. Forty-two percent of participants describe themselves as Black race, and 54% as Hispanic ethnicity. Most children (89%) had Medicaid health insurance. Many caregivers were struggling to brush children's teeth twice a day, provide a healthy diet, and take children for preventive oral healthcare. Multi-level interventions, such as community health workers (CHWs), are needed to target these factors that operate on individual, family, community, and public health levels. COVID-19 has brought new changes to household dynamics and unforeseen stressors to these families. The medical clinics and social service agencies that service these families have also been majorly affected. As we begin the process of resuming health, dental, and social services, we need to consider what changes are needed. Challenges fall into several domains. (1) Dental care: Access to dental services was challenging for low-income families before this crisis; this will worsen as providers and facilities attempt to resume regular services while also catching up on those that had been cancelled and maintaining new safety protocols. Many questions regarding understanding of COVID-19, trust, safety, and logistics surround this process. (2) Oral health behaviors: With the disruption of schools, child care, and employment, how have oral health behaviors changed? (3) Nutrition: How have dietary habits changed with food insecurity challenges and more time at home? (4) Mental health: How has the stress, household chaos, and alternation to social support systems associated with this pandemic affected families? We propose to answer these questions in the Community Intervention Modifications for Low-Income Urban Families after COVID-19 study. The results will inform the interventions dental, health, and social service agencies will need to provide in order to support high-risk families to establish healthy oral health behaviors after a major societal stressor like COVID-19. SPECIFIC AIM: To determine specific intervention needs regarding dental care access, oral health behaviors, nutrition, and mental health for low-income urban families with young children following COVID-19. We will achieve this aim using quantitative and qualitative data collected from the CO-OP Chicago cohort and our 20 partner sites. Our hypothesis is that families will have poor mental health, food insecurity, disrupted home oral health routines, distrust of dental services, and challenges accessing dental care. We expect targeted CHW outreach and care coordination will be the best interventions to address these issues. When it comes to long-term recovery from COVID-19, let us not `go back to normal.'