Great Beginnings for Healthy Native Smiles

健康原生微笑的良好开端

• 批准号: 10408126
• 负责人: Julie Ann Baldwin
• 金额: $ 65.02万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10408126
• 关键词: Absenteeism; Address; Adult; Affect; Age; American Indians; Arizona; Attitude; Behavioral; Belief; Biological; Caregivers; Child; Child Health; Child health care; Chronic Disease; Collaborations; Communities; Community Health; Crow Tribe of Montana; Crows; Dental Care; Dental Clinics; Dental Hygiene; Dental caries; Dentists; Diet; Early treatment; Educational Status; Emotional; Ethnic group; Family member; Fluoride Varnishes; Growth; Guidelines; Head Start Program; Health; Health Knowledge Attitudes Practice; Health Personnel; Health Services; Health Services Accessibility; Health behavior; Health education; Healthcare; Impairment; Incidence; Individual; Infant; Intervention; Interview; Knowledge; Lead; Left; Low income; Measures; Methods; Modeling; Montana; Mothers; Oral health; Outcome; Patients; Perception; Population; Predisposition; Pregnancy; Pregnant Women; Prevention; Recommendation; Research; Research Methodology; Resources; Risk; Risk Factors; Sampling; Self Efficacy; Self Perception; Severities; Site; Smiling; Social Work; Special Supplemental Nutrition Program for Women, Infants, and Children; Surveys; Techniques; Testing; Time; Tooth Loss; Tooth structure; Training; Tribes; United States; United States Indian Health Service; Woman; base; care coordination; care providers; caregiving; chronic pain; cost; deciduous tooth; demographics; design; dietary; early childhood; ethnic diversity; experience; family support; feeding; formative assessment; health belief; health disparity; healthy lifestyle; holistic approach; improved; innovation; lifestyle intervention; low socioeconomic status; motivational enhancement therapy; nutrition; peer; pilot test; postnatal; postnatal period; prenatal; prenatal experience; prenatal health; prevent; randomized controlled study; rural area; social; tooth surface; transportation access; tribal community; tribal health; underserved community

PROJECT SUMMARY Early Childhood Caries (ECC) is the most common chronic disease among children. American Indian (AI) children are 4 times more likely to have untreated dental decay than white children. If left untreated, ECC can lead to chronic pain, loss of teeth, poor nutrition, and impaired growth. The proposed study aims to reduce the burden of ECC in two AI communities through an innovative, community based participatory approach. The project will: 1) partner with 2 tribes, the Hopi Tribe (Arizona) and the Crow Tribe (Montana), to conduct a formative assessment on oral health (OH); 2) adapt a “bundled” best practices OH intervention to be locally and contextually relevant for each of our tribal communities; and 3) conduct a randomized, controlled study to evaluate the impact of the “bundled” best practices OH intervention (compared to a standard prenatal/postnatal healthy lifestyle intervention) on the reduction of ECC. Community health representatives (CHRs) will be trained to deliver the interventions with pregnant women and follow them until the child’s last exam (24-36 months). The OH intervention will consist of 4 intervention components known to be effective (best practices) in the prevention of ECC: 1) dietary and OH education provided during pregnancy and the postnatal period; 2) OH care of children including the application of fluoride varnish; 3) motivational interviewing with children’s mothers; and 4) patient navigation of existing OH and other social services in each study community, facilitated by CHRs. Caries experience (dmfs) and severity will be compared across both conditions at the 1, 2, and 3- year exams. Mother knowledge, attitudes, and behaviors related to ECC will be also measured for both conditions at pre-test and post-test. Surveys will assess each level of the social ecological model. Individual level domains will include: 1) demographics of mother and baby (pre-test only); 2) dental health of the child to date; 3) mother’s and child’s OH (postnatal); 4) mother’s knowledge, beliefs, and attitudes about best practices in OH; 5) mother’s perception of self-efficacy and susceptibility; and 6) mother’s prenatal health and experiences. Interpersonal level domains will include: 1) current living situation and family support; 2) availability of emotional, informational, and instrumental support; and 3) perceptions of peers’ and family members’ attitudes toward caregiving and OH. Community level domains will include: 1) tribal identity and related experiences; 2) care coordination, transportation, and access to social and OH services; and 3) perceptions of cultural congruence of CHR interactions and intervention materials. If successful, this community-based approach may prove to be a feasible method for improving OH of AI children and reducing the burden of ECC in many Native communities with limited access to regular dental care.

项目概要 儿童早期龋齿（ECC）是儿童中最常见的慢性疾病。美洲印第安人 (AI) 儿童未经治疗的蛀牙可能性是白人儿童的 4 倍。如果不及时治疗， ECC 可导致慢性疼痛、牙齿脱落、营养不良和生长受损。拟议的研究 旨在通过创新的、基于社区的方式减轻两个人工智能社区的 ECC 负担 参与式方法。该项目将：1）与 2 个部落合作，霍皮部落（亚利桑那州）和克罗部落 Tribe（蒙大拿州），对口腔健康（OH）进行形成性评估； 2）调整“捆绑”最佳方式 实践 OH 干预措施，使其与我们每个部落社区的本地和环境相关；和 3) 进行随机对照研究来评估“捆绑”最佳实践的影响 OH 干预措施（与标准产前/产后健康生活方式干预相比） 的ECC。社区卫生代表 (CHR) 将接受培训以提供干预措施 孕妇并跟踪他们直到孩子最后一次检查（24-36 个月）。 OH 干预将 包括 4 个已知对预防 ECC 有效的干预措施（最佳实践）：1) 怀孕期间和产后期间提供饮食和健康教育； 2) OH 儿童护理 包括氟化物清漆的应用； 3）对孩子母亲的动机访谈；和 4) 每个研究社区中现有 OH 和其他社会服务的患者导航，由 CHR。将在第 1、2 和 3 个条件下比较龋齿经历 (dmfs) 和严重程度 年考试。母亲与 ECC 相关的知识、态度和行为也将被衡量 测试前和测试后的条件。调查将评估社会生态模型的各个层面。 个人级别的领域将包括： 1) 母亲和婴儿的人口统计数据（仅限预测试）； 2) 牙科 孩子迄今为止的健康状况； 3) 母亲和孩子的 OH（产后）； 4) 母亲的知识、信仰和 对 OH 最佳实践的态度； 5）母亲对自我效能感和敏感性的认知；和 6) 母亲的产前健康状况和经历。人际层面的领域将包括：1）当前的生活 情况和家庭支持； 2) 情感、信息和工具支持的可用性；和 3) 同伴和家庭成员对护理和 OH 态度的看法。社区层面 领域将包括：1）部落身份和相关经验； 2) 护理协调、交通和 获得社会和职业健康服务； 3) 对 CHR 互动的文化一致性的看法 干预材料。如果成功，这种基于社区的方法可能被证明是可行的 改善 AI 儿童 OH 并减轻许多原住民社区 ECC 负担的方法 获得常规牙科护理的机会有限。