Great Beginnings for Healthy Native Smiles

项目摘要 幼儿龋病（ECC）是儿童中最常见的慢性疾病。美国印第安 (AI)儿童患未经治疗的龋齿的可能性是白色儿童的4倍。如果不治疗， ECC可导致慢性疼痛、牙齿脱落、营养不良和生长受损。拟定研究 旨在通过一个创新的，基于社区的 参与式方法。该项目将：1）与两个部落合作，霍皮部落（亚利桑那州）和乌鸦 部落（蒙大拿州），进行口腔健康（OH）的形成性评估; 2）适应“捆绑”的最佳 实践OH干预是当地和上下文相关的每个部落社区; 3)进行随机对照研究，以评估"捆绑"最佳实践的影响 干预（与标准的产前/产后健康生活方式干预相比） ECC的。社区卫生代表将接受培训，以提供干预措施， 孕妇和跟踪他们，直到孩子的最后一次检查（24 - 36个月）。OH干预将 由4个已知有效预防ECC的干预组成部分（最佳实践）组成：1） 在怀孕和产后期间提供饮食和健康教育; 2）儿童健康护理 包括使用氟化物保护漆; 3）与儿童母亲进行动机访谈; 4） 每个研究社区现有OH和其他社会服务的患者导航， CHRs.将在第1、2和3阶段比较两种条件下的龋齿经历（dmfs）和严重程度- 年考试。母亲的知识，态度和行为有关的幼儿保育也将被衡量为两个 测试前和测试后的条件。调查将评估社会生态模式的各个层面。 个体水平领域将包括：1）母亲和婴儿的人口统计学（仅预测试）; 2）牙科 3）母亲和孩子的OH（产后）; 4）母亲的知识，信仰， 对OH最佳实践的态度; 5）母亲对自我效能和易感性的感知;以及6） 母亲的产前健康和经验。人际层面的领域将包括：1）目前的生活 情况和家庭支持; 2）情感，信息和工具支持的可用性;以及3） 同伴和家庭成员对暴力和暴力的态度。社区一级 领域将包括：1）部落身份和相关经验; 2）护理协调，交通， 获得社会和OH服务;和3）的文化一致性的认知， 干预材料。如果成功的话，这种以社区为基础的方法可能被证明是一种可行的方法。 在许多土著社区改善AI儿童OH和减轻ECC负担的方法 无法得到常规的牙科护理。

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.