Great Beginnings for Healthy Native Smiles

项目总结 儿童早期龋病是儿童中最常见的慢性病。美国印第安人 (AI)儿童患未经治疗的龋齿的可能性是白人儿童的4倍。如果不治疗， ECC会导致慢性疼痛、牙齿脱落、营养不良和生长受阻。建议进行的研究 旨在通过基于社区的创新解决方案降低两个AI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)和乌鸦 Tribe(蒙大拿州)，对口腔健康(OH)进行形成性评估；2)最佳改编 在地方和背景上与我们的每个部落社区相关的做法； 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)减少 ECC的。社区卫生代表(CHR)将接受培训，以便通过 并跟踪这些孕妇，直到孩子的最后一次检查(24-36个月)。OH干预将 由4个已知在预防ECC方面有效的干预组成部分(最佳做法)组成：1) 在孕期和产后期间提供饮食和保健教育；2)保健儿童 包括使用含氟清漆；3)与孩子的母亲进行激励性访谈；4) 耐心导航每个研究社区中现有的OH和其他社会服务，由 CHRS。龋齿经历(DMF)和严重性将在1、2和3个条件下进行比较- 年考。母亲对幼儿生长发育相关的知识、态度和行为也将进行测量。 测试前和测试后的情况。调查将评估社会生态模型的每一个层面。 个人级别的领域将包括：1)母亲和婴儿的人口统计(仅限测试前)；2)牙科 到目前为止孩子的健康状况；3)母亲和孩子的健康状况(出生后)；4)母亲的知识、信念和 对最佳实践的态度；5)母亲对自我效能感和敏感度的看法；6) 母亲的产前健康和经历。人际关系层面的领域将包括：1)当前生活 情况和家庭支持；2)情感、信息和工具支持的可用性；以及3) 对同龄人和家庭成员对照看他人的态度和对健康的看法。社区层面 领域将包括：1)部落特性和相关经验；2)护理协调、运输和 获得社会和卫生服务；以及3)对CHR互动和文化一致性的看法 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 在多个原住民社区改善AI儿童的OH和减轻ECC负担的方法 获得常规牙科护理的机会有限。

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.