Modeling Complex Mechanisms Underlying Oral Health Disparities in Young Children and Their Caregivers

模拟幼儿及其照顾者口腔健康差异背后的复杂机制

• 批准号: 10491836
• 负责人: Brenda Heaton
• 金额: $ 62.64万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-21 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10491836
• 关键词: Address; Affect; Behavior; Behavior Therapy; Behavioral; Biological; Boston; Caregivers; Child; Communities; Complex; Data; Data Collection; Dental Care; Dental caries; Development; Disadvantaged; Disease; Feedback; Foundations; Funding; Goals; Government; Health; Health Disparities Research; Health Status; Health behavior; Healthcare; Housing; Individual; Interdisciplinary Study; Intervention; Methods; Minority Groups; Modeling; Mouth Diseases; Oral health; Outcome; Pathway Analysis; Pathway interactions; Pattern; Perception; Population; Population Distributions; Population Dynamics; Population Group; Positioning Attribute; Poverty; Prevalence; Production; Public Housing; Recording of previous events; Research; Risk; Risk Factors; Role; Sampling; Science; Severities; Shapes; Social Development; Social Environment; Social Network; Structure; System; Testing; Work; authority; base; behavior change; burden of illness; care systems; design; early childhood; ethnic minority population; experience; family management; health care disparity; health disparity; improved; in silico; insight; interest; member; programs; psychosocial; racial and ethnic; simulation; social; social influence; social relationships; social stigma; tool

We propose to use complex systems science methods to understand how social connectedness influences the utilization of dental care by young children and their caregivers. The overall goal of our research program is to address disparities in Early Childhood Caries (ECC) as it remains the most prevalent disease afflicting children, the consequences of which can be serious and long lasting. Social influence is an important moderator of the causes of disease, the population distribution of disease (e.g. disparities), and health-related behavior change via social networks. Understanding the role of social influence provides a potent perspective on why behavioral interventions aimed solely at individuals have often failed to produce meaningful results. For these reasons, interest in the development of social network interventions has grown, but much of the information necessary to develop and adequately tailor interventions to the underlying mechanisms responsible for disease production is severely lacking, especially for populations facing the greatest burdens of disease. Complex systems science approaches, such as agent-based modeling and social network analysis, can provide critical insights into the mechanisms responsible for the production of health disparities. Yet, applications to oral health are minimal. We propose to apply complex systems science methods to understand the mechanisms underlying population distributions of ECC. We propose the following specific aims: (1) Characterize the pathways by which social connectedness of caregivers interacts with individual-level perceptions of oral health status, behaviors and dental care practices to shape population patterns of ECC. (2) Evaluate social network structure and composition of caregivers of young children in relation to individual- level dental care utilization behaviors among a sample of Boston public housing residents. (3) Identify and test hypothetical interventions aimed at modifying the social-behavioral and caries risk mechanisms through the use of in silico experimentation (i.e., simulations). Outcomes of our research will inform the design of targeted interventions that respond to complex system dynamics of populations affected by health disparities. ECC prevalence and severity are disproportionately higher among children from disadvantaged groups, including the poor and certain racial/ethnic minority groups. Importantly, ECC is one of the largest unmet healthcare needs of children in the US, and significant disparities in care utilization exist. Public housing residents are a high impact population for the study of disparities. As a population group, they are characterized by spatial clustering of poverty and poor health and are ideally suited for the proposed work. Our results are expected to yield important insights into the strength of the interactions responsible for producing behavioral patterns and their consequences, and provided the necessary data for using social relationships as potential leverage points for interventions to improve oral health.

我们建议使用复杂系统科学方法来理解社会联系如何影响 幼儿及其照顾者利用牙科护理。我们研究计划的总体目标是 解决儿童早期龋齿 (ECC) 方面的差异，因为它仍然是最常见的疾病 儿童，其后果可能是严重且持久的。 社会影响是疾病原因、疾病人口分布的重要调节因素（例如， 差异），以及通过社交网络与健康相关的行为改变。了解社会影响力的作用 提供了一个有力的视角来解释为什么仅针对个人的行为干预往往无法实现 产生有意义的结果。由于这些原因，人们对开发社交网络干预措施产生了兴趣 增长，但开发和充分调整干预措施所必需的大部分信息是针对潜在的 严重缺乏导致疾病产生的机制，特别是对于面临疾病的人群 最大的疾病负担。 复杂的系统科学方法，例如基于代理的建模和社交网络分析，可以 提供对造成健康差异的机制的重要见解。然而， 在口腔健康方面的应用很少。我们建议应用复杂系统科学方法来理解 ECC 群体分布的潜在机制。我们提出以下具体目标： (1) 描述照顾者的社会联系与个人层面相互作用的途径 对口腔健康状况、行为和牙科护理实践的看法，以塑造 ECC 的人口模式。 (2) 评估与个人相关的幼儿照顾者的社会网络结构和构成 评估波士顿公共住房居民样本中的牙科护理利用行为。 (3) 确定并测试旨在改变社会行为和龋齿风险的假设干预措施 通过使用计算机实验（即模拟）来研究机制。 我们的研究结果将为应对复杂系统的有针对性的干预措施的设计提供信息 受健康差异影响的人口动态。 ECC 的患病率和严重程度不成比例 来自弱势群体（包括穷人和某些种族/族裔群体）的儿童的比例更高。 重要的是，ECC 是美国儿童最大的未满足医疗保健需求之一，并且存在巨大差异 在护理利用中存在。公共住房居民是研究差异的高影响人群。作为一个 人口群体，他们的特点是贫困和健康状况不佳的空间聚集，非常适合 对于拟议的工作。我们的结果预计将对相互作用的强度产生重要的见解 负责产生行为模式及其后果，并提供必要的数据 利用社会关系作为改善口腔健康干预措施的潜在杠杆点。