Prevention of Dental Caries in Early Head Start Children

早期启蒙儿童的龋齿预防

• 批准号: 7527992
• 负责人: RICHARD GARY ROZIER
• 金额: $ 91.73万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7527992
• 关键词: 1 year old; 2 year old; Affect; Affective; Age; Age-Months; Age-Years; Appendix; Behavior; Caregivers; Caries prevention; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Child health care; Childhood; Chronic Disease; Clinical; Cognitive; Communities; Community Practice; Control Groups; Counseling; County; Dental; Dental Care; Dental Health Education; Dental caries; Disadvantaged; Disease; Economics; Educational Intervention; Educational workshop; Effectiveness; Effectiveness of Interventions; Enrollment; Ensure; Epidemic; Evaluation; Face; Family; Feedback; Funding; Grant; Head Start Program; Health; Health Personnel; Home environment; Improve Access; Interview; Knowledge; Lesion; Link; Low income; Manuscripts; Measures; Medicaid; Medical; Methods; Modeling; Mouth Diseases; North Carolina; Numbers; Nurses; ORALIT; Oral cavity; Oral health; Outcome; Parenting Education; Parents; Phase; Physicians; Population; Pregnant Women; Preventive; Primary Health Care; Program Evaluation; Provider; Public Health; Public Health Practice; Purpose; Quality of life; Race; Randomized; Readiness; Reporting; Research; Resources; Risk; Risk Assessment; Screening procedure; Self Efficacy; Services; Site; Source; Staging; System; Testing; Tooth Diseases; Tooth structure; Topical Fluorides; Training; United States Dept. of Health and Human Services; United States Health Resources and Services Administration; Work; base; burden of illness; cohort; concept; design; disorder risk; early childhood; expectation; falls; follow-up; health literacy; health related quality of life; improved; instrument; motivational enhancement therapy; prevent; programs; social; social cognitive theory; therapy design

DESCRIPTION (provided by applicant): Early childhood caries (ECC) is the most common chronic disease of childhood, affecting more than 4 million children nationwide. The burden of disease falls mostly on disadvantage children. The purpose of this research is to evaluate an already funded and ongoing intervention designed to prevent ECC in children 0-2 years of age through a combination of preventive dental activities in medical offices and Early Head Start (EHS) centers. EHS staff in North Carolina are being trained to provide dental health education and promotion activities for children and their families, and to link children enrolled in EHS with medical providers in their communities who provide preventive dental services. As part of a statewide Medicaid program, about 500 medical offices are providing preventive dental services for children, including screening, risk assessment and referral, parent counseling and topical fluoride applications. Children and their parents in 18 EHS programs in 28 counties in the state have close geographic proximity to 75 sites where medical providers are offering preventive dental services. The dental educational intervention with EHS staff is based mainly on Social Learning Theory and consists of statewide forums, workshops with audit and feedback of practices, and educational workshops and resource materials. The educational intervention for parents is based in part on the Transtheoretical Model, which uses Stages of Change as its key concept, and motivational interviewing. Staff provide classroom preventive dental activities for children and education for parents, with support provided from local dental public health providers. A non- randomized, pretest-posttest nested cohort control group cluster trial will determine the effects of the combined dental exposures provided in EHS programs and medical offices on preventing noncavitated and cavitated carious lesions in EHS children. About 800 0- and 1-year old children will be enrolled in each of the study groups and examined for ECC at 3 years of age. Age- and race-matched children enrolled in Medicaid but not EHS will serve as community-specific controls. Parents will be interviewed at baseline, and follow-up interviews will take place when their study-enrolled children are 18 and 36 months of age. The clinical examination of the child at 3 years of age will occur at the final follow-up parent interview. Secondary outcomes include cognitive (dental knowledge) and affective (value placed on dental health, self-efficacy, outcome expectations, readiness to change) characteristics, establishment of a dental home for the child and family, and improvements in parent reported oral health-related quality of life (OHRQoL) for the child and themselves. A final aim of the study will determine the extent to which dental health literacy modifies the effectiveness of the intervention in improving outcomes. OHRQoL, dental health literacy and dental "homeness" will be measured with instrument developed by the research team in previous research. Intent-to-treat analyses will determine effects of the intervention on dental outcomes. PUBLIC HEALTH RELEVANCE: Dental disease in young children is at epidemic levels among low-income children and they face a number of barriers that prevent them from getting needed dental care. This study will test several ways in which access to preventive dental services can be increased among children 0-2 years of age enrolled in Early Head Start programs across North Carolina. The result of successful implementation of preventive dental programs should be less disease and improved quality of life among children and their families.

描述（申请人提供）：幼儿龋病是儿童最常见的慢性疾病，影响着全国400多万儿童。疾病的负担大多落在处境不利的儿童身上。本研究的目的是评估一项已经资助并正在进行的干预措施，该干预措施旨在通过医疗办公室和早期开端（EHS）中心的预防性牙科活动相结合，预防0-2岁儿童的ECC。北卡罗来纳州的环境健康健康工作人员正在接受培训，以便为儿童及其家庭提供牙齿健康教育和促进活动，并将参加环境健康健康的儿童与其社区内提供预防性牙科服务的医疗提供者联系起来。作为全州医疗补助计划的一部分，约有500家医疗机构正在为儿童提供预防性牙科服务，包括筛查、风险评估和转诊、家长咨询和局部氟化物应用。在该州28个县的18个EHS项目中，儿童和他们的父母在地理上接近75个医疗提供者提供预防性牙科服务的地点。EHS员工的牙科教育干预主要基于社会学习理论，包括全州范围的论坛、审核和反馈实践的讲习班、教育讲习班和资源材料。对父母的教育干预部分基于跨理论模型，该模型以变化阶段为其关键概念，以及动机访谈。工作人员在当地牙科公共保健提供者的支持下，为儿童提供课堂预防牙科活动，并为家长提供教育。一项非随机、测试前-测试后嵌套队列对照组聚类试验将确定EHS项目和医疗机构提供的联合牙齿暴露对预防EHS儿童非空化和空化龋齿病变的影响。每个研究小组将招募约800名0至1岁的儿童，并在3岁时进行ECC检查。年龄和种族匹配的儿童加入了医疗补助计划，但没有EHS，将作为社区特定控制。父母将在基线时接受采访，并在他们的研究入组儿童年满18个月和36个月时进行后续采访。儿童3岁时的临床检查将在最后一次随访父母面谈时进行。次要结果包括认知（牙科知识）和情感（对牙齿健康的重视、自我效能、结果预期、改变的准备程度）特征，为儿童和家庭建立牙科之家，以及父母报告的儿童和他们自己口腔健康相关生活质量（OHRQoL）的改善。该研究的最终目的是确定牙齿健康素养在多大程度上改变了干预措施改善结果的有效性。OHRQoL、牙齿健康素养和牙齿“居家感”将使用课题组在前期研究中开发的仪器进行测量。意向治疗分析将决定干预对牙齿结果的影响。公共卫生相关性：幼儿牙病在低收入儿童中处于流行病水平，他们面临许多障碍，无法获得所需的牙科护理。这项研究将测试几种方法，这些方法可以增加在北卡罗来纳州早期开始计划中注册的0-2岁儿童获得预防性牙科服务的机会。成功实施预防性牙科计划的结果应该是减少疾病和改善儿童及其家庭的生活质量。