Promoting Behavioral Change for Oral Health in American Indian Mothers and Childr

RC1的目的是证明，通过使用动机性访谈（Ml）来改变母亲的口腔健康行为，可以减少美洲印第安人（Al）保留地社区儿童早期龋齿（ECC）的发病率。具体目标是：1)与人工智能社区一起开发与文化相关的健康教育和宣传材料，用于预防ECC；2)对孕妇/新生儿母亲进行口腔卫生干预；3)在随机试验中测试这种干预。将要求所有在北部平原一个大保留地诊所接受产前护理的15岁或以上的妇女参加这项试验，并向所有妇女提供促进口腔健康的材料和辅助工具，这些材料和辅助工具将根据社区参与战略制定。在示范试验中，大约600名妇女将被随机分配到Ml组或对照组。对于Ml组的人，将在产前和出生后立即进行口腔健康检查，然后在6、12、24和36个月大时进行口腔健康检查。对儿童进行为期3年的随访，并在每个儿童1岁、2岁和3岁生日后的3个月内由经过校准的牙科保健员进行龋齿评估。主要结果将是龋发病率每年增加。次要结果测量将侧重于龋齿模式和项目的成本效益。各种中介/调节因素也将被检查，包括诸如母亲的口腔健康知识和信念，压力，自我效能和控制点等问题。AI/AN儿童未经治疗的龋齿比一般人群儿童多3倍，而且获得预防服务和专业牙科治疗的机会不足。决定不将临床/药理学方法与Ml相结合，以便为最普遍可用的预防策略（即家庭口腔疾病预防行为）提供明确的测试。如果可以证明Ml预防ECC的有效性，那么未来的研究可能会着眼于社区实施的适应性。预计本研究的经验教训可用于调整RC3的最终方案，RC3的重点是由在启智中心工作的经过专门培训的人工智能社区口腔卫生专家提供口腔健康预防服务（包括氟化物清漆）。这对其他临床预防方法的应用也有启示。本研究的一个主要优势是参与者社区代表以及人工智能卫生服务提供者的参与程度正在影响材料的开发和研究方案的设计。这种参与预期也将成为传播活动的一项重要资产。

The goal of RC1 is to demonstrate that the incidence of early childhood caries (ECC) in an American Indian (Al) reservation community can be reduced through the use of Motivational Interviewing (Ml) to change maternal oral health behaviors. The specific aims are: 1) to develop culturally relevant health education and promotional materials for use in ECC prevention with an Al community; 2) to manualize an oral health Ml intervention for pregnant women/mothers of newborns; and 3) to test this intervention in a randomized trial. All of the women, ages 15 or older, who are receiving prenatal care in the clinics of a large Northern Plains Al reservation, will be asked to participate in this trial, and all will be provided with the oral health promotion materials and aids, which will be developed using community participation strategies. For the demonstration trial, approximately 600 women will be randomly assigned to the Ml group, or the control condition. For those in the Ml group, oral health visits will be made to their homes prenatally and immediately after birth, then at 6, 12, 24, and 36 months of age. Children will be followed for 3 years, and caries assessments will be conducted by calibrated dental hygienists within 3 months of each child's 1st, 2nd, and 3rd birthday. The primary outcome will be annual increase in caries incidence. Secondary outcome measures will focus on caries patterns and cost-effectiveness of the program. A variety of mediators/moderators also will be examined, including such issues as mother's oral health knowledge and beliefs, stress, self-efficacy, and locus of control. AI/AN children have 3 times more untreated decay than children in the general population, and access to both preventive services and professional dental treatment are inadequate. The decision was made not to pair clinical/pharmacologic approaches with Ml in order to provide a definitive test of the most universally available strategy for prevention-that is, home oral disease prevention behaviors. If the effectiveness of Ml for preventing ECC can be demonstrated, future studies might look at adaptations for community implementation. It is anticipated that lessons from this study can be used to adapt the final protocol for RC3, which is focused on the provision of oral health prevention services (including fluoride varnish) by specially trained Al community oral health specialists working in Head Start Centers. There are implications for use with other clinical approaches to prevention as well. A major strength of this study is the extent to which involvement by representatives of the participant community, as well as Al health service providers, is shaping the development of materials and the design of the research protocol. This participation is expected to be a major asset for dissemination activities as well.