Sociopolitical Policies That Reduce Disparities in Children's Oral Health

减少儿童口腔健康差异的社会政治政策

• 批准号: 8984402
• 负责人: Anne E. Sanders
• 金额: $ 59.04万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-18 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8984402
• 关键词: 21 year old; Address; Adolescent; Adopted; Adoption; Adult; Affect; Behavior; Behavioral; Beverages; Biology; Child; Childhood; Cigarette; Communities; Community Actions; Complement; Consumption; Cotinine; County; Data; Data Set; Databases; Dental; Dental Care; Dental Epidemiology; Dental Insurance; Dental Research; Dental caries; Disease; Exposure to; Family; Figs - dietary; Funding; Generations; Hand; Health; Health Planning; Healthy People 2020; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Incentives; Income; Income Tax; Individual; Inequality; Influentials; Insurance Coverage; Intake; Intermediate Variables; International; Intervention; Life; Lifting; Low income; Methods; National Health and Nutrition Examination Survey; Natural experiment; Nutrient; Nutritional Science; Oral; Oral health; Outcome; Outcome Measure; Pathway interactions; Periodontitis; Phase; Plant Roots; Policies; Poverty; Price; Public Policy; Publications; Recommendation; Regulation; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sales; Series; Serum; Smoking; Social Welfare; Solutions; Surrogate Markers; Taxes; Time; Tobacco; Tooth Diseases; Translations; Trust; Vaccinated; Vaccines; Variant; Wages; Water; Water fluoridation; World Health Organization; aged; base; behavioral economics; cost; drinking; drinking water; environmental tobacco smoke exposure; experience; health disparity; health economics; health inequalities; high risk; interest; malignant mouth neoplasm; multidisciplinary; nutrition; population based; public health relevance; response; secondary outcome; social; social health determinants; soft drink; sugar; sweetened beverage; tobacco control; uptake

 DESCRIPTION (provided by applicant): The disparity between rich and poor in children's tooth decay doubled in the past two decades at the same time that dental care utilization increased among low income children. Dental care does not eliminate income disparities because it does not target upstream risk factors that disproportionately affect low income groups. The solution requires population-based interventions that preferentially benefit children at highest risk. This proposal draws together investigators from social- and oral epidemiology, health economics, political science, and nutrition to partner with community representatives tapping into experiences of The Pew Charitable Trusts, the Association of State and Territorial Dental Directors and a local Community Advisory Board of influential community stakeholders. At the crux of the project is the idea that state-to-state variation in policy adoption acts as a natural experiment. The overall objective is to identify state policies that influence social, economic and behavioral determinants of oral health disparities and community action to support sustainable reduction in disparities. Dental caries is the primary disease of interest. Secondary outcomes are serum cotinine and oral human papilloma virus (HPV) infection as surrogate markers of early risk of periodontitis and oral cancer. Time series data will be collected on policy adoption for states and, where applicable, counties for all years available. Policy activities prioritize six primary intervention themes: community water fluoridation; restricted soda consumption; tobacco control; HPV vaccine promotion; children's dental insurance coverage; and welfare. The first aim of phase one is to compile a time-series state policy database on: cigarette excise tax; bans/tax on soda; HPV vaccine promotion, minimum wage, earned income tax credit (EITC), and health plans with pediatric dental coverage. Community water fluoridation will be collected at the county level. Aim 2 will enrich the database with time-series intermediary variables at multiple levels of influence between policy and oral health outcomes. For example, state policy influences communities (e.g. per capita sales of cigarettes and soda). The effect flows to behavior (e.g. soda intake, smoking), nutrition (e.g. daily total energy, total nutrient intake); and becomes embedded in biology (e.g. serum cotinine). The database will be merged into the 1988- 2014 National Health and Nutrition Examination Survey (NHANES) cycles using restricted access geocodes. The objective of phase two (years 3-4) is to examine the relationship between state policy, intermediate variables and the individual unit-level outcomes measured in children aged 2 to 21 years in NHANES. Aim 1 will quantify the relationship between fluoridated water and disparities in dental caries. Aim 2 will quantify the relationship between policies governing the sale of soda, consumption, and disparities in dental caries. Aim 3 will quantify the relationship between tobacco regulation and disparities in serum cotinine. Aim 4 will quantify the relationship between HPV vaccine promotion and disparities in oral HPV infection. Aim 5 will explore effects of EITC effects on in income disparities in dental care and oral health outcomes.

 描述（由申请人提供）：在过去二十年中，儿童蛀牙的贫富差距增加了一倍，同时低收入儿童的牙科保健利用率增加。牙科保健并不能消除收入差距，因为它没有针对不成比例地影响低收入群体的上游风险因素。解决办法要求采取以人口为基础的干预措施，优先惠及风险最高的儿童。该提案汇集了来自社会和口腔流行病学，卫生经济学，政治学和营养学的调查人员，与社区代表合作，利用皮尤慈善信托基金，州和地区牙科主任协会以及当地社区咨询委员会的经验有影响力的社区利益相关者。该项目的关键是这样一种想法，即州与州之间在政策采纳方面的差异是一种自然的实验。总体目标是确定影响口腔健康差异的社会，经济和行为决定因素的国家政策和社区行动，以支持可持续减少差异。龋齿是主要的疾病。次要结果是血清可替宁和口腔人乳头瘤病毒（HPV）感染作为牙周炎和口腔癌早期风险的替代标志物。将收集各州和各县（如适用）所有可用年份的政策采用时间序列数据。政策活动优先考虑六个主要干预主题：社区饮水加氟;限制苏打水消费;烟草控制; HPV疫苗推广;儿童牙科保险;福利。第一阶段的第一个目标是编制一个时间序列的国家政策数据库：香烟消费税;对苏打水的禁令/税收; HPV疫苗推广，最低工资，所得税抵免（EITC）和儿童牙科保险的健康计划。社区水氟化将在县一级收集。目标2将丰富数据库的时间序列中介变量在政策和口腔健康结果之间的多个层次的影响。例如，国家政策影响社区（如香烟和汽水的人均销售量）。影响流向行为（例如苏打水摄入量，吸烟），营养（例如每日总能量，总营养摄入量）;并嵌入生物学（例如血清可替宁）。该数据库将使用限制访问的地理编码并入1988- 2014年国家健康和营养检查调查周期。第二阶段（3-4年）的目标是研究国家政策，中间变量和NHANES在2至21岁儿童中测量的个人单位一级结果之间的关系。目标1将量化氟化水和龋齿差异之间的关系。目标2将量化苏打水销售政策、消费和龋齿差异之间的关系。目的3将量化烟草调节和血清可替宁差异之间的关系。目的4将量化HPV疫苗推广与口腔HPV感染差异之间的关系。目标5将探讨EITC效应对牙科保健和口腔健康结果的收入差距的影响。