Interactive Parent-targeted Text Messaging in Pediatric Clinics to Reduce ECC

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The purpose of this competitive revision application is to request additional resources to complete collection of our primary outcome measure and fulfill the parent grant’s primary aim, which is to test the efficacy of a parent- targeted text message-based ECC prevention intervention. This additional time is necessary due unanticipated start-up delays and COVID-19 closures which halted clinical oral exams for 7 months. Enrollment and intervention delivery is complete. We are currently conducting 12 and 24 month follow ups. We also wish to use the natural experiment of the COVID-19 pandemic to examine the effect of the pandemic on pediatric oral health behaviors (tooth brushing, diet, sugar-sweetened beverage intake, fluoride toothpaste use), oral health quality of life, and preventive dental visits. We will examine these factors pre-and post COVID among the 754 families already enrolled. We will also assess the impact of potential moderators such as the effect of minority status/income and whether those families affected more by COVID-19 were more likely to have unhealthy changes in pediatric oral health behaviors pre-post COVID than those who were less severely impacted by COVID-19. The rationale for the main study is to target groups disproportionately affected by Early Childhood Caries (ECC). Our study enrolled 754 parents of children (<7 years) during pediatric clinic visits at three urban community health centers (CHCs) and one safety-net hospital-based clinic. Participants were randomized to either Oral Health Text messages (OHT) or Child Wellness Text messages (CWT). Participants received texts for four months, plus one-month of ‘booster’ texts 8 months later. Texts were in English or Spanish, automated, interactive, customized and gamified, and included a behavioral shaping algorithm to help parents move toward the goal of the arm to which they are randomized (e.g., improved pediatric oral health or improved child wellness). Caries increment at 24 months, our objective primary outcome variable, is measured by calibrated examiners at the 12- and 24-month follow-up visits. We will also assess mediators and moderators of the intervention effect, perform a budget impact analysis to determine the financial consequences of adoption, diffusion, and sustainability of the intervention, and assess changes in oral health behaviors. Effective prevention efforts for high-risk groups require minimally burdensome strategies involving proactive reach through existing channels, such as CHCs and text messaging. More than 85% of adults text message with no disparity by income, education, or ethnicity. The benefits of text message interventions include: use anywhere/anytime, low cost, scalability, and ability to tailor content/dose. Community Health Centers (CHCs) are an ideal venue for oral health promotion; they provide care to the groups at highest risk for ECC. This research has strong potential to be an evidence-based program that could easily be adopted at low cost and provider burden in the 1,362 CHCs that treat almost 7.5 million, high risk U.S. children.