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

此竞争性修订申请的目的是请求额外资源，以完成 我们的主要成果衡量和实现父母补助金的主要目的，这是测试父母的功效- 有针对性的基于文本消息的ECC预防干预。这一额外的时间是必要的，因为意外 启动延迟和COVID-19关闭导致临床口语考试暂停7个月。招生和 干预交付完成。我们目前正在进行12个月和24个月的随访。我们还要 使用COVID-19大流行的自然实验来检查大流行对儿科口腔的影响， 健康行为（刷牙、饮食、含糖饮料摄入、含氟牙膏使用）、口腔健康 生活质量和预防性牙科就诊。我们将在754个国家中研究COVID前后的这些因素， 家庭已经报名。我们还将评估潜在调节因素的影响，例如少数群体的影响。 受COVID-19影响较大的家庭是否更有可能有不健康的 COVID前后儿童口腔健康行为的变化比那些受影响不太严重的人 新冠肺炎。主要研究的基本原理是针对不成比例地受幼儿期影响的群体 龋齿（ECC）。我们的研究在三个城市的儿科诊所就诊期间招募了754名儿童（<7岁）的父母 社区卫生中心和一个安全网医院诊所。参与者被随机分配到 口腔健康短信（OHT）或儿童健康短信（CWT）。与会者收到了 四个月，再加上一个月的“助推器”文本8个月后。文本是英语或西班牙语，自动化， 互动，定制和游戏化，并包括一个行为塑造算法，以帮助父母移动 朝向它们被随机分配到的组的目标（例如，改善儿童口腔健康或改善儿童 健康）。24个月时的龋齿增量，我们的目标主要结果变量，是通过校准的 12个月和24个月随访访视时的检查员。我们还将评估调解人和主持人的 干预效果，进行预算影响分析，以确定采用的财务后果， 扩散和干预的可持续性，并评估口腔健康行为的变化。有效 针对高危人群的预防工作需要采取涉及主动覆盖的最低负担战略 通过现有渠道，如社区卫生中心和短信。超过85%的成年人的短信没有 收入、教育或种族差异。短信干预的好处包括： 任何地方/任何时间、低成本、可扩展性以及定制内容/剂量的能力。社区卫生中心（CHCs） 是推广口腔健康的理想场所，为高危人士提供护理。这 研究有很大的潜力成为一个以证据为基础的计划，可以很容易地以低成本采用， 在1,362个社区卫生中心，治疗近750万，高风险的美国儿童提供者的负担。

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.