Impact of Family Functioning and Violence on Adults? and Children?s Oral Health

家庭功能和暴力对成年人的影响？

• 批准号: 7739171
• 负责人: Richard Eliot Heyman
• 金额: $ 20.39万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-08 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7739171
• 关键词: 11 year old; Accounting; Adult; Area; Arousal; Behavior; Behavioral; Child; Chronic; Chronic Disease; Complex; Conflict (Psychology); Consumption; Couples; Data; Data Set; Dental; Dental Care; Dental Hygiene; Dental caries; Developed Countries; Economics; Emotional; Endocrine system; Environment; Family; Family Study; Family Violence; Food; Functional disorder; Future; Gifts; Government; Grant; Health; Health Care Costs; Health Services; Health behavior; Healthcare; Healthy People 2010; Hostility; Hour; Human; Immune; Individual; Intervention; Investments; Lead; Mediating; Mediator of activation protein; Modeling; Mouth Diseases; National Institute of Child Health and Human Development; Oral health; Outcome; Pain; Parenting behavior; Parents; Participant; Pathway interactions; Persons; Population; Public Health; Quality of life; Reporting; Research; Resources; Sampling; Schools; Series; Socialization; Stress; Testing; Time; Toothbrushing; United States Dept. of Health and Human Services; Violence; Work; World Health Organization; cost; craniofacial; design; drinking; heuristics; public health relevance; self esteem; social; stressor; toothbrush

DESCRIPTION (provided by applicant): Oral health is an important component of overall health (e.g., Tabak, 2008; U.S. Department of Health and Human Services [USDHHS], 2000a) and is one of 28 focus areas in U.S. Government's Healthy People 2010 public health strategy (USDHHS, 2000b). Oral diseases are the most common human chronic diseases (Sheiham, 2005), with dental caries - both infectious and transmissible -being the most prevalent (USDHHS, 2000b). Despite its widespread occurrence, efforts to control caries - especially among diverse ethnic, social, and economic populations - continue to elude clinicians. Research clearly documents that couples conflict has profound effects on the immune and endocrine systems of adults and children. Likewise, parenting problems are a chronic emotional and behavioral stressor on both adults and children, with serious attendant health effects related to chronic arousal (e.g., Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002). We hypothesize that the same mechanisms that result in effects on general health also result in specific effects on oral health. We propose to collect an additional wave of data (including parent reports of child and adult oral health and related behaviors) on a sample of 400 families with young children (now 4-11 years old) who have already completed two waves of assessments in a family study (NICHD grant R01 HD046901). Originally designed to examine the effects of family violence exposure on children and adults, that data set includes family and individual potential mediators and moderators and a range of health and functioning outcomes, but not oral health information. This project has the following specific aims: #1: Test the first hypothesized pathway by establishing the effect sizes of relations between (a) family functioning;(b) child and adult oral health behaviors; [and (c) test whether parental socialization of oral health behaviors mediates these associations in children.] #2: Test the second hypothesized pathway by establishing the effect sizes of relations between (a) family functioning and (b) child and adult oral health outcomes. Test both the direct effects of family function behaviors and whether these effects are mediated by oral health behaviors [and socialization of these behaviors in children]. #3: By applying a moderational framework to identify what makes family functioning sometimes predict oral health and other times not, we can more specifically determine under what conditions which aspects of family functioning predict child or adult oral health outcomes. #4: Determine the extent to which effects of violence exposure in the family on oral health are mediated by (a) non-abusive couple conflict, (b) inept parenting, or (c) both.[#5: Test the hypotheses of Aims 1 - 4 longitudinally to predict change in oral health.] PUBLIC HEALTH RELEVANCE: Oral health (oral health) is an important component of overall health (e.g., Tabak, 2008; U.S. Department of Health and Human Services [USDHHS], 2000a) and is one of 28 focus areas in U.S. Government's Healthy People 2010 public health strategy (USDHHS, 2000b). Oral diseases are the most common human chronic diseases (Sheiham, 2005), with dental caries - both infectious and transmissible -being the most prevalent (USDHHS, 2000b). Despite its widespread occurrence, efforts to control caries, especially among diverse ethnic, social, and economic populations, continue to elude clinicians. Dental and craniofacial problems cause significant discomfort and pain, functional limitations, global health effects, quality of life decrements, and lowered self-esteem (e.g., Locker, 1988; Reisine, 1988; USDHHS, 2000a). The costs of oral health care are extensive, in part because of the ubiquity of need: in 1989, routine and emergent dental care resulted in over 164 million hours of work lost (1.48 hours per worker) and over 50 million hours of school missed (1.17 hours per child; Gift et al., 1992). The World Health Organization (2003) estimates that oral health services account for 5-10% of health costs in industrialized countries. Per capita dental costs exceeded $200 in 1999 (over $262/per person in 2008 dollars; U.S. Department of Health and Human Services, 2002), although many go without needed dental care because of the expense. The general health effects of family dysfunction are now clearly established. In this proposal, we will posit a heuristic model that family dysfunction is related specifically to oral health outcomes through two pathways. First, family dysfunctional behavior is hypothesized to relate to worse oral health behaviors (i.e., less frequent brushing and flossing, greater consumption of cariogenic foods/drinks), [and by this mechanism, to poorer oral health outcomes.] Second, noxious family environments are hypothesized to be directly related to negative oral health outcomes (presumably through deleterious effects on the immune and endocrine systems). Some promising initial support for these hypothesized pathways comes from related (but non-familial) research: less frequent tooth brushing and worse overall oral hygiene is related to higher levels of general hostility (Merchant et al., 2003; Mettovaara et al., 2006) and stress (Deinzer et al., 2001). Research clearly documents that couples conflict has profound effects on the immune and endocrine systems of adults and children. Likewise, parenting problems are a chronic emotional and behavioral stressor on both adults and children, with serious attendant health effects related to chronic arousal (e.g., Kiecolt- Glaser, McGuire, Robles, & Glaser, 2002). We hypothesize that the same mechanisms that result in effects on general health also result in specific effects on oral health. In this R21 proposal, we propose to collect an additional wave of data (including parent reports of child and adult oral health and related behaviors) on a sample of 400 families with children (now 4-11 years old) who have already completed two waves of assessments in a family study. This study (NICHD grant R01 HD046901), originally designed to examine the effects of family violence exposure on children and adults, includes important family and individual potential mediators and moderators and a range of health and functioning outcomes, but not oral health information. We have kept in contact with participants who have participated, and all have signed forms agreeing to be contacted for research in the future. By collecting data from this existing sample with an already rich array of constructs well-assessed over time, we will, for a modest investment of additional resources, be able to test comprehensive series of hypotheses about how and for whom family functioning impacts oral health for both children and adults. Thus, we expect this two-year project to quickly result in well-developed and preliminarily validated models of the complex relationships between behavioral and social factors and oral health. These models can identify new potential targets of intervention that can lead to meaningful improvements in oral health. We will attempt to make these advances through the following specific aims: Specific Aim #1: Test the first hypothesized pathway by establishing the effect sizes of relations between (a) family functioning;(b) child and adult oral health behaviors; [and (c) test whether parental socialization of oral health behaviors mediates these associations in children.] Specific Aim #2: Test the second hypothesized pathway by establishing the effect sizes of relations between (a) family functioning and (b) child and adult oral health outcomes. Test both the direct effects of family function behaviors and whether these effects are mediated by oral health behaviors [and socialization of these behaviors in children]. Specific Aim #3: By applying a moderational framework to identify what makes family functioning sometimes predict oral health and other times not, we can more specifically determine under what conditions which aspects of family functioning predict child or adult oral health outcomes. Specific Aim #4: Determine the extent to which effects of violence exposure in the family on oral health are mediated by (a) non-abusive couple conflict, (b) inept parenting, or (c) both. [Specific Aim #5: Test the hypotheses of Aims 1 - 4 longitudinally to predict change in oral health.]

描述（由申请人提供）：口腔健康是整体健康的重要组成部分（例如，Tabak，2008 年；美国卫生与公众服务部 [USDHHS]，2000a），并且是美国政府 2010 年健康人民公共卫生战略的 28 个重点领域之一（USDHHS，2000b）。口腔疾病是最常见的人类慢性疾病（Sheiham，2005），其中传染性和传播性龋齿最为普遍（USDHHS，2000b）。尽管龋齿广泛存在，但控制龋齿的努力——尤其是在不同种族、社会和经济人群中——仍然困扰着临床医生。研究清楚地表明，夫妻冲突对成人和儿童的免疫和内分泌系统有深远的影响。同样，养育问题对成人和儿童来说都是一种慢性情绪和行为压力源，伴随着与慢性唤醒相关的严重健康影响（例如，Kiecolt-Glaser、McGuire、Robles 和 Glaser，2002）。我们假设对一般健康产生影响的相同机制也会对口腔健康产生特定影响。我们建议以 400 个有幼儿（现在 4-11 岁）的家庭为样本，收集另一波数据（包括儿童和成人口腔健康及相关行为的家长报告），这些家庭已经在家庭研究中完成了两波评估（NICHD 拨款 R01 HD046901）。该数据集最初旨在检查家庭暴力暴露对儿童和成人的影响，包括家庭和个人的潜在调解者和调节者以及一系列健康和功能结果，但不包括口腔健康信息。该项目有以下具体目标：#1：通过确定 (a) 家庭功能；(b) 儿童和成人口腔健康行为；(b) 家庭功能；(b) 儿童和成人口腔健康行为； [并且（c）测试父母口腔健康行为的社会化是否介导儿童的这些关联。]#2：通过建立（a）家庭功能和（b）儿童和成人口腔健康结果之间关系的效应大小来测试第二个假设途径。测试家庭功能行为的直接影响以及这些影响是否由口腔健康行为[以及儿童中这些行为的社会化]介导。 #3：通过应用适度框架来确定家庭功能有时可以预测口腔健康而有时不能的原因，我们可以更具体地确定在什么条件下家庭功能的哪些方面可以预测儿童或成人的口腔健康结果。 #4：确定家庭暴力暴露对口腔健康的影响在多大程度上是由（a）非虐待性夫妻冲突，（b）无能的养育方式，或（c）两者介导的。[#5：纵向检验目标 1 - 4 的假设，以预测口腔健康的变化。] 公共卫生相关性：口腔健康（口腔健康）是整体健康的重要组成部分（例如，Tabak，2008 年；美国卫生与公众服务部 [USDHHS]，2000a），并且是美国政府 2010 年健康人民公共卫生战略中 28 个重点领域之一（USDHHS，2000b）。口腔疾病是最常见的人类慢性疾病（Sheiham，2005），其中传染性和传播性龋齿最为普遍（USDHHS，2000b）。尽管龋齿广泛存在，但控制龋齿的努力，特别是在不同种族、社会和经济人群中，仍然困扰着临床医生。牙齿和颅面问题会导致严重的不适和疼痛、功能限制、全球健康影响、生活质量下降和自尊心降低（例如，Locker，1988；Reisine，1988；USDHHS，2000a）。口腔保健费用高昂，部分原因是需求无处不在：1989 年，常规和紧急牙科保健导致超过 1.64 亿小时的工作损失（每个工人 1.48 小时）和超过 5000 万小时的缺课（每个儿童 1.17 小时；Gift 等，1992）。世界卫生组织（2003）估计口腔健康服务占工业化国家健康成本的 5-10%。 1999 年，人均牙科费用超过 200 美元（按 2008 年美元计算，每人超过 262 美元；美国卫生与公众服务部，2002 年），尽管许多人由于费用而得不到必要的牙科护理。家庭功能障碍对健康的总体影响现已明确。在本提案中，我们将提出一个启发式模型，即家庭功能障碍通过两种途径与口腔健康结果特别相关。首先，家庭功能失调行为被假设与较差的口腔健康行为有关（即，刷牙和使用牙线的频率较低，食用更多的致龋食品/饮料），[并且通过这种机制，导致口腔健康结果较差。]其次，假设有害的家庭环境与负面的口腔健康结果直接相关（可能是通过对免疫和内分泌系统的有害影响）。对这些假设途径的一些有希望的初步支持来自相关（但非家族）的研究：刷牙频率较低和整体口腔卫生状况较差与较高水平的普遍敌意（Merchant 等，2003；Mettovaara 等，2006）和压力（Deinzer 等，2001）有关。研究清楚地表明，夫妻冲突对成人和儿童的免疫和内分泌系统有深远的影响。同样，养育问题对成人和儿童来说都是一种慢性情绪和行为压力源，伴随着与慢性唤醒相关的严重健康影响（例如，Kiecolt-Glaser、McGuire、Robles 和 Glaser，2002）。我们假设对一般健康产生影响的相同机制也会对口腔健康产生特定影响。在此 R21 提案中，我们建议以 400 个有儿童（现为 4-11 岁）的家庭为样本，收集另一波数据（包括儿童和成人口腔健康及相关行为的家长报告），这些家庭已经在家庭研究中完成了两波评估。这项研究（NICHD 拨款 R01 HD046901）最初旨在研究家庭暴力暴露对儿童和成人的影响，包括重要的家庭和个人潜在调节因素和调节因素以及一系列健康和功能结果，但不包括口腔健康信息。我们一直与参与的参与者保持联系，并且所有人都签署了同意在未来进行研究联系的表格。通过从现有样本中收集数据，并随着时间的推移对已经丰富的结构进行充分评估，我们将能够通过适度的额外资源投资，测试一系列全面的假设，了解家庭功能如何以及对谁影响儿童和成人的口腔健康。因此，我们预计这个为期两年的项目将很快产生完善且经过初步验证的行为和社会因素与口腔健康之间复杂关系的模型。这些模型可以确定新的潜在干预目标，从而显着改善口腔健康。我们将尝试通过以下具体目标取得这些进展： 具体目标#1：通过确定（a）家庭功能；（b）儿童和成人口腔健康行为；（b）儿童和成人口腔健康行为；（e）之间关系的影响大小来测试第一个假设途径。 [并且（c）测试父母口腔健康行为的社会化是否介导了儿童的这些关联。]具体目标#2：通过确定（a）家庭功能和（b）儿童和成人口腔健康结果之间关系的效应大小来测试第二个假设途径。测试家庭功能行为的直接影响以及这些影响是否由口腔健康行为[以及儿童中这些行为的社会化]介导。具体目标#3：通过应用适度框架来确定家庭功能有时可以预测口腔健康而有时不能的原因，我们可以更具体地确定在什么条件下家庭功能的哪些方面可以预测儿童或成人的口腔健康结果。具体目标#4：确定家庭暴力暴露对口腔健康的影响在多大程度上是由(a)非虐待性夫妻冲突、(b)无能的养育方式或(c)两者共同介导的。 [具体目标 5：纵向检验目标 1 - 4 的假设，以预测口腔健康的变化。]