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

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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.]