Development and Evaluation of School-based Digital Adolescent Oral Health Promotion Program for the Reduction of Oral Health Disparities

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PROJECT SUMMARY Dental caries, or tooth decay, is a highly prevalent chronic disease afflicting a significant proportion of the U.S. population, including a majority of youth and adults. Health disparities in oral health have persisted for decades, with lower-income youth, Black/African Americans and Latinx minorities being especially at risk for dental caries. Although adolescence is an ideal time to implement healthy behavioral habits that will be sustained into adulthood, there is a dearth of effective dental health programs for at-risk adolescents. Research has shown that primary oral health promotion strategies during adolescence include improving dental health behaviors, abstaining from tobacco use and vaping, and reducing sugar consumption. Following these recommendations and informed by our formative research findings, our proposed digital dental program for adolescents will target three oral health behavior domains: twice-daily tooth brushing with fluoride toothpaste, abstaining from tobacco use, including vaping, and reducing consumption of sugar-sweetened beverages. Grounded in the Theory of Planned Behavior, augmented by the Prototype/Willingness Model for adolescents, the proposed cross-platform digital program will target theoretically based mechanisms to promote these three targeted oral health behaviors. It will include engaging video and interactive game components. Thus, in this UG3/UH3 application, we will develop and evaluate a theoretically based digital dental health promotion program designed to engage lower income Black/African Americans, Latinx/Hispanic, and white non-Hispanic 7th and 8th grade students. In the UG3 phase, we propose to conduct formative work to iteratively develop a school-based, web-based oral health promotion program. In the UH3 phase, we will conduct a clinical randomized control trial (RCT) in schools, to evaluate “real world” program efficacy. In the RCT, we will assess program acceptability, feasibility, usability, satisfaction, and engagement, as well as the three primary behavioral and clinical health outcomes. Secondary outcomes are the theoretically based mechanisms the program targets for behavior change. Seventh and 8th grade students (N = 2,000) from 40 lower-income schools across multiple states will be randomized to receive the program intervention or to be on the waitlist (control condition). Participating students will complete assessments at three time points (baseline, six weeks post-baseline, and six months post-baseline) to evaluate both short- and long-term program outcomes. If effective, this comprehensive digital behavioral dental health program would greatly impact public health by decreasing persistent oral health disparities. Delivering the program via schools will address disparities in access to such programs, as students will access the program via school internet and school-owned digital devices. A web-based intervention is also easily scalable and can be widely disseminated at little cost, reaching adolescent populations most at risk for dental caries. The long- term goal is to facilitate healthy dental habits and related oral health behaviors for adolescents to attain a lifetime free from preventable oral disease.