Oral Health Advocates in Public Housing

公共房屋中的口腔健康倡导者 摘要 龋病是儿童最常见的慢性疾病，患病率和 不成比例地影响到经济上处于不利地位的个人以及来自种族和少数民族的人 组。鉴于龋齿的慢性性质，仅以临床为基础的预防和恢复性护理将是 不足以减少ECC患病率的差异。相反，我们假设一个基于多式联运的社区 解决龋齿的慢性、传染性和多因素性质的方法将是 比行为咨询和氟化物的化疗效果更有效，无论是单独的还是在 组合。成功的基于社区的多模式干预将纳入这些战略，但将 还需要让照顾者具备参与预防和管理ECC的技能，因为 以及促进社区和环境支持，以减少ECC风险因素。类似的策略也有 已成功应用于各种慢性病，如哮喘、糖尿病和抑郁症， 大多数研究都显示出显著的短期和长期影响。 该项目利用以社区为基础的参与性研究原则，在早期减少差距 儿童龋齿，扩展了正在进行的合作伙伴关系的工作“研究中心，以评估和 消除牙科差异[CREEDD]，疾控中心资助的健康和住房预防合作伙伴 研究中心“[PHH-PRC]、波士顿住房管理局(BHA)和社区健康委员会 促销(CCPH)。这一办法不仅与所有伙伴的目标协同，而且与 我们校园范围内的临床和转化科学研究所，特别是CTSI对社区的关注 参与研究。为了促进与联合国儿童基金会的持续合作关系 公共住房社区和其他合作伙伴Henshaw博士表示，该项目将作为具体的 负责项目与社区合作伙伴协调的主要负责人。 在过去的两年里，亨肖博士成功地担任了这一角色，在此期间，研究小组 已与公共房屋社区合作，进行先导干预研究、参与 参加社区委员会会议、特别社区会议和活动，以及举办焦点小组 在拟议研究的所有方面获得社区意见。这项工作将建立在扩大的 慢性护理模式，并将测试基于社区的多模式干预是否会降低2年的ECC 0-5岁儿童居住在公共房屋发展项目的发生率。干预结合了证据 构成部分(口腔健康倡导者提供的激励性访谈、口腔健康评估和转介、 护理管理和社区健康促进)和独特的提供环境(公共住房)。我们 假设因为咨询活动，实验组不仅会更有可能 降低ECC的个人行为风险因素，但更有可能获得初级牙科保健和 基于社区的氟化物应用将在实验点和控制点都可用， 导致实验组ECC减少的发生率较高。建议的具体目标 研究的目的是：具体目标1：确定多模式干预(口腔健康评估和 口腔健康倡导者提供的反馈、氟化物清漆涂抹、励志访谈和 社区口腔健康促进计划)，建立在慢性护理模式的基础上，可以减少 ECC与接受牙齿筛查和氟化物清漆涂抹的匹配对照组的比较 独自一人。具体目标2：确定多模式干预是否可以降低ECC行为风险因素 在牙齿监测、口腔卫生和饮食习惯方面与匹配的对照组进行比较 只接受牙齿筛查和氟化物清漆涂抹。具体目标3：评价促进者和 公共住房场地多式联运干预的障碍。 这项研究已经做好了传播的准备，并将利用1-4年至#年间与过程有关的项目结果 在第5年、第6年和第7年进行有针对性的扩展，在此期间将在3个住房部门实施 设在纽约、纽约州、华盛顿特区和俄亥俄州哥伦布，那里也有类似的倡导模式。 最终，这项工作可以通过波士顿住房管理局的全国范围内的网络进行传播 并有可能改善500,000多个家庭和100多万个家庭的口腔健康 住在公共住房的儿童。

Oral Health Advocates in Public Housing Abstract Dental caries is the most common, chronic disease of childhood, is increasing in prevalence and disproportionately affects individuals who are financially disadvantaged and from racial and ethnic minority groups. Given the chronic nature of dental caries, clinically based preventive and restorative care alone will be inadequate to decrease disparities in ECC prevalence. Instead, we posit that a multimodal communitybased approach, which addresses the chronic, infectious and multifactorial nature of dental caries, will be more effective than behavioral counseling and the chemotherapeutic effects of fluoride, either alone or in combination. A successful community-based multimodal intervention will incorporate these strategies, but will also need to equip caregivers with the skills to become involved in the prevention and management of ECC as well as to foster community and environmental support for decreasing ECC risk factors. Similar strategies have been applied successfully to a variety of chronic diseases such as asthma, diabetes, and depression, with most studies showing significant short and long term effects. This project, using community based participatory research principles to decrease disparities in early childhood caries, extends the work of the ongoing partnership of the "Center for Research to Evaluate and Eliminate Dental Disparities" [CREEDD], the CDC funded "Partners in Health and Housing Prevention Research Center" [PHH-PRC], the Boston Housing Authority (BHA) and the Community Committee for Health Promotion (CCPH). This approach is synergistic not only with the goals of all partners, but also with the goal of our campus wide clinical and translational science institute, particularly the CTSI's focus on community involvement in research. In order to facilitate the ongoing collaborative working relationships with the public housing communities and other partners, Dr. Henshaw, the project PI will serve as the specific key person responsible for the project's coordination with community partners. Dr. Henshaw has successfully served in this role for the past 2 years, during which time the research team has collaborated with the public housing community through conduct of pilot intervention studies, participation in community committee meetings, special community sessions and events, and the conduct of focus groups to obtain community input in all aspects of the proposed research. The work will build on the Expanded Chronic Care Model, and will test if a community-based multimodal intervention will reduce the 2-year ECC incidence of children aged 0-5 living in public housing developments. The intervention combines evidentiary components (motivational interviewing delivered by oral health advocates, oral health assessment and referral, care management and community health promotion) and a unique delivery setting (public housing). We hypothesize that because of the counseling activities, the experimental group will not only be more likely to reduce individual behavioral risk factors for ECC, but will be more likely to access both primary dental care and the community-based fluoride applications that will be available at both the experimental and control sites, leading to a greater incidence of ECC reduction in the experimental group. The specific aims of the proposed research are to: Specific Aim 1: Determine if a multimodal intervention (oral health assessment and feedback, fluoride varnish application, motivational interviewing delivered by oral health advocates and a community-based oral health promotion program), built upon the chronic care model, can reduce incidence of ECC compared with a matched control group that receives dental screening and fluoride varnish application alone. Specific Aim 2: Determine if the multimodal intervention can reduce ECC behavioral risk factors in the domains of tooth monitoring, oral hygiene and dietary practices compared with a matched control group that receives dental screening and fluoride varnish application alone. Specific Aim 3: Evaluate facilitators and barriers to the multimodal intervention in public housing sites. This study is well poised for dissemination and will utilize process-related project findings from years 1-4 to conduct targeted expansion in years 5, 6 and 7 in which implementation will occur in 3 housing authorities located in New York, NY, Washington, D.C. and Columbus, OH where similar advocacy models are in place. Ultimately, this work could be disseminated through the Boston Housing Authority's network of nationwide contacts and could potentially improve the oral health of over 500,000 family households and over 1 million children living in public housing.