Integrating Oral Biology and Behavioral and Social Mechanisms for ECC Onset

 描述(由申请人提供)：国家健康和营养检查调查数据显示，在过去十年中，美国儿童早期儿童龋齿(ECC)的患病率显著上升，2至5岁儿童的患病率达到28%。ECC对儿童的生活质量有深远的影响，很难有效地治疗，而且有一种令人痛苦的趋势，即在治疗后继续执行。导致ECC的口腔生物学已经确立，但对生物学机制的了解并未导致在减少ECC方面取得非常实质性的进展。针对最近的研究证据，越来越多的人认识到，对ECC的评估和干预需要解决风险的社会和行为机制；这现在是研究的优先事项(RFA-14-143)。然而，关于哪些社会和行为因素可能是最相关的，证据的强度，以及它们的运作机制，仍然存在相当大的不确定性。例如，社会经济地位(SES)是ECC的可靠预测指标，但标示了一系列看似合理的机制，本身并不是一个实际的干预目标。我们采用了来自行为科学的发现，这些发现反复表明，低SES通过儿童压力暴露的近端测量影响儿童健康，特别是照顾孩子和家庭压力。我们提出了一项多学科前瞻性纵向研究，研究对象为206名具有低SES的ECC高危儿童。最初，1-3岁的无龋齿儿童将在两年内接受治疗。在5次牙科就诊中，我们将进行口腔检查，并评估社会和行为风险，包括照料和家庭压力。横断面和纵向分析将考虑口腔生物学标记物和ECC发病和病程的护理素及家庭应激措施的可接受性、结构效度和临床相关性。这些分析的结果将确定下一阶段因果治疗研究的关键社会和行为目标，以改善幼儿的口腔健康。该项目的具体目标是：1)确定与儿童牙科环境中可接受的ECC相关的社会和行为风险；2)评估目标社会和行为风险的结构验证和临床相关性 ECC的行为风险；3)将风险的社会和行为测量纳入ECC更广泛的预测模型。拟议的ECC发病纵向研究将通过开发适用于儿童牙科环境的社会和行为风险指标来指导下一阶段的ECC干预，并可能索引导致ECC的部分因果路径。

 DESCRIPTION (provided by applicant): National Health and Nutritional Examination Survey data indicate that the prevalence of early childhood caries (ECC) in US children has increased significantly in the last decade, to 28% in 2 to 5 year-old children. ECC has a profound impact on a child's quality of life, is difficult to treat effectively, and has a distressing tendency to ecur following treatment. The oral biology leading to ECC is well-established, but knowledge of the biological mechanism has not led to very substantial progress in reducing ECC. In response to recent research evidence, there is a growing appreciation that assessments and interventions for ECC need to address social and behavioral mechanisms of risk; this is now a research priority (RFA-14-143). However, there remains considerable uncertainty about which social and behavioral factors may be most relevant, the strength of the evidence, and the mechanisms by which they operate. For example, socio-economic status (SES) is a reliable predictor of ECC, but indexes a broad array of plausible mechanisms and is not itself a practical intervention target. We adapt the findings from behavioral science which repeatedly show that low SES influences child health via proximal measures of child stress exposure, particularly caregiving and family stress. We propose a multi-disciplinary prospective longitudinal study of 206 children at-risk for ECC by virtue of low SES. Initially caries-free children aged 1-3 years will be followe over a 2-year period. At each of 5 dental visits we will conduct oral exams and assess social and behavioral risks, including caregiving and family stress. Cross-sectional and longitudinal analyses will consider the acceptability and construct validity and clinical relevance of caregivin and family stress measures for oral biology markers and ECC onset and course. Results from these analyses will identify key social and behavioral targets for the next stage of causal treatment research to improve oral health in young children. The specific aims of the project are to: 1) Identify social and behavioral risks relevant to ECC that are acceptable for a pediatric dentistry setting; 2) Assess construct validation for and clinical relevance of targeted social and behavioral risks for ECC; 3) Incorporate social and behavioral measures of risk in a broader prediction model of ECC. The proposed longitudinal study of ECC onset will guide the next stage of ECC interventions by developing social and behavioral risk measures that are suitable for pediatric dental setting and may index part of the causal pathway leading to ECC.