Testing a Multi-behavioral Intervention to Improve Oral Health Behaviors in the Pediatric Dental Surgery Population

项目摘要。弱势儿童(参加医疗补助、低收入、小规模、城乡居民)儿童 儿童早期严重龋齿的高风险(S-ECC)。治疗年幼儿童S-ECC通常需要牙科治疗 全身麻醉下的手术(DGA)。不幸的是，手术并不是有效的治疗方法。DGA事件不会 解决潜在的口腔健康行为，如刷牙和饮食，因此龋齿通常会复发。正在改变 口腔健康行为是具有挑战性的，因为父母正在与同时存在的生活压力作斗争。然而，父母们希望 改变他们孩子的口腔健康行为，并确定他们需要帮助才能在 DGA活动。我们提出了一种行为父母干预，以支持口腔健康行为的改变 其子女在口腔健康的临界点经历最严重疾病负担的家庭。 我们将开发和测试PROTECT(预防复发操作)的有效性，目标为早期 儿童龋齿治疗)，社区卫生工作者(CHW)提供的行为父母干预 适用于计划接受DGA的学龄前儿童。主要结果是刷牙频率和 来自添加糖的总卡路里摄入量的百分比。第一次治疗将在手术时亲自进行(60 分钟)，剩下的10次会议(30分钟)将通过电话进行，以解决 订婚。干预将在6个月内进行，从手术事件开始， 在基线、2周、6个月和12个月时评估主要和次要结果 向上。我们的研究人员是临床(麻醉学、牙科、儿科、心理学、营养学)和 科学领域(随机对照试验、纵向行为的管理和分析、 心理社会、临床结果、营养科学、临床干预措施的发展、传播和 实施)。在UG3阶段，我们的目标是开发保护并测试可行性和可接受性。 保护的发展将受到社会认知理论的行为变化机制的启发 (SCT；例如，积极的父母养育、自我效能、知识)和基于证据的行为养育和饮食 干预措施，以及利益相关者(护理者、提供者、社区卫生工作者)的意见。我们将确定招聘的障碍， 保留率、干预交付和结果测量。在<English>U</English>三<English>H</English>阶段，我们将测试<English>UH</English>的疗效。 与平时护理(UC)相比，保护以改善口腔健康行为。参与者将被随机分配到 接受保护(n=210)或UC(n=210)。我们假设保护组的参与者将 与UC组相比，增加刷牙和减少添加糖摄入量的程度更大。 次要结果和假设的干预效果的SCT机制也将被测试。AS 作为一项探索性的目标，将收集唾液样本以评估从基线到 六个月。这项工作符合我们改善儿童口腔健康的广泛研究目标，从外科手术开始 而且有可能扩大到家庭内的儿童和成人。

Project Summary. Vulnerable (Medicaid enrolled, low-income, minoritized, urban/rural resident) children are at high risk for severe early childhood caries (S-ECC). Treating young children for S-ECC often requires dental surgery under general anesthesia (DGA). Unfortunately, surgery is not an effective cure. A DGA event does not address underlying oral health behaviors such as tooth brushing and diet, so caries commonly recurs. Changing oral health behaviors is challenging, as parents struggle with concurrent life stressors. However, parents want to change their child’s oral health behaviors and identify that they need help to enact change at the time of a DGA event. We propose a behavioral parenting intervention to support oral health behavior change within families whose children experience the most severe disease burden at a critical point in their child’s oral health. We will develop and test the efficacy of PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered, behavioral parenting intervention for preschool-aged children scheduled for DGA. The primary outcomes are frequency of tooth brushing and percent of total calorie intake from added sugar. The first session will occur in person at the time of surgery (60 minutes) and the remaining 10 sessions (30 minutes) will be delivered by phone to address barriers to engagement. The intervention will take place over a 6-month period, starting with the surgical event, with assessments measuring primary and secondary outcomes at baseline, 2 weeks, 6 months and 12-month follow up. Our investigators are experts in clinical (anesthesiology, dentistry, pediatrics, psychology, nutrition) and scientific realms (randomized controlled trials, management and analysis of longitudinal behavioral, psychosocial, and clinical outcomes, nutrition science, development of clinical interventions, dissemination and implementation). During the UG3 phase, we aim to develop PROTECT and test for feasibility and acceptability. The development of PROTECT will be informed by behavior change mechanisms of Social Cognitive Theory (SCT; e.g., positive parenting, self-efficacy, knowledge) and evidence-based behavioral parenting and dietary interventions, along with stakeholder (caregivers, providers, CHWs) input. We will identify barriers to recruitment, retention, intervention delivery, and outcome measurements. During the UH3 phase, we will test the efficacy of PROTECT compared to Usual Care (UC) to improve oral health behaviors. Participants will be randomized to receive PROTECT (n = 210) or UC (n = 210). We hypothesize that participants in the PROTECT group will increase tooth brushing and decrease added sugar intake to a greater degree than those in the UC group. Secondary outcomes and hypothesized SCT mechanisms of intervention effectiveness will also be tested. As an exploratory aim, saliva samples will be collected to assess changes to the oral microbiome from baseline to 6 months. This work fits within our broad research goal to improve children’s oral health, starting with the surgical population and potentially extending to children and adults within households.