Examining California's Oral Health Disparities: New Models and Methods

描述(由申请人提供)：2005年加州儿童口腔健康需求评估(COHNAC)是一项复杂的全州范围内对超过21,000名幼儿园和三年级儿童的健康检查调查，显示自1993-2004年COHNAC以来，未经治疗的龋病患病率有所下降，龋齿经历略有下降。然而，这些患病率没有达到2010年健康人的目标，加州儿童的口腔健康状况在报告的25个州中排名第二，低收入家庭和有色人种儿童的口腔健康状况继续恶化。这项拟议项目的总体目标是在2005年COHNAC中应用最先进的HD方法，评估某些特定的文化适应因素、父母的健康素养和社会环境与口腔健康的关系，测试和评估应用于口腔健康的HD方法，并为同事提供一套可用于类似的国家口腔健康调查和其他方面的方法/工具。具体目标是：1)在2005年《加州儿童口腔健康需求评估》中使用传统的基于回归的测量方法以及最新的测量方法(如HCI和Thiel‘s指数)来估计口腔健康差异(OHD)；2)使用缺失的问卷数据和模型的多重归因来检验与加州OHD相关的儿童、家庭、邻里和学校因素(包括文化适应和健康素养相关测量)；3)使用计算机模拟来验证递归划分方法和复杂的调查抽样回归相结合的多水平集合统计建模方法；以及4)根据加州大学旧金山分校的CAN-DO数据使用政策发布多个2005年COHNAC数据，以及b)在UCSF CAN-DO网站上免费发布HD指数的计算机程序和文档以及调查系综模型的回归部分。惠普2010年的首要目标是消除或减少美国人口中的健康差距(HD)。更具体的目标包括目标21-1b和21-2b：分别降低儿童患龋率和未经治疗的龋患率。目标11-2是一项发展目标，旨在提高健康素养水平不足的人的健康素养。这项拟议的研究是对这些目标的回应。

DESCRIPTION (provided by applicant): The 2005 California Oral Health Needs Assessment of Children (COHNAC), a complex statewide health examination survey of over 21,000 kindergarten and third grade children, has shown decreases in the prevalence of untreated caries and slight decreases in caries experience since the 1993-4 COHNAC. However, these prevalences have not met Healthy People 2010 Objectives, California's children have the 2nd worst oral health of the 25 states reporting data, and children in families with low income and children of color continue to have worse oral health. Overall goals of this proposed project are to apply state-of-the-art HD methods in the 2005 COHNAC, to assess associations of some particular factors of acculturation, parental health literacy, and social environment in relation to oral health, to test and evaluate HD methods applied to oral health, and to provide a suite of methods/tools to colleagues that can be used in similar state oral health surveys and beyond. Specific Aims are: 1) To estimate oral health disparities (OHD) with traditional regression based measures as well as state-of-the art disparities measures (e.g. HCI and Thiel's index) in the 2005 statewide California Oral Health Needs Assessment of Children; 2) To use multiple imputation for missing questionnaire data and models to examine child, family, neighborhood and school factors (including acculturation and health literacy related measures) associated with California OHD; 3) To validate a multi-level ensemble statistical modeling approach combining recursive partitioning methods with complex survey sampling regression using computer simulations; and 4) To disseminate a) multiple imputed 2005 COHNAC data according to the UCSF CAN-DO data use policy and b) computer programs and documentation for HD indices and survey regression portion of ensemble models freely on the UCSF CAN-DO website. An overarching goal for HP 2010 is the elimination or reduction of health disparities (HDs) in the US population. More specific objectives include Objectives 21-1b and 21- 2b: to reduce the percentage of children with caries and untreated caries, respectively. Objective 11-2 is a developmental objective to improve health literacy among those with inadequate health literacy levels. This proposed research is responsive to those objectives.