Prevention of Dental Caries in Early Head Start Children

描述(申请人提供)：幼儿龋病(ECC)是儿童最常见的慢性疾病，影响全国400多万儿童。疾病的负担主要落在弱势儿童身上。这项研究的目的是评估一项已经资助并正在进行的干预措施，旨在通过医疗办公室和早期学前教育(EHS)中心的预防性牙科活动相结合来预防0-2岁儿童的ECC。北卡罗来纳州的EHS工作人员正在接受培训，为儿童及其家人提供牙科健康教育和促进活动，并将参加EHS的儿童与其社区提供预防性牙科服务的医疗提供者联系起来。作为全州医疗补助计划的一部分，大约500家医疗机构正在为儿童提供预防性牙科服务，包括筛查、风险评估和转诊、家长咨询和局部氟化物应用。在该州28个县的18个EHS项目中，儿童及其父母在地理上靠近75个医疗提供者提供预防性牙科服务的地点。对EHS工作人员的牙科教育干预主要基于社会学习理论，包括全州论坛、具有实践审计和反馈的研讨会以及教育研讨会和资源材料。对父母的教育干预在一定程度上是基于跨理论模型，该模型以变化阶段为核心概念，并采用动机访谈。工作人员在当地牙科公共卫生提供者的支持下，为儿童提供课堂预防牙科活动，并为家长提供教育。一项非随机、前测-后测嵌套队列控制组群集性试验将确定EHS计划和医疗机构提供的联合牙齿暴露对预防EHS儿童非空洞和空洞龋损的效果。大约800名0岁和1岁的儿童将被登记在每个研究小组中，并在3岁时进行ECC检查。参加医疗补助但不参加EHS的年龄和种族匹配的儿童将作为社区特定的控制措施。父母将在基线上接受采访，后续采访将在他们参加研究的孩子18个月和36个月大时进行。3岁儿童的临床检查将在最后的后续家长访谈中进行。次要结果包括认知(牙科知识)和情感(重视牙齿健康、自我效能、结果预期、准备改变)特征，为儿童和家庭建立牙科之家，以及父母报告的儿童和他们自己的口腔健康相关生活质量(OHRQOL)的改善。这项研究的最终目标将确定牙齿健康素养在多大程度上改变了干预措施在改善结果方面的有效性。OHRQOL、牙齿健康素养和牙齿“本质感”将使用研究小组在之前的研究中开发的工具进行测量。意向治疗分析将确定干预对牙科结果的影响。公共卫生相关性：幼儿的牙病在低收入儿童中处于流行水平，他们面临许多障碍，使他们无法获得所需的牙科护理。这项研究将测试北卡罗来纳州参加早期Head Start计划的0-2岁儿童获得预防性牙科服务的几种方法。成功实施预防性牙科计划的结果应该是减少儿童及其家庭的疾病和提高生活质量。

DESCRIPTION (provided by applicant): Early childhood caries (ECC) is the most common chronic disease of childhood, affecting more than 4 million children nationwide. The burden of disease falls mostly on disadvantage children. The purpose of this research is to evaluate an already funded and ongoing intervention designed to prevent ECC in children 0-2 years of age through a combination of preventive dental activities in medical offices and Early Head Start (EHS) centers. EHS staff in North Carolina are being trained to provide dental health education and promotion activities for children and their families, and to link children enrolled in EHS with medical providers in their communities who provide preventive dental services. As part of a statewide Medicaid program, about 500 medical offices are providing preventive dental services for children, including screening, risk assessment and referral, parent counseling and topical fluoride applications. Children and their parents in 18 EHS programs in 28 counties in the state have close geographic proximity to 75 sites where medical providers are offering preventive dental services. The dental educational intervention with EHS staff is based mainly on Social Learning Theory and consists of statewide forums, workshops with audit and feedback of practices, and educational workshops and resource materials. The educational intervention for parents is based in part on the Transtheoretical Model, which uses Stages of Change as its key concept, and motivational interviewing. Staff provide classroom preventive dental activities for children and education for parents, with support provided from local dental public health providers. A non- randomized, pretest-posttest nested cohort control group cluster trial will determine the effects of the combined dental exposures provided in EHS programs and medical offices on preventing noncavitated and cavitated carious lesions in EHS children. About 800 0- and 1-year old children will be enrolled in each of the study groups and examined for ECC at 3 years of age. Age- and race-matched children enrolled in Medicaid but not EHS will serve as community-specific controls. Parents will be interviewed at baseline, and follow-up interviews will take place when their study-enrolled children are 18 and 36 months of age. The clinical examination of the child at 3 years of age will occur at the final follow-up parent interview. Secondary outcomes include cognitive (dental knowledge) and affective (value placed on dental health, self-efficacy, outcome expectations, readiness to change) characteristics, establishment of a dental home for the child and family, and improvements in parent reported oral health-related quality of life (OHRQoL) for the child and themselves. A final aim of the study will determine the extent to which dental health literacy modifies the effectiveness of the intervention in improving outcomes. OHRQoL, dental health literacy and dental "homeness" will be measured with instrument developed by the research team in previous research. Intent-to-treat analyses will determine effects of the intervention on dental outcomes. PUBLIC HEALTH RELEVANCE: Dental disease in young children is at epidemic levels among low-income children and they face a number of barriers that prevent them from getting needed dental care. This study will test several ways in which access to preventive dental services can be increased among children 0-2 years of age enrolled in Early Head Start programs across North Carolina. The result of successful implementation of preventive dental programs should be less disease and improved quality of life among children and their families.