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）是一项对21,000多名幼儿园和三年级儿童进行的复杂的全州健康检查调查，结果显示，自1993-4年COHNAC以来，未经治疗的龋齿患病率有所下降，龋齿经历略有下降。然而，这些患病率并没有达到健康人群2010年的目标，加州儿童的口腔健康状况在25个州的报告数据中排名第二，低收入家庭的儿童和有色人种的儿童的口腔健康状况仍然较差。这一拟议项目的总体目标是在2005年COHNAC中应用最先进的口腔健康方法，评估与口腔健康有关的文化适应、父母健康素养和社会环境等某些特定因素的关联，测试和评估适用于口腔健康的口腔健康方法，并为同事提供一套可用于类似州口腔健康调查及其他领域的方法/工具。具体目的是：1)在2005年全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和最新的差异测量方法（如HCI和Thiel指数）估计口腔健康差异（OHD）；2)对缺失的问卷数据和模型进行多重归因，检验与加州OHD相关的儿童、家庭、社区和学校因素（包括文化适应和健康素养相关措施）；3)通过计算机模拟验证递归分划与复杂调查抽样回归相结合的多层次集成统计建模方法；4)根据UCSF CAN-DO数据使用政策，在UCSF CAN-DO网站上免费发布a) 2005年COHNAC的多重估算数据，b)集成模型的HD指数和调查回归部分的计算机程序和文档。HP 2010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和目标21- 2b：分别降低患龋齿和未治疗龋齿儿童的百分比。目标11-2是一项发展目标，旨在提高卫生知识普及水平不高的人的卫生知识普及程度。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.