The Environment in Pediatric Tooth Brushing Frequency: A System Dynamics Model

描述（由申请人提供）：目前，导致许多健康行为产生和维持的环境和行为过程并没有在系统动力学模型中得到体现。缺乏这样的模型是一个问题，因为在它们被开发出来之前，没有办法确定那些使健康行为最大化、同时使政策阻力最小化的变革杠杆。当前应用的目的是开发和测试刷牙频率环境的初步系统动力学模型。刷牙是一种理想的健康行为，因为刷牙往往与其他健康行为（如系安全带和戴头盔）同时发生。因此，我们对刷牙的了解很可能推广到其他健康行为。第二，它表现出政策抵抗倾向。该应用程序的中心假设是家庭和社区的过程影响儿童的刷牙行为。这一假设来源于健康行为理论。审查这些进程的理由是，家庭可能是最易变和最容易获得预防性干预措施的目标。中心假设将在三个具体目标中得到检验。目的1是建立个人、家庭和社区层面刷牙频率动态关系的初步模型。假设刷牙频率是由社区和家庭中表现出来的文化过程决定的。目标2是确定在最大限度地减少政策阻力的同时最大限度地提高刷牙的杠杆。假设干预措施应该针对家庭和同伴群体。目标3是识别模型中重要的、未指定的部分。据推测，该模型的某些部分将未得到充分说明，并且将需要来自尚不存在的研究的数据。本应用中提出的研究是创新的，因为它利用了系统动力学建模。预计这项研究的贡献将是确定应该随着时间的推移进行更深入研究的推定监管机构。这一贡献是重要的，因为它是研究计划的第一步，预计将导致开发更准确的龋齿风险评估和增加刷牙频率的干预措施。

DESCRIPTION (provided by applicant): Currently, the environmental and behavioral processes that contribute to the emergence and maintenance of many health behaviors are not represented in system dynamics models. The lack of such models is a problem because until they are developed, there is no way to identify those levers of change that maximize healthful behavior while minimizing policy resistance. The objective of the current application is to develop and test a preliminary system dynamics model of the environment in tooth brushing frequency. Tooth brushing is an ideal health behavior to model because tooth brushing tends to co-occur with other health behaviors, such as seatbelt and helmet wearing. Thus, what we learn about tooth brushing is likely to generalize to those other health behaviors. Second, it displays policy-resistant tendencies. The central hypothesis of the application is that processes in the family and community affect tooth brushing behaviors in the child. This hypothesis is derived from health behavior theories. The rationale for examining these processes is that the family may be the most mutable and accessible target for preventive interventions. The central hypothesis will be tested in three specific aims. Aim 1 is to create a preliminary model of the dynamic relationships among individual-, family-, and community-level processes in tooth brushing frequency. It is hypothesized that tooth brushing frequency is determined by cultural processes manifested in the community and family. Aim 2 is to identify the levers that maximize tooth brushing while minimizing policy resistance. It is hypothesized that interventions should target the family and peer group. Aim 3 is to identify important, underspecified portions of the model. It is hypothesized that some portions of the model will be underspecified and will require data from studies that do not yet exist. The research proposed in this application is innovative because it utilizes system dynamics modeling. The contribution of the study is expected to be the identification of putative regulators that should be studied more intensively over time. This contribution is significant because it is the first step in a program of research that is expected to lead to the development of more accurate risk assessments for dental caries and interventions that increase tooth brushing frequency.