Promoting Behavioral Change for Oral Health in American Indian Mothers and Childr

RC1的目标是证明通过使用动机访谈(ML)来改变母亲的口腔健康行为，可以降低美洲印第安人(Al)保留地社区儿童早期龋齿(ECC)的发生率。具体目标是：1)开发与文化相关的健康教育和宣传材料，与Al社区一起用于预防ECC；2)为孕妇/新生儿母亲制定口腔健康ML干预措施；3)在随机试验中测试这一干预措施。在北部平原的一个大型保留地的诊所接受产前护理的所有15岁或15岁以上的妇女都将被要求参加这项试验，所有人都将获得口腔健康促进材料和辅助设备，这些材料和辅助设备将使用社区参与战略进行开发。在示范试验中，大约600名妇女将被随机分配到ML组或对照组。对于ML组的儿童，产前和出生后立即对他们的家庭进行口腔健康检查，然后在6、12、24和36个月大的时候进行口腔健康检查。儿童将接受为期3年的跟踪调查，在每个儿童1、2和3岁生日后的3个月内，由经过校准的牙齿卫生师进行龋齿评估。主要结果将是龋齿发病率每年都在增加。次要结果指标将侧重于龋齿模式和该计划的成本效益。此外，还将考察各种中介/主持人，包括母亲的口腔健康知识和信念、压力、自我效能和控制点等问题。AI/AN儿童未经治疗的龋齿比一般人口中的儿童多3倍，获得预防服务和专业牙科治疗的机会不足。决定不将临床/药理学方法与ML配对，以提供对最普遍可用的预防策略的最终测试-即家庭口腔疾病预防行为。如果可以证明ML预防ECC的有效性，未来的研究可能会着眼于适应社区实施。预计这项研究的经验教训可用于调整RC3的最终方案，该方案的重点是由在Head Start中心工作的经过专门培训的Al社区口腔健康专家提供口腔健康预防服务(包括氟化物清漆)。这对其他临床预防方法的使用也有影响。这项研究的一个主要优点是，参与社区的代表以及保健服务提供者的参与在多大程度上影响了材料的开发和研究方案的设计。这种参与预计也将是传播活动的一项重要资产。

The goal of RC1 is to demonstrate that the incidence of early childhood caries (ECC) in an American Indian (Al) reservation community can be reduced through the use of Motivational Interviewing (Ml) to change maternal oral health behaviors. The specific aims are: 1) to develop culturally relevant health education and promotional materials for use in ECC prevention with an Al community; 2) to manualize an oral health Ml intervention for pregnant women/mothers of newborns; and 3) to test this intervention in a randomized trial. All of the women, ages 15 or older, who are receiving prenatal care in the clinics of a large Northern Plains Al reservation, will be asked to participate in this trial, and all will be provided with the oral health promotion materials and aids, which will be developed using community participation strategies. For the demonstration trial, approximately 600 women will be randomly assigned to the Ml group, or the control condition. For those in the Ml group, oral health visits will be made to their homes prenatally and immediately after birth, then at 6, 12, 24, and 36 months of age. Children will be followed for 3 years, and caries assessments will be conducted by calibrated dental hygienists within 3 months of each child's 1st, 2nd, and 3rd birthday. The primary outcome will be annual increase in caries incidence. Secondary outcome measures will focus on caries patterns and cost-effectiveness of the program. A variety of mediators/moderators also will be examined, including such issues as mother's oral health knowledge and beliefs, stress, self-efficacy, and locus of control. AI/AN children have 3 times more untreated decay than children in the general population, and access to both preventive services and professional dental treatment are inadequate. The decision was made not to pair clinical/pharmacologic approaches with Ml in order to provide a definitive test of the most universally available strategy for prevention-that is, home oral disease prevention behaviors. If the effectiveness of Ml for preventing ECC can be demonstrated, future studies might look at adaptations for community implementation. It is anticipated that lessons from this study can be used to adapt the final protocol for RC3, which is focused on the provision of oral health prevention services (including fluoride varnish) by specially trained Al community oral health specialists working in Head Start Centers. There are implications for use with other clinical approaches to prevention as well. A major strength of this study is the extent to which involvement by representatives of the participant community, as well as Al health service providers, is shaping the development of materials and the design of the research protocol. This participation is expected to be a major asset for dissemination activities as well.