Social Network Dynamics and Oral Health Disparities in Mexican American Immigrants

 描述(由申请者提供)：在美国的拉丁裔经历了严重的口腔健康差距(OHD)。他们在获得口腔保健服务方面面临障碍(例如，他们是所有种族或族裔群体中牙科保险费率最低的群体之一)，而且不成比例地不太可能寻求定期和预防性的牙科护理。拉丁裔儿童和成人患龋齿、牙周炎和/或慢性牙周炎的几率也较高。对拉丁裔口腔健康的研究一直局限于确定个人层面的社会经济和社会文化机制，而很少关注更广泛的个人和社区网络背景。从网络科学的角度来看，个人的健康行为、信念和态度是通过与他人的接触和沟通来形成的；社会网络与健康结果之间存在着密切的关系。目前的口腔健康研究工具箱没有充分捕捉到OHD所体现的多个嵌套水平的影响。我们建议应用社会网络分析(SNA)方法来解决了解有关牙科保健和口腔健康的社会规范、态度、资源和信息如何通过个人和社区网络传播并影响个人行为和结果的迫切需要。在拟议的研究中，我们将建立在我们完成的形成性项目(NIDCR DE022096)的基础上，这是一项使用SNA方法进行OHD研究的先驱研究，目标是美国的墨西哥裔(或墨西哥裔美国人[MAS])。在之前的横断面设计中，我们将食物、口腔健康行为和牙齿护理的体验放在他们生活的网络背景下进行表征。描述影响MA的OHD因素和机制具有重大的公共卫生意义，因为MA亚群约占美国拉丁裔的60%。在目前的纵向设计中，我们将通过关注最近移民的MA之间随着时间的推移网络、口腔健康文化以及牙科护理态度和行为的共同进化的动态过程，来开发OHD的强大因果模型。我们的具体目标是：1)描述MA移民对牙科保健和口腔健康障碍的规范、态度、行为和认知，特别关注这些因素与个人社会网络特征之间的关联；2)确定MA移民的文化适应、个人和社区网络动态、规范和资源的传播以及随时间演变的口腔健康行为、态度和结果之间的关系。对OHD背后的复杂和动态机制拥有更多和更准确的知识，将为发展四个方面提供基础：有效的公共政策、有效的临床指南、对文化敏感的临床和预防护理，以及具有实际应用的未来研究方向。此外，利用现有关于网络干预和其他卫生领域创新扩散的丰富研究，我们的发现可以应用于定制项目，利用MA社区的优势和资源来改善人口口腔健康。

 DESCRIPTION (provided by applicant): Latinos in the US experience substantial oral health disparities (OHD). They face barriers to accessing oral health services (e.g., among the lowest rates of dental insurance among any racial or ethnic group), and are disproportionately less likely to seek regular and preventive dental care. Latino children and adults also experience higher rates of dental caries, gingivitis, and/or chronic periodontitis. Studies of oral health among Latinos have been limited to identifying individual-level socioeconomic and sociocultural mechanisms, with little attention to broader personal and community network contexts. Viewed from a network science perspective, the health behaviors, beliefs, and attitudes of individuals are shaped through contact and communication with others; there is a strong relationship between social networks and health outcomes. The current oral health research toolbox does not adequately capture the multiple nested levels of influence embodied in OHD. We propose to apply Social Network Analysis (SNA) methods to address the critical need to understand how social norms, attitudes, resources, and information around dental care and oral health propagate through personal and community networks, and affect individual behavior and outcomes. In the proposed research we will build on our completed formative project (NIDCR DE022096), a pioneer study using SNA methods in OHD research targeting people of Mexican descent (or Mexican-Americans [MAs]) in the US. In that prior cross-sectional design we characterized experiences about food, oral health behaviors, and dental care in the context of the networks they live in. Describing OHD factors and mechanisms affecting MAs has great public health significance because the MA sub-group makes up about 60% of Latinos in the US. In the present longitudinal design, we will develop a strong causal model of OHD by focusing on the dynamic processes underlying the coevolution of networks, oral health culture, and dental care attitudes and behaviors over time among MAs who have recently immigrated. Our specific aims are to: 1) characterize the norms, attitudes, behaviors, and perceptions of barriers around dental care and oral health among MA immigrants, with specific attention to associations between these factors and personal social network features; and 2) determine the relationships between acculturation, personal and community network dynamics, diffusion of norms and resources, and evolving oral health behaviors, attitudes, and outcomes over time among MA immigrants. Having additional, and more accurate knowledge about the complex and dynamic mechanisms underlying OHD will provide a foundation to develop four aspects: effective public policy, efficient clinical guidelines, culturally-sensitive clinical and preventive care, and futur research directions with practical applications. Moreover, drawing on the rich body of existing research on network interventions and diffusion of innovation from other health areas, our findings can be applied to tailoring programs that leverage the strengths and resources of MA communities to improve population oral health.