Impact of Family Functioning and Violence on Adults? and Children?s Oral Health

描述（由申请人提供）：口腔健康是整体健康的重要组成部分（例如，Tabak, 2008；美国卫生与公众服务部[USDHHS]， 2000a），是美国政府健康人2010公共卫生战略的28个重点领域之一（USDHHS, 2000b）。口腔疾病是最常见的人类慢性疾病（Sheiham， 2005年），其中最常见的是龋齿——无论是传染性的还是传染性的（美国卫生与公众服务部，2000年b）。尽管龋病广泛发生，但临床医生仍然难以控制龋齿，尤其是在不同种族、社会和经济人群中。研究清楚地证明，夫妻冲突对成人和儿童的免疫系统和内分泌系统都有深远的影响。同样，养育问题对成人和儿童来说都是一种慢性的情绪和行为压力源，伴随着与慢性觉醒相关的严重的健康影响（例如，Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002）。我们假设，对一般健康产生影响的相同机制也会对口腔健康产生特定影响。我们建议在400个有幼儿（现在4-11岁）的家庭样本中收集另外一波数据（包括儿童和成人口腔健康及相关行为的父母报告），这些家庭已经完成了一项家庭研究（NICHD资助R01 HD046901）的两波评估。该数据集最初旨在检查家庭暴力暴露对儿童和成人的影响，包括家庭和个人潜在的中介和调节因素以及一系列健康和功能结果，但不包括口腔健康信息。该项目有以下具体目的：#1：通过建立(a)家庭功能之间关系的效应大小来测试第一种假设途径；(b)儿童和成人口腔卫生行为；[和(c)检验父母的口腔健康行为社会化是否介导了儿童的这些关联。#2：通过建立(a)家庭功能与(b)儿童和成人口腔健康结果之间关系的效应大小来检验第二种假设途径。测试家庭功能行为的直接影响，以及这些影响是否由口腔健康行为（以及这些行为在儿童中的社会化）介导。通过应用一个适度的框架来确定是什么使得家庭功能有时可以预测口腔健康，有时不能，我们可以更具体地确定在什么条件下，家庭功能的哪些方面可以预测儿童或成人的口腔健康结果。#4：确定家庭暴力暴露对口腔健康的影响在多大程度上是由(a)非虐待性夫妻冲突，(b)不称职的养育方式，或(c)两者共同介导的。[#5：纵向检验目标1 - 4的假设，以预测口腔健康的变化。]

DESCRIPTION (provided by applicant): Oral health is an important component of overall health (e.g., Tabak, 2008; U.S. Department of Health and Human Services [USDHHS], 2000a) and is one of 28 focus areas in U.S. Government's Healthy People 2010 public health strategy (USDHHS, 2000b). Oral diseases are the most common human chronic diseases (Sheiham, 2005), with dental caries - both infectious and transmissible -being the most prevalent (USDHHS, 2000b). Despite its widespread occurrence, efforts to control caries - especially among diverse ethnic, social, and economic populations - continue to elude clinicians. Research clearly documents that couples conflict has profound effects on the immune and endocrine systems of adults and children. Likewise, parenting problems are a chronic emotional and behavioral stressor on both adults and children, with serious attendant health effects related to chronic arousal (e.g., Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002). We hypothesize that the same mechanisms that result in effects on general health also result in specific effects on oral health. We propose to collect an additional wave of data (including parent reports of child and adult oral health and related behaviors) on a sample of 400 families with young children (now 4-11 years old) who have already completed two waves of assessments in a family study (NICHD grant R01 HD046901). Originally designed to examine the effects of family violence exposure on children and adults, that data set includes family and individual potential mediators and moderators and a range of health and functioning outcomes, but not oral health information. This project has the following specific aims: #1: Test the first hypothesized pathway by establishing the effect sizes of relations between (a) family functioning;(b) child and adult oral health behaviors; [and (c) test whether parental socialization of oral health behaviors mediates these associations in children.] #2: Test the second hypothesized pathway by establishing the effect sizes of relations between (a) family functioning and (b) child and adult oral health outcomes. Test both the direct effects of family function behaviors and whether these effects are mediated by oral health behaviors [and socialization of these behaviors in children]. #3: By applying a moderational framework to identify what makes family functioning sometimes predict oral health and other times not, we can more specifically determine under what conditions which aspects of family functioning predict child or adult oral health outcomes. #4: Determine the extent to which effects of violence exposure in the family on oral health are mediated by (a) non-abusive couple conflict, (b) inept parenting, or (c) both.[#5: Test the hypotheses of Aims 1 - 4 longitudinally to predict change in oral health.] PUBLIC HEALTH RELEVANCE: Oral health (oral health) is an important component of overall health (e.g., Tabak, 2008; U.S. Department of Health and Human Services [USDHHS], 2000a) and is one of 28 focus areas in U.S. Government's Healthy People 2010 public health strategy (USDHHS, 2000b). Oral diseases are the most common human chronic diseases (Sheiham, 2005), with dental caries - both infectious and transmissible -being the most prevalent (USDHHS, 2000b). Despite its widespread occurrence, efforts to control caries, especially among diverse ethnic, social, and economic populations, continue to elude clinicians. Dental and craniofacial problems cause significant discomfort and pain, functional limitations, global health effects, quality of life decrements, and lowered self-esteem (e.g., Locker, 1988; Reisine, 1988; USDHHS, 2000a). The costs of oral health care are extensive, in part because of the ubiquity of need: in 1989, routine and emergent dental care resulted in over 164 million hours of work lost (1.48 hours per worker) and over 50 million hours of school missed (1.17 hours per child; Gift et al., 1992). The World Health Organization (2003) estimates that oral health services account for 5-10% of health costs in industrialized countries. Per capita dental costs exceeded $200 in 1999 (over $262/per person in 2008 dollars; U.S. Department of Health and Human Services, 2002), although many go without needed dental care because of the expense. The general health effects of family dysfunction are now clearly established. In this proposal, we will posit a heuristic model that family dysfunction is related specifically to oral health outcomes through two pathways. First, family dysfunctional behavior is hypothesized to relate to worse oral health behaviors (i.e., less frequent brushing and flossing, greater consumption of cariogenic foods/drinks), [and by this mechanism, to poorer oral health outcomes.] Second, noxious family environments are hypothesized to be directly related to negative oral health outcomes (presumably through deleterious effects on the immune and endocrine systems). Some promising initial support for these hypothesized pathways comes from related (but non-familial) research: less frequent tooth brushing and worse overall oral hygiene is related to higher levels of general hostility (Merchant et al., 2003; Mettovaara et al., 2006) and stress (Deinzer et al., 2001). Research clearly documents that couples conflict has profound effects on the immune and endocrine systems of adults and children. Likewise, parenting problems are a chronic emotional and behavioral stressor on both adults and children, with serious attendant health effects related to chronic arousal (e.g., Kiecolt- Glaser, McGuire, Robles, & Glaser, 2002). We hypothesize that the same mechanisms that result in effects on general health also result in specific effects on oral health. In this R21 proposal, we propose to collect an additional wave of data (including parent reports of child and adult oral health and related behaviors) on a sample of 400 families with children (now 4-11 years old) who have already completed two waves of assessments in a family study. This study (NICHD grant R01 HD046901), originally designed to examine the effects of family violence exposure on children and adults, includes important family and individual potential mediators and moderators and a range of health and functioning outcomes, but not oral health information. We have kept in contact with participants who have participated, and all have signed forms agreeing to be contacted for research in the future. By collecting data from this existing sample with an already rich array of constructs well-assessed over time, we will, for a modest investment of additional resources, be able to test comprehensive series of hypotheses about how and for whom family functioning impacts oral health for both children and adults. Thus, we expect this two-year project to quickly result in well-developed and preliminarily validated models of the complex relationships between behavioral and social factors and oral health. These models can identify new potential targets of intervention that can lead to meaningful improvements in oral health. We will attempt to make these advances through the following specific aims: Specific Aim #1: Test the first hypothesized pathway by establishing the effect sizes of relations between (a) family functioning;(b) child and adult oral health behaviors; [and (c) test whether parental socialization of oral health behaviors mediates these associations in children.] Specific Aim #2: Test the second hypothesized pathway by establishing the effect sizes of relations between (a) family functioning and (b) child and adult oral health outcomes. Test both the direct effects of family function behaviors and whether these effects are mediated by oral health behaviors [and socialization of these behaviors in children]. Specific Aim #3: By applying a moderational framework to identify what makes family functioning sometimes predict oral health and other times not, we can more specifically determine under what conditions which aspects of family functioning predict child or adult oral health outcomes. Specific Aim #4: Determine the extent to which effects of violence exposure in the family on oral health are mediated by (a) non-abusive couple conflict, (b) inept parenting, or (c) both. [Specific Aim #5: Test the hypotheses of Aims 1 - 4 longitudinally to predict change in oral health.]