Development and Evaluation of School-based Digital Adolescent Oral Health Promotion Program for the Reduction of Oral Health Disparities

项目摘要 龋齿，或蛀牙，是一种非常普遍的慢性疾病，困扰着美国很大一部分人。 人口，包括大多数青年和成年人。口腔健康方面的健康差距已经持续了几十年， 低收入青年、黑人/非裔美国人和拉丁裔少数民族患龋齿的风险尤其高。 虽然青春期是一个理想的时间来实施健康的行为习惯，将持续到 成年后，缺乏针对高危青少年的有效牙齿健康计划。研究表明 青春期的主要口腔健康促进策略包括改善牙齿健康行为， 避免使用烟草和电子烟，并减少糖的消耗。按照这些建议 根据我们的形成性研究结果，我们提出的青少年数字牙科计划将针对 三个口腔健康行为领域：每天用含氟牙膏刷牙两次，戒烟 使用，包括电子烟，并减少含糖饮料的消费。基于以下理论： 计划行为，由青少年的原型/意愿模型增强，拟议的跨平台 数字计划将以理论为基础的机制为目标，以促进这三个有针对性的口腔健康行为。 它将包括引人入胜的视频和互动游戏组件。因此，在此UG 3/UH 3应用程序中，我们将 开发和评估一个基于理论的数字牙齿健康促进计划，旨在吸引低 收入黑人/非裔美国人、拉丁裔/西班牙裔以及非西班牙裔的白色七年级和八年级学生。在UG 3 在第一阶段，我们建议进行初步的工作，以反覆发展一个以学校为本、以互联网为本的口腔健康 推广计划。在UH 3阶段，我们将在学校开展临床随机对照试验（RCT）， 评估“真实的世界”计划的有效性。在RCT中，我们将评估项目的可接受性、可行性、可用性， 满意度和参与度，以及三个主要的行为和临床健康结果。二次 成果是该方案针对行为改变的理论基础机制。第七和第八次 来自多个州40所低收入学校的2,000名学生将被随机分配接受 程序干预或等待列表（控制条件）。参与的学生将完成 在三个时间点（基线、基线后6周和基线后6个月）进行评估，以评价 短期和长期方案的结果。如果有效，这种全面的数字行为牙齿健康 该计划将通过减少持续的口腔健康差异来极大地影响公众健康。递送 通过学校的计划将解决在获得这些计划方面的差距，因为学生将获得该计划 通过学校互联网和学校拥有的数字设备。基于网络的干预也很容易扩展， 以低廉的成本广泛传播，使最易患龋齿的青少年群体受益。很长的- 长期目标是促进健康的牙齿习惯和相关的口腔健康行为，为青少年实现终身 没有可预防的口腔疾病。

PROJECT SUMMARY Dental caries, or tooth decay, is a highly prevalent chronic disease afflicting a significant proportion of the U.S. population, including a majority of youth and adults. Health disparities in oral health have persisted for decades, with lower-income youth, Black/African Americans and Latinx minorities being especially at risk for dental caries. Although adolescence is an ideal time to implement healthy behavioral habits that will be sustained into adulthood, there is a dearth of effective dental health programs for at-risk adolescents. Research has shown that primary oral health promotion strategies during adolescence include improving dental health behaviors, abstaining from tobacco use and vaping, and reducing sugar consumption. Following these recommendations and informed by our formative research findings, our proposed digital dental program for adolescents will target three oral health behavior domains: twice-daily tooth brushing with fluoride toothpaste, abstaining from tobacco use, including vaping, and reducing consumption of sugar-sweetened beverages. Grounded in the Theory of Planned Behavior, augmented by the Prototype/Willingness Model for adolescents, the proposed cross-platform digital program will target theoretically based mechanisms to promote these three targeted oral health behaviors. It will include engaging video and interactive game components. Thus, in this UG3/UH3 application, we will develop and evaluate a theoretically based digital dental health promotion program designed to engage lower income Black/African Americans, Latinx/Hispanic, and white non-Hispanic 7th and 8th grade students. In the UG3 phase, we propose to conduct formative work to iteratively develop a school-based, web-based oral health promotion program. In the UH3 phase, we will conduct a clinical randomized control trial (RCT) in schools, to evaluate “real world” program efficacy. In the RCT, we will assess program acceptability, feasibility, usability, satisfaction, and engagement, as well as the three primary behavioral and clinical health outcomes. Secondary outcomes are the theoretically based mechanisms the program targets for behavior change. Seventh and 8th grade students (N = 2,000) from 40 lower-income schools across multiple states will be randomized to receive the program intervention or to be on the waitlist (control condition). Participating students will complete assessments at three time points (baseline, six weeks post-baseline, and six months post-baseline) to evaluate both short- and long-term program outcomes. If effective, this comprehensive digital behavioral dental health program would greatly impact public health by decreasing persistent oral health disparities. Delivering the program via schools will address disparities in access to such programs, as students will access the program via school internet and school-owned digital devices. A web-based intervention is also easily scalable and can be widely disseminated at little cost, reaching adolescent populations most at risk for dental caries. The long- term goal is to facilitate healthy dental habits and related oral health behaviors for adolescents to attain a lifetime free from preventable oral disease.