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Chaffee BW, Couch ET, Donaldson CD, Farooq O, Cheng NF, Ameli N, Zhang X, Gansky SA. Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations. Subst Use Misuse 2024; 59:1240-1248. [PMID: 38509707 PMCID: PMC11045304 DOI: 10.1080/10826084.2024.2330912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.
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Affiliation(s)
- Benjamin W. Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Elizabeth T. Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Candice D. Donaldson
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Omara Farooq
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Nancy F. Cheng
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Niloufar Ameli
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
| | - Xueying Zhang
- California Tobacco Prevention Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA, USA 95899
| | - Stuart A. Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, USA 94143
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA, USA 94143
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Banava S, Lippman SA, Schenk G, Gansky SA. Intimate partner violence and orofacial injuries in a multi-school dental data repository. J Dent Educ 2023; 87 Suppl 3:1827-1831. [PMID: 35703990 PMCID: PMC9751224 DOI: 10.1002/jdd.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/25/2022] [Accepted: 05/28/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sepideh Banava
- University of California San Francisco, Division of Oral Epidemiology and Dental Public Health, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Ave., San Francisco, CA, USA 94143
- Center to Address Disparities in Children’s Oral Health, 3333 California Street, San Francisco, CA, USA 94143
| | - Sheri A. Lippman
- University of California San Francisco, Division of Prevention Science, Department of Medicine, School of Medicine, Box 0886, Floor 03, Room 3168, San Francisco, CA, USA 94143
| | - Gundolf Schenk
- University of California San Francisco, Bakar Computational Health Sciences Institute, Box 2933, San Francisco, CA, USA 94143
| | - Stuart A. Gansky
- University of California San Francisco, Division of Oral Epidemiology and Dental Public Health, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Ave., San Francisco, CA, USA 94143
- Center to Address Disparities in Children’s Oral Health, 3333 California Street, San Francisco, CA, USA 94143
- University of California San Francisco, Bakar Computational Health Sciences Institute, Box 2933, San Francisco, CA, USA 94143
- Philip R. Lee Institute for Health Policy Studies, Box 0936, San Francisco, CA, USA 94118
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Ta Park VM, Grill JD, Tsoh J, Meyer OL, Ameli N, Helman S, Tzuang M, Nam B, Hinton L, Kanaya A, Gallagher-Thompson D, Vuong Q, Bang J, Shin HW, Gansky SA. Asian Americans' and Pacific Islanders' preferences in recruitment strategies and messaging for participation in the CARE registry: A discrete choice experiment. Alzheimers Dement 2023; 19:5198-5208. [PMID: 37171018 DOI: 10.1002/alz.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This discrete choice experiment (DCE) identified Asian American and Pacific Islander (AAPI) adults' preferences for recruitment strategies/messaging to enroll in the Collaborative Approach for AAPI Research and Education (CARE) registry for dementia-related research. METHODS DCE recruitment strategy/messaging options were developed in English, Chinese, Korean, and Vietnamese. AAPI participants 50 years and older selected (1) who, (2) what, and (3) how they would prefer hearing about CARE. Analyses utilized conditional logistic regression. RESULTS Participants self-identified as Asian Indian, Chinese, Filipino, Japanese, Korean, Samoan, or Vietnamese (N = 356). Overall, they preferred learning about CARE from the healthcare community (vs. community champions and faith-based organizations), joining CARE to advance research (vs. personal experiences), and hearing about CARE through social media/instant messaging (vs. flyer or workshop/seminar). Preferences varied by age, ethnic identity, and survey completion language. DISCUSSION DCE findings may inform tailoring recruitment strategies/messaging to engage diverse AAPI in an aging-focused research registry.
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Affiliation(s)
- Van M Ta Park
- Department of Community Health Systems, University of California, San Francisco, California, USA
- Asian American Research Center on Health (ARCH), University of California, San Francisco, California, USA
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
| | - Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, USA
| | - Janice Tsoh
- Asian American Research Center on Health (ARCH), University of California, San Francisco, California, USA
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Oanh L Meyer
- Department of Neurology, University of California Davis, Sacramento, California, USA
| | - Niloufar Ameli
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Sarit Helman
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Marian Tzuang
- Department of Community Health Systems, University of California, San Francisco, California, USA
| | - Bora Nam
- Department of Community Health Systems, University of California, San Francisco, California, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
| | - Alka Kanaya
- Asian American Research Center on Health (ARCH), University of California, San Francisco, California, USA
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Quyen Vuong
- International Children Assistance Network (ICAN), San Jose, California, USA
| | - Joon Bang
- Iona Senior Services, Washington DC, USA
| | - Hye-Won Shin
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, USA
| | - Stuart A Gansky
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
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Donaldson CD, Couch ET, Hoeft KS, Wilkinson ML, Guerra C, Gansky SA, Zhang X, Chaffee BW. Flavored Tobacco and Nicotine Use Among California Adolescents: Preferences by Use Experience and Survey Format Effects. J Adolesc Health 2023; 73:753-760. [PMID: 37389531 PMCID: PMC10528341 DOI: 10.1016/j.jadohealth.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This study assessed flavored tobacco use among adolescent e-cigarette, cigarette, cigar, hookah, and smokeless tobacco users; specific e-cigarette flavor preferences; risk profiles of youth that use various flavors; and the impact of survey question wording on prevalence. METHODS Cross-sectional data from 4,956 California adolescent participants (aged 12-17 years) in the Teens, Nicotine, and Tobacco 2021-2022 online panel survey estimated the survey-weighted prevalence of flavored tobacco use. An embedded randomized experiment assessed survey wording effects (i.e., any vs. "usual" flavor use). Qualitative data from four contemporaneous cycles of Teens, Nicotine, and Tobacco focus groups with California adolescents (N = 63) added themes relevant to the quantitative findings. RESULTS 88.1% of current any tobacco users reported flavored tobacco use in the past 30 days. Flavor use was lowest for cigarettes (66.7%) and highest for hookah (92.8%). Fruit was the most popular e-cigarette flavor (51.6% any use; 28.8% usual use). E-cigarette users also commonly reported use of candy and cooling flavors. Sweet flavors were used most often among adolescents otherwise at low risk of tobacco use. Survey item format did not meaningfully affect overall prevalence of flavored product use but did impact reports of specific e-cigarette flavors. Focus group participants described sweet and fruity flavors as a motivating factor in their own e-cigarette use and as designed to appeal to children. DISCUSSION Despite local policies, flavored tobacco use remains common among California adolescents. Survey items asking about any flavor use rather than usual use provide more information without affecting the overall prevalence of flavored tobacco use.
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Affiliation(s)
- Candice D Donaldson
- California Tobacco Control Program, California Department of Public Health, Sacramento, California
| | - Elizabeth T Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Kristin S Hoeft
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Monica L Wilkinson
- California Tobacco Control Program, California Department of Public Health, Sacramento, California
| | - Claudia Guerra
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Stuart A Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California
| | - Xueying Zhang
- California Tobacco Control Program, California Department of Public Health, Sacramento, California
| | - Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California.
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Chaffee BW, Couch ET, Wilkinson ML, Donaldson CD, Cheng NF, Ameli N, Zhang X, Gansky SA. Flavors increase adolescents' willingness to try nicotine and cannabis vape products. Drug Alcohol Depend 2023; 246:109834. [PMID: 36963159 PMCID: PMC10121941 DOI: 10.1016/j.drugalcdep.2023.109834] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 03/05/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Certain product characteristics, such as flavor, may increase adolescents' willingness to try vaped nicotine and cannabis (marijuana) products. METHODS A discrete choice experiment embedded within the 2021-2022 California Teens Nicotine and Tobacco Project Online Survey was administered to a non-probability sample of N = 2342 adolescents ages 12-17. Participants were sequentially presented four randomly-generated pairs of hypothetical vape products that varied in device type (disposable, refillable), content (nicotine, marijuana, "just vapor"), and flavor (seven options) and asked which of these (or neither) they would be more willing to try if a best friend offered. Conditional logistic regression quantified associations between product characteristics and participants' selections, including interactions by past 30-day use of e-cigarettes, marijuana, or both. RESULTS Candy/dessert, fruit, and fruit-ice combination flavors were all associated with greater willingness to try a vape product (versus tobacco flavor) among participants not using e-cigarettes or marijuana, those using only e-cigarettes, and those co-using e-cigarettes and marijuana. Among participants only using marijuana, the most preferred flavors were no flavor, candy/dessert, and icy/frost/menthol. Among participants not using e-cigarettes or marijuana, model-predicted willingness to try a displayed vape product was greater when products were sweet or fruit flavored than tobacco or unflavored, regardless of whether displayed options contained nicotine (fruit/sweet: 21 %, tobacco/unflavored: 4 %), marijuana (fruit/sweet: 18 %, tobacco/unflavored: 6 %), or "just vapor" (fruit/sweet: 29 %, tobacco/unflavored: 16 %). CONCLUSIONS In this online non-probability sample, flavors in nicotine and cannabis vape products increased adolescents' willingness to try them. Comprehensive bans on flavored vapes would likely reduce adolescent use.
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Affiliation(s)
- Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA.
| | - Elizabeth T Couch
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Monica L Wilkinson
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Candice D Donaldson
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Nancy F Cheng
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Niloufar Ameli
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
| | - Xueying Zhang
- California Tobacco Control Program, California Department of Public Health, CHC/California Tobacco Control Branch, MS 7206, P.O. Box 997377, Sacramento, CA 95899, USA
| | - Stuart A Gansky
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA 94143, USA; Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, 707 Parnassus Avenue, D3214 Box 0758, San Francisco, CA 94143, USA
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Avenetti DM, Martin MA, Gansky SA, Ramos-Gomez FJ, Hyde S, Van Horn R, Jue B, Rosales GF, Cheng NF, Shiboski CH. Calibration and reliability testing of a novel asynchronous photographic plaque scoring system in young children. J Public Health Dent 2023; 83:108-115. [PMID: 36781405 PMCID: PMC10329468 DOI: 10.1111/jphd.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 02/15/2023]
Abstract
OBJECTIVES The Simplified Oral Hygiene Index for Maxillary Incisors (OHI-MIS) is a novel plaque scoring system adapted for young children. This study describes calibration training and testing used to establish the inter- and intra-rater reliability for OHI-MIS measured from clinical photographs. METHODS Two raters from the Coordinated Oral Health Promotion Chicago (CO-OP) and one from the Behavioral EConomics for Oral health iNnovation (BEECON) randomized controlled trials (RCTs) underwent calibration with gold standard raters, followed by annual re-calibration. Raters from CO-OP also completed inter-rater reliability testing; all three raters completed intra-rater reliability testing rounds. Photographs were obtained from children aged 9-39 months. RESULTS All three raters achieved greater than 0.77 Lin's Concordance Correlation (LCC) versus gold standard consensus during calibration. All three raters had LCC ≥0.83 at recalibration 1 year later. CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as "clear" (90% and 81%). The CO-OP inter-rater LCC for total OHI-MIS score was 0.86, changing little when low quality or confidence photos were removed. All three raters demonstrated high intra-rater reliability (≥0.83). CONCLUSIONS The OHI-MIS plaque scoring system on photos had good reliability within and between trials following protocol training and calibration. OHI-MIS provides a novel asynchronous plaque scoring system for use in young children. Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.
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Affiliation(s)
- David M. Avenetti
- Department of Pediatric Dentistry, UIC College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Molly A. Martin
- Department of Pediatrics, UIC College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Stuart A. Gansky
- Department Preventive and Restorative Dental Sciences, UCSF School of Dentistry, University of California, San Francisco, California, USA
| | - Francisco J. Ramos-Gomez
- Division of Preventative and Restorative Sciences, Section of Pediatric Dentistry, UCLA School of Dentistry, University of California, Los Angeles, California, USA
| | - Susan Hyde
- Department Preventive and Restorative Dental Sciences, UCSF School of Dentistry, University of California, San Francisco, California, USA
| | - Rebecca Van Horn
- Department of Pediatric Dentistry, UIC College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Bonnie Jue
- Department Preventive and Restorative Dental Sciences, UCSF School of Dentistry, University of California, San Francisco, California, USA
| | - Genesis F. Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nancy F. Cheng
- Department Preventive and Restorative Dental Sciences, UCSF School of Dentistry, University of California, San Francisco, California, USA
| | - Caroline H. Shiboski
- Department of Orofacial Sciences, UCSF School of Dentistry, University of California, San Francisco, California, USA
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Schillinger D, Banava S, Gansky SA. Integrating Oral, Physical, and Mental Health Via Public Health Literacy. Health Lit Res Pract 2022; 6:e17-e24. [PMID: 35133945 PMCID: PMC8823462 DOI: 10.3928/24748307-20220105-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dean Schillinger
- Address correspondence to Dean Schillinger, MD, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA, 94143;
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8
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Ramos-Gomez FJ, Martin MA, Nelson SS, Borrelli B, Henshaw MM, Curtan S, Lindau HE, Rueras N, Sandoval AS, Gansky SA. COVID-19 Impact on Community-Based Participatory Randomized Controlled Trials—Lessons From the Oral Health Disparities in Children Consortium. Front Dent Med 2021; 2. [PMID: 35669970 PMCID: PMC9164288 DOI: 10.3389/fdmed.2021.671911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on nearly every sector of science and industry worldwide, including a significant disruption to clinical trials and dentistry. From the beginning of the pandemic, dental care was considered high risk for viral transmission due to frequent aerosol-generating procedures. This resulted in special challenges for dental providers, oral health care workers, patients, and oral health researchers. By describing the effect that the COVID-19 pandemic had on four community-based randomized clinical trials in the Oral Health Disparities in Children (OHDC) Consortium, we highlight major challenges so researchers can anticipate impacts from any future disruptions.
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Affiliation(s)
- Francisco J. Ramos-Gomez
- Department of Pediatric Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
- Center to Address Disparities in Children’s Oral Health (CAN DO), University of California, San Francisco, San Francisco, CA, United States
| | - Molly A. Martin
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - Suchitra S. Nelson
- Department of Community Dentistry, Case Western Reserve University, Cleveland, OH, United States
| | - Belinda Borrelli
- Center for Behavioral Sciences Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Michelle M. Henshaw
- Global and Population Health, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Shelley Curtan
- Department of Community Dentistry, Case Western Reserve University, Cleveland, OH, United States
| | - Helen E. Lindau
- Department of Pediatric Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicolle Rueras
- Center for Behavioral Sciences Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Anna S. Sandoval
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - Stuart A. Gansky
- Center to Address Disparities in Children’s Oral Health (CAN DO), University of California, San Francisco, San Francisco, CA, United States
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Correspondence: Stuart A. Gansky,
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Banava S, Gansky SA, Reddy MS. Coronavirus Disease Update on Epidemiology, Virology, and Prevention. Compend Contin Educ Dent 2021; 42:280-289. [PMID: 34077666 PMCID: PMC8440952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In March 2020, the World Health Organization declared COVID-19 as the first coronavirus-initiated pandemic. COVID-19's fast-paced global spread with a broad range of clinical manifestations compelled health regulatory organizations, public health professionals, and researchers to update their information about the disease and provide individual- and community-based guidelines, solutions, and regulations to break the disease cycle, mitigate person-to-person transmission, and reduce cross-contamination in healthcare settings. In this review, the authors provide known facts and updated information about SARS-CoV-2 virology and its new variants, transmission routes, reported clinical symptoms, epidemiology, and infection control and prevention guidelines with a focus on a hierarchy of controls in dental settings.
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Affiliation(s)
- Sepideh Banava
- Postdoctoral Fellow, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | - Stuart A Gansky
- Associate Dean for Research, Professor, and Lee Hysan Chair of Oral Epidemiology, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, California; Affiliate Member, Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Michael S Reddy
- Dean and Associate Vice Chancellor, Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
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Jang A, Wang B, Ustriyana P, Gansky SA, Maslenikov I, Useinov A, Prevost R, Ho SP. Functional adaptation of interradicular alveolar bone to reduced chewing loads on dentoalveolar joints in rats. Dent Mater 2021; 37:486-495. [PMID: 33589268 DOI: 10.1016/j.dental.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/23/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The effects of reduced chewing loads on load bearing integrity of interradicular bone (IB) within dentoalveolar joints (DAJ) in rats were investigated. METHODS Four-week-old Sprague Dawley rats (N = 60) were divided into two groups; rats were either fed normal food, which is hard-pellet food (HF) (N = 30), or soft-powdered chow (SF) (N = 30). Biomechanical testing of intact DAJs and mapping of the resulting mechanical strains within IBs from 8- through 24-week-old rats fed HF or SF were performed. Tension- and compression-based mechanical strain profiles were mapped by correlating digital volumes of IBs at no load with the same IBs under load. Heterogeneity within IB was identified by mapping cement lines and TRAP-positive multinucleated cells using histology, and mechanical properties using nanoindentation technique. RESULTS Significantly decreased interradicular functional space, IB volume fraction, and elastic modulus of IB in the SF group compared with the HF group were observed, and these trends varied with an increase in age. The elastic modulus values illustrated significant heterogeneity within IB from HF or SF groups. Both compression- and tension-based strains were localized at the coronal portion of the IB and the variation in strain profiles complemented the observed material heterogeneity using histology and nanoindentation. SIGNIFICANCE Interradicular space and IB material-related mechanoadaptations in a DAJ are optimized to meet soft food related chewing demands. Results provided insights into age-specific regulation of chewing loads as a plausible "therapeutic dose" to reverse adaptations within the periodontal complex as an attempt to regain functional competence of a dynamic DAJ.
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Affiliation(s)
- Andrew Jang
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States
| | - Bo Wang
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States
| | - Putu Ustriyana
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States
| | - Stuart A Gansky
- Division of Oral Epidemiology & Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States
| | - Igor Maslenikov
- Technological Institute of Superhard and New Carbon Materials (TISNUM), ul. Tsentral'naya 7, Troitsk, Moscow, 142190, Russia
| | - Alex Useinov
- Technological Institute of Superhard and New Carbon Materials (TISNUM), ul. Tsentral'naya 7, Troitsk, Moscow, 142190, Russia
| | - Richard Prevost
- LaVision Inc. 211 W. Michigan Ave./Suite 100, Ypsilanti, MI 48197, United States
| | - Sunita P Ho
- Division of Preclinical Education, Biomaterials & Engineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States; Department of Urology, University of California San Francisco, CA 94143, United States.
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11
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Fernandez AM, Sherer BA, Gansky SA, Mena JD, Srirangapatanam S, Wiener SV, Chi T, Ho SP, Stoller ML. Ectopic biomineralization in kidney stone formers compared to non-stone formers. Transl Androl Urol 2020; 9:2129-2137. [PMID: 33209676 PMCID: PMC7658123 DOI: 10.21037/tau-19-927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Kidney stone formers (SFs) are at increased risk of stroke, myocardial infarction, and atherosclerosis of the carotid and coronary arteries. These cardiovascular and urologic pathologies can result from ectopic biomineral deposition. The objectives of this study are: (I) to evaluate risk factors for ectopic biomineralization, and (II) to characterize the overall burden of ectopic minerals in known SFs compared to non-stone formers (NSFs) matched for these risk factors. Methods Presence and quantity of biominerals at eight anatomic locations (abdominal aorta, common iliac arteries, pelvic veins, prostate or uterus, mesentery, pancreas, and spleen) were determined in a case control study by retrospective analysis of clinical non-contrast computed tomography scans obtained from 190 SFs and 190 gender- and age-matched NSFs (renal transplant donors). Predictors of biomineralization were determined using negative binomial regression. A subgroup of 140 SFs and 140 NSFs were matched for risk factors for systemic biomineralization, and mineralization was compared between these matched SFs and NSFs using ordinal logistic regression. Results Hypertension, hyperlipidemia, diabetes mellitus, and smoking were more common amongst SFs. Risk factors for increased systemic biomineralization included history of nephrolithiasis, male gender, older age, and history of hyperlipidemia. When controlling for these comorbidities, SFs had significantly increased biomineralization systemically and at the abdominal aorta, iliac arteries, prostate, mesentery, pancreas, and spleen compared to NSFs. Conclusions The current study provides evidence that SFs are at increased risk of biomineralization systemically, independent of common risk factors of atherosclerosis.
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Affiliation(s)
- Adrian M Fernandez
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin A Sherer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Stuart A Gansky
- Department of Preventative and Restorative Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Jorge D Mena
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | | | - Scott V Wiener
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Sunita P Ho
- Department of Preventative and Restorative Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Marshall L Stoller
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
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12
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Ramos-Gomez F, White JS, Lindau HE, Lin TK, Finlayson TL, Liu JX, Gansky SA. Family monetary incentives as a value-based care model for oral hygiene: rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial. J Public Health Dent 2020; 80:10.1111/jphd.12406. [PMID: 33090505 PMCID: PMC8761083 DOI: 10.1111/jphd.12406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective prevention-focused, value-based strategies are needed to improve oral health. Despite evidence that monetary incentives can motivate healthy behavior, well-powered studies have yet to examine incentives for improving children's oral hygiene. AIM Describe the rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial, which tests lottery-based monetary incentives as a consumer-oriented, value-based care model for improving children's oral hygiene. DESIGN Phase II, stratified, permuted block randomized, controlled, two-arm, parallel groups, prevention trial. SETTING Study visits occur at three Los Angeles, CA health clinics. PARTICIPANTS Two hundred and forty-four parent-child dyads with a child aged 6-48 months. INTERVENTIONS Eligible dyads were randomized in equal allocation to one of two groups: lottery incentive group or waitlist (delayed incentive) control group. Weekly lottery incentives were offered for 6 months based on Bluetooth-recorded toothbrushing frequency. Both groups received weekly text message feedback on toothbrushing performance. OUTCOMES The primary outcome was toothbrushing performance from baseline to 6 months, measured as the mean number of qualifying half-day Bluetooth-recorded episodes per week when the child's teeth were brushed. Secondary outcomes included toothbrushing performance sustainability through 12 months and dental caries status. CONCLUSIONS BEECON offers a consumer-oriented approach to promoting value-based oral health care. We hypothesize that lottery-based incentives can improve oral hygiene in young children. Study results will inform programming efforts to enhance oral disease prevention in young children. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03576326.
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Affiliation(s)
- Francisco Ramos-Gomez
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Center for Children’s Oral Health (UCCOH), University of California Los Angeles, Los Angeles, California, USA
| | - Justin S. White
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, University of California San Francisco, San Francisco, California, USA
| | - Helen E. Lindau
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Tracy K. Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Tracy L. Finlayson
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jenny X. Liu
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Stuart A. Gansky
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, University of California San Francisco, San Francisco, California, USA
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13
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White JS, Ramos-Gomez F, Liu JX, Jue B, Finlayson TL, Garza JR, Crawford AH, Helman S, Santo W, Cheng J, Kahn JG, Gansky SA. Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial. PLoS One 2020; 15:e0236692. [PMID: 32730310 PMCID: PMC7392266 DOI: 10.1371/journal.pone.0236692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/10/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. DESIGN A stratified, parallel-group, three-arm individually randomized controlled pilot trial. SETTING Two Los Angeles area Early Head Start (EHS) sites. PARTICIPANTS 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. INTERVENTIONS Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. OUTCOMES Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. FINDINGS Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. CONCLUSIONS Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03862443.
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Affiliation(s)
- Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
| | - Francisco Ramos-Gomez
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jenny X. Liu
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Institute for Health and Aging, University of California San Francisco, San Francisco, California, United States of America
| | - Bonnie Jue
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Tracy L. Finlayson
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Jeremiah R. Garza
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Alexandra H. Crawford
- California Protons Cancer Therapy Center, University of California San Diego Health, San Diego, California, United States of America
| | - Sarit Helman
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - William Santo
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jing Cheng
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Stuart A. Gansky
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
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14
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Yukawa M, Gansky SA, O'Sullivan P, Teherani A, Feldman MD. A new Mentor Evaluation Tool: Evidence of validity. PLoS One 2020; 15:e0234345. [PMID: 32544185 PMCID: PMC7297334 DOI: 10.1371/journal.pone.0234345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Mentorship plays an essential role in enhancing the success of junior faculty. Previous evaluation tools focused on specific types of mentors or mentees. The main objective was to develop and provide validity evidence for a Mentor Evaluation Tool (MET) to assess the effectiveness of one-on-one mentoring for faculty in the academic health sciences. Methods Evidence was collected for the validity domains of content, internal structure and relationship to other variables. The 13 item MET was tested for internal structure evidence with 185 junior faculty from Schools of Dentistry, Medicine, Nursing, and Pharmacy. Finally, the MET was studied for additional validity evidence by prospectively enrolling mentees of three different groups of faculty (faculty nominated for, or winners of, a lifetime achievement in mentoring award; faculty graduates of a mentor training program; and faculty mentors not in either of the other two groups) at the University of California San Francisco (UCSF) and asking them to rate their mentors using the MET. Mentors and mentees were clinicians, educators and/or researchers. Results The 13 MET items mapped well to the five mentoring domains and six competencies described in the literature. The standardized Cronbach’s coefficient alpha was 0.96. Confirmatory factor analysis supported a single factor (CFI = 0.89, SRMR = 0.05). The three mentor groups did not differ in the single overall assessment item (P = 0.054) or mean MET score (P = 0.288), before or after adjusting for years of mentoring. The mentorship score means were relatively high for all three groups. Conclusions The Mentor Evaluation Tool demonstrates evidence of validity for research, clinical, educational or career mentors in academic health science careers. However, MET did not distinguish individuals nominated as outstanding mentors from other mentors. MET validity evidence can be studied further with mentor-mentee pairs and to follow prospectively the rating of mentors before and after a mentorship training program.
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Affiliation(s)
- Michi Yukawa
- Department of Medicine, University of California San Francisco, Division of Geriatrics, San Francisco, California, United States of America.,San Francisco VA Medical Center, Department of Medicine, Geriatrics, Palliative and Extended Care Service, San Francisco, California, United States of America
| | - Stuart A Gansky
- Department of Dentistry, University of California San Francisco, San Francisco, California, United States of America
| | - Patricia O'Sullivan
- Department of Medicine, University of California San Francisco, Division of Geriatrics, San Francisco, California, United States of America
| | - Arianne Teherani
- Department of Medicine, University of California San Francisco, Division of Geriatrics, San Francisco, California, United States of America
| | - Mitchell D Feldman
- Department of Medicine, University of California San Francisco, Division of Geriatrics, San Francisco, California, United States of America
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15
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Martin MA, Zimmerman LJ, Rosales GF, Lee HH, Songthangtham N, Pugach O, Sandoval AS, Avenetti D, Alvarez G, Gansky SA. Design and sample characteristics of COordinated Oral health Promotion (CO-OP) Chicago: A cluster-randomized controlled trial. Contemp Clin Trials 2020; 92:105919. [PMID: 31899372 PMCID: PMC7309222 DOI: 10.1016/j.cct.2019.105919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022]
Abstract
COordinated Oral health Promotion (CO-OP) Chicago is a two-arm cluster-randomized trial with a wait-list control. The primary aim is to evaluate the efficacy of an oral health community health worker (CHW) intervention to improve oral health behaviors in low-income, urban children under the age of three years. Exploratory aims will determine cost-effectiveness, and if any CHW intervention impact on child tooth brushing behaviors varies when CHWs are based out of a medical clinic compared to a community setting. This paper describes progress toward achieving these aims. Participating families were recruited from community social service centers and pediatric primary care medical clinics in Cook County, Illinois. Sites were cluster-randomized to CHW intervention or usual services (a wait-list control). The intervention is oral health support from CHWs delivered in four visits to individual families over one year. The trial sample consists of 420 child/caregiver dyads enrolled at the 20 participating sites over 11 months. Participant demographics varied across the sites, but primary outcomes values at baseline did not. Data on brushing frequency, plaque, and other oral health behaviors are collected at three timepoints: baseline, 6-, and 12-months. The primary analysis will assess differences in caregiver-reported child brushing frequency and observed plaque score between the two arms at 12-months. The trial is currently in the active intervention phase. The trial's cluster-randomized controlled design takes a real-world approach by integrating into existing health and social service agencies and collecting data in participant homes. Results will address an important child health disparity. ClinicalTrials.gov identifier: NCT03397589. CLINICAL TRIAL REGISTRATION: University of Illinois at Chicago Protocol Record 2017-1090. National Institutes of Dental & Craniofacial Research of the National Institutes of Health (NIDCR) Protocol Number: 17-074-E. NCT03397589.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago, College of Medicine, 1853 W Polk St, Chicago, IL 60612, United States; University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States.
| | - Lacey J Zimmerman
- University of Illinois at Chicago, College of Medicine, 1853 W Polk St, Chicago, IL 60612, United States
| | - Genesis F Rosales
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Helen H Lee
- University of Illinois at Chicago, College of Medicine, 1853 W Polk St, Chicago, IL 60612, United States; University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Nattanit Songthangtham
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Oksana Pugach
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Anna S Sandoval
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - David Avenetti
- University of Illinois at Chicago, College of Dentistry, 801 S Paulina St, Chicago, IL 60612, United States
| | - Gizelle Alvarez
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Stuart A Gansky
- University of California, Box# 1361, San Francisco, CA 94143, United States
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16
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Finlayson TL, Cabudol M, Liu JX, Garza JR, Gansky SA, Ramos-Gomez F. A qualitative study of the multi-level influences on oral hygiene practices for young children in an Early Head Start program. BMC Oral Health 2019; 19:166. [PMID: 31349826 PMCID: PMC6660967 DOI: 10.1186/s12903-019-0857-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individual child-level risk factors for Early Childhood Caries (ECC) have been studied, but broader family- and community-level influences on child oral hygiene behaviors are less well understood. This study explored multiple levels of influence on oral hygiene behaviors for young children in Early Head Start (EHS) to inform a future behavioral intervention targeting children from low-income families. METHODS Twenty-four semi-structured interviews were conducted with mothers of children under 4 years old, enrolled in the home visitor (HV) component of one EHS program in Los Angeles, CA, who participated in the BEhavioral EConomics for Oral health iNnovation pilot study (BEECON) in 2016-7. Audio-recordings of interviews were translated if needed, and transcribed in English, and coding and analysis was facilitated by Dedoose qualitative software. This investigation used general thematic analysis guided by the Fisher-Owens child oral health conceptual framework to identify influences on oral hygiene behaviors for the young children. RESULTS Many mothers reported brushing their children's teeth twice/day, and concern that most children frequently resisted brushing. They identified children being sick or tired/asleep after outings as times when brushing was skipped. Several child-, family-, and community-level themes were identified as influences on child oral hygiene behaviors. At the child-level, the child's developmental stage and desire for independence was perceived as a negative influence. Family-level influences included the mother's own oral hygiene behaviors, other family role models, the mother's knowledge and attitudes about child oral health, and mothers' coping skills and strategies for overcoming challenges with brushing her child's teeth. Overall, mothers in the EHS-HV program were highly knowledgeable about ECC risk factors, including the roles of bacteria and sugar consumption, which motivated regular hygiene behavior. At the community-level, mothers discussed opportunities to connect with other EHS-HV families during parent meetings and playgroups that HV coordinated. A few mothers noted that EHS-HV playgroups included brushing children's teeth after snacking, which can be a potential positive influence on children's hygiene practices. CONCLUSION Child-, family- and community-level factors are important to consider to inform the development of tailored oral health preventive care programs for families in EHS-HV programs.
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Affiliation(s)
- Tracy L Finlayson
- School of Public Health, Health Management and Policy, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA.,Center to Address Disparities in Children's Oral Health (known as CAN DO), University of California San Francisco, School of Dentistry, Box #1361, San Francisco, CA, 94143, USA
| | - MarkJason Cabudol
- University of Washington (UCLA School of Dentistry at the time of this work), Seattle, WA, USA.,Center to Address Disparities in Children's Oral Health (known as CAN DO), University of California San Francisco, School of Dentistry, Box #1361, San Francisco, CA, 94143, USA
| | - Jenny X Liu
- Department of Social and Behavioral Sciences, School of Nursing, Institute for Health & Aging, University of California San Francisco, San Francisco, CA, 94143, USA.,Center to Address Disparities in Children's Oral Health (known as CAN DO), University of California San Francisco, School of Dentistry, Box #1361, San Francisco, CA, 94143, USA.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, Box #0936, San Francisco, CA, 94143, USA
| | - Jeremiah R Garza
- Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, 650 South Charles E. Young Drive South, Box 951772, Los Angeles, CA, 90095-1772, USA.,Center to Address Disparities in Children's Oral Health (known as CAN DO), University of California San Francisco, School of Dentistry, Box #1361, San Francisco, CA, 94143, USA
| | - Stuart A Gansky
- School of Dentistry, University of California San Francisco, Box #1361, San Francisco, CA, 94143, USA. .,Center to Address Disparities in Children's Oral Health (known as CAN DO), University of California San Francisco, School of Dentistry, Box #1361, San Francisco, CA, 94143, USA. .,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, Box #0936, San Francisco, CA, 94143, USA.
| | - Francisco Ramos-Gomez
- Section of Pediatric Dentistry, University of California Los Angeles, School of Dentistry, 10833 Le Conte Avenue, Box 951668, CHS Room 23-020B, Los Angeles, CA, 90095-1668, USA.,Center to Address Disparities in Children's Oral Health (known as CAN DO), University of California San Francisco, School of Dentistry, Box #1361, San Francisco, CA, 94143, USA
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17
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White JM, Mertz EA, Mullins JM, Even JB, Guy T, Blaga E, Kottek AM, Kumar SV, Bangar S, Vaderhobli R, Brandon R, Santo W, Jenson L, Gansky SA. Developing and Testing Electronic Health Record-Derived Caries Indices. Caries Res 2019; 53:650-658. [PMID: 31167186 DOI: 10.1159/000499700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/18/2019] [Indexed: 12/15/2022] Open
Abstract
Caries indices, the basis of epidemiologic caries measures, are not easily obtained in clinical settings. This study's objective was to design, test, and validate an automated program (Valid Electronic Health Record Dental Caries Indices Calculator Tool [VERDICT]) to calculate caries indices from an electronic health record (EHR). Synthetic use case scenarios and actual patient cases of primary, mixed, and permanent dentition, including decayed, missing, and filled teeth (DMFT/dmft) and tooth surfaces (DMFS/dmfs) were entered into the EHR. VERDICT measures were compared to a previously validated clinical electronic data capture (EDC) system and statistical program to calculate caries indices. Four university clinician-researchers abstracted EHR caries exam data for 45 synthetic use cases into the EDC and post-processed with SAS software creating a gold standard to compare the -VERDICT-derived caries indices. Then, 2 senior researchers abstracted EHR caries exam data and calculated caries indices for 24 patients, allowing further comparisons to VERDICT indices. Agreement statistics were computed among abstractors, and discrepancies were resolved by consensus. Agreement statistics between the 2 final-phase abstractors and the VERDICT measures showed extremely high concordance: Lin's concordance coefficients (LCCs) >0.99 for dmfs, dmft, DS, ds, DT, dt, ms, mt, FS, fs, FT, and ft; LCCs >0.95 for DMFS and DMFT; and LCCs of 0.92-0.93 for MS and MT. Caries indices, essential to developing primary health outcome measures for research, can be reliably derived from an EHR using VERDICT. Using these indices will enable population oral health management approaches and inform quality improvement efforts.
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Affiliation(s)
- Joel M White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA, .,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA,
| | - Elizabeth A Mertz
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Joanna M Mullins
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Joshua B Even
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Trey Guy
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Elena Blaga
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Aubri M Kottek
- Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Shwetha V Kumar
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Suhasini Bangar
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ram Vaderhobli
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - William Santo
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA
| | - Larry Jenson
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Stuart A Gansky
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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Gansky SA, Shafik S. At the crossroads of oral health inequities and precision public health. J Public Health Dent 2019; 80 Suppl 1:S14-S22. [PMID: 31063590 DOI: 10.1111/jphd.12316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/06/2019] [Accepted: 03/14/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This paper reviews the precision public health literature pertaining to oral health, identifies possible threats that could inadvertently increase health inequities, and proposes potential opportunities that precision public health could utilize to reduce oral health inequities. METHODS The health sciences literature was reviewed and supplemented with new data to identify important issues relating to precision medicine, precision oral health, precision public health, and health equity. RESULTS Examples from general health and oral health were provided to illustrate salient concepts. CONCLUSIONS Future precision public health should utilize multifactorial, multi-level conceptual frameworks and conceptual causal models with upstream social determinants and downstream health effects, as well as a proportionate universalism perspective; and proper analytic methods, including sufficient sample sizes, appropriate statistical competitors, health disparity indices, causal modeling, and internal and external validation.
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Affiliation(s)
- Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health, University of California, San Francisco, CA, USA
| | - Sarah Shafik
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health, University of California, San Francisco, CA, USA
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19
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Cheng J, Gregorich SE, Gansky SA, Fisher-Owens SA, Kottek AM, White JM, Mertz EA. Constructing Matched Groups in Dental Observational Health Disparity Studies for Causal Effects. JDR Clin Trans Res 2019; 5:82-91. [PMID: 30931723 DOI: 10.1177/2380084419830655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Electronic health record (EHR) systems provide investigators with rich data from which to examine actual impacts of care delivery in real-world settings. However, confounding is a major concern when comparison groups are not randomized. OBJECTIVES This article introduced a step-by-step strategy to construct comparable matched groups in a dental study based on the EHR of the Willamette Dental Group. This strategy was employed in preparation for a longitudinal study evaluating the impact of a standardized risk-based caries prevention and management program across patients with public versus private dental insurance in Oregon. METHODS This study constructed comparable dental patient groups through a process of 1) evaluating the need for and feasibility of matching, 2) considering different matching methods, and 3) evaluating matching quality. The matched groups were then compared for their average ratio in the number of decayed, missing, and filled tooth surfaces (DMFS + dmfs) at baseline. RESULTS This systematic process resulted in comparably matched groups in baseline covariates but with a clear baseline disparity in caries experience between them. The weighted average ratio in our study showed that, at baseline, publicly insured patients had 1.21-times (95% CI: 1.08 to 1.32) and 1.21-times (95% CI: 1.08 to 1.37) greater number of DMFS + dmfs and number of decayed tooth surfaces (DS + ds) than privately insured patients, respectively. CONCLUSION Matching is a useful tool to create comparable groups with EHR data to resemble randomized studies, as demonstrated by our study where even with similar demographics, neighborhood and clinic characteristics, publicly insured pediatric patients had greater numbers of DMFS + dmfs and DS + ds than privately insured pediatric patients. KNOWLEDGE TRANSFER STATEMENT This article provides a systematic, step-by-step strategy for investigators to follow when matching groups in a study-in this case, a study based on electronic health record data. The results from this study will provide patients, clinicians, and policy makers with information to better understand the disparities in oral health between comparable publicly and privately insured pediatric patients who have similar values in individual, clinic, and community covariates. Such understanding will help clinicians and policy makers modify oral health care and relevant policies to improve oral health and reduce disparities between publicly and privately insured patients.
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Affiliation(s)
- J Cheng
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - S E Gregorich
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Department of Medicine, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - S A Gansky
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California-San Francisco, San Francisco, CA, USA
| | - S A Fisher-Owens
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Department of Pediatrics, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - A M Kottek
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA, USA
| | - J M White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - E A Mertz
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA, USA
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20
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Chaffee BW, Couch ET, Urata J, Gansky SA, Essex G, Cheng J. Predictors of Smokeless Tobacco Susceptibility, Initiation, and Progression Over Time Among Adolescents in a Rural Cohort. Subst Use Misuse 2019; 54:1154-1166. [PMID: 30694094 PMCID: PMC6483853 DOI: 10.1080/10826084.2018.1564330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball. OBJECTIVES This study aimed to assess factors associated with adolescent male athletes' ST-related behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort. METHODS Baseline and one-year follow-up questionnaires assessed sociodemographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9- to12th-grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use). RESULTS Of 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this high-risk adolescent population.
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Affiliation(s)
- Benjamin W Chaffee
- a Department of Preventive and Restorative Dental Sciences , University of California , San Francisco , CA , USA
| | - Elizabeth T Couch
- a Department of Preventive and Restorative Dental Sciences , University of California , San Francisco , CA , USA
| | - Janelle Urata
- a Department of Preventive and Restorative Dental Sciences , University of California , San Francisco , CA , USA
| | - Stuart A Gansky
- a Department of Preventive and Restorative Dental Sciences , University of California , San Francisco , CA , USA
| | - Gwen Essex
- a Department of Preventive and Restorative Dental Sciences , University of California , San Francisco , CA , USA
| | - Jing Cheng
- a Department of Preventive and Restorative Dental Sciences , University of California , San Francisco , CA , USA
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21
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Abstract
Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.
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Affiliation(s)
- Richard G Watt
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | - Manu Raj Mathur
- Department of Dental Public Health, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Gurgaon, Haryana 122002, India
| | - Jun Aida
- Department of International Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Marcelo Bönecker
- Dental Faculty, Av. Prof Lineu Prestes 2227 - University of Sao Paulo, Sao Paulo 05508-900, Brazil
| | - Renato Venturelli
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health (Known As CAN DO), Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Box #1361, San Francisco, CA 94143, USA
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22
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Abstract
Different conventional and causal approaches have been proposed for mediation analysis to better understand the mechanism of a treatment. Count and zero-inflated count data occur in biomedicine, economics, and social sciences. This paper considers mediation analysis for count and zero-inflated count data under the potential outcome framework with nonlinear models. When there are post-treatment confounders which are independent of, or affected by, the treatment, we first define the direct, indirect, and total effects of our interest and then discuss various conditions under which the effects of interest can be identified. Proofs are provided for the sensitivity analysis proposed in the paper. Simulation studies show that the methods work well. We apply the methods to the Detroit Dental Health Project's Motivational Interviewing DVD trial for the direct and indirect effects of motivational interviewing on count and zero-inflated count dental caries outcomes.
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Affiliation(s)
- Jing Cheng
- Division of Oral Epidemiology & Dental Public Health, University of California at San Francisco
| | - Nancy F. Cheng
- Division of Oral Epidemiology & Dental Public Health, University of California at San Francisco
| | - Zijian Guo
- Department of Statistics, Wharton School, University of Pennsylvania
| | - Steve Gregorich
- Department of Medicine, School of Medicine, University of California at San Francisco
| | - Amid I. Ismail
- Department of Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple Universty
| | - Stuart A. Gansky
- Division of Oral Epidemiology & Dental Public Health, University of California at San Francisco
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23
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Wides CD, Brody HA, Alexander CJ, Gansky SA, Mertz EA. Long-Term Outcomes of a Dental Postbaccalaureate Program: Increasing Dental Student Diversity and Oral Health Care Access. J Dent Educ 2018. [DOI: 10.1002/j.0022-0337.2013.77.5.tb05501.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Cynthia D. Wides
- Department of Preventive and Restorative Dental Sciences; Center for the Health Professions; School of Dentistry University of California; San Francisco
| | - Harvey A. Brody
- Department of Oral and Maxillofacial Surgery; School of Dentistry, University of California, San Francisco, and Professor of Biology, San Francisco State University
| | | | - Stuart A. Gansky
- Department of Preventive and Restorative Dental Sciences; School of Dentistry, University of California; San Francisco
| | - Elizabeth A. Mertz
- Department of Preventive and Restorative Dental Sciences; Center for the Health Professions; School of Dentistry, University of California; San Francisco
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Hayashi Y, Taylor G, Yoshihara A, Iwasaki M, Gansky SA, Miyazaki H. Relationship between autoantibody associated with rheumatoid arthritis and tooth loss. Gerodontology 2018; 35:229-236. [PMID: 29781538 DOI: 10.1111/ger.12344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 02/28/2024]
Abstract
INTRODUCTION This study evaluated the relationship between serum Rheumatoid Factor (RF) levels and tooth loss in a community-dwelling elderly Japanese women. It was hypothesised that women with high baseline RF levels would experience greater tooth loss over 10 years than age-matched women with lower baseline serum RF levels. MATERIALS AND METHODS The study population consisted of 197 women aged 70 years with ≥12 teeth at baseline. One hundred and twenty-four participants completed a 10-year follow-up and were divided into 2 groups according to their baseline serum RF levels as follows: RF negative (<15 U/mL; n = 114) and RF positive (>15 U/mL; n = 10). Negative binomial regression was used to investigate the relationship between baseline RFs and tooth lost over the 10-year period. RF and its interaction with the baseline number of teeth were independent variables, with 9 other adjustment covariates. RESULTS Baseline RFs were significantly associated with tooth loss (P = .035). In addition, a statistical interaction between baseline RFs and baseline number of teeth was identified (P = .023), modifying the association between RFs and tooth loss. The adjusted incidence rate ratio (IRR) for RF-positive participants with 21 baseline teeth was 1.88 (95% confidence interval (95% CI): 0.76, 4.65). IRRs obtained for participants who had 25 baseline teeth (3.02; 95% CI: 1.03, 8.83) or 30 baseline teeth (5.47; 95% CI: 1.29, 23.13) suggested that RF-positive participants with a high number of baseline teeth would exhibit greater tooth loss than RF-negative participants. CONCLUSION High serum RF levels were associated with a greater IRR for future tooth loss in elderly Japanese women.
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Affiliation(s)
- Yuko Hayashi
- Division of Preventive Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - George Taylor
- Division of Oral Epidemiology and Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, CA, USA
| | - Akihiro Yoshihara
- Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan
| | - Masanori Iwasaki
- Department of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, CA, USA
| | - Hideo Miyazaki
- Division of Preventive Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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25
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Hastings NB, Centore LS, Gansky SA, Finzen FC, White JM, Wong E, Marshall GW, Chung L, Kalenderian E. A novel approach for effective integration of new faculty leadership. J Healthc Leadersh 2018; 10:1-9. [PMID: 29720883 PMCID: PMC5919165 DOI: 10.2147/jhl.s150493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose We report on an accelerated and effective way of assimilating a new leader into a team at a large academic dental school department. Methods At University of California, San Francisco (UCSF), a new Chair was recruited through a national search to lead its largest department in the School of Dentistry. Two months after arrival, the new Chair embarked on a process of leadership assimilation among her executive team, facilitated by a professional consultant. Within four weeks, team members participated in one-on-one interviews with the professional facilitator consultant and then completed the leadership assimilation questionnaire and returned it electronically to the facilitator. The facilitator then summarized all answers into themes and met with the team members without the Chair to debrief. Thereafter, the facilitator met with the Chair to discuss the major themes. Next, the Chair met with the team members in a facilitated session to discuss the results and negotiate a path forward. Results Approximately half of the feedback described the “how” of leadership: comments on communication, building relationships, building trust, and understanding UCSF history. The remaining half described the “what”: comments on vision, strategy, and operations. Team members indicated that the first debriefing session was helpful to alleviate initial anxiety and to start building team spirit. The session with the Chair was perceived as open and fruitful in which team members were able to express their concerns and hopes for the Department, while the Chair showed commitment to the team and the communication process. Conclusion Leader assimilation allows teams to share their expectations and anxieties with the new leader early in the relationship in an open way, before new habits and beliefs are formed. Conversely, for the leader, it effectively and efficiently allows a window into the team members’ thinking at a critical time period when otherwise first impressions occur. With a safe space created for open communication, the process allowed siloed individual division leaders to move toward a cohesive group while at the same time solidifying a commitment to the success of the new leader.
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Affiliation(s)
- Natalie B Hastings
- Division of Clinical General Dentistry, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Linda S Centore
- Division of Behavioral Sciences … Community Dental Education, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Stuart A Gansky
- Division of Oral Epidemiology … Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Frederick C Finzen
- Division of Prosthodontics, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Joel M White
- Division of Preclinical Simulation, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Eric Wong
- Division of Endodontics, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Grayson W Marshall
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Lisa Chung
- Division of Oral Epidemiology … Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Elsbeth Kalenderian
- Division of Oral Epidemiology … Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
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26
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Guo Z, Small DS, Gansky SA, Cheng J. Mediation analysis for count and zero-inflated count data without sequential ignorability and its application in dental studies. J R Stat Soc Ser C Appl Stat 2018; 67:371-394. [PMID: 30983638 DOI: 10.1111/rssc.12233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mediation analysis seeks to understand the mechanism by which a treatment affects an outcome. Count or zero-inflated count outcomes are common in many studies in which mediation analysis is of interest. For example, in dental studies, outcomes such as the number of decayed, missing and filled teeth are typically zero inflated. Existing mediation analysis approaches for count data often assume sequential ignorability of the mediator. This is often not plausible because the mediator is not randomized so unmeasured confounders are associated with the mediator and the outcome. We develop causal methods based on instrumental variable approaches for mediation analysis for count data possibly with many 0s that do not require the assumption of sequential ignorability. We first define the direct and indirect effect ratios for those data, and then we propose estimating equations and use empirical likelihood to estimate the direct and indirect effects consistently. A sensitivity analysis is proposed for violations of the instrumental variables exclusion restriction assumption. Simulation studies demonstrate that our method works well for different types of outcome under various settings. Our method is applied to a randomized dental caries prevention trial and a study of the effect of a massive flood in Bangladesh on children's diarrhoea.
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Affiliation(s)
| | | | | | - Jing Cheng
- University of California, San Francisco, USA
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27
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Chaffee BW, Couch ET, Gansky SA. Adolescents' smokeless tobacco susceptibility by perceived professional baseball players' use. J Public Health Dent 2017; 78:5-8. [PMID: 28590522 DOI: 10.1111/jphd.12228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/05/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Measure associations between adolescent baseball players' perceptions of smokeless tobacco (ST) use by professional baseball players and those adolescents' actual ST use and susceptibility. METHODS Male baseball players (N = 360) at 25 rural California high schools completed tobacco behavior surveys and reported how likely they believed it was their favorite major league baseball player used ST. We compared ST use and, among ST never-users, willingness and expectations to use ST, according to perceived favorite player's use. RESULTS Adolescents responding that their favorite player definitely or probably used ST were significantly more likely to use ST themselves. High school ST never-users who perceived that their favorite player definitely used ST were 2.5 to 3-times more likely to be susceptible to ST initiation than participants responding that their favorite player definitely did not use ST. CONCLUSIONS Adolescents' ST behaviors and intentions were correlated with their perceptions of professional baseball players' ST use.
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Affiliation(s)
- Benjamin W Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth T Couch
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Stuart A Gansky
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA
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28
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Albino J, Tiwari T, Gansky SA, Henshaw MM, Barker JC, Brega AG, Gregorich SE, Heaton B, Batliner TS, Borrelli B, Geltman P, Kressin NR, Weintraub JA, Finlayson TL, Garcia RI. The basic research factors questionnaire for studying early childhood caries. BMC Oral Health 2017; 17:83. [PMID: 28526003 PMCID: PMC5437655 DOI: 10.1186/s12903-017-0374-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We describe development of the Early Childhood Caries (ECC) Basic Research Factors Questionnaire (BRFQ), a battery of measures assessing common potential predictors, mediators, and moderators of ECC. Individual-, family-, and community-level factors that are linked to oral health outcomes across at-risk populations are included. Developing standard measures of factors implicated in ECC has the potential to enhance our ability to understand mechanisms underlying successful prevention and to develop more effective interventions. METHODS The Early Childhood Caries Collaborating Centers (EC4), funded by National Institute of Dental and Craniofacial Research, developed the BRFQ, which was used across four randomized trials to develop and test interventions for reducing ECC in at-risk populations. Forty-five investigators from across the centers and NIDCR were involved in the development process. Eight "measures working groups" identified relevant constructs and effective measurement approaches, which were then categorized as "essential" or "optional" common data elements (CDEs) for the EC4 projects. RESULTS Essential CDEs include 88 items, with an additional 177 measures categorized as optional CDEs. Essential CDEs fell under the following domains: oral health knowledge, oral health behavior, utilization/insurance and cost, parent/caregiver dental self-efficacy, quality of life, caregiver and family characteristics, and child characteristics. CONCLUSIONS The BRFQ makes available a battery of measures that support efforts to understand population risk factors for ECC and to compare oral health outcomes across populations at risk. The BRFQ development process may be useful to other clinical research networks and consortia developing CDEs in other health research fields. TRIAL REGISTRATION All the trial that used the BRFQ were registered at Clinicaltrial.gov NCT01116726 , April 29, 2010; NCT01116739 , May 3, 2010; NCT01129440 , May 21, 2010; and NCT01205971 , September 19, 2010.
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Affiliation(s)
- Judith Albino
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tamanna Tiwari
- Department of Applied Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Stuart A Gansky
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Michelle M Henshaw
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Judith C Barker
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Angela G Brega
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven E Gregorich
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA.,Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Brenda Heaton
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Terrence S Batliner
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Belinda Borrelli
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Paul Geltman
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Nancy R Kressin
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.,Section of General Internal medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,VA Boston Healthcare System, Jamaica Plain, MA, USA
| | - Jane A Weintraub
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA.,University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - Tracy L Finlayson
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA.,Graduate School of Public Health, San Diego State University, San Diego, USA
| | - Raul I Garcia
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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29
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White JM, Jenson LE, Gansky SA, Walsh CJ, Accurso BT, Vaderhobli RM, Kalenderian E, Walji MF, Cheng J. Dental Students’ Clinical Experience Across Three Successive Curricula at One U.S. Dental School. J Dent Educ 2017; 81:366-377. [DOI: 10.21815/jde.016.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/08/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Joel M. White
- Department of Preventive and Restorative Dentistry; University of California, San Francisco School of Dentistry
| | | | - Stuart A. Gansky
- Department of Preventive and Restorative Dentistry; University of California, San Francisco School of Dentistry
| | | | | | - Ram M. Vaderhobli
- Department of Preventive and Restorative Dentistry; University of California, San Francisco School of Dentistry
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dentistry; University of California, San Francisco School of Dentistry
| | | | - Jing Cheng
- Department of Preventive and Restorative Dentistry; University of California, San Francisco School of Dentistry
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Garcia RI, Gregorich SE, Ramos-Gomez F, Braun PA, Wilson A, Albino J, Tiwari T, Harper M, Batliner TS, Rasmussen M, Cheng NF, Santo W, Geltman PL, Henshaw M, Gansky SA. Absence of Fluoride Varnish-Related Adverse Events in Caries Prevention Trials in Young Children, United States. Prev Chronic Dis 2017; 14:E17. [PMID: 28207379 PMCID: PMC5313125 DOI: 10.5888/pcd14.160372] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Fluoride varnish is an effective prevention intervention for caries in young children. Its routine use in clinical care is supported by meta-analyses and recommended by clinical guidelines, including the US Preventive Services Task Force (B rating). This report is the first prospective systematic assessment of adverse events related to fluoride varnish treatment in young children. Methods We determined the incidence of adverse events related to fluoride varnish treatment in 3 clinical trials on the prevention of early childhood caries, conducted under the auspices of the Early Childhood Caries Collaborating Centers, an initiative sponsored by the National Institute of Dental and Craniofacial Research. Each trial incorporated use of fluoride varnish in its protocol and systematically queried all children’s parents or legal guardians about the occurrence of acute adverse events after each fluoride varnish treatment. Results A total of 2,424 community-dwelling, dentate children aged 0 to 5 years were enrolled and followed for up to 3 years. These children received a cumulative total of 10,249 fluoride varnish treatments. On average, each child received 4.2 fluoride varnish treatments. We found zero fluoride varnish–related adverse events. Conclusion Fluoride varnish was not associated with treatment-related adverse events in young children. Our findings support its safety as an effective prevention intervention for caries in young children.
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Affiliation(s)
- Raul I Garcia
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Steven E Gregorich
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco.,Department of Medicine, School of Medicine, University of California, San Francisco
| | | | - Patricia A Braun
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anne Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Judith Albino
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maya Harper
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Terrence S Batliner
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Rasmussen
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
| | - Nancy F Cheng
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
| | - William Santo
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
| | - Paul L Geltman
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Michelle Henshaw
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Stuart A Gansky
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
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Abstract
Knowledge Discovery and Data Mining (KDD) have become popular buzzwords. But what exactly is data mining? What are its strengths and limitations? Classic regression, artificial neural network (ANN), and classification and regression tree (CART) models are common KDD tools. Some recent reports ( e.g., Kattan et al., 1998 ) show that ANN and CART models can perform better than classic regression models: CART models excel at covariate interactions, while ANN models excel at nonlinear covariates. Model prediction performance is examined with the use of validation procedures and evaluating concordance, sensitivity, specificity, and likelihood ratio. To aid interpretation, various plots of predicted probabilities are utilized, such as lift charts, receiver operating characteristic curves, and cumulative captured-response plots. A dental caries study is used as an illustrative example. This paper compares the performance of logistic regression with KDD methods of CART and ANN in analyzing data from the Rochester caries study. With careful analysis, such as validation with sufficient sample size and the use of proper competitors, problems of naïve KDD analyses ( Schwarzer et al., 2000 ) can be carefully avoided.
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Affiliation(s)
- S A Gansky
- Center for Health and Community, Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, CA 94143-1361, USA.
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32
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Garcia RI, Tiwari T, Ramos-Gomez F, Heaton B, Orozco M, Rasmussen M, Braun P, Henshaw M, Borrelli B, Albino J, Diamond C, Gebel C, Batliner TS, Barker JC, Gregorich S, Gansky SA. Retention strategies for health disparities preventive trials: findings from the Early Childhood Caries Collaborating Centers. J Public Health Dent 2016; 77:63-77. [PMID: 27759164 DOI: 10.1111/jphd.12182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/27/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify successful strategies for retention of participants in multiyear, community-based randomized controlled trials (RCTs) aiming to reduce early childhood caries in health disparities populations from diverse racial/ethnic backgrounds and across diverse geographic settings. METHODS Four RCTs conducted by the Early Childhood Caries Collaborating Centers (EC4), an initiative of the National Institute of Dental and Craniofacial Research, systematically collected information on the success of various strategies implemented to promote participant retention in each RCT. The observational findings from this case series of four RCTs were tabulated and the strategies rated by study staff. RESULTS Participant retention at 12 months of follow-up ranged from 52.8 percent to 91.7 percent, and at 24 months ranged from 53.6 percent to 85.9, across the four RCTs. For the three RCTs that had a 36-month follow-up, retention ranged from 53.6 percent to 85.1 percent. Effectiveness of different participant retention strategies varied widely across the RCTs. CONCLUSIONS Findings from this case series study may help to guide the design of future RCTs to maximize retention of study participants and yield needed data on effective interventions to reduce oral health disparities.
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Affiliation(s)
- Raul I Garcia
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Tamanna Tiwari
- Department of Applied Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Francisco Ramos-Gomez
- Division of Growth and Development, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Brenda Heaton
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Mario Orozco
- Division of Growth and Development, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Margaret Rasmussen
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Patricia Braun
- Center for Native Oral Health Research (CNOHR), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michelle Henshaw
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Belinda Borrelli
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Judith Albino
- Center for Native Oral Health Research (CNOHR), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Courtney Diamond
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Christina Gebel
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Terrence S Batliner
- Center for Native Oral Health Research (CNOHR), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Judith C Barker
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Steven Gregorich
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.,Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stuart A Gansky
- Center to Address Disparities in Children's Oral Health (CAN DO), Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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Affiliation(s)
- Gary G. Koch
- Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Stuart A. Gansky
- Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
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Couch ET, Chaffee BW, Gansky SA, Walsh MM. The changing tobacco landscape: What dental professionals need to know. J Am Dent Assoc 2016; 147:561-9. [PMID: 26988178 PMCID: PMC4925234 DOI: 10.1016/j.adaj.2016.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tobacco products in the United States and the patterns of tobacco use are changing. Although cigarette smoking prevalence has declined, dental professionals are likely to encounter substantial numbers of patients who have tried and are continuing to use new and alternative tobacco products, including cigars, water pipes (hookahs), and electronic cigarettes, as well as conventional and new smokeless tobacco products. METHODS The authors reviewed conventional and new tobacco products in the United States, their adverse oral and systemic health effects, and their prevalence of use. RESULTS Tobacco products other than cigarettes account for a substantial portion of tobacco use. For this reason, tobacco-use prevention and cessation counseling provided by dental health care professionals must address all tobacco products, including cigarettes, cigars, water pipes, and electronic cigarettes, as well as conventional and new smokeless tobacco products. Cigarette smoking and smokeless tobacco use are associated with immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Novel products may attract new tobacco users, potentially leading to addiction that results in enduring tobacco product use and associated adverse health effects. CONCLUSIONS This critical review of conventional, new, and emerging tobacco products presents information that dental professionals can use in providing tobacco-related counseling to patients who use or who are at risk for using tobacco products. PRACTICAL IMPLICATIONS It is essential that dental professionals are knowledgeable about tobacco products and are able to answer patients' questions and provide them with evidence-based tobacco-related counseling. This information may prevent patients from initiating use or help reduce or cease use to avoid immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death.
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Affiliation(s)
- Elizabeth T. Couch
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, USA 94143-1361
| | - Benjamin W. Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, USA 94143-1361
| | - Stuart A. Gansky
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, USA 94143-1361
| | - Margaret M. Walsh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, USA 94143-1361
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Chaffee BW, Featherstone JDB, Gansky SA, Cheng J, Zhan L. Caries Risk Assessment Item Importance: Risk Designation and Caries Status in Children under Age 6. JDR Clin Trans Res 2016; 1:131-142. [PMID: 27403458 DOI: 10.1177/2380084416648932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Caries risk assessment (CRA) is widely recommended for dental caries management. Little is known regarding how practitioners use individual CRA items to determine risk and which individual items independently predict clinical outcomes in children under age 6-years. OBJECTIVES Assess the relative importance of pediatric CRA items in dental providers' decision-making regarding patient risk and in association with clinically evident caries, cross-sectionally and longitudinally. METHODS CRA information was abstracted retrospectively from electronic patient records of children initially ages 6-72 months at a university pediatric dentistry clinic (N=3810 baseline; N=1315 with follow-up). The 17-item CRA form included caries risk indicators, caries protective items, and clinical indicators. Conditional random forests classification trees were implemented to identify and assign variable importance to CRA items independently associated with baseline high-risk designation, baseline evident tooth decay, and follow-up evident decay. RESULTS Thirteen individual CRA items, including all clinical indicators and all but one risk indicator, were independently and statistically significantly associated with student/resident providers' caries-risk designation. Provider-assigned baseline risk category was strongly associated with follow-up decay, which increased from low (20.4%), moderate (30.6%), to high/extreme risk patients (68.7%). Of baseline CRA items, before adjustment 12 were associated with baseline decay and 7 with decay at follow-up; however, in the conditional random forests models, only the clinical indicators (evident decay, dental plaque, and recent restoration placement) and one risk indicator (frequent snacking) were independently and statistically significantly associated with future disease, for which baseline evident decay was the strongest predictor. CONCLUSIONS In this predominantly high-risk population under caries-preventive care, more individual CRA items were independently associated with providers' risk determination than with future caries status. These university dental providers considered many items in decision-making regarding patient risk, suggesting that in turn, these comprehensive CRA forms could also aid individualized care, linking risk assessment to disease management.
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Affiliation(s)
- Benjamin W Chaffee
- University of California San Francisco, Department of Preventive and Restorative Dental Sciences, 3333 California St. Suite 495 Box 1361, San Francisco, CA 94143,
| | | | | | | | - Ling Zhan
- University of California San Francisco,
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36
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Fisher-Owens SA, Soobader MJ, Gansky SA, Isong IA, Weintraub JA, Platt LJ, Newacheck PW. Geography matters: state-level variation in children's oral health care access and oral health status. Public Health 2016; 134:54-63. [PMID: 26995567 DOI: 10.1016/j.puhe.2015.04.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. STUDY DESIGN Observational study using cross-sectional surveys. METHODS Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. RESULTS Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. CONCLUSION Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.
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Affiliation(s)
- S A Fisher-Owens
- University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA.
| | | | - S A Gansky
- Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA; Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA
| | - I A Isong
- MGH Center for Child and Adolescent Health Policy, Boston, MA, USA
| | - J A Weintraub
- Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA
| | - L J Platt
- Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, San Francisco, CA, USA
| | - P W Newacheck
- University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
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Murray SG, Schmajuk G, Trupin L, Gensler L, Katz PP, Yelin EH, Gansky SA, Yazdany J. National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia. PLoS One 2016; 11:e0144918. [PMID: 26731012 PMCID: PMC4701172 DOI: 10.1371/journal.pone.0144918] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 11/26/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Infection is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE). Therapeutic practices have evolved over the past 15 years, but effects on infectious complications of SLE are unknown. We evaluated trends in hospitalizations for severe and opportunistic infections in a population-based SLE study. METHODS Data derive from the 2000 to 2011 United States National Inpatient Sample, including individuals who met a validated administrative definition of SLE. Primary outcomes were diagnoses of bacteremia, pneumonia, opportunistic fungal infection, herpes zoster, cytomegalovirus, or pneumocystis pneumonia (PCP). We used Poisson regression to determine whether infection rates were changing in SLE hospitalizations and used predictive marginals to generate annual adjusted rates of specific infections. RESULTS We identified 361,337 SLE hospitalizations from 2000 to 2011 meeting study inclusion criteria. Compared to non-SLE hospitalizations, SLE patients were younger (51 vs. 62 years), predominantly female (89% vs. 54%), and more likely to be racial/ethnic minorities. SLE diagnosis was significantly associated with all measured severe and opportunistic infections. From 2000 to 2011, adjusted SLE hospitalization rates for herpes zoster increased more than non-SLE rates: 54 to 79 per 10,000 SLE hospitalizations compared with 24 to 29 per 10,000 non-SLE hospitalizations. Conversely, SLE hospitalizations for PCP disproportionately decreased: 5.1 to 2.5 per 10,000 SLE hospitalizations compared with 0.9 to 1.3 per 10,000 non-SLE hospitalizations. CONCLUSIONS Among patients with SLE, herpes zoster hospitalizations are rising while PCP hospitalizations are declining. These trends likely reflect evolving SLE treatment strategies. Further research is needed to identify patients at greatest risk for infectious complications.
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Affiliation(s)
- Sara G. Murray
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Gabriela Schmajuk
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, Veterans Administration, San Francisco, California, United States of America
| | - Laura Trupin
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Lianne Gensler
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Patricia P. Katz
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Edward H. Yelin
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Stuart A. Gansky
- Division of Oral Epidemiology and Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jinoos Yazdany
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
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Dooley D, Moultrie NM, Heckman B, Gansky SA, Potter MB, Walsh MM. Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System. Pediatrics 2016; 137:peds.2014-3532. [PMID: 26647374 PMCID: PMC4702016 DOI: 10.1542/peds.2014-3532] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years. METHODS Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle. RESULTS In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits. CONCLUSIONS With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.
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Affiliation(s)
- Diane Dooley
- Contra Costa Regional Medical Center, Martinez, California;
| | | | - Barbara Heckman
- Departments of Preventive and Restorative Dental Sciences and
| | - Stuart A Gansky
- Departments of Preventive and Restorative Dental Sciences and
| | - Michael B Potter
- Family and Community Medicine, University of California San Francisco, San Francisco, California
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Jang AT, Merkle AP, Fahey KP, Gansky SA, Ho SP. Multiscale biomechanical responses of adapted bone-periodontal ligament-tooth fibrous joints. Bone 2015; 81:196-207. [PMID: 26151121 PMCID: PMC4663099 DOI: 10.1016/j.bone.2015.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 12/31/2022]
Abstract
Reduced functional loads cause adaptations in organs. In this study, temporal adaptations of bone-ligament-tooth fibrous joints to reduced functional loads were mapped using a holistic approach. Systematic studies were performed to evaluate organ-level and tissue-level adaptations in specimens harvested periodically from rats (N=60) given powder food for 6 months over 8,12,16,20, and 24 weeks. Bone-periodontal ligament (PDL)-tooth fibrous joint adaptation was evaluated by comparing changes in joint stiffness with changes in functional space between the tooth and alveolar bony socket. Adaptations in tissues included mapping changes in the PDL and bone architecture as observed from collagen birefringence, bone hardness and volume fraction in rats fed soft foods (soft diet, SD) compared to those fed hard pellets as a routine diet (hard diet, HD). In situ biomechanical testing on harvested fibrous joints revealed increased stiffness in SD groups (SD:239-605 N/mm) (p<0.05) at 8 and 12 weeks. Increased joint stiffness in early development phase was due to decreased functional space (at 8 weeks change in functional space was -33 μm, at 12 weeks change in functional space was -30 μm) and shifts in tissue quality as highlighted by birefringence, architecture and hardness. These physical changes were not observed in joints that were well into function, that is, in rodents older than 12 weeks of age. Significant adaptations in older groups were highlighted by shifts in bone growth (bone volume fraction 24 weeks: Δ-0.06) and bone hardness (8 weeks: Δ-0.04 GPa, 16 weeks: Δ-0.07 GPa, 24 weeks: Δ-0.06 GPa). The response rate (N/s) of joints to mechanical loads decreased in SD groups. Results from the study showed that joint adaptation depended on age. The initial form-related adaptation (observed change in functional space) can challenge strain-adaptive nature of tissues to meet functional demands with increasing age into adulthood. The coupled effect between functional space in the bone-PDL-tooth complex and strain-adaptive nature of tissues is necessary to accommodate functional demands, and is temporally sensitive despite joint malfunction. From an applied science perspective, we propose that adaptations are registered as functional history in tissues and joints.
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Affiliation(s)
- Andrew T Jang
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States
| | - Arno P Merkle
- Carl Zeiss X-ray Microscopy, Inc., 4385 Hopyard Road, Suite 100, Pleasanton, CA 94588, United States
| | - Kevin P Fahey
- Carl Zeiss X-ray Microscopy, Inc., 4385 Hopyard Road, Suite 100, Pleasanton, CA 94588, United States
| | - Stuart A Gansky
- Division of Oral Epidemiology & Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States
| | - Sunita P Ho
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, CA 94143, United States.
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Bernabé E, Sabbah W, Delgado-Angulo EK, Murasko JE, Gansky SA. Income gradients in oral health according to child age. Eur J Oral Sci 2015; 123:260-6. [DOI: 10.1111/eos.12194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Eduardo Bernabé
- Division of Population and Patient Health; King's College London Dental Institute at Guy's; King's College and St Thomas' Hospitals; London UK
| | - Wael Sabbah
- Division of Population and Patient Health; King's College London Dental Institute at Guy's; King's College and St Thomas' Hospitals; London UK
| | - Elsa K. Delgado-Angulo
- Division of Population and Patient Health; King's College London Dental Institute at Guy's; King's College and St Thomas' Hospitals; London UK
- Departamento Académico de Odontología Social; Universidad Peruana Cayetano Heredia; Lima Perú
| | - Jason E. Murasko
- Department of Economics; University of Houston - Clear Lake; Houston TX USA
| | - Stuart A. Gansky
- Department of Preventive & Restorative Dental Sciences; University of California San Francisco School of Dentistry; San Francisco CA USA
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Warren JJ, Weber-Gasparoni K, Tinanoff N, Batliner TS, Jue B, Santo W, Garcia RI, Gansky SA. Examination criteria and calibration procedures for prevention trials of the Early Childhood Caries Collaborating Centers. J Public Health Dent 2015; 75:317-26. [PMID: 26011444 DOI: 10.1111/jphd.12102] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To summarize diagnostic criteria and examiner training and calibration of the National Institute of Dental and Craniofacial Research-funded Early Childhood Caries Collaborating Centers (EC4) and report examiner calibration results from 2010 to 2014. The EC4 at Boston University, University of Colorado, and University of California San Francisco are performing randomized controlled early childhood caries (ECC) prevention trials with caries as the main outcome measure. METHODS The EC4 with University of Iowa consultants developed standardized tooth and tooth surface status examination criteria for use in field conditions, examiner training materials, and examiner calibration and re-calibration methodologies. Calibration and re-calibration were performed with 1- to 5-year-old children in the San Francisco Mission District in which assessments from each examiner to be calibrated were compared with those from a single gold standard examiner from 2010 to 2014. Cohen's kappa statistic was used to determine inter-examiner agreement. RESULTS A total of seven examiners were successfully (re)calibrated during that period, examining a total of 231 children. Overall unweighted Cohen's kappas for 10 surface conditions exceeded the criterion of 0.70. However, separate agreement for assessment of noncavitated lesions, as in other studies, was lower. CONCLUSIONS An experienced multidisciplinary and multi-institutional team was able to develop criteria and training materials to anticipate situations and field conditions the main trials would encounter. Examiners were successfully trained and (re)calibrated.
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Affiliation(s)
- John J Warren
- University of Iowa College of Dentistry, Iowa City, IA, USA
| | | | - Norman Tinanoff
- University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Terence S Batliner
- School of Dental Medicine, University of Colorado-Anschutz Medical Campus, Denver, CO, USA
| | - Bonnie Jue
- University of California, San Francisco School of Dentistry, San Francisco, CA, USA
| | - William Santo
- University of California, San Francisco School of Dentistry, San Francisco, CA, USA
| | - Raul I Garcia
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Stuart A Gansky
- University of California, San Francisco School of Dentistry, San Francisco, CA, USA
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Chaffee BW, Gansky SA, Halpern-Felsher B, Couch ET, Essex G, Walsh MM. Conditional risk assessment of adolescents' electronic cigarette perceptions. Am J Health Behav 2015; 39:421-32. [PMID: 25741686 DOI: 10.5993/ajhb.39.3.14] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To adapt an established instrument for measuring adolescents' cigarette-related perceptions for new application with electronic cigarettes (e-cigarettes). METHODS In this exploratory study, 104 male high school students (40% tobacco ever-users) estimated the probability of potential e-cigarette risks (eg, lung cancer) or benefits (eg, look cool). We calculated associations between risk/benefit composite scores, ever-use, and use intention for e-cigarettes, and analogously, for combustible cigarettes. RESULTS E-cigarette ever-use was associated with lower perceived risks, with adjusted differences versus never-users greater for e-cigarettes than for cigarettes. Risk composite score was inversely associated, and benefit score positively associated, with e-cigarette ever-use and use intention. CONCLUSION Conditional risk assessment characterized adolescents' perceived e-cigarette risk/benefit profile, with potential utility for risk-perception measurement in future studies.
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Affiliation(s)
| | - Stuart A Gansky
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Gwen Essex
- University of California San Francisco, San Francisco, CA, USA
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43
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Finlayson TL, Gansky SA, Shain SG, Weintraub JA. Dental utilization by children in Hispanic agricultural worker families in California. J Dent Oral Craniofac Epidemiol 2015; 2:15-24. [PMID: 25621285 PMCID: PMC4301614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Agricultural worker families encounter multiple barriers to accessing all needed dental care. This study investigated predisposing, enabling, and need factors associated with children's past year dental utilization among Hispanic agricultural worker families in central California. METHODS Oral health survey and clinical data were collected from families participating in a larger, population-based study in 2006-7. Generalized estimating equation logit regression assessed effects on a dental visit among children aged 0-17 (n=405). Analyses adjusted for clustering of children in the same household. Predisposing (sociodemographics), enabling (child's dental insurance, usual source of dental care, caregiver past year dental visit, acculturation level, income and education), and need (caregiver's oral health rating, perception of cavities, and clinically-determined treatment urgency) factors were examined. RESULTS Half (51%) the children had a past year dental visit, while 23% had never been to a dentist. In the final model, children were less likely to have a past year dental visit if they were foreign-born, male, had caregivers that thought they had cavities or were unsure, and if the dentist recommended treatment 'at earliest convenience'. Children aged 6-12, with a regular dental care source, and whose caregivers had a recent dentist visit were more likely to have a past year dental visit. CONCLUSIONS Children were more likely to have a past year dental visit if they had a usual source of dental care (OR =4.78, CI=2.51-9.08), and if the caregiver had a past year dental visit (OR=1.88, CI=1.04-3.38). Emphasis should be placed on these two modifiable factors to increase children's dental utilization.
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Affiliation(s)
- Tracy L Finlayson
- Graduate School of Public Health San Diego State University 5500 Campanile Drive San Diego CA 92182-4162
| | - Stuart A Gansky
- University of California San Francisco School of Dentistry John C. Greene Professor of Primary Care Dentistry Associate Director, Center to Address Disparities in Children's Oral Health Assistant Director, CTSI Mentor Development Program Division of Oral Epidemiology & Dental Public Health
| | - Sara G Shain
- University of California San Francisco School of Dentistry
| | - Jane A Weintraub
- The University of North Carolina at Chapel Hill School of Dentistry
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Cheng J, Chaffee BW, Cheng NF, Gansky SA, Featherstone JDB. Understanding treatment effect mechanisms of the CAMBRA randomized trial in reducing caries increment. J Dent Res 2014; 94:44-51. [PMID: 25355774 DOI: 10.1177/0022034514555365] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Caries Management By Risk Assessment (CAMBRA) randomized controlled trial showed that an intervention featuring combined antibacterial and fluoride therapy significantly reduced bacterial load and suggested reduced caries increment in adults with 1 to 7 baseline cavitated teeth. While trial results speak to the overall effectiveness of an intervention, insight can be gained from understanding the mechanism by which an intervention acts on putative intermediate variables (mediators) to affect outcomes. This study conducted mediation analyses on 109 participants who completed the trial to understand whether the intervention reduced caries increment through its action on potential mediators (oral bacterial load, fluoride levels, and overall caries risk based on the composite of bacterial challenge and salivary fluoride) between the intervention and dental outcomes. The primary outcome was the increment from baseline in decayed, missing, and filled permanent surfaces (ΔDMFS) 24 mo after completing restorations for baseline cavitated lesions. Analyses adjusted for baseline overall risk, bacterial challenge, and fluoride values under a potential outcome framework using generalized linear models. Overall, the CAMBRA intervention was suggestive in reducing the 24-mo DMFS increment (reduction in ΔDMFS: -0.96; 95% confidence interval [CI]: -2.01 to 0.08; P = 0.07); the intervention significantly reduced the 12-mo overall risk (reduction in overall risk: -19%; 95% CI, -7 to -41%;], P = 0.005). Individual mediators, salivary log10 mutans streptococci, log10 lactobacilli, and fluoride level, did not represent statistically significant pathways alone through which the intervention effect was transmitted. However, 36% of the intervention effect on 24-mo DMFS increment was through a mediation effect on 12-mo overall risk (P = 0.03). These findings suggest a greater intervention effect carried through the combined action on multiple aspects of the caries process rather than through any single factor. In addition, a substantial portion of the total effect of the CAMBRA intervention may have operated through unanticipated or unmeasured pathways not included among the potential mediators studied.
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Affiliation(s)
- J Cheng
- University of California San Francisco, San Francisco, CA, USA
| | - B W Chaffee
- University of California San Francisco, San Francisco, CA, USA
| | - N F Cheng
- University of California San Francisco, San Francisco, CA, USA
| | - S A Gansky
- University of California San Francisco, San Francisco, CA, USA
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Igumbor EU, Puoane T, Gansky SA, Plesh O. Pain as a reason for primary care visits: cross-sectional survey in a rural and periurban health clinic in the Eastern Cape, South Africa. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2012.10874224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- EU Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - T Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - SA Gansky
- School of Dentistry, University of California, San Francisco, USA
| | - O Plesh
- School of Dentistry, University of California, San Francisco, USA
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Igumbor EU, Puoane TR, Gansky SA, Plesh O. Chronic pain in the community: a survey in a township in Mthatha, Eastern Cape, South Africa. Southern African Journal of Anaesthesia and Analgesia 2014. [DOI: 10.1080/22201173.2011.10872801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- EU Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - TR Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - SA Gansky
- Division of Oral Epidemiology, School of Dentistry, University of California, San Francisco, USA
| | - O Plesh
- Department of Preventive and Restorative Dental Science, School of Dentistry, University of California, San Francisco, USA
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Tiwari T, Casciello A, Gansky SA, Henshaw M, Ramos-Gomez F, Rasmussen M, Garcia RI, Albino J, Batliner TS. Recruitment for health disparities preventive intervention trials: the early childhood caries collaborating centers. Prev Chronic Dis 2014; 11:E133. [PMID: 25101490 PMCID: PMC4193429 DOI: 10.5888/pcd11.140140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Four trials of interventions designed to prevent early childhood caries are using community-engagement strategies to improve recruitment of low-income, racial/ethnic minority participants. The trials are being implemented by 3 centers funded by the National Institute of Dental and Craniofacial Research and known as the Early Childhood Caries Collaborating Centers (EC4): the Center for Native Oral Health Research at the University of Colorado, the Center to Address Disparities in Children's Oral Health at the University of California San Francisco, and the Center for Research to Evaluate and Eliminate Dental Disparities at Boston University. COMMUNITY CONTEXT The community contexts for the EC4 trials include urban public housing developments, Hispanic communities near the US-Mexican border, and rural American Indian reservations. These communities have a high prevalence of early childhood caries, suggesting the need for effective, culturally acceptable interventions. METHODS Each center's intervention(s) used community-based participatory research approaches, identified community partners, engaged the community through various means, and developed communication strategies to enhance recruitment. OUTCOME All 3 centers have completed recruitment. Each center implemented several new strategies and approaches to enhance recruitment efforts, such as introducing new communication techniques, using media such as radio and newspapers to spread awareness about the studies, and hosting community gatherings. INTERPRETATION Using multiple strategies that build trust in the community, are sensitive to cultural norms, and are adaptable to the community environment can enhance recruitment in underserved communities.
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Affiliation(s)
- Tamanna Tiwari
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus. 13055 E 17th Ave, Aurora, CO 80045. E-mail
| | - Alana Casciello
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Stuart A Gansky
- University of California San Francisco, School of Dentistry, San Francisco, California
| | - Michelle Henshaw
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | | | - Margaret Rasmussen
- University of California San Francisco, School of Dentistry, San Francisco, California
| | - Raul I Garcia
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Judith Albino
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Terrence S Batliner
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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48
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Jang AT, Lin JD, Choi RM, Choi EM, Seto ML, Ryder MI, Gansky SA, Curtis DA, Ho SP. Adaptive properties of human cementum and cementum dentin junction with age. J Mech Behav Biomed Mater 2014; 39:184-96. [PMID: 25133753 DOI: 10.1016/j.jmbbm.2014.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 07/02/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate age related changes in physical (structure/mechanical properties) and chemical (elemental/inorganic mineral content) properties of cementum layers interfacing dentin. METHODS Human mandibular molars (N=43) were collected and sorted by age (younger=19-39, middle=40-60, older=61-81 years). The structures of primary and secondary cementum (PC, SC) types were evaluated using light and atomic force microscopy (AFM) techniques. Chemical composition of cementum layers were characterized through gravimetric analysis by estimating ash weight and concentrations of Ca, Mn, and Zn trace elements in the analytes through inductively coupled plasma mass spectroscopy. The hardness of PC and SC was determined using microindentation and site-specific reduced elastic modulus properties were determined using nanoindentation techniques. RESULTS PC contained fibrous 1-3 µm wide hygroscopic radial PDL-inserts. SC illustrated PC-like structure adjacent to a multilayered architecture composing of regions that contained mineral dominant lamellae. The width of the cementum dentin junction (CDJ) decreased as measured from the cementum enamel junction (CEJ) to the tooth apex (49-21 µm), and significantly decreased with age (44-23 µm; p<0.05). The inorganic ratio defined as the ratio of post-burn to pre-burn weight increased with age within primary cementum (PC) and secondary cementum (SC). Cementum showed an increase in hardness with age (PC (0.40-0.46 GPa), SC (0.37-0.43 GPa)), while dentin showed a decreasing trend (coronal dentin (0.70-0.72 GPa); apical dentin (0.63-0.73 GPa)). SIGNIFICANCE The observed physicochemical changes are indicative of increased mineralization of cementum and CDJ over time. Changes in tissue properties of teeth can alter overall tooth biomechanics and in turn the entire bone-tooth complex including the periodontal ligament. This study provides baseline information about the changes in physicochemical properties of cementum with age, which can be identified as adaptive in nature.
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Affiliation(s)
- Andrew T Jang
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143, USA
| | - Jeremy D Lin
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143, USA
| | - Ryan M Choi
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143, USA
| | - Erin M Choi
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143, USA
| | - Melanie L Seto
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143, USA
| | - Mark I Ryder
- Division of Periodontology, Department of Orofacial Sciences, School of Dentistry, UCSF, San Francisco, CA, USA
| | - Stuart A Gansky
- Division of Oral Epidemiology & Dental Public Health, Deptartment of Preventive & Restorative Dental Sciences, School of Dentistry, UCSF, San Francisco, CA, USA
| | - Donald A Curtis
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143, USA
| | - Sunita P Ho
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, 707 Parnassus Avenue, University of California San Francisco, San Francisco, CA 94143, USA.
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Lazar AA, Gansky SA, Halstead DD, Slajs A, Weintraub JA. Improving Patient Care Using the Johnson-Neyman Analysis of Heterogeneity of Treatment Effects According to Individuals' Baseline Characteristics. J Dent Oral Craniofac Epidemiol 2013; 1:19-33. [PMID: 25705704 PMCID: PMC4335806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Because each patient's baseline (pre-treatment) characteristics differ (e.g., age, sex, socioeconomic status, ethnicity/race, biomarkers), treatments do not work the same for every patient-some can even cause detrimental effects. To improve patient care, it is critical to identify such heterogeneity of treatment effects. But the standard analytic approach dichotomizes baseline characteristics (low vs. high) which often leads to a loss of critical patient-care information and power to detect heterogeneity, as the results may depend strongly on the cut-points chosen. A more powerful analytic approach is to analyze baseline characteristics (i.e., covariates) measured on a continuous scale that retains all of the information available for the covariate. METHODS In this article, we show how the Johnson-Neyman (J-N) method can be used to identify the prognostic and predictive value of baseline covariates measured on a continuous scale - findings that often cannot be determined using the traditional dichotomized approach. As an example, we used the J-N method to explore treatment effects for varying levels of the biomarker salivary mutans streptococci (MS) in a randomized clinical prevention trial comparing fluoride varnish with no fluoride varnish for 376 initially caries-free high-risk children, all of whom received oral health counseling. RESULTS The J-N analysis showed that children with higher baseline MS values who were randomized to receive fluoride varnish had the poorest dental caries prognosis and may have benefitted most from the preventive agent. CONCLUSION Such methods are likely to be an important tool in the field of personalized oral health care.
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Affiliation(s)
- Ann A. Lazar
- The University of California, San Francisco (UCSF) School of Dentistry, Division of Oral Epidemiology and Dental Public Health, & School of Medicine, Division of Biostatistics, USA
| | - Stuart A. Gansky
- The University of California, San Francisco (UCSF) School of Dentistry, Division of Oral Epidemiology and Dental Public Health, USA
| | | | - Anthony Slajs
- The University of California, San Francisco (UCSF) School of Dentistry, Division of Oral Epidemiology and Dental Public Health, USA
| | - Jane A. Weintraub
- The University of North Carolina at Chapel Hill School of Dentistry, USA
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50
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Weintraub JA, Finlayson TL, Gansky SA, Santo W, Ramos-Gomez F. Clinically determined and self-reported dental status during and after pregnancy among low-income Hispanic women. J Public Health Dent 2013; 73:311-20. [PMID: 23889689 DOI: 10.1111/jphd.12029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This analysis assessed, during and 1 year after pregnancy: a) the prevalence of and relationship between self-reported and clinically determined dental caries and oral health status, and whether self-reports are a potential proxy for professional determination; and b) factors associated with high levels of professionally determined or self-reported oral disease. METHODS Data are from a randomized clinical trial of 301 pregnant, low-income Hispanic women at the California-Mexico border to compare two interventions to prevent early childhood caries. Interviews and dental examinations were conducted at enrollment (second trimester) and 1-year postpartum (PP). RESULTS During pregnancy and PP, 93 percent had untreated caries and most had gingival inflammation. Sensitivity and specificity of self-reported measures compared to dentists' determinations were modest (ranging from 45-80 percent for sensitivity and 41-77 percent for specificity at both time points); positive predictive values for women reporting current tooth decay or fair/poor oral health were high (>94 percent), but negative predictive values were low (<23 percent). In a bivariate GEE model, factors associated with fair/poor self-reported oral health during and after pregnancy included self-reported dental symptoms (current tooth decay, bleeding gums without brushing), dental behaviors (not flossing) and number of decayed tooth surfaces. In a logistic regression model, the only significant factor PP associated with less extensive untreated disease was if women ever had their teeth cleaned professionally (OR = 0.44). CONCLUSIONS There is a great need for dental treatment in this underserved population both during pregnancy and PP. Women may not be able to accurately recognize or act on their treatment needs. At baseline and PP, few demographic or behavioral factors were associated with either self-reported or clinically determined oral disease (e.g., being less educated or acculturated and not flossing) in the bivariate analyses. Ever having a professional teeth cleaning significantly predicted less disease PP.
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Affiliation(s)
- Jane A Weintraub
- Center to Address Disparities in Children's Oral Health, University of California, San Francisco School of Dentistry, San Francisco, CA, USA; University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA
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