1
|
Albino J, Batliner TS, Tiwari T, Henderson WG. Response to the Letter to the Editor: "Preventing Caries in American Indian Children: Lost Battle or New Hope?". JDR Clin Trans Res 2019; 3:213-214. [PMID: 30931766 DOI: 10.1177/2380084417751343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J Albino
- 1 Center for Native Oral Health Research University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T S Batliner
- 1 Center for Native Oral Health Research University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Tiwari
- 2 School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W G Henderson
- 1 Center for Native Oral Health Research University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
2
|
Brega AG, Henderson WG, Harper MM, Thomas JF, Manson SM, Batliner TS, Braun PA, Quissell DO, Wilson A, Tiwari T, Albino J. Association of Ethnic Identity with Oral Health Knowledge, Attitudes, Behavior, and Outcomes on the Navajo Nation. J Health Care Poor Underserved 2019; 30:143-160. [PMID: 30827975 PMCID: PMC6400317 DOI: 10.1353/hpu.2019.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
American Indians and Alaska Natives (AI/ANs) experience poor oral health. Children and adults living on the Navajo Nation have a particularly high rate of dental decay. The literature suggests that health outcomes are often associated with the strength of one's ethnic identity. We investigated the association of ethnic identity among Native parents with oral health knowledge, attitudes, behavior, and outcomes. Analyses used baseline data from a randomized controlled trial designed to reduce dental decay among AI/AN preschoolers enrolled in the Navajo Nation Head Start Program. Greater perceived importance of ethnic identity was associated with better oral health knowledge and attitudes but was unassociated with oral health behavior and was linked to worse oral health status. Parents who were better able to speak their tribal language had greater confidence in their ability to manage their children's oral health, engaged in better oral health behavior, and reported better parental oral health status.
Collapse
|
3
|
Wilson AR, Brega AG, Thomas JF, Henderson WG, Lind KE, Braun PA, Batliner TS, Albino J. Validity of Measures Assessing Oral Health Beliefs of American Indian Parents. J Racial Ethn Health Disparities 2018; 5:1254-1263. [PMID: 29508373 PMCID: PMC6123310 DOI: 10.1007/s40615-018-0472-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/08/2017] [Revised: 02/02/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This aimed to validate measures of constructs included in an extended Health Belief Model (EHBM) addressing oral health beliefs among American Indian (AI) parents. METHODS Questionnaire data were collected as part of a randomized controlled trial (n = 1016) aimed at reducing childhood caries. Participants were AI parents with a preschool-age child enrolled in the Navajo Nation Head Start program. Questionnaire items addressed five EHBM constructs: perceived susceptibility, severity, barriers, benefits, and parental self-efficacy. Subscales representing each construct underwent reliability and validity testing. Internal consistency reliability of each subscale was evaluated using Cronbach's alpha. Convergent validity was assessed using linear regression to evaluate the association of each EHBM subscale with oral health-related measures. RESULTS Internal consistency reliability was high for self-efficacy (α = 0.83) and perceived benefits (α = 0.83) compared to remaining EHBM subscales (α < 0.50). Parents with more education (p < 0.0001) and income (p = 0.0002) perceived dental caries as more severe younger parents (ps = 0.02) and those with more education (ps < 0.0001) perceived greater benefits and fewer barriers to following recommended oral health behavior. Female parents (p < 0.0001) and those with more education (p = 0.02) had higher levels of self-efficacy. Parental knowledge was associated with all EHBM measures (ps < 0.0001) excluding perceived susceptibility (p > 0.05). Parents with increased self-efficacy had greater behavioral adherence (p < 0.0001), whereas lower behavioral adherence was associated with parents who reported higher perceived barriers (p < 0.0001). Better pediatric oral health outcomes were associated with higher levels of self-efficacy (p < 0.0001) and lower levels of perceived severity (p = 0.02) and barriers (p = 0.05). CONCLUSIONS Results support the value of questionnaire items addressing the EHBM subscales, which functioned in a manner consistent with the EHBM theoretical framework in AI participants.
Collapse
Affiliation(s)
- Anne R Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave., B240, Aurora, CO, 80045, USA.
| | - Angela G Brega
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
| | - Jacob F Thomas
- Children's Outcomes Research/Colorado Health Outcomes Programs, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO, 80045, USA
| | - William G Henderson
- Children's Outcomes Research/Colorado Health Outcomes Programs, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO, 80045, USA
| | - Kimberly E Lind
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
- School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Ave, Aurora, CO, 80045, USA
| | - Patricia A Braun
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
- School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Ave, Aurora, CO, 80045, USA
| | - Terrence S Batliner
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
| | - Judith Albino
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
| |
Collapse
|
4
|
Batliner TS, Tiwari T, Henderson WG, Wilson AR, Gregorich SE, Fehringer KA, Brega AG, Swyers E, Zacher T, Harper MM, Plunkett K, Santo W, Cheng NF, Shain S, Rasmussen M, Manson SM, Albino J. Randomized Trial of Motivational Interviewing to Prevent Early Childhood Caries in American Indian Children. JDR Clin Trans Res 2018; 3:366-375. [PMID: 30238061 DOI: 10.1177/2380084418787785] [Citation(s) in RCA: 26] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction In a randomized controlled trial, the effectiveness of motivational interviewing (MI) combined with enhanced community services (MI + ECS) was compared with ECS alone for reducing dental caries in American Indian children on the Pine Ridge Reservation. The intervention was developed and delivered with extensive tribal collaboration. Methods A total 579 mother-newborn dyads were enrolled and randomized to the MI + ECS and ECS groups. They were followed for 36 mo. Four MI sessions were provided, the first shortly after childbirth and then 6, 12, and 18 mo later. Both groups were exposed to ECS, which included public service announcements through billboards and tribal radio, as well as broad distribution of brochures on behavioral risk factors for early childhood caries (ECC), toothbrushes, and toothpaste. MI impact was measured as decayed, missing, and filled tooth surfaces (dmfs). Secondary outcomes included decayed surfaces, caries prevalence, and maternal oral health knowledge and behaviors. Modified intention-to-treat analyses were conducted. Eighty-eight percent of mothers completed at least 3 of 4 MI sessions offered. Results After 3 y, dmfs was not significantly different for the 2 groups (MI + ECS = 10, ECS = 10.38, P = 0.68). In both groups, prevalence of caries experience was 7% to 9% after 1 y, 35% to 36% at 2 y, and 55% to 56% at 3 y. Mean knowledge scores increased by 5.0, 5.3, and 5.9 percentage points at years 1, 2, and 3 in the MI + ECS group and by 1.9, 3.3, and 5.0 percentage points in the ECS group (P = 0.03), respectively. Mean maternal oral health behavior scores were not statistically significantly different between the treatment arms. Conclusion In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of ECC (ClinicalTrials.gov NCT01116726). Knowledge Transfer Statement The findings of this study suggest that motivational interviewing focusing on parental behaviors may not be as effective as previously hoped for slowing the development of childhood caries in some high-risk groups. Furthermore, social factors may be even more salient determinants of oral health than what we previously supposed, perhaps interfering with the capacity to benefit from behavioral strategies that have been useful elsewhere. The improvement of children's oral health in high-risk populations characterized by poverty and multiple related life stresses may require more holistic approaches that address these formidable barriers.
Collapse
Affiliation(s)
- T S Batliner
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W G Henderson
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A R Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S 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
| | - K A Fehringer
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A G Brega
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - E Swyers
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Zacher
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M M Harper
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - K Plunkett
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W Santo
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - N F Cheng
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - S Shain
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - M Rasmussen
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - S M Manson
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Albino
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
5
|
Wilson AR, Fehringer KA, Henderson WG, Venner K, Thomas J, Harper MM, Batliner TS, Albino J. Fidelity of motivational interviewing in an American Indian oral health intervention. Community Dent Oral Epidemiol 2018; 46:310-316. [PMID: 29461622 PMCID: PMC5948136 DOI: 10.1111/cdoe.12368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/30/2017] [Accepted: 01/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Assess fidelity of a motivational interviewing (MI) intervention focused on preventing early childhood caries in a cohort of American Indian mothers with newborns. METHODS Four interventionists were trained to administer an oral health MI intervention. The MI sessions were audio recorded to enable scoring as part of fidelity studies to assess the interventionist's degree of competence in using MI principles. Evaluation of the interventionists was completed using the Motivational Interviewing Treatment Integrity (MITI) 3.1.1. which assesses global ratings and behaviour counts. Two reviewers evaluated and scored the MI sessions; a random sample of twenty per cent of the total interviews was scored by a trained reviewer and fifty per cent of the randomly selected files scored by an external expert. A total of 225 files were coded by the trained reviewer and 121 files by the external expert. RESULTS Mean global scores for all interventionists combined were around 4.0 (expert competence). Scores for reflection to question ratios (around 0.6) were below beginner competence. Scores ranged from beginner to expert competence for open-ended questions (54%-56%), complex reflections (38%-43%) and MI-adherent statements (93%-95%). There was variation in competence for the four interventionists when analysed individually. Inter-rater reliability scores for the two reviewers ranged from fair (0.40-0.59) to good (0.60-0.74). The MI interventionist rated the best in the fidelity assessment had the worst study outcomes compared to other interventionists. CONCLUSIONS Individual interventionists' scores for the MITI global ratings and behaviour counts reflected variation in competence and ranged from below beginner to expert levels. A higher competence level of the interventionist as assessed by the fidelity study was not related to better study outcomes.
Collapse
Affiliation(s)
- Anne R Wilson
- Department of Pediatric Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen A Fehringer
- Centers of American Indian and Alaska Native Health, Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William G Henderson
- Children's Outcomes Research, Colorado Health Outcomes Programs, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kamilla Venner
- Department of Psychology, Center on Alcoholism, Substance Abuse and Addiction (UNM CASAA), University of New Mexico, Albuquerque, NM, USA
| | - Jacob Thomas
- Children's Outcomes Research, Colorado Health Outcomes Programs, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Maya M Harper
- Centers of American Indian and Alaska Native Health, Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Terrence S Batliner
- Centers of American Indian and Alaska Native Health, Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Judith Albino
- Centers of American Indian and Alaska Native Health, Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
6
|
Albino J, Tiwari T, Henderson WG, Thomas JF, Braun PA, Batliner TS. Parental psychosocial factors and childhood caries prevention: Data from an American Indian population. Community Dent Oral Epidemiol 2018; 46:360-368. [PMID: 29637583 DOI: 10.1111/cdoe.12376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/26/2017] [Accepted: 02/24/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to examine the association among psychological and social variables reported by American Indian parents/caregivers of preschool children and changes in their Oral Health Knowledge and Behaviors related to care of their children's teeth. We also investigated the relationship of these factors with progression of caries, as reflected by changes in their children's dmfs. METHODS The data used for this study were collected at baseline in a clinical trial of an oral health promotion intervention comprising behavioural and clinical interventions for caries prevention delivered by tribal members on a large Southwestern American Indian reservation. Linear regression analyses were performed for changes (baseline to Year 1) in dmfs, Oral Health Knowledge and Oral Health Behavior scores, with baseline psychosocial measures, taken individually, as the independent variables. RESULTS Parents' attitudes and beliefs were associated with increases in their Oral Health Knowledge and Behavior and also with the progression of caries for their children. When all participants were considered together, increases in children's dmfs were smaller when the caregiver had higher Internal Oral Health Locus of Control (e = -1.33, P = .004), higher Health Literacy (e = -1.55, P < .01), and higher Financial Stability (e = -4.46, P = .03), and lower scores for the Barriers subscale (e = 1.57, P < .01) of the Health Belief Model. For parents in the Intervention group, higher scores on Locus of Control, reflecting beliefs that chance, or other people determine their children's oral health, were associated with larger increases in Oral Health Knowledge (e = 1.73, P = .04) and Behaviors (e = 4.00, P = .005). CONCLUSIONS Prevention of early childhood caries in American Indian children has proved to be especially challenging. Some of the measures identified in this report may suggest promising directions to prevention through approaches that build on competencies and skills to be learned and used within a context more broadly focused on parenting and management of health and family challenges.
Collapse
Affiliation(s)
- Judith Albino
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William G Henderson
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob F Thomas
- Adult and Child Consortium of Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Patricia A Braun
- Adult and Child Consortium of Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Terrence S Batliner
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
7
|
Tiwari T, Jamieson L, Broughton J, Lawrence HP, Batliner TS, Arantes R, Albino J. Reducing Indigenous Oral Health Inequalities: A Review from 5 Nations. J Dent Res 2018; 97:869-877. [PMID: 29554440 DOI: 10.1177/0022034518763605] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Indigenous populations around the world experience a disproportionate burden in terms of oral diseases and conditions. These inequalities are likely due to a complex web of social determinants that includes poverty, historical consequences of colonialism, social exclusion, government policies of assimilation, cultural annihilation, and racism in all its forms (societal, institutional). Despite documented oral health disparities, prevention interventions have been scarce in Indigenous communities. This review describes oral health interventions and their outcomes conducted for Indigenous populations of the United States, Canada, Brazil, Australia, and New Zealand. The review includes research published since 2006 that are available in English in electronic databases, including MEDLINE. A total of 13 studies were included from the United States, Canada, Brazil, and Australia. The studies reviewed provide a wide range of initiatives, including interventions for prevention and treatment of dental disease, as well as interventions that improve oral health knowledge, behaviors, and other psychosocial factors. Overall, 6 studies resulted in improved oral health in the study participants, including improvements in periodontal health, caries reduction, and oral health literacy. Preferred intervention methodologies included community-based research approaches, culturally tailored strategies, and use of community workers to deliver the initiative. Although these studies were conducted with discrete Indigenous populations, investigators reported similar challenges in research implementation. Recommendations for future work in reducing oral health disparities include addressing social determinants of health in various Indigenous populations, training future generations of dental providers in cultural competency, and making Indigenous communities true partners in research.
Collapse
Affiliation(s)
- T Tiwari
- 1 University of Colorado Anschutz Medical Campus, School of Dental Medicine, Aurora, CO, USA
| | - L Jamieson
- 2 Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, South Australia, Australia
| | - J Broughton
- 3 Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - H P Lawrence
- 4 School of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - T S Batliner
- 5 University of Colorado Anschutz Medical Campus, School of Public Health, Aurora, CO, USA
| | - R Arantes
- 6 Fundação Oswaldo Cruz-Fiocruz Mato Grosso do Sul, Brazil
| | - J Albino
- 5 University of Colorado Anschutz Medical Campus, School of Public Health, Aurora, CO, USA
| |
Collapse
|
8
|
Abstract
Knowledge Transfer Statement: Preventing early childhood caries in American Indian children has proved to be an unexpectedly challenging goal. Biological and behavioral variables, as well as parental psychosocial characteristics and experiences, suggest new routes for understanding and mitigating the progress of disease. We provide our reflections after a decade of studying these issues in collaboration with tribal communities.
Collapse
Affiliation(s)
- J Albino
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - T S Batliner
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - T Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Brega AG, Thomas JF, Henderson WG, Batliner TS, Quissell DO, Braun PA, Wilson A, Bryant LL, Nadeau KJ, Albino J. Association of parental health literacy with oral health of Navajo Nation preschoolers. Health Educ Res 2016; 31:70-81. [PMID: 26612050 PMCID: PMC4751219 DOI: 10.1093/her/cyv055] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/16/2015] [Indexed: 05/25/2023]
Abstract
Health literacy is 'the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'. Although numerous studies show a link between health literacy and clinical outcomes, little research has examined the association of health literacy with oral health. No large-scale studies have assessed these relationships among American Indians, a population at risk for limited health literacy and oral health problems. This analysis was conducted as part of a clinical trial aimed at reducing dental decay among preschoolers in the Navajo Nation Head Start program. Using baseline data for 1016 parent-child dyads, we examined the association of parental health literacy with parents' oral health knowledge, attitudes, and behavior, as well as indicators of parental and pediatric oral health. More limited health literacy was associated with lower levels of oral health knowledge, more negative oral health attitudes, and lower levels of adherence to recommended oral health behavior. Parents with more limited health literacy also had significantly worse oral health status (OHS) and reported their children to have significantly worse oral health-related quality of life. These results highlight the importance of oral health promotion interventions that are sensitive to the needs of participants with limited health literacy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - K J Nadeau
- Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - J Albino
- Colorado School of Public Health
| |
Collapse
|
13
|
Abstract
American Indians and Alaska Natives (AI/AN) experience significant health disparities relative to the general U.S. POPULATION In particular, oral diseases affect the majority of the AI/AN population and their prevalence is significantly greater than observed in other demographic sectors of the U.S. POPULATION The reasons for these disparities are multiple but lack of access to dental care is clearly a contributing factor. The dentist-to-population ratio in many AI/AN communities is less than half the U.S. average. A solution has been developed in Alaska by AI/AN leaders: dental therapists, i.e., local people trained for two years to provide basic dental services. This solution is being fought by organized dentistry that sees the approach as an economic threat, but AI/AN organizations are committed to implementing this Native solution to their access problem. The Alaska experience indicates that access to oral health services can be improved through the addition of dental therapists to the dental team.
Collapse
|
14
|
Wilson AR, Brega AG, Campagna EJ, Braun PA, Henderson WG, Bryant LL, Batliner TS, Quissell DO, Albino J. Validation and Impact of Caregivers' Oral Health Knowledge and Behavior on Children's Oral Health Status. Pediatr Dent 2016; 38:47-54. [PMID: 26892215 PMCID: PMC4762180] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To validate oral health knowledge and behavior measures from the Basic Research Factors Questionnaire, developed to capture specific themes contributing to children's oral health outcomes and the influence of caregivers. METHODS Data were collected as part of a randomized clinical trial (n equals 992) aimed at reducing dental caries in young children. Participants were American Indian/Alaska Native caregivers with a three- to five-year-old child enrolled in a Navajo Nation Head Start Center. Caregivers completed the questionnaire at enrollment with concomitant evaluation of children for decayed, missing, and filled tooth surfaces (dmfs). Oral health knowledge and behavior outcomes were compared with convergent measures (participant sociodemographic characteristics, oral health attitudes, and indicators of oral health status). RESULTS Caregiver oral health knowledge was significantly associated with education, income, oral health behavior, and all but one of the oral health attitude measures. Behavior was significantly associated with several measures of oral health attitudes and all but one measure of oral health status. As the behavior score improved, dmfs scores declined, child/caregiver overall oral health status improved, and pediatric oral health quality of life improved. CONCLUSIONS Questionnaire measures were valid for predicting specific caregiver factors potentially contributing to children's oral health status.
Collapse
Affiliation(s)
- Anne R Wilson
- Department of Pediatric Dentistry, School of Dental Medicine, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA.
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| | - Elizabeth J Campagna
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| | - Patricia A Braun
- Department of Pediatrics and Family Medicine, Adult and Child Center Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| | - William G Henderson
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| | - Lucinda L Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| | - Terrence S Batliner
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| | - David O Quissell
- Department of Craniofacial Biology, School of Dental Medicine, Colorado School of Public Health, at the University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| | - Judith Albino
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo., USA
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Albino J, Tiwari T, Henderson WG, Thomas J, Bryant LL, Batliner TS, Braun PA, Wilson A, Quissell DO. Learning from caries-free children in a high-caries American Indian population. J Public Health Dent 2014; 74:293-300. [PMID: 24961881 DOI: 10.1111/jphd.12058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 10/04/2013] [Accepted: 05/02/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We aimed to identify salutogenic patterns of parental knowledge, behaviors, attitudes, and beliefs that may support resistance to early childhood caries (ECC) among a high caries population of preschool American Indian (AI) children. METHOD Participants were 981 child-parent dyads living on a Southwestern reservation who completed baseline assessments for an ongoing randomized clinical trial. T-tests were used to assess differences between reported knowledge, behaviors, and beliefs of parents whose children were caries-free (10.7 percent) and those whose children had caries (89.3 percent). Chi-square analyses were used for categorical variables. RESULTS Although there were no socio-demographic differences, parents of caries-free children viewed oral health as more important and reported more oral health knowledge and adherence to caries-preventing behaviors for their children. Parents of caries-free children were more likely to have higher internal locus of control, to perceive their children as less susceptible to caries, and to perceive fewer barriers to prevention. These parents also had higher sense of coherence scores and reported lower levels of personal distress and community-related stress. CONCLUSIONS Effective interventions for ECC prevention in high-caries AI populations may benefit from approaches that support and model naturally salutogenic behaviors.
Collapse
Affiliation(s)
- Judith Albino
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Wilson A, Brega AG, Batliner TS, Henderson W, Campagna EJ, Fehringer K, Gallegos J, Daniels D, Albino J. Assessment of parental oral health knowledge and behaviors among American Indians of a Northern Plains tribe. J Public Health Dent 2013; 74:159-67. [PMID: 24117628 DOI: 10.1111/jphd.12040] [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: 11/09/2012] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Investigate the relationship between sociodemographic variables and oral health knowledge and behaviors of American Indian (AI) parents as the initial step in a program aimed at reducing caries experience among AI children. METHODS Survey data were collected from a sample of 147 AI parents of children ages 0-7 years who are residents of a Northern Plains reservation. Questions addressed sociodemographic variables for parents/their children and parent oral health knowledge and behavior. Overall knowledge was measured as percentage of items answered correctly. Overall behavior was measured as percentage of items reflecting behavior consistent with accepted oral health recommendations. Oral health knowledge and behaviors, and the relationship between them, were evaluated across groups defined by quartiles. RESULTS Parent sociodemographic variables were not significantly associated with behavior scores. Female gender, higher level of education, and higher income were significantly and positively associated with mean knowledge scores. Behavior and knowledge scores were significantly correlated. On average, survey participants identified the best answer for 75 percent of knowledge items and engaged in 58 percent of optimal oral health behaviors. Participants in higher oral health knowledge quartiles had greater adherence with recommended oral health behaviors than those in lower quartiles. CONCLUSIONS Surveyed AI parents had reasonably high levels of knowledge about oral health and caries prevention for their children but engaged at relatively lower levels in parental behaviors necessary to promote oral health. Strategies focused on behavior change, rather than knowledge alone, may be most likely to affect oral health outcomes for AI children.
Collapse
Affiliation(s)
- Anne Wilson
- University of Colorado School of Dental Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | | | | | | | | | | | | | | | | |
Collapse
|