Prevention of Dental Caries in Early Head Start Children

早期启蒙儿童的龋齿预防

基本信息

批准号：
7527992
负责人：
RICHARD GARY ROZIER
金额：
$ 91.73万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-01 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7527992
关键词：
1 year old 2 year old Affect Affective Age Age-Months Age-Years Appendix Behavior Caregivers Caries prevention Caring Centers for Disease Control and Prevention (U.S.)Characteristics Child Child health care Childhood Chronic Disease Clinical Cognitive Communities Community Practice Control Groups Counseling County Dental Dental Care Dental Health Education Dental caries Disadvantaged Disease Economics Educational Intervention Educational workshop Effectiveness Effectiveness of Interventions Enrollment Ensure Epidemic Evaluation Face Family Feedback Funding Grant Head Start Program Health Health Personnel Home environment Improve Access Interview Knowledge Lesion Link Low income Manuscripts Measures Medicaid Medical Methods Modeling Mouth Diseases North Carolina Numbers Nurses ORALIT Oral cavity Oral health Outcome Parenting Education Parents Phase Physicians Population Pregnant Women Preventive Primary Health Care Program Evaluation Provider Public Health Public Health Practice Purpose Quality of life Race Randomized Readiness Reporting Research Resources Risk Risk Assessment Screening procedure Self Efficacy Services Site Source Staging System Testing Tooth Diseases Tooth structure Topical Fluorides Training United States Dept. of Health and Human Services United States Health Resources and Services Administration Work base burden of illness cohort concept design disorder risk early childhood expectation falls follow-up health literacy health related quality of life improved instrument motivational enhancement therapy prevent programs social social cognitive theory therapy design

项目摘要

DESCRIPTION (provided by applicant): Early childhood caries (ECC) is the most common chronic disease of childhood, affecting more than 4 million children nationwide. The burden of disease falls mostly on disadvantage children. The purpose of this research is to evaluate an already funded and ongoing intervention designed to prevent ECC in children 0-2 years of age through a combination of preventive dental activities in medical offices and Early Head Start (EHS) centers. EHS staff in North Carolina are being trained to provide dental health education and promotion activities for children and their families, and to link children enrolled in EHS with medical providers in their communities who provide preventive dental services. As part of a statewide Medicaid program, about 500 medical offices are providing preventive dental services for children, including screening, risk assessment and referral, parent counseling and topical fluoride applications. Children and their parents in 18 EHS programs in 28 counties in the state have close geographic proximity to 75 sites where medical providers are offering preventive dental services. The dental educational intervention with EHS staff is based mainly on Social Learning Theory and consists of statewide forums, workshops with audit and feedback of practices, and educational workshops and resource materials. The educational intervention for parents is based in part on the Transtheoretical Model, which uses Stages of Change as its key concept, and motivational interviewing. Staff provide classroom preventive dental activities for children and education for parents, with support provided from local dental public health providers. A non- randomized, pretest-posttest nested cohort control group cluster trial will determine the effects of the combined dental exposures provided in EHS programs and medical offices on preventing noncavitated and cavitated carious lesions in EHS children. About 800 0- and 1-year old children will be enrolled in each of the study groups and examined for ECC at 3 years of age. Age- and race-matched children enrolled in Medicaid but not EHS will serve as community-specific controls. Parents will be interviewed at baseline, and follow-up interviews will take place when their study-enrolled children are 18 and 36 months of age. The clinical examination of the child at 3 years of age will occur at the final follow-up parent interview. Secondary outcomes include cognitive (dental knowledge) and affective (value placed on dental health, self-efficacy, outcome expectations, readiness to change) characteristics, establishment of a dental home for the child and family, and improvements in parent reported oral health-related quality of life (OHRQoL) for the child and themselves. A final aim of the study will determine the extent to which dental health literacy modifies the effectiveness of the intervention in improving outcomes. OHRQoL, dental health literacy and dental "homeness" will be measured with instrument developed by the research team in previous research. Intent-to-treat analyses will determine effects of the intervention on dental outcomes. PUBLIC HEALTH RELEVANCE: Dental disease in young children is at epidemic levels among low-income children and they face a number of barriers that prevent them from getting needed dental care. This study will test several ways in which access to preventive dental services can be increased among children 0-2 years of age enrolled in Early Head Start programs across North Carolina. The result of successful implementation of preventive dental programs should be less disease and improved quality of life among children and their families.

描述（由申请人提供）：儿童早期龋齿 (ECC) 是儿童最常见的慢性疾病，影响全国超过 400 万儿童。疾病负担主要落在弱势儿童身上。本研究的目的是评估一项已经获得资助且正在进行的干预措施，该干预措施旨在通过医疗办公室和早期启蒙 (EHS) 中心的预防性牙科活动相结合来预防 0-2 岁儿童 ECC。北卡罗来纳州的 EHS 工作人员正在接受培训，为儿童及其家庭提供牙科健康教育和宣传活动，并将参加 EHS 的儿童与社区中提供预防性牙科服务的医疗提供者联系起来。作为全州医疗补助计划的一部分，大约 500 个医疗机构正在为儿童提供预防性牙科服务，包括筛查、风险评估和转诊、家长咨询和局部氟化物应用。该州 28 个县的 18 个 EHS 项目中的儿童及其家长距离医疗服务提供者提供预防性牙科服务的 75 个地点很近。 EHS 工作人员的牙科教育干预主要基于社会学习理论，包括全州论坛、实践审核和反馈研讨会以及教育研讨会和资源材料。对家长的教育干预部分基于跨理论模型，该模型使用变革阶段作为其关键概念和动机访谈。在当地牙科公共卫生服务提供者的支持下，工作人员为儿童提供课堂预防性牙科活动，并为家长提供教育。一项非随机、前后测试嵌套队列对照组集群试验将确定 EHS 计划和医疗办公室提供的组合牙齿暴露对预防 EHS 儿童非空洞和空洞龋损的影响。每个研究组将招募约 800 名 0 岁和 1 岁儿童，并在 3 岁时进行 ECC 检查。参加医疗补助计划但未参加 EHS 的年龄和种族匹配的儿童将作为社区特定的对照。家长将在基线时接受采访，后续采访将在他们参加研究的孩子年满 18 个月和 36 个月时进行。孩子 3 岁时的临床检查将在最后一次后续家长访谈中进行。次要结果包括认知（牙科知识）和情感（对牙齿健康的重视、自我效能、结果期望、改变的准备程度）特征、为儿童和家庭建立牙科之家以及家长报告的口腔健康相关的改善孩子和他们自己的生活质量（OHRQoL）。该研究的最终目标将确定牙齿健康素养在多大程度上改变干预措施改善结果的有效性。 OHRQoL、牙齿健康素养和牙齿“居家感”将通过研究团队在前期研究中开发的仪器进行测量。意向治疗分析将确定干预措施对牙科结果的影响。公共卫生相关性：幼儿牙科疾病在低收入儿童中处于流行水平，他们面临着许多阻碍他们获得所需牙科护理的障碍。这项研究将测试几种方法，以增加北卡罗来纳州参加早期启蒙计划的 0-2 岁儿童获得预防性牙科服务的机会。成功实施预防性牙科计划的结果应该是减少儿童及其家庭的疾病并提高生活质量。