Sociopolitical Policies That Reduce Disparities in Children's Oral Health

减少儿童口腔健康差异的社会政治政策

• 批准号: 8984402
• 负责人: Anne E. Sanders
• 金额: $ 59.04万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-18 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8984402
• 关键词: 21 year old; Address; Adolescent; Adopted; Adoption; Adult; Affect; Behavior; Behavioral; Beverages; Biology; Child; Childhood; Cigarette; Communities; Community Actions; Complement; Consumption; Cotinine; County; Data; Data Set; Databases; Dental; Dental Care; Dental Epidemiology; Dental Insurance; Dental Research; Dental caries; Disease; Exposure to; Family; Figs - dietary; Funding; Generations; Hand; Health; Health Planning; Healthy People 2020; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Incentives; Income; Income Tax; Individual; Inequality; Influentials; Insurance Coverage; Intake; Intermediate Variables; International; Intervention; Life; Lifting; Low income; Methods; National Health and Nutrition Examination Survey; Natural experiment; Nutrient; Nutritional Science; Oral; Oral health; Outcome; Outcome Measure; Pathway interactions; Periodontitis; Phase; Plant Roots; Policies; Poverty; Price; Public Policy; Publications; Recommendation; Regulation; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sales; Series; Serum; Smoking; Social Welfare; Solutions; Surrogate Markers; Taxes; Time; Tobacco; Tooth Diseases; Translations; Trust; Vaccinated; Vaccines; Variant; Wages; Water; Water fluoridation; World Health Organization; aged; base; behavioral economics; cost; drinking; drinking water; environmental tobacco smoke exposure; experience; health disparity; health economics; health inequalities; high risk; interest; malignant mouth neoplasm; multidisciplinary; nutrition; population based; public health relevance; response; secondary outcome; social; social health determinants; soft drink; sugar; sweetened beverage; tobacco control; uptake

 DESCRIPTION (provided by applicant): The disparity between rich and poor in children's tooth decay doubled in the past two decades at the same time that dental care utilization increased among low income children. Dental care does not eliminate income disparities because it does not target upstream risk factors that disproportionately affect low income groups. The solution requires population-based interventions that preferentially benefit children at highest risk. This proposal draws together investigators from social- and oral epidemiology, health economics, political science, and nutrition to partner with community representatives tapping into experiences of The Pew Charitable Trusts, the Association of State and Territorial Dental Directors and a local Community Advisory Board of influential community stakeholders. At the crux of the project is the idea that state-to-state variation in policy adoption acts as a natural experiment. The overall objective is to identify state policies that influence social, economic and behavioral determinants of oral health disparities and community action to support sustainable reduction in disparities. Dental caries is the primary disease of interest. Secondary outcomes are serum cotinine and oral human papilloma virus (HPV) infection as surrogate markers of early risk of periodontitis and oral cancer. Time series data will be collected on policy adoption for states and, where applicable, counties for all years available. Policy activities prioritize six primary intervention themes: community water fluoridation; restricted soda consumption; tobacco control; HPV vaccine promotion; children's dental insurance coverage; and welfare. The first aim of phase one is to compile a time-series state policy database on: cigarette excise tax; bans/tax on soda; HPV vaccine promotion, minimum wage, earned income tax credit (EITC), and health plans with pediatric dental coverage. Community water fluoridation will be collected at the county level. Aim 2 will enrich the database with time-series intermediary variables at multiple levels of influence between policy and oral health outcomes. For example, state policy influences communities (e.g. per capita sales of cigarettes and soda). The effect flows to behavior (e.g. soda intake, smoking), nutrition (e.g. daily total energy, total nutrient intake); and becomes embedded in biology (e.g. serum cotinine). The database will be merged into the 1988- 2014 National Health and Nutrition Examination Survey (NHANES) cycles using restricted access geocodes. The objective of phase two (years 3-4) is to examine the relationship between state policy, intermediate variables and the individual unit-level outcomes measured in children aged 2 to 21 years in NHANES. Aim 1 will quantify the relationship between fluoridated water and disparities in dental caries. Aim 2 will quantify the relationship between policies governing the sale of soda, consumption, and disparities in dental caries. Aim 3 will quantify the relationship between tobacco regulation and disparities in serum cotinine. Aim 4 will quantify the relationship between HPV vaccine promotion and disparities in oral HPV infection. Aim 5 will explore effects of EITC effects on in income disparities in dental care and oral health outcomes.

 描述（由适用提供）：在过去的二十年中，儿童衰败的富人与穷人之间的差异增加了一倍，同时牙齿护理利用率增加了低收入儿童。牙科护理不会消除收入差异，因为它并不针对不成比例地影响低收入群体的上游风险因素。该解决方案需要基于人群的干预措施，这些干预措施优先受益于最高风险的儿童。该提案吸引了来自社会和口头流行病学，健康经济学，政治学和营养的调查人员与代表皮尤慈善信托，国家和地区牙科董事协会以及当地有影响力社区利益相关者的当地社区顾问委员会的经验的社区合作。该项目的关键是，政策采用的州对国家的变化是自然实验。总体目的是确定影响口腔健康差异的社会，经济和行为决定者的国家政策，以及社区行动，以支持可持续的差异。牙齿携带是感兴趣的主要疾病。次要结局是血清可替氨酸和口服人乳头状瘤病毒（HPV）感染，是牙周炎和口腔癌早期风险的替代标志物。时间序列数据将根据各州的政策采用以及适用的县的所有可用年份收集。政策活动优先考虑六个主要干预主题：社区水氟化；苏打水的限制；烟草控制； HPV疫苗促进；儿童牙科保险范围；和福利。第一阶段的第一个目的是通过以下方式汇编时间序列国家政策数据库：民事锻炼税；禁令/苏打税； HPV疫苗促进，最低工资，所得税抵免额（EITC）和儿科牙科覆盖范围的健康计划。社区水氟化将在县一级收集。 AIM 2将在政策和口腔健康成果之间多个级别的影响下，以中间变量的时间序列中间变量丰富数据库。例如，国家政策影响社区（例如，文明测试和苏打水的人均销售）。效果流向行为（例如苏打摄入量，吸烟），营养（例如每日总能量，总营养摄入量）；并嵌入生物学（例如血清可替宁）。该数据库将使用受限的访问地理编码限制为1988年至2014年国家健康和营养检查调查（NHANES）周期。第二阶段（第3-4年）的目的是检查国家政策，中间变量与在NHANES 2至21岁的儿童中测得的个人单位级别结果之间的关系。 AIM 1将量化氟化水与牙科差异之间的关系。 AIM 2将量化牙科携带中苏打，消费和差异的政策之间的关系。 AIM 3将量化血清可替氨酸的烟草调节与差异之间的关系。 AIM 4将量化口服HPV感染中HPV疫苗促进与差异之间的关系。 AIM 5将探索EITC对牙科护理和口腔健康结果中收入分配中影响的影响。