Research Program Administrative Center

研究项目管理中心

• 批准号: 7568377
• 负责人: Jane A Weintraub
• 金额: $ 54.97万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-24 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7568377
• 关键词: 3 year old; 5 year old; 6 year old; Acids; Address; Adolescent; Adopted; Adult; Affect; Age; American; Anterior; Apatites; Behavioral; Behavioral Research; Biocompatible Materials; Bite; California; Caregivers; Caries prevention; Censuses; Child; Child health care; Childhood; Chronic; Classification; Clinical; Clinical Research; Clinical Trials; Collaborations; Color; Communication; Communities; Community Health Centers; Community Healthcare; Community Practice; Complement; Condition; Conscious Sedation; Counseling; Dental; Dental Assistants; Dental Enamel; Dental Hygienists; Dental caries; Dentists; Development; Disease; Early Intervention; Economics; Effectiveness; Environment; Ethnic Origin; Ethnic group; Ethnography; Extramural Activities; Family; Fluoride Ion; Fluoride Varnishes; Fluorides; Funding; Future; General Anesthesia; Geographic Locations; Goals; Health; Healthy People 2010; Hispanics; Incidence; Incisor; Individual; Infant; Infection; Institutes; Intervention; Intervention Studies; Leadership; Learning; Life; Link; Low income; Maxilla; Medicaid; Medical; Medical Staff; Mentors; Methodology; Methods; Minority; Mission; Modeling; Molar tooth; Monitor; National Health and Nutrition Examination Survey; Needs Assessment; Not Hispanic or Latino; Nursery Schools; Object Attachment; Office of Administrative Management; Operating Rooms; Oral; Oral health; Paint; Parents; Participant; Physicians; Pit and Fissure Sealants; Placement; Plant Resins; Pliability; Policies; Policy Research; Population; Population Group; Population Growth; Population Heterogeneity; Positioning Attribute; Poverty; Prevalence; Prevention; Preventive; Primary Health Care; Process; Program Development; Protocols documentation; Provider; Public Health; Public Health Dentistry; Qualifying; Race; Randomized Clinical Trials; Recommendation; Research; Research Ethics Committees; Research Personnel; Research Project Grants; Resources; Risk; San Francisco; Schools; Science; Site; Social Work; Strategic Planning; Supervision; Surface; Surgeon; Surveys; System; Techniques; Telephone; Testing; Text; Time; Tooth structure; Topical Fluorides; Training; Translating; Translational Research; Triage; Underserved Population; Universities; Update; Viscosity; Vision; Woman; Work; age group; base; career; clinical efficacy; community organizations; contextual factors; cost; craniofacial; data acquisition; deciduous tooth; design; disorder prevention; dissemination research; early childhood; elementary school; experience; fluorapatite; glass ionomer; health disparity; health literacy; health practice; improved; multidisciplinary; new technology; permanent tooth; prescription document; prescription procedure; prevent; programs; racial and ethnic; scale up; social; success; tooth surface

A. DESCRIPTION OF CENTER OVERALL A.1 INTRODUCTION This proposal for a Center for Research to Reduce Disparities in Oral Health (CRRDOH) builds on the strengths, experience, research endeavors, and collaborations developed over 6 years for the existing NIH-funded UCSF Center to Address Disparities in Children's Oral Health, nicknamed CAN DO (not an acronym). For this renewal, "CAN DO 2," we will continue our efforts to understand, prevent, and reduce early childhood caries (ECC), beginning about age 1 when primary teeth erupt, and caries progression in 3-6-year-olds. We will focus on disease prevention in children and the broader context of the family, community, health-care and social-service delivery systems, as in our conceptual model of children's oral health1. Thus, our vulnerable "health disparity population" is young children at high caries risk due to low socio-economic position, race/ethnicity (i.e., Hispanic; see note, A.3 Table), low health literacy, or underserved geographic location. Our goal is to reduce and eliminate ECC, a difficult and costly condition, often requiring conscious sedation or general anesthesia in an operating room. The most vulnerable children often lack these treatment or prevention options. A1.1 Description of Problem and Significance For almost four decades, dental caries incidence in US children has been declining. Yet, it remains the most prevalent chronic childhood disease3, treatment disparities remain, and prevalence among the youngest children has increased4. Between NHANES 1988-94 and NHANES 1999-2004, dental caries prevalence in primary teeth of 2-5 year olds increased from 24 to 28%. In 1999-2004, 20% of 2-5 year olds had untreated caries. Nationally, caries experience and untreated caries disproportionately affects children living in poverty and children of color. In California (CA), two statewide oral health children's needs assessments concurred, demonstrating large unmet dental needs 6. In 2006, CA ranked 2nd worst of 25 states surveyed. Caries experience was greater in Hispanics than non-Hispanic whites (72% vs 47%); 26% had rampant caries (7+ teeth)6. Hispanic children had higher ECC than other racial/ethnic groups. In San Francisco public schools, kindergarteners from lowerincome families and from families of color had higher caries prevalence than non-Hispanic whites7. Although our work will not be limited to Hispanic populations, most participating families will be Hispanic, the largest US minority group8. The Hispanic population is rapidly growing and expected to be 24% of the 2050 US population9. The 2005 US Census estimates 43 million Americans (14%) are of Hispanic origin, and 13 million Californians, over 1/3 of CA's 36.5 million10. CA has the largest Hispanic population in the US with the largest percent increase from 2000 to 200311. Nationally, Hispanics are the racial/ethnic group most likely to be under age 5; 21% of all US children under 5 are Hispanic12. By 2010, ~50% of CA children are predicted to be Hispanic13. The oral-health disparities and population growth underscore an urgent need for effective, culturally appropriate, disease prevention. A.1.2 Mission The CAN DO 2 mission is to reduce oral health disparities through early intervention and prevention with children and their caregivers. A.1.3 Vision CAN DO shares the vision articulated in the Surgeon General's Call to Action14 and adopted by the American Association of Public Health Dentistry: Optimal Oral Health for All15. A.1.4 Responding to National Objectives CAN DO responds to several Healthy People 2010 national oral-health objectives16 (especially italicized text): 21-1: Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth 21-2: Reduce the proportion of children, adolescents, and adults with untreated dental decay. 21-8: Increase the proportion of children who have received dental sealants on their molar teeth. A.1.5 Responding to NIDCR Strategic and Implementation Plans Our overall plan responds to several National Institute of Dental and Craniofacial Research (NIDCR) goals17"19: developing effective community-based approaches to prevent dental caries, expanding the clinical research and clinical trials program integrated with social and behavioral research, enhancing research capacity and cross-disciplinary research, translating research findings into clinical practice, communicating science-based health information to the public, evaluating new technologies for clinical trial and survey data acquisition, and most salient to this proposal, eliminating oral-health disparities in underserved populations and groups. Specifically, we propose to accomplish these objectives by actively engaging communities and providers in two large-scale intervention studies of caries-prevention methods in young children. Both studies will utilize randomized clinical trial (RCT) methodology stratified by dental and non-dental settings to assess the effectiveness or clinical efficacy of different caries preventive methods on caries incidence and increment among low-income children in diverse populations to reduce oral health disparities. Project 1: A dissemination/implementation study (a practical RCT) of an efficacious fluoride varnish (FV) and parent oral health counseling/anticipatory guidance program delivered in dental, medical (primary care) and social service agency settings (Women, Infants and Children [WIC] programs), on caries incidence/increment among participating 1-3 year olds, and program reach and sustainability across delivery sites, providers, and populations. Two automated telephone counseling approaches will also be compared. Study findings will identify "best practices" for widespread dissemination of FV and parental counseling methods that could be scaled up to increase reach and prevent ECC among high-risk children. Project 2: An intervention study conducted in a dental (federally qualified community health center-FQHC) and a non-dental community setting (linked to a FQHC) among vulnerable young children to compare the efficacy of glass ionomer (Gl) sealants placed on caries susceptible occlusal (biting) surfaces of primary teeth and parent oral health counseling/anticipatory guidance with and without FV, and counseling alone, on caries incidence/increment of participating 3-6 year old children. FV, a resin-based, high-concentration topical fluoride, applied to enamel, transforms apatite to fluoride-rich apatite (fluorapatite) to inhibit caries20'21. FV is painted on teeth with a small brush. The material and single-use applicator can cost <$0.65 per application22. Our CAN DO 1 RCT demonstrated efficacy of FV with parental oral-health counseling to prevent ECC in 1-3-year-old high-caries-risk children, in community health center settings23. Children assigned FV once/year and twice/year were two and -four times less likely, respectively, to develop caries than those with no FV. Children receiving only one FV application over 2 years also benefited vs. those receiving none. In CA, FV can be applied by dentists, hygienists (under a dentist's general supervision), trained dental assistants (under a hygienist's direct supervision), and trained medical staff with a physician prescription. In CA, dentists, registered dental hygienists in alternative practice settings (RDHAP) and physicians can bill Medicaid for FV application. Gl sealants are a low-viscosity, fluoride-releasing, self-bonding biocompatible material placed on the occlusal tooth surfaces to protect the caries-susceptible pits and fissures not easily cleaned. Unlike traditional resinbased sealants that mechanically bond to enamel, Gl sealants primarily chemically bond to enamel. Fluoride ions released from Gl are absorbed by enamel. Several glass ionomer materials exist; some are designed as restorative filling materials. The new Triage material to be tested was designed as a protective sealant. Resinbased sealants require a prior acid-etch step and keeping etched surfaces dry for sealant placement, difficult in young children. Etching and moisture control processes are not needed for Gl sealants. Instead, a conditioner cleans the surface to improve bonding. Gl sealants are more quickly and easily applied than resin-based ones. A. 1.6 So What? If successful, we will learn effective ways to implement and disseminate an efficacious, low-cost, low-tech intervention, FV, and change or enhance clinical and/or social service agency practices to improve young children's health. Some state and local programs have begun FV programs in preschool settings without systematic, rigorously conducted dissemination research determining best practices. We will also develop methods serving as models for disseminating other health interventions in various settings. Our previous work in 1-3 year olds, and success in showing efficacy of FV and parental counseling to prevent ECC23, led us to ask: what interventions would be efficacious in the next age group, 3-5 year olds, when occlusal molar surfaces have increased risk. FV protects these surfaces somewhat, but protects smooth ones better, an advantage for primary anterior maxillary incisors, typically the initial ECC infection site. Resin-based sealants very occlusal molar surfaces24"26, but technique sensitivity and the requirement for a very dry oral environment complicate applications in young children. Gl sealants which do not require dry tooth surfaces are quicker and easier to apply, boosting feasibility in young children. Before extensive provider training and disseminating Gl sealants for primary teeth, their efficacy and feasibility among high caries-risk children, with varying fluoride exposure, must be determined. In this trial in two community-based settings serving mostly low-income Hispanic families, we target children most likely to have oral health disparities. Anecdotally, state and local public health programs are considering switching from established elementary school-based sealant programs to preschool-based FV programs due to lower cost and flexibility (utilizing non-dental providers). Our findings will help guide relevant policy recommendations and program development. CAN DO 1 had three major aims: (1) To identify cultural, environmental, workforce, behavioral, biologic and contextual factors associated with health disparities among ethnic/racial groups in the very diverse CA environment, (2) To enhance our ability to target children likely to be at risk for dental caries, and (3) To provide successful inter-disciplinary interventions to prevent disease and reduce oral health disparities. We accomplished these aims through studies using broad methods and expertise, from qualitative, ethnographic research to better understand cultural and contextual factors to rigorous randomized clinical trials to provide the evidence base for the proposed dissemination project. The scientific expertise and community relationships provide the basis to conduct both studies and future community-based interventions. This proposal expands our community partner network as well as our multi- and interdisciplinary team including new investigators to oral health and health disparity research. CAN DO 2 combines new collaborations with UCSF NIH-funded Clinical and Translational Science Institute (CTSI) experts and closer ties with practicing community clinicians and social service agencies serving low-income families with young children.

A.中心整体描述 A.1简介 该研究中心减少口腔健康差异（CRRDOH）的这一建议是基于优势， 经验，研究努力和合作为现有的NIH资助的UCSF发展了6年以上 解决儿童口腔健康差异的中心，昵称为昵称（不是首字母缩写）。为此， “可以做2，”我们将继续努力理解，预防和减少幼儿龋齿（ECC）， 大约在1岁时爆发牙齿爆发，而3-6岁儿童的龋齿进展。我们将重点关注 儿童的疾病预防以及家庭，社区，医疗保健和社会服务的更广泛背景 交付系统，如我们的儿童口腔健康概念模型1。因此，我们脆弱的“健康差异 人口“由于社会经济地位低，种族/民族（即西班牙裔），幼儿是高龋齿风险的幼儿； 请参阅注释，A.3表），低健康素养或服务不足的地理位置。我们的目标是减少和消除 ECC是一种困难且昂贵的状况，通常需要有意识的镇静或一般麻醉 房间。最脆弱的儿童通常缺乏这些治疗方法或预防选择。 A1.1问题和意义的描述 在近四十年的时间里，美国儿童的牙齿发病率一直在下降。但是，它仍然是最大的 流行的慢性儿童疾病3，治疗差异仍然是最年轻的 儿童增加了4。在NHANES 1988-94和NHANES 1999-2004之间，龋齿患病率 2-5岁的初级牙齿从24％增加到28％。在1999 - 2004年，有20％的2-5岁儿童未经治疗 龋齿。在全国范围内，龋齿经验和未经治疗的龋齿不成比例地影响生活在贫困中的儿童 和有色人种。 在加利福尼亚州（CA），两次全州口腔健康儿童的需求评估同意，证明很大 未满足的牙齿需求6。2006年，CA在接受调查的25个州中排名第二。性经验更大 西班牙裔比非西班牙裔白人（72％vs 47％）； 26％的龋齿（7+牙齿）6。西班牙裔孩子有 ECC高于其他种族/族裔群体。在旧金山公立学校，较低收入的幼儿园 与非西班牙裔白人相比，家庭和有色人种的龋齿患病率更高。 尽管我们的工作不仅限于西班牙裔人口，但大多数参与的家庭将是西班牙裔， 美国最大的少数民族集团8。西班牙裔人口迅速增长，预计将是24％ 2050年美国人口9。 2005年美国人口普查估计有4,300万美国人（14％）具有西班牙裔，并且 1300万加州人，超过3650万的1/3。 CA在美国拥有最大的西班牙裔人口 从2000年到200311年的百分比最大。在全国范围内，西班牙裔是种族/族裔 年龄在5岁以下；在5岁以下的我们5岁以下儿童中，有21％是西班牙裔12。到2010年，预计约有50％的CA儿童 成为西班牙裔13。口腔健康差异和人口增长强调了迫切需要有效的 在文化上适当，预防疾病。 A.1.2任务 可以执行2个任务是通过早期干预和预防措施来减少口腔健康差异 儿童及其照顾者。 A.1.3视觉 可以分享外科医生呼吁动作的愿景14并由美国人采用 公共卫生牙科协会：ALL 15的最佳口腔健康。 A.1.4回应国家目标 可以对几个健康的人做出回应2010年国家口腔健康目标16（尤其是斜体化文本）： 21-1：减少在小学或主要的儿童和青少年的比例 永久牙齿 21-2：减少患有未经处理的牙齿衰减的儿童，青少年和成年人的比例。 21-8：增加在摩尔牙齿上接受牙齿密封剂的儿童的比例。 A.1.5响应NIDCR战略和实施计划 我们的整体计划对几个国家牙科和颅面研究所（NIDCR）的目标做出了回应17“ 19： 开发有效的基于社区的方法来预防龋齿，扩大临床研究 以及与社会和行为研究相结合的临床试验计划，增强了研究能力和 跨学科研究，将研究结果转化为临床实践，传达基于科学的 向公众提供健康信息，评估用于临床试验和调查数据获取的新技术，以及 最重要的是该提案，消除了服务不足的人群和群体中的口腔健康差异。 具体而言，我们建议通过积极吸引社区和提供者来实现这些目标 两项大规模干预研究对幼儿的预防方法。两项研究都将使用 通过牙科和非牙科设置分层的随机临床试验（RCT）方法，以评估 不同龋齿预防方法对龋齿的有效性或临床功效 在不同人群中的低收入儿童中，以减少口腔健康差异。 项目1：有效的氟化物清漆（FV）和 在牙科，医疗（初级保健）和 社会服务机构环境（妇女，婴儿和儿童[WIC]计划），龋齿 参与1-3岁的年轻人的发病率/增长，以及跨越计划的范围和可持续性 交货地点，提供者和人口。两种自动电话咨询方法也将是 比较的。研究结果将确定FV和父母广泛传播的“最佳实践” 可以扩大咨询方法以增加覆盖范围并防止高风险儿童中的ECC。 项目2：在牙科（联邦合格的社区卫生中心-FQHC）和 脆弱的幼儿中的非牙科社区环境（与FQHC相关），以比较 玻璃离子体（GL）密封剂的功效放在龋齿上易感咬合（咬人）原发性表面 牙齿和父母的口腔健康咨询/预期指导有或没有FV，并且仅咨询， 关于参与3-6岁儿童的龋齿发病率/增加。 FV是一种基于树脂的高浓度局部氟化物，应用于搪瓷，将磷灰石转化为富含氟化物的磷灰石 磷灰石（氟磷灰石）抑制Caries20'21。 FV用小刷子在牙齿上涂上。材料和一次性 涂抹器的价格<$ 0.65，每个应用程序22。我们的可以做1 RCT证明了FV与父母的功效 口服健康咨询以防止ECC在社区健康中心的1-3岁高野风险儿童中 设置23。每年分配FV的儿童分别分配了两次，两次分别为两倍，四倍的可能性降低了 比没有FV的人养育龋齿。在2年内仅收到一份FV申请的儿童也受益 与那些没有收到的人。在CA中，FV可以由牙医，卫生学家（在牙医的一般情况下）应用 监督），受过训练的牙科助理（在卫生员的直接监督下），并培训了医务人员 医师处方。在CA，牙医，替代练习环境中的注册牙科卫生员（RDHAP） 医生可以向医疗补助申请医疗补助。 GL密封剂是低粘度，释放氟化物的，自构成的生物相容性材料 牙齿表面以保护龋齿敏感的凹坑和裂缝不容易清洁。与传统的树脂不同 将机械键合的密封剂与搪瓷，GL密封剂主要是化学与搪瓷键合。氟化物 从GL释放的离子被搪瓷吸收。存在几种玻璃离子材料；有些被设计为 恢复性填充材料。要测试的新分类材料被设计为保护性密封剂。基于树脂 密封剂需要先前的酸蚀刻步骤，并保持蚀刻表面干燥以进行密封剂放置，很难 年幼的孩子。 GL密封剂不需要蚀刻和水分控制过程。而是护发素 清洁表面以改善粘结。 GL密封剂比基于树脂的密封剂更快，更容易施用。 A. 1.6那呢？ 如果成功，我们将学习实施和传播有效，低成本，低技术的有效方法 干预，FV，更改或增强临床和/或社会服务机构实践，以改善年轻人 儿童健康。一些州和本地计划已经在没有学龄前的情况下开始了FV计划 系统的，严格进行的传播研究决定了最佳实践。我们还将发展 作为在各种环境中传播其他健康干预措施的模型的方法。我们以前的工作 在1-3岁的年轻人中，以及表现出FV和父母咨询以防止ECC23的功效的成功，导致我们前往 问：下一个年龄段的3-5岁年龄段，咬合摩尔表面的年龄将有效的干预措施 风险增加。 FV在某种程度上保护了这些表面，但可以更好地保护光滑的表面 对于原发性前上颌切牙，通常是初始的ECC感染部位。基于树脂的密封剂非常 咬合摩尔表面24“ 26，但是技术敏感性和对非常干燥的口腔环境的要求 使幼儿的应用复杂化。不需要干齿表面的GL密封剂更快，并且 更容易应用，增强幼儿的可行性。在广泛的提供商培训和传播GL之前 高级牙齿的密封剂，高性风里儿童的功效和可行性，氟化物有不同 曝光必须确定。在这两个基于社区的设置中，大多为低收入的设置 西班牙裔家庭，我们针对最有可能患有口腔健康差异的儿童。轶事，州和地方 公共卫生计划正在考虑从既定的基于小学的密封胶计划转换 由于成本较低和灵活性（使用非牙科提供者），基于学龄前的FV计划。我们的发现 将有助于指导相关政策建议和计划制定。 可以做1个主要目标：（1）确定文化，环境，劳动力，行为，生物学和 与种族/种族群体之间的健康差异相关的情境因素非常多样化 环境，（2）增强我们针对可能有龋齿风险的儿童的能力，以及（3） 提供成功的跨学科干预措施，以预防疾病并减少口腔健康差异。我们 通过广泛的方法和专业知识从定性的人种学来实现这些目标 研究以更好地了解严格的随机临床试验的文化和上下文因素以提供 拟议的传播项目的证据基础。科学专业知识和社区关系 提供基础来进行研究和未来的基于社区的干预措施。该提案扩大了 我们的社区合作伙伴网络以及我们的跨学科团队，包括新的调查员 口腔健康与健康差异研究。可以做2结合与UCSF NIH资助的新合作 临床和转化科学研究所（CTSI）专家，与实践社区临床医生的紧密联系 和社会服务机构为低收入家庭提供小孩的社会服务机构。