In 2001, in response to the high burden of oral disease experienced by some segments of the U.S. population, the National Institute of Dental and Craniofacial Research (NIDCR) established the Health Disparities Research Program, funding Centers for Research to Reduce Disparities in Oral Health. Studies within the Centers helped identify factors contributing to oral health disparities and developed and tested intervention strategies. The expanded understanding of the wide range of factors associated with specific diseases, such as early childhood caries, contributed to a more comprehensive conceptual framing that recognizes multiple levels of influence on oral health. The Centers also focused on training and career development opportunities, to expand the cadre of scientists from diverse disciplines and backgrounds committed to conducting oral health disparities research.
In 2008, NIDCR funded a second cohort of Centers, which focused on interventional research with populations most affected by oral health disparities. The studies are being conducted in community-based settings, such as Federally Qualified Health Centers, public housing, Project Head Start classrooms, Women, Infants, and Children (WIC) offices, and participants’ homes. To enhance rigor and reproducibility, researchers from different Centers studying disparate populations collaborated to develop standard metrics and methods for conducting their trials. While these interventional studies are ongoing, the methods developed by the collaborating Centers have already become a resource for the health disparities research community. With ongoing efforts to engage scientifically and culturally diverse researchers, trainees, and staff, the Centers continue to enrich the oral health disparities research workforce.
“The Consortium will take decisive action against oral health disparities at multiple levels of influence.”
Ruth Nowjack-Raymer, Ph.D., M.P.H.
NIDCR Program Officer
In September 2015, NIDCR continued its commitment to research aimed at reducing inequities in access to care and oral health disparities, by funding a Consortium made up of nine separate studies focused on the oral health of U.S. children, with support from a single data coordinating center. This initiative reflects NIDCR’s support for research with active community engagement. The Consortium is expected to catalyze advances in the areas of population health promotion, disease prevention, and access to care. Some study teams in the Consortium plan to develop or refine and test innovative interventions, while others will evaluate the effects of existing programs and policies intended to reduce oral health disparities and inequities. A key component of all of the studies is consideration of multiple influences on children’s oral health. Each of the studies will address a range of determinants of health and risk factors at varied levels of influence, such as individual, family, community, organizational/institutional, health services, or public policy. The studies will also conduct cost analyses of interventions.
2015 Consortium Participants
Integrating Interactive Parent Text Messaging and Oral Health Guidelines into Pediatric Community Health Centers to Reduce Early Childhood Caries
Principal Investigators: Belinda Borrelli, Ph.D. and Michelle M. Henshaw, D.D.S., M.P.H.
Boston University, Henry M. Goldman School of Dental Medicine; UH2DE025492-01
The investigators plan to develop and implement an early childhood caries intervention that engages pediatric providers at community health centers and parents/guardians of children 6 years of age or younger attending well-child visits. The multilevel, theory-based intervention will utilize a novel interactive text-messaging approach in tandem with American Academy of Pediatrics oral health guidelines.
Using Social Networks to Improve Oral Health
Principal Investigator: Raul I. Garcia, D.M.D.
Boston University, Henry M. Goldman School of Dental Medicine; UH2DE025505-01
The study team, a collaboration among Boston University, Indiana University, and the Boston Housing Authority, will conduct a social network analysis and use the results to develop an oral health intervention with public housing development families and children 1-5 years of age. The intervention will leverage identified networks to disseminate oral health promoting and disease prevention messages to public housing residents to facilitate the adoption of positive community-based change.
Multi-Level Interventions to Reduce Caries Disparities in Primary Care Settings
Principal Investigator: Suchitra S. Nelson, Ph.D., M.Sc., M.S.
Case Western Reserve University; UH2DE025487-01
The study team will develop and implement a cluster randomized clinical trial to test the effectiveness of parent, provider, and pediatric practice interventions to increase dental utilization among low-income children 3-6 years of age attending well-child visits within the Rainbow Research Network.
Influence of Financial Incentives on Oral Disease Management in Young Children (BEhavioral EConomics for Oral health iNnovation [BEECON])
Principal Investigators: Stuart A. Gansky, Dr.P.H., James G. Kahn, M.D., M.P.H., and Francisco J. Ramos-Gomez, D.D.S., M.S., M.P.H.
University of California, San Francisco, with subcontract to University of California, Los Angeles; UH2DE025514-01
The investigators of the BEhavioral EConomics for Oral health iNnovation (BEECON) project will use mixed methods to design incentives for promoting caregiver behaviors to prevent caries in young children, assess child oral health outcomes and evaluate cost-effectiveness of the intervention. BEECON will enroll underserved, low-income Hispanic/Latino families with children 0-5 years of age in Early Head Start and Women, Infants, and Children (WIC) supplemental nutrition programs in Los Angeles County.
Evaluating Standardized Preventive Care to Reduce Dental Disparities in Children
Principal Investigators: Elizabeth A. Mertz, Ph.D. and Joel M. White, D.D.S., M.S.
University of California, San Francisco; UH2DE025504-01
The investigators will assess a standardized caries prevention program’s capacity to reduce disparities in untreated tooth decay and caries incidence for low-income and rural children 0-20 years of age in Oregon. This mixed-methods evaluation will also assess organizational sustainability, cost, and Medicaid policy implications.
COordinated Oral Health Promotion (CO-OP) Chicago
Principal Investigator: Molly A. Martin, M.D., M.A.P.P.
University of Illinois at Chicago; UH2DE025483-01
The study team plans to assess the impact of a family-focused intervention for oral health promotion delivered by community health workers in medical clinics, Women, Infants and Children (WIC) centers, family homes, or in a combination of these settings. Investigators will assess caries outcomes in children aged 0 to 3 who are from low-income families.
Evaluating the Outcomes of Oral Health Workforce Policy to Increase Access to Dental Providers and Reduce Oral Health Disparities
Principal Investigators: Melanie L. Simmer-Beck, Ph.D., R.D.H. and Patricia J. Kelly, Ph.D., M.P.H., A.P.R.N.
University of Missouri Kansas City; UH2DE025510-01
The investigators plan to examine the impact of an existing state policy of dental workforce expansion, the Extended Care Permit Registered Dental Hygienist (ECP RDH). Oral health and social outcomes will be assessed in pre-K through high school aged children from underserved, primarily rural, communities who receive care delivered by ECP RDHs.
Sociopolitical Policies That Reduce Disparities in Children’s Oral Health
Principal Investigators: Anne E. Sanders, Ph.D., and Gary D. Slade, Ph.D.
University of North Carolina at Chapel Hill; UH2DE025494-01
The investigators will analyze the impact of water fluoridation policies in effect since 1980, by linking time-series data on fluoride content of community water supplies with dental caries data from the National Health and Nutrition Examination Surveys (NHANES) over the period 1998 to 2014. The purpose is to determine whether access to fluoridated drinking water reduces race- and income-related disparities in dental caries among children.
Oral Health Equity in Alaska (OHEAL): Implementation and Evaluation of Delivery System Changes to Reduce Oral Health Disparities for Native American Children
Principal Investigator: Joana Cunha-Cruz, D.D.S., M.P.H., Ph.D.
University of Washington; UH2DE025488-01
The study team plans to assess the effect of a culturally tailored, multilevel intervention that includes integration of care, risk assessment and referral, and chronic disease management. The intervention will be delivered via primary dental health aides, dental health aide therapists, pediatric and primary care dentists, all serving as part of a dental care team. Investigators will assess caries outcomes in pre-kindergarten to high school-aged American Indian/Alaska Native children.
Coordinating Center to Help Eliminate/Reduce Oral Health Inequalities in Children
Principal Investigators: Stuart A. Gansky, Dr.P.H. and Steven Gregorich, Ph.D.
University of California, San Francisco; U01DE025507-01
The UCSF-based Data Coordinating Center will support the Oral Health Disparities and Inequities Research Consortium by assisting with study design, instrumentation, and protocol development; providing and configuring tools for secure data collection, data management, and research project monitoring; contributing to participant safety monitoring; coordinating consortium communication and activities, including Steering Committee meetings; facilitating synergistic working groups on cross-cutting topics; training and calibrating oral health examiners; and assisting compliance with post-study data sharing obligations.
Ruth Nowjack-Raymer, MPH, PhD
Health Disparities Research Program
Center for Clinical Research
Division of Extramural Research
National Institute of Dental and Craniofacial Research
6701 Democracy Blvd.
Room 640, Mail Stop 4878
Bethesda, MD 20892-4878
Telephone: (301) 594-5394
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