Preventing Cavities in Preschoolers: Testing a Unique Service Delivery Model in American Indian Head Start Programs

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• Preventing Cavities in Preschoolers Testing a
  Unique Service Delivery Model in American Indian
  Head Start Programs
• Principal Investigator David Quissell, PhD.
• University of Colorado Anschutz Medical Center
• Colorado Native Oral Health Research (CNOHR)

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Study Team

• Co-investigators

• Interventionists/COHS

• Judith Albino, PhD.
• Terry Batliner, DDS.
• Patty Braun, MD., MPH.
• Lucinda Bryant, PhD.
• Diana Cudeii, RDH.
• Carmen George, MS.
• Nicolas Johs, BA.
• David Quissell, PhD.
• Vong Smith, BA.
• Nikola Toledo, MSA.
• Others

• Stella Begay
• Helen Curley
• Nicole Garcia
• Tracy Goldtooth
• Rose Lee
• Lolita Spencer
• Nikola Toledo
• Cherise Watson

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Partnerships

• Colorado School of Public Health
• University of Colorado School of Medicine
• University of Colorado School of Dentistry
• Colorado Native Oral Health Research Program
• Navajo Head Start
• Navajo Nation Human Research Review Board

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Early Childhood Caries

• Dental caries in the primary teeth of children
  0-6 years of age
• Most common chronic disease of childhood
• 5 times more common than asthma
• Infectious disease
• Largely preventable

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Disparities

• 79 of AI/AN preschool children have caries
  experience
• 3 times greater than their non-Native
  counterparts
• Navajo children have highest rates among American
  Indians
• Mean number of dental surfaces 19
• IHS not able to meet need

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World Health Organization

• Oral Health Promotion
• the process of enabling people to increase
  control over, and to improve their health
• moving beyond a focus on individual behavior
  towards a wide range of social and environmental
  interventions
• World Health Organization. 2010
  http//www.who.int/topics/healthpromotion/en/

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WHO Goals of Oral Health Promotion

• Increase awareness of oral disease, its severity
  and factors that contribute to it
• Reduce the number and intensity of risk factors
  for oral disease, e.g. reduce sugar intake
• Decrease barriers to oral health, e.g. increase
  access to tooth-healthy foods
• Increase access to prevention activities, e.g.
  fluoride varnish, dental visits
• Create healthy environments, e.g. fluoridated
  water

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Conceptual Framework
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Theoretical Framework

• Well-being of children depends primarily on the
  household production of health
• the physical and social setting in which the
  child lives,
• the customs of child care and child rearing
  regulated by the culture in which the setting is
  embedded, and
• the psychology of the childs caretakers
• Harkness S. Super CM. The developmental niche a
  theoretical framework for analyzing the household
  production of health. Soc Sci Med. Jan 1994
  38(2) 217-226.

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Study Setting

• Navajo Head Start Centers
• Federal program-105 HS Centers
• Comprehensive child development program serving
  children ages 3-6 years and their families
• Community-based, child-focused program
• Overarching goal increasing the social
  competence of young children in low-income
  families
• Head Start performance standards

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Study Design

• Design Phase 4 cluster randomized trial
• Unit of analysis Head start classroom
• Intervention fluoride varnish parent oral
  health promotion education classroom
  activities, delivered by Community Oral Health
  Specialists (COHS)
• Control usual care
• Sample 26 intervention classrooms 26 usual
  care classrooms
• Timing 2 years of intervention 3 years of data
  collection

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Intervention

• Structured for Academic Year
• Quarterly Fluoride Varnish Application
• Four Parent/Caregiver Events
• Five Child Activities

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Community Oral Health Specialist

• Community Lay Health Worker
• Oral Health Specialist
• Child Educator
• Parent Educator
• Culturally Sensitive

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Educational Strategy

• Engage the Learner
• informal conversations, storytelling
• Active Learning
• emphasize hands-on
• Small Groups
• encourage opportunities to interact
• Application of Knowledge
• practical applications
• Appropriate Communication
• culturally appropriate, teach-back
• Reinforcement
• messages will be presented in a variety of
  formats, repeated

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Curriculum

• Curriculum targets many influences on disease
  process
• Teeth
• Fermentable carbohydrates
• Bacteria
• Parent/caregiver
• Child
• Head Start teacher

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Curriculum- Messages

• Improving oral health
• Tooth brushing twice daily
• Use fluoridated toothpaste
• Drink fluoridated water
• Fluoride varnish
• Help child brush
• Regular dental visits
• Reducing fermentable carbohydrates
• Reduce sugary/sticky foods
• Reduce frequent snacking
• More healthy snacks
• Reduce vertical transmission of S. Mutans
• Reduce oral sharing

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Fluoride Varnish Application
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Parent/Caregiver Events

• KickOff event with parents/caregivers and
  children
• Brings caregiver/child together
• Incorporates Head Start classroom into the
  intervention
• Engages the Head Start teacher into the process

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Parent/Caregiver Events

• Begins with an educational presentation to give
  necessary knowledge to empower caregivers to make
  change
• Move to small group stations
• Engaging
• Hands on
• Self goal setting
• Follow up contact to assess progress on goal

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Brief Educational Presentation
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Small Group Stations
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Caregiver Goal Setting Tool
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Child Specific Sessions

• Builds on primary concepts
• Tooth function
• Tooth brushing
• Healthy eating
• Fluoride
• Dental visits
• Short, fun activities
• Coloring
• Sorting games
• Role playing
• Matching games

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Summary

• Early childhood caries affects many Navajo
  children and is preventable
• Innovative use of Community Oral Health
  Specialists
• Directed toward the household production of
  health
• Head Start classrooms
• Theory-based curriculum

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• This research is supported by funding from the
  National Institute of Dental and Craniofacial
  Researchagreement 1U54DE019259-01.

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Thank you!Ahéhee!