Collaborating Research Centers to reduce oral health disparities

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Collaborating Research Centers to reduce oral
health disparities
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Judith Albino, PhD, University of Colorado
Denver, Aurora, CO, R. GARCIA, Boston University,
Boston, MA, J.A. WEINTRAUB, University of
California San Francisco, San Francisco, CA, and
S.A. GANSKY, University of California San
Francisco, San Francisco, CA. These centers are
funded by the National Institute of Dental and
Craniofacial Research (NIDCR), National
Institutes of Health, United States Department
of Health and Human Services.
The NIDCR-funded Collaborating Research Centers
to Reduce Oral Health Disparities (CRCROHD)
represent an innovative approach to understanding
determinants of oral health disparities,
conducting research to address disparities, and
translating research findings into action.
Objectives The NIH-funded Centers at the
University of California San Francisco
(U54DE019285), the University of Colorado Denver
(U54DE019259), and Boston University
(U54DE019275), with the support and encouragement
of NIDCR, have organized as a research
collaborative to take on the unusual and
challenging task of working across wide
geographical distances to design coordinated
research studies that increase comparability and
validity. A Data Coordinating Center is managed
at UCSF. Methods In six randomized clinical
trials, the Centers are testing culturally
appropriate interventions focused on preventing
Early Childhood Caries (ECC) in vulnerable and
minority populations. The studies share common
baseline and outcome measures, as well as
critical moderating and mediating variables.
Three studies involve the use of fluoride varnish
in community settings two include the use of
community workers to deliver interventions two
involve motivational interviewing all involve
extensive community participation. Study sites
are diverse and include community health centers
with medical and dental providers, participants'
homes, and educational and social service agency
settings. American Indian, Latino, and
African-American populations are participating,
as well as other underserved groups of young
children and their families.
Results Common measures have been developed
across studies to allow the Centers to address
the efficacy of different interventions with
common goals as well as distinctive aspects of
research designs. Innovative approaches to
ensuring community-based participation are being
shared across the Centers as well. Conclusions
This collaborative research process is leading to
comparisons of the efficacy of a variety of
approaches and their use in populations that
differ in needs, cultural expectations, and
access to services. Characteristics of
underserved populations, as well as product and
process considerations, will play determining
roles in the acceptability and effectiveness of
preventive interventions.
University of Colorado Denver Center for Native
Oral Health Research (CNOHR)
Boston University Northeast Center for Research
to Evaluate and Eliminate Dental
Disparities (CREED)
University of California San Francisco Center to
Address Childrens Oral Health Disparities (CAN
DO)
About the Collaboration The CRCROHD focused in
the first year on developing a common core set of
measures these include study participant
demographics, parental knowledge, attitudes,
beliefs, behaviors related to early childhood
oral health, dental services utilization, and
clinical field assessments of caries in primary
teeth. The Centers worked together to pilot test
an innovative strategy for capturing data and
measuring inter-rater reliability with caries
examinations. Analyses also are being included
to determine the relative costs of implementing
community-based interventions across the centers.
Each Center is implementing two clinical
trials the paired study descriptions below
summarize critical elements in the research
designs and community populations for each
cross-institutional pair of studies. All trials
utilize changes in caries incidence/increment
(dmfs) as the primary outcome.
Motivational Interviewing

• Background Motivational Interviewing (MI) is a
  specific health communication technology that has
  been used to address a wide range of health
  behaviors by actively engaging the client in
  developing a plan for change. With these two
  trials we hope to learn whether MI can improve
  oral health behaviors and reduce dental caries
  in young children.
• Study Designs
• One urban (public housing) and one rural (in
  homes) research site.
• Non-health professionals will be trained to
  deliver MI sessions to parents of young children.

Community Health Centers

• Background Accessing dental care continues to
  be difficult for low-income families, and primary
  medical care providers may provide a more readily
  available source of dental care. These trials
  assess whether fluoride varnish (FV), coupled
  with counseling and education offered in primary
  care or social service settings, can reduce ECC
  experience among children in low-income families.
• Study Designs
• Both include urban settings and one involves a
  rural setting.
• Community health center clinicians will be
  trained to place FV.
• One study will compare oral health counseling
  methods by different types of providers with and
  without FV the other study will compare FV
  applied by medical staff compared to referral to
  a dentist. This latter study also will take
  place within Women Infants and Children (WIC)
  supplemental nutrition programs for low-income
  families.

Community Based Clinical Interventions with
Preschoolers

• Background Preschool children from low income
  households are among those at highest risk for
  ECC. FV has a strong evidence base for caries
  prevention in primary teeth. Methods for
  expanding access to this preventive service are
  explored, including the use of trained
  community-based oral health educators and service
  providers. The use of FV in combination with
  Glass Ionomer Sealants and oral health counseling
  also will be tested in dental and non-dental
  settings.
• Study Designs
• Non-dental and dental facility research sites.
• One group is testing parental counseling and
  fluoride-releasing Glass Ionomer Sealants with
  FV.
• The other group is testing education/counseling
  with FV.

Collaboration for Innovation in Community
Oral Health