The National Institutes of Health (NIH) will award 10 research grants designed to eliminate inequities in access to care and improve the oral health of children. With more than $7 million in first-year funding and the potential for additional funding later, these awards support the Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children, a new initiative of NIH’s National Institute of Dental and Craniofacial Research (NIDCR).
“By establishing this research consortium, NIDCR seeks to lead national efforts in reducing childhood oral health disparities,” said NIDCR director Martha J. Somerman, DDS, PhD. “Among the projects awarded are those that test innovative health promotion and disease prevention strategies and evaluate and refine existing programs and policies.”
Children from certain racial and ethnic groups or from families with low levels of education and income are far more likely than other children to develop oral diseases, including tooth decay. In March, the National Center for Health Statistics reported that Hispanic and Latino children and African-American children are about twice as likely as white children to have untreated tooth decay in primary teeth.
NIDCR’s previous investments established the Centers for Research to Reduce Disparities in Oral Health, which gave rise to a cadre of dedicated oral health disparities researchers. Their community-based investigations illuminated the complex social and behavioral determinants of oral health disparities and inequities.
“Research has shown that individual-level approaches alone are not sufficient to reduce rates of tooth decay and other oral diseases,” said NIDCR health disparities research program director Ruth Nowjack-Raymer, PhD, RDH, MPH. “Therefore, the consortium’s research projects will involve holistic, population health, and other approaches to take decisive action against oral health disparities at multiple levels of influence, such as families, neighborhoods, and healthcare systems.”
The following projects will be funded for up to 5 years, pending available funds:
- Integrating Interactive Parent Text Messaging and Oral Health Guidelines into Pediatric Community Health Centers to Reduce Early Childhood Caries, Boston University Medical Campus;
- Using Social Networks to Improve Oral Health, Boston University Medical Campus;
- Multi-Level Interventions to Reduce Caries Disparities in Primary Care Settings, Case Western Reserve University;
- Behavioral Economics for Oral Health Innovation (BEECON), University of California, San Francisco (UCSF);
- Improving Dental Care Quality and Outcomes Through Evidence-Based Prevention and Treatment, UCSF;
- Coordinated Oral Health Promotion (CO-OP) Chicago, University of Illinois at Chicago;
- Evaluating the Outcomes of Oral Health Workforce Policy to Increase Access to Dental Providers and Reduce Oral Health Disparities, University of Missouri, Kansas City (UMKC);
- Sociopolitical Policies That Reduce Disparities in Children’s Oral Health, University of North Carolina at Chapel Hill;
- Oral Health Equity in Alaska (OHEAL): Implementation of Delivery System Changes to Reduce Oral Health Disparities for Native American Children, University of Washington, Seattle;
- Coordinating Center to Help Eliminate/Reduce Oral Health Inequalities in Children (CC HEROIC), UCSF.
With 3 grants, UCSF could see $21 million in support during the next 5 years.
“Although significant progress has been made in discovering ways to prevent rampant tooth decay in preschoolers, these new awards will allow for evaluating innovative ways to reduce decay among those populations most at risk,” said John D. B. Featherstone, PhD, MSc, dean of the USCF School of Dentistry and professor in the department of preventative and restorative dental sciences.
UCSF previously received 2 consecutive 7-year awards totaling more than $35 million, creating and expanding the UCSF Center to Address Disparities in Children’s Oral Health (CAN DO). The 3 new awards comprise CAN DO3. Its primary focus is preventing tooth decay or early childhood caries in young children and eliminating health disparities among low-income individuals and communities.
With up to $4.8 million, BEECON will design incentives that promote caregiver behaviors to prevent caries in young children, assess child oral health outcomes, and evaluate the cost-effectiveness of intervention. It will enroll underserved, low-income Hispanic and Latino families with children up to the age of 5 in Early Head Start and Women, Infants, and Children (WIC) supplemental nutrition programs in Los Angeles County.
The second award of up to $4.8 million will be used to evaluate the impact of a standardized evidence-based prevention and treatment program on reducing disparities, providing better overall population health, improving the care experience, and lowering per capita costs. It will focus on Oregon, where children in lower-income households have twice the rate of untreated decay.
Funded at $11 million, CC HEROIC will provide collaborative research and coordinating center expertise and services to 9 NIDCR-funded community-engaged projects. Its goal is to enable projects to assess multilevel interventions, programs, of policies that will reduce or eliminate oral health disparities in diverse, vulnerable populations of children and young adults up to the age of 21.
Meanwhile, the University of Illinois at Chicago (UIC) will use its 5-year, $5 million grant to develop and test an outreach program to reduce cavities in the city’s low-income and minority infants and toddlers. Community health workers will reach out to educate families about oral hygiene at health clinics, at WIC centers, and in their homes.
“We want to improve the oral health of the child by improving the oral health of the whole family,” said Dr. Molly Martin, associate professor of pediatrics at the UIC College of Medicine. “If the parents or caregivers aren’t practicing good oral hygiene themselves, the chance that the children will take good care of their own teeth is much lower.”
CO-OP Chicago will recruit and train 6 community health workers to talk with 1,500 families with children between the ages of 6 months and 3 years. Families will be followed for 2 years to evaluate their overall health and the incidence of cavities in their children. And the stakes are high, as 63% of third graders in Chicago have cavities, and more than half of them are untreated.
“Improving oral health and access to care for families and children is something we are very excited to be a part of through this grant,” said Marcio da Fonseca, head of pediatric dentistry at the UIC College of Dentistry.
And, the UMKC School of Dentistry and School of Nursing and Health Studies will use its $4.38 million grant to collaborate with the Kansas Bureau of Oral Health Sealant Program to examine the impact of dental hygienists in Kansas. They will assess the oral health and social outcomes in children from 17 underserved, primarily rural communities who receive care from dental hygienists in about 355 schools.
“Kansas is uniquely positioned in providing oral health care by the extended-care permit dental hygienist, and this funding opportunity will allow the evaluation, data collection, and formulation of evidence-based recommendations to further improve the health of Kansas children,” said Cathleen Taylor-Osorne, director of the bureau of oral health.
Extended-care permits allow dental hygienists who meet specific criteria and are sponsored by a Kansas dentist to deliver care directly to children in their community without being directly supervised. Missouri doesn’t currently permit that care model.
“This project will identify cost-effective, evidence-based strategies that improve access to dental providers in rural and urban underserved communities and ultimately reduce the number of children in Kansas who experience pain and suffering from oral health problems that are largely preventable,” said Melanie Simmer-Beck, a UMKC School of Dentistry professor and co-primary investigator of the grant.