Assessment of Changes in Access/Utilization and Oral Health Behaviors Among Children Participating in the Oral Health Project at 12-Month Follow-Up 

By Juan M. Chavez

Professor Annette Aalborg, Dr. PH, Faculty Advisor Professor Gayle Cummings, MPH, Faculty Co-Advisor

Master of Public Health Touro University – California, 2015

Acknowledgements A sincere thank you…Advisors• Professor Annette Aalborg, Dr. PH, Faculty Advisor• Professor Gayle Cummings, MPH, Faculty Co-Advisor• Professor Jaesin Sa, Ph.D., CHES, Faculty

Elsa Widenmann School Based Clinic: Dental Clinic • Janelle Glosser • Maruluz Rodriguez• Dr. English, DDS

Kristine Lalic – Solano County Coalition for Better Health

All the parents and students who participated in the Oral Health Project

Presentation Outline Capstone Thesis Project: Study Overview

Literature Review/Related Work

Background of Oral Health Project

Problem Statement

Introduction to Oral Health Project

Study Aim

Methodology

Results

Summary

Literature Review

o Oral health key to overall child health (Kwan, et al., 2005)

o Access to preventive case important (Gillcrist et. al, 2001)

o Many children do not have equal access to dental services (Butani, et al., 2009)

o Parents participation in is key (Gould, et al., 2008)

o School Based Interventions found to be successful (Stokes, et al., 2009)

Related Work• The the project incorporated elements from two large national

family oral health projects:

o One in Detroit/University of Michigan focused on low-income African-

American families. (Finlayson, et al., 2007)

o Another major Oral Health Project in New York (NYU) (Tellez, et al., 2006)

• Both focused on general pediatric populations with significant oral

health problems.

• The project adapted elements from these two projects (Surveys)

Oral Health Project Background• Oral health Project is a collaboration between:

• School-Based Health Center at Elsa Widenmann• Vallejo City Unified School District • Touro University • Dental Health Professionals • Solano County Coalition for Better Health

• This collaboration identified oral health care as an unmet need for the families

• This project integrates oral health with existing primary care.

• Serves low-income families lacking access to oral health services.

• The project is grant funded by the Health Resources and Services Administration (HRSA).

• TUC’s role was designing and implementing the program evaluation.

Problem Statement

• Oral health is a serious and often neglected Public Health problem particularly in communities like Vallejo

• The goal of the Oral Health Project is to reduce the disparity in oral health care.

• The Oral Health Project uses SBHC as a platform to provide much needed dental services.

• The objective is to instill the importance of oral health in childhood

What is the Oral Health Project?The Oral Health Project

• Established an fully functional oral health clinic.

• Dental professionals provide mainly on-going preventive care children.

• Children qualify if they are considered underinsured.

• Parents are assisted to obtain dental insurance for their child.

• Further, the project provides an standardized oral health education at clinic and in their schools.

This Project’s SummaryProject’s Objective: Assess changes in oral health behaviors and access/utilization of oral health services among the children utilizing parent report data.

Study Procedures: • Enroll participants (parents and children)

• Collect parents reported data from baseline and a one-year follow-up questionnaires (n=100).

• Data collection by Student Research Assistants

Goal:• Provide data to the program stakeholders and the funders

Study Aim

• Our study aim is:

TO DETERMINE IF CHILDREN WHO PARTICIPATED IN THIS PROJECT HAVE IMPROVED ACCESS AND UTILIZATION OF ORAL CARE AND IMPROVED ORAL HEALTH BEHAVIOR AND PRACTICES OVER TIME

MethodologyStudy Design: • Quasi-experimental • Pre-post intervention design

Study Sample • 436 participants were enrolled in the Oral Health Project, this

project sample is a subset of 100 whose follow-up survey was completed.

• The participants:• Underserved• Lacking access to oral health services. • Mostly of low-income• Immigrant Latino families • No dental insurance

MethodsStudy Procedures • Parents/guardians are explained the study (overview) at child’s first clinic

visit..

• Their basic information is collected and they are given a uniquestudy identifier number.

• Informed consent forms are reviewed with parents in detail and the study questionnaire is administered.

• Both English and Spanish.

• Parents complete the survey while the dental professionals see their children.

• At follow-up (12-months post baseline), a shorter version of survey is administered.

• Data collectors are all trained MPH Student Researchers in the Community Health Track from TUC.

Methodology

Data Management

• An identifying number is generated per survey

• Surveys were stored in a secured cabinet

• Data dictionary was developed

• Surveys were coded and entered into SPSS software

• Data was cleaned for analysis

Methodology

Oral Health Project Parent Survey

Measuring Tool

• Adapted from two larger studies

• Developed the survey for our project

• Translated the survey into Spanish

• Survey Main topics

• Takes approximately 40 mins

MethodologyAnalysis Plan:• Descriptive statistics were used to describe the study’s population.

• We are analyzing the first 100 matched participants from the baseline and follow-up surveys.

• The data was entered into SPSS (PASW) software.

• We looked at basic demographic data to describe the sample.

• We used descriptive univariate analysis to provide indications of benefit of the intervention. (Change in access and Behavior)

• For a statistical significance, the “Pearson’s Chi Squared Test” was used.

ResultsDemographics of Children

• 70% Latino/Hispanic

• 75% from married households

• 50% living in households incomes of $10,000-39,000 (Within FPL)

• 56% with parents not employed (staying home to care for children)

• Average age is 7 (2 and 14 most frequented)

• 49 mothers, 1 father, 1 grandmother (n=101)

• Family size per household: 21 families with only one child 15 families with two children 10 families with three children 5 families with four children.

Results

Access to Dental Care for Families

ResultsSignificant Findings • Children having a dentist

Increased from baseline to follow up dramatically from 29% to 78%Chi-Square (having insurance):

P=0.262 at baseline to p=0.007 at follow-up

• Caregivers taking their child to see a dentist Increased from 83% from 94% Chi-square (having insurance):

P=0.039 at baseline to P=0.001 at follow-up

• Having dental insurance that covered dental care Increased from 54% to 67% Government insurance increase 57% to 83%

Results

Oral Health Behaviors

Caregivers intent to take their child to see a dentist within:

• Three-months: Decreased from 48% to 21%

• Six-months: Increased from 42% to 72%

Brushing and Flossing Practices:

• Brushing at least twice a day: Increased 58% to 69%

• Flossing at least at least once a day: Increased 35% to 44%

Summary• School Based Health Centers appear to be an effective way to deliver

oral health services for school children.

• The objective was to observe changes in access and utilization of oral care and improved oral health behavior and practices over time.

• Using this model, the Oral Health Project appeared to have accomplished the aim to reduce the disparity in dental health access among participants.

• Improved access to oral health services was corroborated using Chi-square statistical tests.

• Improved access to oral health services was corroborated using Chi-square statistical tests.

Summary• Data supports an overall increase benefit of the Oral Health

Project in reducing oral health disparity.

• The final study analysis should provide more conclusive and concrete results.

• We can conclude that School Based Health Centers have a strong potential to improve access to oral health services and to potentially reduce disparities in oral health among low-income children.

• More research in the effectiveness of School Based Health Centers could provide enough significant evidence of the value of SBHS in reducing health disparities.

SummarySignificant Limitations• Baseline to Follow-Up Survey Consistency

• Lack of access to the actual visit records of patients

• Study size of the sample

Future Direction

• Oral Health Project will continue to collect data of all participants

enrolled (n=436)

• Final analysis will be similar in methodology as this project

• Abstract for this project was submitted to APAHA

• If selected, will be presented at the annual conference in Chicago, Illinois,

October 31st-November 4th, 2015

ReferencesButani, Y., Gansky, S.A., & Weintraub, J.A. (2009). Parental Perception of Oral Health Status of Children in Mainstream and Special Education Classrooms. Spec Care Dentist. 29(4): 156-162. Finlayson TL, Siefert K, Ismail AI, Sohn W. (2007). Psychosocial factors and early

childhood caries among low-income African-American children in Detroit. Community Dent Oral Epidemiology. 2007 Dec: 35(6):439-48.

Gould, Ellen, RDH, MPA; Goodson, J. Max, DDS, Phd; Soncini, Jennifer DMD; Tavares, Mary, DMD, MPH; Osborn, Valarie RDH; Niederman, Richard, DMD, MA. (2008). A Model For Extending The Reach Of The Traditional Dental Practice: The Forsythkids

Program. American Dental Association. JADA, Vol. 139: 1040-1050. August 2008.

Kwan, Stella Y.L.; Erik Petersen, Poul, et al. (2005). Health-Promoting Schools: An Opportunity For Oral Health Promotion. Bulletin of the World Health Organization. September

2005, 83 (9).Stokes, E., Pine, C.M., & Harris, R.V. (2009). The promotion of oral health within the healthy School context in England: a qualitative research study. BMC Oral Health. 9(3): 1-10. Tellez, Marisol, BDS, MPH, PhD, Sohn, Woosung, DDS, DrPH, PhD, Burt, Brian A.

BDS, MPH, PhD, and Ismail, Amid I. BDS, MPH, DrPH. (2006). Assessment of the Relationship between Neighborhood Characteristics and Dental Caries Severity among Low-Income African-Americans: A Multilevel Approach. Journal Public Health Dent. 2006 ; 66(1): 30–36.