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 CenterColorado Native Oral Health Research (CNOHR)

Study TeamCo-investigators• 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

Interventionists/COHS

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

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

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

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

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/

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

Conceptual Framework

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 child’s 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.

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

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

Intervention

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

Community Oral Health Specialist

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

• 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

Educational Strategy

Curriculum

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

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

Fluoride Varnish Application

Parent/Caregiver Events

• Kick–Off 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

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

Brief Educational Presentation

Baby Teeth are Importantfor:

SMILING!

SPEAKING and SINGING!

HOLDING SPACE FOR PERMANENT

TEETH!EATING!

Small Group Stations

Caregiver Goal Setting

Tool

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

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

This research is supported by funding from the National Institute of Dental and Craniofacial

Researchagreement #1U54DE019259-01.

Thank you!Ahéhee!