Specific Aims

The Detroit Center for Research on Oral Health Disparities (DCR-OHD) was established with the following specific aims:

1. To promote oral health and reduce the disparities in oral health within the community of low-income African-American children (0-5 years) and their main caregivers, living in the City of Detroit. This goal will be addressed through understanding of the social, familial, biological, and neighborhood determinants of dental caries and periodontal disease, and designing and implementing tailored interventions to target oral health knowledge and behaviors and access to dental care.
2. To develop a multidisciplinary cadre of health providers knowledgeable about oral health care and research in the City of Detroit.
3. To assist in the provision of dental care services to low-income and dentally underserved residents of the City of Detroit.

The Center developed and is implementing an interdisciplinary research program that seeks to find answers to the following question:

Why do some African-American children and their main caregivers have better oral health (based upon the 2010 USPHS Oral Health Objectives) than others who live in the same community and share similar social, economic, and cultural characteristics?

The Center includes four integrated research projects that are centered on the targeted population and one research project that evaluates the impact of a state-sponsored pragmatic experiment on access to dental care and utilization of dental services. 

Project #1: Socio-cultural determinants, context of parenting and children's oral health
This project contends that current research is inadequate to explain the process by which social stratification translates into poor oral health starting in earliest childhood. Without an understanding of the process by which this occurs, preventive interventions are doomed to failure.  Accordingly, the aim of this research is to examine the influence of material and social context at the individual (e.g., family income, supports and stresses) and neighborhood (Census track, police precinct, and City of Detroit data) level, on child oral health, and the mediating and moderating effects of caregiver parenting behaviors, beliefs and identity.  Special attention will be given to the interface between racial identity and health promotion as part of parenting.

Project #2: Lead exposure and dietary factors in children's oral health
This study seeks to identify the relationships between lead levels, intake of dietary fats and sugars, and dental caries experience in disadvantaged African-American children, and to identify how these variables in the parent/caregiver relate to the child’s oral health status.  The purpose is to identify areas for successful intervention toward reducing the disparities between those with the poorest oral health and their better-off peers.  Each caregiver will complete a food frequency questionnaire (FFQ) at home for him/herself and the child(ren). The adult caregiver will be asked for a finger stick blood sample and a saliva sample (for lead assay); saliva samples will be sought from the children only at the exams in years 4 and 6.  Participants will also be measured for height and weight at the first and subsequent examinations.  The outcomes of this project are severe dental caries experience in the child, and exposures will be lead levels in child, and sugars and fats in the diets of child and caregiver.  Other variables, such as the demographic information collected in other Center studies and body mass index of the caregiver and child, will be included in the multivariate analyses to determine relative risk.  The child’s FFQ, to be developed for this study, will also be a valuable tool for other studies of child obesity, nutrition, and diabetes in young African Americans.

Project #4: Efficacy of a tailored oral health education program
The long-term objective of this project is to develop an effective tailored behavior change expert system (ES) education program to promote and maintain good oral health and prevent oral diseases among low-income children and their caregivers.  To achieve this, the proposed multimedia-based, self-help intervention is designed to be easy to use and easy to diffuse for large-scale use through personal computers.  Due to the current lack of tailored self-help behavior change dental interventions, substantial time and resources are needed to develop the content and to test the instruments and feasibility of the proposed intervention.  This project has five specific aims: (1) To design and produce two interventions to promote oral health and prevent oral disease among caregivers and their children: (i) an interactive, tailored, theory-driven, behavior change ES education program, and (ii) an untailored health information (HI) comparison program; (2) To assess the feasibility and usability of these unique interventions with a small-scale feasibility study prior their final implementation; (3) To revise the interventions based on the findings of the feasibility study and implement the efficacy trial; (4) To evaluate the efficacy of the interventions with two clinical outcomes: gingivitis among caregivers and untreated tooth decay among caregivers and their children; and (5) To examine the extent to which the clinical outcomes are mediated by the affective, evaluative, and situational individual factors influenced by the tailored intervention, or by broader psychosocial factors addressed in other Center projects.

Project #5: A pragmatic study of a new payment system for Medicaid
This study will monitor utilization of dental care in Michigan children, in order to evaluate the effectiveness of recent and future SCHIP (State Children’s Health Insurance Program) and Medicaid initiatives in reducing disparities in access to and utilization of dental care.  Evidence from many sources demonstrates a wide disparity in utilization of dental care that is associated with the socioeconomic status of children.  Disparities exist as measured by both visits for dental care as well as untreated oral disease.  Dental insurance claims data will be used to demonstrate historical patterns of utilization and the disparities between privately-insured and Medicaid-eligible children.  Future data from both the privately-insured child population in Michigan and from the newly-implemented private-insurance based SCHIP and Medicaid programs in Michigan will then be monitored for the next several years to assess the ability of these innovative methods of payment and administration to reduce the historical disparities in dental care utilization.  Specific hypotheses to be tested are: 1) Payment for dental care at market rates will result in no difference in the percent of children with at least one dental visit per year, among children with Medicaid, SCHIP, or private insurance coverage, 2) Payment for dental care at market rates will result in no difference in the distance traveled to receive care, among children with Medicaid, SCHIP, or private insurance coverage, and 3) Payment for dental care at market rates will result in no difference in the mix of services received among children with Medicaid, SCHIP, or private insurance coverage.