Addressing Oral Health Disparities...
How the School of Dentistry's Detroit Dental Health Project is Making a Difference in the Lives of Children and their Caregivers
Initial Meetings with City and Community Groups
Before attempting to learn more about the extent of the oral health disparity problem, Ismail and others with DDHP reached out to city and community organizations ask for their support and ideas.
Dr. William Ridella, deputy director of the Detroit Health Department, worked extensively with the leaders of the Detroit Dental Health Project.
“Amid approached us at the Detroit Health Department in 2000 to talk to us about an idea he had to try to determine the extent of the oral health disparities among children in Detroit,” Ridella said. “We have worked with many organizations in the past, including the University of Michigan, and saw this as an opportunity to be a major participant in addressing an issue that is important to the community.”
Ridella, who has been with the Detroit Health Department for 27 years, said the project “was intriguing because of what DDHP was trying to measure, that trained community survey specialists would be going door to door, and that they would assess family dental needs and make appropriate referrals.”
Another organization that was approached was the Voices of Detroit Initiative (VODI), a community-based coalition of health care providers whose mission is to address the needs of the uninsured and the underinsured. Lucille Smith, VODI executive director who has worked for more than 10 years to help improve access to health care in Detroit, was enthused from the start.
“We were very pleased that DDHP was going to talk to parents or caregivers of the children, so we helped tailor some of their approaches so they could obtain the information they were looking for as well as identify the needs in the households,” she said.
Selma Goode, coordinator of Westside Mothers, a 500-member organization “whose membership includes about 25 percent men and a few grandmothers too,” she said, has been helping families for more than four decades.
When she publicized the news of DDHP’s plans for a door-to-door oral health survey in the organization’s monthly newsletter, “the response was so overwhelming that I’m sure they were busy for a long time,” she said with a laugh.
However, before others went to homes to talk to residents, Goode said she spent “a lot of time” reviewing the questionnaire and suggested wording changes.
“I was amazed at how open Dr. Ismail and his group were in listening to us and hearing so many different ideas from people in the community,” she said. “I never met a professional person in the last forty years who really heard us and really understood what we were really saying.”
By comparison, Goode said, “we previously worked with other professionals and had to tell them how to listen to us and how to treat us, as I would tell them, ‘as million dollar clients.’ Dr. Ismail and his team did that with us.”
10,000 Homes and 3,000 Examinations
Using data from the 2000 census, DDHP conducted door-to-door surveys of children and parents or caregivers (aunts, uncles, grandparents) in 39 census tracts in Detroit with the largest proportions of households with African-American children where annual incomes were less than $29,025 for a family of two and less than $44,125 for a family of four. These amounts, 2000 figures, are 250% above the federal government’s official poverty levels. However, most families in the DDHP studied reported income of less than $10,000 annually.
An individual extensively involved in gathering data in Detroit neighborhoods of the 2000 census played a major role in helping DDHP gather its data.
Charity Hicks, project coordinator and clinical research associate, was leader of the “Wave One,” or recruiting phase effort. Responsible for reaching out to community organizations, organizing focus groups, sample recruitment, and tracking, she also supervised and coordinated the efforts of researchers who went door to door to learn more about the oral health of children from birth to age five. They also assessed the oral health knowledge and attitudes of parents or caregivers.
“Because of the work I did with the 2000 census in Detroit, where I canvassed many households in many neighborhoods, I got to know the city like the back of my hand,” she said with a smile. “I was able to use that knowledge and experience with this project.”
Between September 2002 and August 2003, Hicks said she and other trained interviewers “probably knocked on the doors of about 10,000 homes and apartments and examined about 3,000 children ranging in age from newborn to five years old.”
Hicks said she thought the project was exciting “because it offered an opportunity to talk to families and caregivers and be proactive.”
Research assistant Nikia Banks agreed, saying, “I liked the way community research could help families.”
“I was one of those who went door to door,” said Charles Jackson, treasurer with the Krainzwood Neighborhood Organization, a community group of about 1,500 families on the northeast side of Detroit. The group researched an area on the southeast side of the city bounded by Gratiot, Cadieux, E. Jefferson, and Grosse Pointe.
“We probably went to fifty or one hundred homes, and we were welcomed with open arms,” he said. “But I found that, in many cases, parents or caregivers didn’t know what they could do to improve their children’s oral health.”
Jackson said he and members of the organization “got a lot of satisfaction being able to help because it’s just as disturbing for a child to go to school with a toothache as it is to go to school hungry.”
During the one-on-one interviews, which sometimes lasted three hours, information was gathered about an adult’s oral health care knowledge and beliefs, dietary habits, access to health care, and more.
Later, children whose parents participated in the initial survey were examined at a nearby health center or clinic. The examination included a detailed oral health assessment, screenings for diabetes, plaque bacteria, and caries treatment.
During those 12 months, individuals in 9,781 occupied housing units were contacted and screened. A total of 1,021 children and caregivers completed interviews and examinations.
“I have to compliment Dr. Ismail and his team because going door to door isn’t exactly the easiest thing to do,” Ridella said. “But that was one reason the Detroit Health Department wanted to get involved, because those asking the questions were properly trained and were gathering critical community data.”
Ismail said that one of the “good news findings” from the door-to-door surveys “was that we found about 20 percent of families in the same neighborhood were totally healthy. But what’s frustrating,” he continued, “is that it seems that percentage isn’t increasing.”
