Almost half of children 11 years old and younger suffer from dental caries, making caries one of the most common chronic diseases of childhood. Low-income and minority children bear a disproportionate portion of this burden. In Chicago, these disparities are obvious, with 63% of Chicago-area 3rd-graders having dental caries and over half of those caries untreated. Pediatric dental caries are associated with pain, more severe infections, malnutrition, speech difficulties, poor school performance, cosmetic problems, and an overall lower quality of life.
While many oral health interventions have been developed to reduce the incidence of caries, even the most successful programs have limited effectiveness in high risk children. The delivery and receipt of proper preventive oral healthcare involves social and environmental factors that operate on individual, family, and community levels. Multi-level interventions recognize the need to target these levels simultaneously but multi-level oral health interventions for the primary prevention of dental caries are lacking.
COordinated Oral health Promotion (CO-OP) Chicago is one of nine studies in the Oral Health Disparities and Inequities Research Consortium, and one of four studies selected to test oral health interventions. The Consortium, funded by the National Institute of Dental and Craniofacial Research Consortium, aims to reduce inequities in access to care and oral health disparities of U.S. children. Consortium studies are supported by a single data coordinating center.
CO-OP Chicago brings together a team of clinical pediatricians and dentists, researchers, health psychologists, and policy experts to rigorously test the ability of an oral health promotion intervention to improve child and family oral health. The primary intervention is family-focused education and support from community health workers (CHWs); this intervention will be applied in a range of settings to determine which settings, or combination of settings, result in the best outcomes.
CO-OP Chicago is funded by a grant from the National Institutes of Health awarded in two phases. The first phase, or the UH2 phase, took place in 2015–2017. The second phase, or the UH3 phase, takes place in 2017-2020.
The aim of the UH2 Phase was to formalize partnerships and finalize study design and protocol, including:
1) A formative assessment to determine partner operations, resources, and needs;
2) Training of community health workers (CHWs);
3) Pilot testing of recruitment and intervention protocols;
4) Creation of a final Manual of Procedures; and
5) Clearances and signed contracts from all institutional and community partners.
The UH3 Phase then implements and evaluates the intervention in clinics, WIC sites, and individual families. The aims of this phase are to do the following:
Primary Aim: To evaluate the efficacy of a one-year oral health CHW intervention, compared to usual care, to improve self- reported brushing frequency and observed plaque score in low income urban children under the age of 3 years old. The scientific team hypothesizes that receipt of CHW intervention will be associated with improved behaviors at 12-months compared to usual care.
Exploratory Aim: To determine if the oral health CHW intervention impact on child brushing behaviors varies when the intervention is delivered out of a medical clinic compared to a community WIC center.
The results of this study have the potential to influence oral health programming, workforce development, and reimbursement on the local, state, and national level.
The trial is registered on ClinicalTrials.gov.
For more scientific information about this study, see this project’s page on the website of the UIC Institute for Health Research and Policy, which administers our grant.