Mary Daum and Jody Dove
In partnership with the National Center on Minority Health and Health Disparities, NIDCR will provide approximately $7 million per year over a seven-year period to support the centers through cooperative agreements. The new centers at Boston University, New York University, the University of California at San Francisco, the University of Michigan, and the University of Washington will focus on a wide variety of populations at risk for oral health disparities. They will partner with other academic health centers, state and local health agencies, community and migrant health centers, and institutions that serve targeted patient populations.
"The centers represent a cornerstone of NIDCR's efforts to redress oral health disparities," said NIDCR Director Dr. Lawrence Tabak. "More needs to be done, however, and we are working to identify the remaining gaps and the best ways to fill them. Our overall efforts have been markedly strengthened by our partnership with the National Center on Minority Health and Health Disparities and the wise counsel of its director, Dr. John Ruffin."
The need for the centers is underscored by findings reported in the first-ever Surgeon General's Report on Oral Health, released in May 2000 (http://www.nidcr.nih.gov/sgr/oralhealth.asp). The report identified a "silent epidemic" of dental and oral diseases that disproportionately burden the nation's poor, especially children and the elderly, as well as members of minority racial and ethnic groups. People with disabilities or complex health problems also are at greater risk for oral diseases that can, in turn, further complicate their health. The new centers will address concerns raised in the Surgeon General's report, and also will help meet the goals of the Healthy People 2010 initiative, the national effort coordinated by the U.S. Department of Health and Human Services that aims to improve the health of all Americans and eliminate disparities in health (http://www.health.gov/healthypeople).
"Our partnership with NIDCR has been longstanding and very productive," said Dr. John Ruffin, Director of the National Center on Minority Health and Health Disparities and its predecessor, the Office of Research on Minority Health. "We are so pleased to join in the promising efforts of the NIDCR by helping to support these centers, which create new opportunities to reduce and ultimately eliminate oral health disparities. They will play a key role across the nation in conducting the research and research training that will establish a solid foundation for future progress."
Northeast Center for Research To Reduce Oral Health Disparities
Despite progress in reducing dental caries, tooth decay remains one of the most common diseases of childhood, particularly among poor children and children from minority racial and ethnic groups. The Northeast Center for Research To Reduce Oral Health Disparities, headed by Dr. Raul Garcia at Boston University School of Dental Medicine, will focus on reducing early childhood caries. Researchers at the center will examine the effects of tooth decay on the quality of life of low-income African American, Asian, Hispanic, and white children, and determine whether severe caries can slow growth. Additionally, investigators will determine the best ways to involve pediatricians in reducing early childhood caries. They also will conduct studies of children and caregivers from the various racial and ethnic groups to learn more about the oral microbes that trigger tooth decay and how they are transmitted.
The center is a collaborative effort involving Harvard University, The Forsyth Institute in Boston, the Children's National Medical Center in Washington, D.C., and Boston Medical Center.
The New York University Oral Cancer Research for Adolescent and Adult Health Promotion Center
(New York University)
Oral cancer, like many diseases, continues to take a disproportionate toll on minorities. African American males suffer the highest incidence of any group in the U.S. mainland. Puerto Rican males residing in Puerto Rico also have a high incidence of the disease. Failure to diagnose oral cancers in their earliest stages is probably the greatest factor contributing to poor treatment outcome. The New York University center, headed by Dr. Ralph Katz, will determine why minorities do not get oral cancer exams that might pick up the earliest signs of the disease. Specifically, they will look at differences in willingness to participate in cancer screening exams among African Americans, Puerto Ricans residing in Puerto Rico, Puerto Ricans residing in the U.S. mainland, and whites. The researchers also will look for ways to alter behavior to reduce risk factors such as tobacco and alcohol use.
Collaborating with the New York University center are Boston University, Howard University, the Johns Hopkins University, the University of Pittsburgh, Tuskegee University, the University of Alabama, the University of Puerto Rico, the Puerto Rico Health Department, and Memorial Sloan Kettering Cancer Center.
Center Addressing Disparities in Children's Oral Health
(University of California, San Francisco)
The primary focus of this center, directed by Dr. Jane Weintraub of UCSF, is the prevention of early childhood caries, particularly among Mexican-, African-, Chinese-, and Filipino-Americans and low-socioeconomic-status whites. Researchers at the UCSF center will explore factors such as cultural attitudes and other barriers that may prevent parents and caregivers from taking their young children to the dentist. Such knowledge may then be used to influence the development of public policy to reduce these barriers. The researchers also will use individual, community, and statewide data to determine what risk factors most likely lead to early childhood caries to help identify susceptible children. Finally, they will conduct clinical trials to test two interventions to prevent dental disease. The effectiveness of fluoride varnish painted on children's teeth is being evaluated at two diverse sites in San Francisco the San Francisco General Hospital Family Dental Center and the Chinatown Public Health Center. An additional study evaluates a combination of preventive oral care methods for pregnant women, their infants, and toddlers who live on the U.S.-Mexican border.
Collaborating with UCSF are the San Francisco Department of Public Health, the San Ysidro Community Health Center, a model health care center located near the U.S.-Mexican border, and 12 other agencies and institutions along the West coast.
(University of Michigan)
The Detroit Center for Research on Oral Health Disparities will work with a Detroit community of low-income African American children and their primary caregivers to promote oral health and reduce disparities. Investigators will seek to answer the question: Why do some low-income African American children and their caregivers have better oral health than others from their same community? The researchers will look at the influence of cultural, biological, and dietary factors on oral health status. Using this information, they will develop an educational campaign targeted at the community to improve oral health. Additionally, the center will evaluate whether children's access to dental services improves when Medicaid is managed like private health insurance.
The Detroit Center for Research on Oral Health Disparities, under the leadership of Dr. Amid Ismail, consists of the University of Michigan's Schools of Dentistry, Public Health, Social Work, and Medicine, the Institute for Social Research, and the University of Detroit-Mercy. Additional collaborators are the Detroit Department of Health, and the Voices of Detroit Initiative, funded by the Kellogg Foundation.
The Northwest/Alaska Center To Reduce Oral Health Disparities
(University of Washington)
The Northwest/Alaska center will address the needs of poor, minority, and rural children and their caregivers. These groups include Alaska Natives, Native Americans from the Yakima Indian Nation, Hispanic migrant farm workers, African Americans and Hispanics from the local military bases, Hispanics and Pacific Islanders served by urban hospitals, as well as rural and low-income whites.
Researchers will examine why, within some minority populations, individuals are afraid to go to the dentist, and whether parents and caregivers may be passing on cultural beliefs that lead to dental fear. The researchers will use culturally appropriate approaches to talk about dental fear and will create long-distance learning programs to help people overcome their fear. In other research, scientists will test the theory that there are natural antibodies in epithelial cells lining the mouth that protect against dental caries. They will work with caries-prone children to determine if these children experience a breakdown in such antibody protection.
The Northwest/Alaska Center To Reduce Oral Health Disparities, directed by Dr. Peter Milgrom, represents a collaborative effort of the University of Washington School of Dentistry with the UW School of Medicine and Heritage College, the Alaska Native Tribal Health Consortium, the Yukon-Koskokwim Native Health Corporation, the Yakima Valley Farm Workers Clinic, the Northwest Portland Area Indian Health Board, the Northwest Tribal Epidemiology Center, Washington Dental Services Foundation, and the Medical Assistance Administration.
The National Institute of Dental and Craniofacial Research and the National Center on Minority Health and Health Disparities, which are funding the new centers on oral health disparities, are components of the National Institutes of Health, U.S. Department of Health and Human Services. The NIDCR is the nation's leading supporter of research on oral, dental, and craniofacial health.