Oral health disparities research initiative

October 02, 2001

ANN ARBOR---The University of Michigan School of Dentistry has received funding from the National Institute of Dental and Craniofacial Research (NIDCR) to develop a research program to investigate the social, economic, environmental, and biological causes of disparities in oral health.

The main theme of the U-M research project is centered on finding answers to the question: why do some low-income African American children and their care-givers have better oral health than others who live in the same neighborhood? To try to answer that question, NIDCR, a division of the National Institutes of Health, approved approximately $6.5 million to fund the Detroit Center for Research on Oral Health Disparities.

The Center's efforts to answer that question will represent the first and largest evaluation of oral health among low-income African Americans. The Detroit Center is a collaborative venture that involves the U-M School of Dentistry, other U-M schools and colleges, the Voices of Detroit Initiative (VODI), and the Detroit Department of Health.

The Detroit Center's research builds upon one of the major themes of last year's report on oral health by the U.S. surgeon general which cited "profound and consequential oral health disparities within the U.S. population." It also said "reducing disparities requires wide-ranging approaches that target populations at highest risk for specific oral diseases and involves improving access to existing care."

The Detroit Center will attempt to promote oral health and reduce disparities of low-income African-American children (ages: birth to 5 years) and their main care-givers (ages: 14-54 years) who live in Detroit. The Center will also be the site of a training program of clinical research and research training on reducing disparities.

Research will focus on 1,529 low-income African American care-givers and 1,676 children who reside in about 40 census tracts in Detroit that have incomes below 200 percent of federal guidelines. (Family of four earning less than $17,050 annually; a family of two earning less than $11,250 annually.)

During the recruiting phase of the research projects, family members will be questioned about their oral health care practices. Trained interviewers will visit households in the 40 census tracts to gather the information on social, behavioral, and dietary habits, as well as access to health care.

Participating families will be examined at a neighborhood center or clinic. The examination will include a detailed oral health assessment, screening for lead, and screenings for diabetes, lipids, plaque bacteria and markets associated with periodontal diseases.

Respected senior investigators in dentistry, medicine, social sciences, epidemiology, genetics, and public health will closely examine the data to determine the reasons for intra-group disparities in oral health. Approximately three dozen researchers will focus on two core projects:

The Center will conduct oral health assessments of a random sample of children and adults in 2002, 2004, and 2006.

Once information from these projects has been gathered, investigators will develop a customized, long-term oral health education program. The program will seek to promote and maintain good oral health and prevent oral diseases among low-income children and their care-givers. Unto Pallonen, with the Cancer Care Research Center at the U-M Medical School, will lead this project.

Simultaneously, the Detroit Center will monitor how dental care in Michigan is used and how oral health care providers are compensated to determine if funding needs to be improved. Funding mechanisms include Medicaid and the State Children's Health Insurance Program (SCHIP). Stephen Eklund, associate professor of epidemiology at the U-M School of Public Health and adjunct professor at the School of Dentistry, will lead this study.

The Detroit Center for Research on Oral Health Disparities includes several U-M schools and colleges: the School of Dentistry, the School of Public Health, the School of Social Work, the Institute for Social Research, and the Medical School's Health Media Lab. Other members include the University of Detroit Mercy School of Dentistry, the Detroit Department of Health, and the Voices of Detroit Initiative, funded by the Kellogg Foundation.

Amid Ismail, professor of dentistry in the Department of Cariology, Restorative Sciences, and Endodontics at the U-M School of Dentistry, will serve as the director of the Detroit Center. He has been active in research in caries (cavity) diagnosis, epidemiology of fluorosis, and other oral conditions. A reviewer and member of editorial boards of several major dental journals and the National Institutes of Health, Ismail has developed the Detroit Center and worked to obtain funding from the U-M and the Delta Dental Fund.

"This project is a unique opportunity for the School of Dentistry and other schools and colleges at University of Michigan, the City of Detroit, the Voices of Detroit Initiative, to build a strong network to help the neediest of the needy," Ismail said. "Our focus is on promoting oral health through research and providing dental care to the underserved in Detroit."

Ismail will collaborate with Lucille Smith, executive director of the Voices of Detroit Initiative (VODI). She will assume the position of deputy director of community affairs for the Detroit Center. Both have been working together to develop a network of dental clinics to serve poor residents of Detroit. Their collaboration led to the opening of a dental clinic at the Detroit Department of Health and two dental clinics at the Detroit Community Health Connection health centers in the city. Plans for future clinics are under way.

Smith, who has been a leader in efforts to create coalitions designed to improve access to health care in Detroit, said, "the Center will help tremendously. It's a major step in helping to improve the oral health care of the underserved in Detroit."

Citing a pervasiveness of hypertension, diabetes, asthma and other chronic diseases among the underserved in the city, Smith said the Center would play two major roles. "First, it will help us better understand why there are differences in oral health, not just within communities, but even within families." Another important role of the Center, she said, "will go beyond studying the problem. It will help us put together a framework so we can develop programs that will allow us to provide oral health care services and improve the quality of life for those who need those services."

James Buford, director of the Detroit Department of Public Health, another partner in the Detroit Center for Research, said, "it's important to take a larger view of the factors that affect the health of the underserved. This study will accomplish that. The invaluable insight that comes from this effort will serve public health in many ways for years to come."

George Kaplan, professor and chair of the Department of Epidemiology at the U-M School of Public Health, said, "with the creation of the Detroit Center for Research on Oral Health Disparities, the University of Michigan is becoming the nation's focal point for health disparities research."

Kaplan estimates that there are more than 100 researchers from U-M investigating an array of socioeconomic factors contributing to health disparities. "What's important to note," he continued, "is that because of partnerships the University has established with various community groups and organizations, the research is focused and is being conducted in communities where the problems are occurring."

In addition to NIDCR, nearly half-a-million dollars in funding for the Detroit Center for Research on Oral Health Disparities is being provided by the School of Dentistry, the School of Public Health, and the U-M Office of Vice President for Research. VODI has obtained more than $400,000 from the Health Resources and Services Administration and the Legacy Foundation to cover the cost of dental care for recipients and to develop a tobacco prevention program. Delta Dental Fund of Michigan has pledged $300,000 to support the Center's activities.
The U-M School of Dentistry is one of the nation's leading dental schools engaged in oral health care education, research, patient care, and community service. General dental care clinics and specialty clinics providing advanced treatment enable the School to offer dental services and programs to patients throughout Michigan. Classroom and clinic instruction train future dentists, dental specialists, and dental hygienists for practice in private offices, hospitals, academia, and public agencies. Research seeks to discover and apply new knowledge that can help patients worldwide.

More information is available at http://www.dent.umich.edu

University of Michigan

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