Center for Health Promotion and Behavioral Research
OBJECTIVE:
The objective of this Funding Opportunity Announcement (FOA) is to support health promotion research directed at women before, during and after pregnancy to improve their well-being and that of their infant. The focus of the health promotion research could encompass any of the following areas:
Testing behavioral theories and/or health promotion models to encourage preventive activities on oral health
Developing, implementing and evaluating oral health promotion research specific to the target population
Conducting research on how to integrate oral health into existing health promotion programs for pregnant women.
BACKGROUND:
Adverse maternal and infant health outcomes (e.g., low birth weight, preterm delivery, and cognitive impairments) often can be prevented by modifying maternal lifestyle and preventive behaviors. Use of tobacco during pregnancy is the strongest known risk factor for low birth weight and is associated with spontaneous abortion and preterm delivery. Alcohol use during early pregnancy can result in spontaneous abortion, behavior and learning problems in children, fetal alcohol syndrome, or low birth weight. Continued alcohol use throughout pregnancy can worsen these effects and cause preterm delivery. Low level of folic acid intake prior to pregnancy or early in the pregnancy increases the incidence of neural tube defects. These adverse outcomes can be mitigated or prevented with appropriate medical and dental care before and during pregnancy. Medical visits during these periods offer an opportunity to provide information about the adverse health effects of tobacco and alcohol use, and the promotion of folic acid intake. Women’s knowledge about nutrition, prevention of dental caries, periodontal diseases and craniofacial anomalies are critical to their health and that of their infant.
Findings from surveys demonstrate there is a need for research targeting women before, during and after pregnancy. In the 1998 Pregnancy Risk Assessment Monitoring System (PRAMS), four states (Arkansas, Illinois, Louisiana and New Mexico) included the optional oral health questions and reported that only 23% to 35% of respondents reported dental care use during pregnancy. Pregnant women perceptions of oral health, the barriers and motivations to seek dental care must be assessed to adequately introduce preventive information on oral health in the prenatal care that they are exposed to. Furthermore, NHANES 1999-2002 data show that 41% of children 2-11 years of age had caries in their primary dentition and that 21% of children in this age group had untreated tooth decay. Despite research efforts to prevent early childhood caries (ECC), data from NHANES 1988-1994 and NHANES 1999-2002 suggest no change in the prevalence and severity of dental caries in the primary teeth. To prevent ECC and reverse this trend, health promotion must start before the child is born, in the period prior to or during pregnancy.
Health promotion is defined as “any planned combination of educational, political, regulatory and organizational supports of actions and conditions of living conducive to the health of individuals, groups and communities.” Thus, a variety of factors must be assessed and address the individual, practitioner, organizational, community and system levels to change behavior and encourage preventive practices. Behavioral and social theories provide a platform that can be used to study why behaviors that protect health or increase health risks occur. In addition, health promotion models can be used or modified to give organization and structure to the research process. Essential to health promotion is an understanding of the target group’s health, economic, education and social characteristics, their cultural beliefs, opinions, values, skills and past behaviors, as well as an understanding of the environment (health care institution, community) in which the intervention will be tested and the individuals who deliver the intervention (dentists, dental hygienists, medical practitioners, nurses).
This initiative would support research that applies or adapts existing behavioral theories, and planning research models to known risk factors and lifestyle aspects related to the general an oral health of women before, during and after pregnancy and that of the child. Collaborations between researchers, clinical practitioners and a community are critical to generate better-informed hypotheses, develop more effective interventions, and enhance the translation of the research results into practice.
Examples of research activities:
Studies to determine the training, acceptance and effectiveness of trained “oral health advisors” in primary care settings such as community health centers, pediatrician offices or WIC clinics.
Studies testing programs aimed at teaching and empowering gravid women to understand and manage their own oral health and general health, and that of their newborn, including basic hygiene, disease prevention and examination procedures.
Studies that include innovative approaches involving families, social networks or communities in interventions designed to enhance behaviors promoting and improving oral health.
Studies that determine the best dissemination approaches and settings to optimize the use and outcomes of known preventive strategies for dental caries, periodontal disease and other oral conditions among pregnant women.
Studies that develop and test innovative ways to improve patient-provider communication related to oral preventive measures.
CURRENT PORTFOLIO OVERVIEW:
Most of the research activities related to maternal and child oral health are focused in two major areas: the relationship between periodontal disease during pregnancy and low birth weight of the child, and the prevention of early childhood caries (ECC) in the child. Ongoing multi-center trials are investigating the association between periodontal disease and adverse outcomes such as preterm delivery and infant low birth weight. Other research is studying dental caries as an infectious and transmittable disease; the infection primarily is transmitted from caregiver (mother) to child. Oral diseases and disorders affecting mothers and infants can be preventable at this stage. Thus, attention should be given to developing, implementing and evaluating oral health promotion research prior, during and after pregnancy to be incorporated in their regular medical or dental care.
RECOMMENDATIONS FROM WORKSHOPS:
- Workgroups convened for the NIDCR implementation plan on the topics of behavioral research and health disparities
- Conference on Early Childhood Caries, Bethesda, MD, October 1999
FUNDING MECHANISMS:
This initiative would fund exploratory, pilot or planning studies that would help develop and test programs aimed at teaching and empowering pregnant women to understand and manage their own oral and general health and that of the child.