Oral Health Disparities Research without a Dental School: Hawaiian Strategies D. Easa 1, R. Harrigan 1 , C. Kuba 1 , H. DeCambra 1 , C. LeSaux 1 , S. Maurillo 2 , R.G. McKaig 2 , D.J. Caplan 2 , J. Beck 2 , S. Offenbacher 2 , R. Strauss 2 , and M. Greer 1 1 University of Hawai`i, Honolulu, USA, 2 University of North Carolina, Chapel Hill, USA University of North Carolina School of Dentistry Abstract While oral health disparities exist in many ethnic groups in Hawai`i, the challenge of developing research and intervention programs is hampered by the lack of a dental school and adequate state resources. Objective: To use a collaboration model to establish a mentoring relationship with a research intensive School of Dentistry in order to develop competence in dental research, conduct pilot studies, and write an RO1 application, with the overall goal of reducing oral health disparities in Hawai`i. Methods: Collaborative interactions with the University of Hawai`i School of Medicine (UH) and the University of North Carolina School of Dentistry (UNC) (Chapel Hill) include: bi-monthly teleconferences, on site planning and mentoring sessions, yearly conferences in Hawai`i open to the community utilizing UNC faculty, and on-site skills training sessions (calibration of “research dental hygienists”). The community was also asked to participate in determining priorities for research through focus group interactions. Results: Both universities have been awarded NIDCR Planning Grants to fund activities to support the combined intellectual and physical resources of multiple private, public, and community organizations in order to achieve the goal of improving the oral health status of the people of Hawai`i. As a result of initial planning, two related grants have been submitted (one approved, one pending) to fund pilot studies on the oral health status of mothers and their babies in a rural community (Waimanalo Health Center). These studies include both UH and UNC investigators. Conclusions: Collaborative models can be used to successfully address the lack of research in health disparities in communities without research intensive Dental Schools. Introduction Major oral health disparities exist in the Asian and Pacific Islanders (API) population of Hawai’i. API children have twice the national rate of caries and four times the rate of early childhood caries despite Hawai`i having a large, single payer health insurance program and the highest dental utilization rate in the country. Limited data suggest that adults of Hawaiian ancestry may have a high rate of tooth loss, extensive periodontal disease and an increased incidence of caries. Significance • The University of Hawai`i lacks a dental school, the expertise and infrastructure to address significant oral health disparities in Hawai`i. • Through collaboration with the UNC Dental Research Center, a successful collaborative partnership has been established, and with this, the accomplishment of the initial goals of the R-21. Conclusions • The research network has been established • Collaboration with UNC has been productive • The focus of the R01 has been determined: Molecular and Epidemiological Correlates of Periodontal Disease in Asian and Pacific Island Peoples • Collection of preliminary data is complete • Refinement of skills to develop a fundable R01 application continue. Acknowledgements • This investigation/manuscript/etc. was supported by a NIDCR R-21 award (DE15020-01) “A Study of Oral Health Disparities in Adult Asian & Pacific Islanders” and a Research Centers in Minority Institutions (NCRR) award, P20 RR11091, from the National Institutes of Health. Results - Preliminary Studies • A pilot study was funded by the Hawai`i State-Biomedical Research Infrastructure Network (C. Jourdan-Le Saux, Ph.D.) to support preliminary data collection. • The study aims to evaluate the social, economic, and cultural environment associated with oral health status from the Waimanalo community in a population of Asian and Pacific Islanders with oral health disparities. - Develop and test questionnaires - Conduct clinical oral examinations in a group of API subjects • To date, 25 subjects have been recruited to the study with preliminary data collection completed but not analyzed. Specific Aim 3 - Preliminary Studies • These studies will assist in the development of the knowledge base needed to test the science proposed in the R01. • Activities will include: - Feasibility studies - Tool development studies - Studies that result in definition and refinement of study variables. Results - Network Development • Network development has been accomplished through teleconferencing, training sessions and in the conduct of preliminary studies. • Focus groups: Co-Principal Investigator Rosanne Harrigan completed the training of focus group facilitators (primarily Native Hawaiian women) on the islands of Maui (N=6) and Oahu (N=15). • The Waimanalo Health Center has become an integral part of the oral health research infrastructure network Specific Aim 2 - Network Development • To establish a collaborative oral health research network to include: - John A. Burns School of Medicine (JABSOM) - The University of Hawai‘i School of Nursing and Dental Hygiene (SONDH), - State Department of Health - UH Clinical Research Center (CRC) - UNC Dental Research Center Results - Training • Bimonthly teleconference meetings - Discussions focused on instrumentation, protocol development, seminar planning, data management and analysis, selection of clinical indices, and sample selection. • Seminars were telecasted from UNC to UH. • Six members of UNC traveled to Hawai`i to participate in a conference (Feb. 3-4, 2003) to present “A Short Course Addressing Oral Health Disparities: Development of Research Competence” • Members of the UNC team came to UH to provide training in calibration to dental hygienists Specific Aim 1 - Training • To provide mentorship and consultation between UNC and UH. • Utilizing existing biostatistical support within the Clinical Research Center (CRC) and mentorship from UNC for optimal training of future oral health researchers. • This will be achieved through: - Teleconferencing - Visits to UNC by the investigators - Visits to Hawai’i by UNC post-doctoral fellows and other faculty - Seminars telecast from UNC to UH to provide training in collecting clinical indices, collecting and processing biological samples, data management, and data analysis. Objective The primary objective of this research program is for the John A Burns School of Medicine of the University of Hawai`i to develop collaborative affiliations with the Dental Research Center at the University of North Carolina and the Community in preparation for conducting research on molecular and epidemiological correlates of oral health disparities in APIs. This objective is consistent with the NIDCR’s “A Plan to Eliminate Craniofacial, Oral, and Dental Health Disparities.” The research plan will prepare the research team and the community by providing preliminary data and training needed to conduct the proposed R01 studies. Background • A major health research focus of the NIH is the reduction of health disparities in minority populations • Hawai‘i ’s cultural diversity and physical setting provide a unique laboratory for research. - the population is comprised entirely of migrants with no single majority ethnic group. - it is the only state in the U.S. located in the semi-tropics and is geographically isolated. • The people of Hawai’i enjoy a health status higher than many U.S. communities, while the status of dental health falls far below the national average • According to the Department of Health, children ages five through nine have twice the rate of tooth decay compared to children on the mainland. • There is wide variance in decay rates among Hawai’i’s various ethnic groups; the worst rates occur in Native Hawaiian, Other Pacific Islander, and Filipino children • Hawai’i’s civilian community does not benefit from fluoridated drinking water • Hawai’i’s unique position is a state of ethnic minorities without a Dental School University of Hawai`i at Manoa Future Site of John A. Burns School of Medicine