Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial.

AIMS: To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. DESIGN: A stratified, parallel-group, three-arm individually randomized controlled pilot trial. SETTING: Two Los Angeles area Early Head Start (EHS) sites. PARTICIPANTS: 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. INTERVENTIONS: Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. OUTCOMES: Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. FINDINGS: Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. CONCLUSIONS: Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03862443.

A qualitative study of the multi-level influences on oral hygiene practices for young children in an Early Head Start program.

BACKGROUND: Individual child-level risk factors for Early Childhood Caries (ECC) have been studied, but broader family- and community-level influences on child oral hygiene behaviors are less well understood. This study explored multiple levels of influence on oral hygiene behaviors for young children in Early Head Start (EHS) to inform a future behavioral intervention targeting children from low-income families. METHODS: Twenty-four semi-structured interviews were conducted with mothers of children under 4 years old, enrolled in the home visitor (HV) component of one EHS program in Los Angeles, CA, who participated in the BEhavioral EConomics for Oral health iNnovation pilot study (BEECON) in 2016-7. Audio-recordings of interviews were translated if needed, and transcribed in English, and coding and analysis was facilitated by Dedoose qualitative software. This investigation used general thematic analysis guided by the Fisher-Owens child oral health conceptual framework to identify influences on oral hygiene behaviors for the young children. RESULTS: Many mothers reported brushing their children's teeth twice/day, and concern that most children frequently resisted brushing. They identified children being sick or tired/asleep after outings as times when brushing was skipped. Several child-, family-, and community-level themes were identified as influences on child oral hygiene behaviors. At the child-level, the child's developmental stage and desire for independence was perceived as a negative influence. Family-level influences included the mother's own oral hygiene behaviors, other family role models, the mother's knowledge and attitudes about child oral health, and mothers' coping skills and strategies for overcoming challenges with brushing her child's teeth. Overall, mothers in the EHS-HV program were highly knowledgeable about ECC risk factors, including the roles of bacteria and sugar consumption, which motivated regular hygiene behavior. At the community-level, mothers discussed opportunities to connect with other EHS-HV families during parent meetings and playgroups that HV coordinated. A few mothers noted that EHS-HV playgroups included brushing children's teeth after snacking, which can be a potential positive influence on children's hygiene practices. CONCLUSION: Child-, family- and community-level factors are important to consider to inform the development of tailored oral health preventive care programs for families in EHS-HV programs.

Subjective Social Status and Self-Reported Health Among US-born and Immigrant Latinos.

Subjective social status is associated with a range of health outcomes. Few studies have tested the relevance of subjective social status among Latinos in the U.S.; those that have yielded mixed results. Data come from the Latino subsample of the 2003 National Latino and Asian American Study (N = 2554). Regression models adjusted for socioeconomic and demographic factors. Stratified analyses tested whether nativity status modifies the effect of subjective social status on health. Subjective social status was associated with better health. Income and education mattered more for health than subjective social status among U.S.-born Latinos. However, the picture was mixed among immigrant Latinos, with subjective social status more strongly predictive than income but less so than education. Subjective social status may tap into stressful immigrant experiences that affect one's perceived self-worth and capture psychosocial consequences and social disadvantage left out by conventional socioeconomic measures.

The association between nutrition facts label utilization and comprehension among Latinos in two east Los Angeles neighborhoods.

BACKGROUND: The Nutrition Facts label can facilitate healthy dietary practices. There is a dearth of research on Latinos' utilization and comprehension of the Nutrition Facts label. OBJECTIVE: To measure use and comprehension of the Nutrition Facts label and to identify correlates among Latinos in East Los Angeles, CA. DESIGN: Cross-sectional interviewer-administered survey using computer-assisted personal interview software, conducted in either English or Spanish in the participant's home. PARTICIPANTS/SETTING: Eligibility criteria were: living in a household within the block clusters identified, being age 18 years or older, speaking English or Spanish, identifying as Latino and as the household's main food purchaser and preparer. Analyses were based on 269 eligible respondents. STATISTICAL ANALYSES PERFORMED: χ(2) test and multivariate logistic regression analysis assessed the associations among the main outcomes and demographics. Multiple imputations addressed missing data. RESULTS: Sixty percent reported using the label; only 13% showed adequate comprehension of the label. Utilization was associated with being female, speaking Spanish, and being below the poverty line. Comprehension was associated with younger age, not being married, and higher education. Utilization was not associated with comprehension. CONCLUSIONS: Latinos who are using the Nutrition Facts label are not correctly interpreting the available information. Targeted education is needed to improve use and comprehension of the Nutrition Facts label to directly improve diet, particularly among males, older Latinos, and those with less than a high school education.

Corner Store Inventories, Purchases, and Strategies for Intervention: A Review of the Literature.

INTRODUCTION: An increasingly popular strategy to improving the food retail environment and promoting healthy eating in low-income and minority communities is the corner store conversion. This approach involves partnering with small 'corner' food stores to expand access to high-quality fruits, vegetables, and other healthy foods. METHODS: We conducted a structured review of the literature to assess inventories and sales in corner stores, as well as to identify intervention strategies employed by corner store conversions. RESULTS: Our review returned eight descriptive studies that discussed corner store inventories and sales, as well as ten intervention studies discussing six unique corner store conversion interventions in the United States, the Marshall Islands, and Canada. Common intervention strategies included: 1) partnering with an existing store, 2) stocking healthy foods, and 3) social marketing and nutrition education. We summarize each strategy and review the effectiveness of overall corner store conversions at changing peoples' food purchasing, preparation, and consumption behaviors. CONCLUSIONS: Consumption of fresh, healthy, affordable foods could be improved by supporting existing retailers to expand their selection of healthy foods and promoting healthy eating at the neighborhood level. Additional corner store conversions should be conducted to determine the effectiveness and importance of specific intervention strategies.

The health status of youth in Puerto Rico.

BACKGROUND: Few population-based studies have assessed health outcomes and health care access and use among youth in the US Commonwealth of Puerto Rico. METHODS: Data are from an island population-based sample of 337 youth, 10 to 17 years old, who participated in the Asthma, Depression, and Anxiety in Puerto Rican Youth Study. In-person interviews with youth and caregivers assessed self-rated physical and mental health, weight status, diagnosed health conditions, and health care access and use. RESULTS: Island Puerto Rican youth report slightly worse physical and mental health than mainland youth. Puerto Rican youth have high rates of asthma, headaches, and stomachaches. Also, 6 in 10 island youth use public health insurance, and 1 in 3 regularly receive care at the emergency department. CONCLUSIONS: Island Puerto Rican youth are at a health disadvantage compared with mainland youth. Public health research is needed to fully understand and combat health challenges among Puerto Rican youth.

Immigration disparities in cardiovascular disease risk factor awareness.

The association between immigration status and cardiovascular disease (CVD) risk factor awareness is unknown. Using physical examination-based data and participants' self-report of prior diagnosis, we assessed immigration-based disparities in awareness of diabetes, hypertension, hypercholesterolemia, and overweight among 12,124 participants in the 2003-2008 National Health and Nutrition Examination Survey. Unawareness of CVD risk factors is high among all groups, but tends to be higher among foreign-born English and non-English speaking participants than among US-born participants. After adjusting for demographic factors and access to health care, foreign-born participants appear more likely to be unaware of their hypertension and overweight than US-born participants. Immigrants are more likely than those born in the US to be unaware of their CVD risk factors, and therefore may be less motivated to seek treatment and modify their behavior to prevent negative CVD outcomes.

Occurrence and correlates of overweight and obesity among island Puerto Rican youth.

UNLABELLED: OBJECTIVE AND MAIN OUTCOME MEASURES: This article provides 2005-2008 population-based prevalence data on obesity and overweight among youth residing in Puerto Rico. DESIGN AND SETTING: Data for this report are from the Asthma, Depression, and Anxiety in Puerto Rican Youth (ADA) study. Measures included height and weight level data on youth in Puerto Rico aged 10 to 19 years with and without asthma as well as body mass index data on their caregivers. PARTICIPANTS: A total of 436 youth-caregiver dyads were selected and weighted to represent the general population of youth in Puerto Rico using 2008 US Census data. RESULTS: Household surveys demonstrated that 40% of youth aged 10 to 19 were overweight or obese. Twenty-five percent met moderate-to-vigorous-intensity physical activity guidelines, however, physical activity was not associated with overweight or obesity in this sample. In multivariate analyses, females were 50% less likely than males to be overweight or obese. Older youth were 73% less likely to be overweight or obese than younger youth. Youth whose parents were obese were more than two times more likely to be overweight or obese than those whose parents were at a desirable weight. CONCLUSIONS: Youth in Puerto Rico have higher rates of overweight and obesity and lower compliance to moderate-to-vigorous-intensity physical activity guidelines than rates reported for youth on the mainland. More population-based research is needed to understand the epidemiology of obesity and overweight among island Puerto Rican youth and the contribution of physical activity to the phenomenon.