Tracy L. Finlayson, Ph.D. - US grants

Project Summary Nationwide, Mexican-American adults over age 30 have the highest prevalence of periodontal disease of all racial/ethnic groups (67% vs. 43% fornon-Hispanic Whites)(Eke, Dye et al. 2015). Poor oral hygiene is one risk factor for this common, preventable disease. However, few interventions focus on improving oral hygiene in this high-risk group, many of whom are also low-income and lack access to dental care. Social support has been targeted successfully in social and behavioral interventions to improve dietary behaviors, physical activity, and chronic disease management among Mexican-origin adults, but it has not been studied extensively in an oral health context. In addition, the role of social support differs for men and women with other health behaviors, supporting the need to study differences between men and women. This study addresses these gaps by developing a bilingual (English/Spanish) oral health behavior-specific social support scale for use in future intervention research. Developing such a measure will enable more precise assessment of the role and perceived impact of different sources and types of social support on daily hygiene behavior, dental care utilization, and oral health outcomes. Our experienced, multi-disciplinary team proposes a two-phase mixed methods study that will: 1) qualitatively explore the relevant social influences on oral health behavior for lower income Mexican-origin young adult men and women to understand structural and functional aspects of social support; 2) develop and pilot test an oral health behavior-specific social support scale, and 3) quantitatively assess the scale?s psychometric properties and association with oral health status and behavior. Phase I proposes semi-structured interviews with 25-40 men and 25-40 women from the target population of Mexican- origin young adults, to explore dimensions of social support in an oral health context as part of scale item generation and refinement. Cognitive interviews will be conducted to assess scale content and understanding of item and response option wording and order of the draft scale with 40 different adults from the target population, before it is piloted with 200 adults. Phase II will quantitatively validate the scale. Surveys will be conducted with 500 men and women, and a subset of >250 will also receive a dental exam. Phase II analysis will include cluster and factor analysis of the new social support scale, calculate the Cronbach?s alpha to assess internal consistency, and assess scale and subscale validity (content, face, construct, concurrent, divergent, and discriminant validity) and reliability. Sex-stratified analyses will examine associations with self-reported oral hygiene behavior (brushing, flossing, rinsing), dental care utilization, multiple self-rated oral health status indices, and clinically-assessed oral health status (tooth loss; caries; periodontal disease). This study will yield a culturally-sensitive social support scale that will advance understanding of potential pathways through which social relationships affect oral health behavior and outcomes for young adults of Mexican-origin, at high risk for oral disease, findings important for future theory-informed, evidence-based randomized controlled trials.

COMMUNITY ENGAGEMENT CORE ? Project Summary Health disparities in the US are more pronounced among racially/ethnically diverse, sexual and gender minority (SGM), and lower-income populations. Academic-community partnerships are critical to research focused on addressing these health disparities. When academics and partners collaborate to conduct such research, the collaboration can result in more sizable and longer lasting changes. However, research is lacking on effective models for partnerships that simultaneously promote reciprocal capacity building and knowledge transfer among academics and partners, including those that serve the same minority and health disparate populations (e.g., Hispanic/Latino, SGM, and lower-income populations). Thus, a driving force for the proposed Center and Community Engagement Core (CEC) is to solidify a bidirectional learning process, one that seeks to reduce the research-to-practice and research-to-policy gaps that exist, and improve the collective impact of our work. We seek this with clinical and population-focused organizations that serve underserved populations who are at greatest risk of poor health outcomes. Specifically, the CEC will partner with two FQHCs, one located in an urban environment (Family Health Centers of San Diego in San Diego County) and one located in a rural environment (Clinicas de Salud del Pueblo, Inc. in Imperial County, California), as well as a large county health and human service agency that serves over three million residents in San Diego County (County of San Diego Health and Human Services Agency). We seek to promote capacity building and knowledge transfer by and between the Center investigators and CEC partners through three Workgroups and a CEC Committee: (1) the Research Workgroup will involve a collaboration between the Center CEC investigators, CEC partners, and other interested parties on processes for meaningful use of Electronic Health Record (EHR) data and the development of a Patient Registry for Health Research to address recruitment challenges with underserved and hard-to-reach populations; (2) the Research Translation Workgroup will identify effective methods for dissemination of Center research findings and products from transdisciplinary efforts. The dissemination activities are designed to inform practices and policies to promote the diffusion, adoption, and sustainability of effective evidence-based interventions and build the capacity of community residents to use these data to effect changes in their communities; and, (3) the Clinical Practice Workgroup, in collaboration with the AC Evaluation team, will assess the needs of clinical partners to develop a `Practice and Provider Toolkit'. Finally, the CEC will collaborate with other Cores and Research Projects to maximize what is achievable. For example, CEC Committee members and partners will be encouraged to help design trainings for academics and partners on how to establish successful partnerships. Collaborations between CEC partners, Research Projects and Investigator Development Core pilot projects will further inform infrastructure needs and priorities.

ABSTRACT This Administrative Supplement for Collaborative Science will support a new research partnership (between Dr. Tracy Finlayson in Public Health, and Dr. Lourdes Martinez in Communication) and the addition of social network science applied to an existing bilingual (English/Spanish) Oral Health Behavior Social Support (OHBSS) scale validation grant, specifically for Mexican-origin young adults (ages 21-40 years old). Our proposed research will focus on collecting and analyzing egocentric social network data, using the results to validate the new social support scale, and identifying differences in the way social structures impact the target oral health behaviors of interest (oral hygiene, accessing dental care). This proposed study is complementary to the parent grant?s scale validation goals, bridges theories and methodological approaches, and adds a new level of validation to the new OHBSS scale. The Structural Influence Model of Health Communication will be used as a guiding framework. Social Network Analysis (SNA) is a compelling addition that naturally extends the social support focus. Our work will generate key input examining the social network structures that facilitate the transmission of effective social support in promoting oral health behaviors, and lead to future studies addressing oral health disparities among Mexican-origin individuals by providing insight into whom members of this population perceive receiving effective social support for oral health behaviors. Identifying these critical individuals within one?s social network may enhance the design and deployment of future oral health interventions that ultimately reduce oral health disparities, a goal that aligns with the mission of the National Institutes of Health. This one-year project will address three integrated research aims. Aim 1 will focus on collecting and analyzing egocentric network data using a sex-stratified and balanced subsample of 60 study participants (50% men, 50% Spanish language dominant, 50% single marital status) from both parent study sites (1 urban, 1 rural area in two counties in California along the US-Mexico border). These participants will complete a half-hour individual interview, in either English or Spanish, to collect network density data through a standard name-generation social network mapping approach. Aim 2 proposes to validate the OHBSS self- report scale responses through the identification of specific individuals in the participants? social networks. Specifically, convergent and discriminant validity with OHBSS scale responses will be examined. Aim 3 focuses on comparing modes of communication and influence on Mexican-origin young adult men and women?s oral health behaviors by family members, health providers, or others in the participants? social networks. Analyses will specifically focus on determining whether effects of network structure on oral health behaviors are differentially stratified by socio-demographic characteristics. Findings from the SNA data can then inform the development of interventions to promote oral health behaviors among Mexican-origin young adult men and women designed to reduce the unequal burden of oral health disparities.