Network science and oral health research

The present overview of research methods describes a scientific enquiry paradigm that is well established in other disciplines, including health research, but that is fairly new to oral health research. Social networks analysis (SNA) or network science research is a set of relational methods purporting to identify and characterize the connections between members of a system or network, as well as the structure of the network. Persons and communities making up the members of networks have commonly been the focus of SNA studies but corporations or living organisms might just as well be organized in networks. SNA is grounded in both graphic imagery and computational models. SNA is based on the assumptions that features and structure of networks are amenable to characterization, that such information sheds light on the ways members of the network relate to each other (sharing information, diseases, norms, and so on), and that through these connections between members the overall network structure and characteristics are shaped. The overview resorts to examples specific to oral health themes and proposes a few general avenues for population-based research

Segmentation of Mexican-Heritage Immigrants: Acculturation Typology and Language Preference in Health Information Seeking

With the fast growing number of Mexican immigrants in the United States, more attention is needed to understand the relationship between acculturation and language preference in health information seeking. Latent class analysis provides one useful approach to understanding the diversity in sample of Mexican immigrants (N = 238). Based on 13 linguistic, psychological and behavioral indicators for acculturation, four discrete subgroups were characterized: (1) Less acculturated, (2) Moderately acculturated, (3) Highly acculturated, (4) Selectively bicultural. A Chi-square test revealed that three sub-groups were significantly different in language preference when seeking health information. Less acculturated and moderately acculturated groups sought health information in Spanish, whereas the highly acculturated group preferred English for health information. Selectively bicultural group preferred bilingual health information. Implications for health campaign strategies using audience segmentation are discussed

Clinician-Patient Small Talk: Comparing Fourth-Year Dental Students and Practicing Dentists in a Standardized Patient Encounter

The aim of this study was to establish whether frequency of non-diagnostic, non-management exchanges between clinicians and patient (called “socioemotional communication,” SC) during a consultation differed between fourth-year dental students and dentists, controlling for clinically driven exchanges of information. Fifteen dentists and 17 fourth-year dental students were recorded in 2006 while undergoing a consultation with a live standardized patient and were subsequently interviewed by investigators in a separate room with the recording present for analysis. Their shared interpretations of cognitive strategies were recorded and compared for differences in the presence of SC. The results showed that most of the students and dentists engaged in SC throughout the consultation with a few exceptions. There were no significant differences between student and dentist cohorts for overall SC presence (p=0.62), time to first instance of SC from overall start of the consultation (p=0.73), and time to first instance of SC after first intraoral examination had taken place (p=0.76). Nonsignificant differences were also recorded for overall frequency at which SC occurred from overall start of the consultation (p=0.89) and after the first intraoral examination had taken place (p=0.12). The patterns showed SC interaction occurring throughout the consultation, not concentrated at the beginning or end. SC did not appear to differ between practitioners and students in terms of prevalence, frequency, or timing. Future research should examine the detailed association between SC and diagnostic thinking processes to further delineate the relationship and characterize possible pedagogical applications

Clinician-Patient Small Talk: Comparing Competent Students and Expert Dentists in a Standardized Patient Encounter

poster abstractObjectives: To establish whether the frequency of non-diagnostic, non-management exchanges between clinicians and patient (socioemotional communication, SC) during the consultation differed between senior dental students and dentists, controlling for clinically driven exchanges of information. Methods: Dentists and students were recorded while undergoing a consultation with a live standardized patient, and subsequently interviewed by investigators; their shared interpretation of cognitive strategies were recorded and compared for differences in the presence of SC using a χ2 test; first consultation occurrence of SC using log-rank tests; and number of times that SC occurred using mixed-model ANOVA. Results: Most clinicians engaged in SC throughout the consultation with a few exceptions. Statistical analyses produced non-significant differences for overall SC presence (p=0.62), time to first instance of SC from overall start of the consultation (p=0.73), and time after first intraoral examination had taken place (p=0.76). Non-significant differences were also recorded for the summary of time intervals when SC occurred at time from overall start of the consultation (p=0.89), and time after first intra-oral examination had taken place (p=0.12). Conclusions: SC occurred in most clinicians. Patterns depicted this interaction occurring throughout the consultation, not concentrated at the beginning or end. SC did not appear to differ between experts and students in terms of prevalence, frequency, or timing. Future research should examine the detailed association between SC and diagnostic thinking processes, to further delineate their relationship and characterize possible pedagogical applications

"Does this Look Infected to You?" Social Network Predictors of Dental Help-Seeking Among Mexican Immigrants

Compared to U.S. born Latinos, Mexican immigrants (MAs) have diminished health care access and face substantial barriers to accessing needed dental health services. However, little research has examined how MAs social networks shape their use of dental health services. Using data from 332 Mexican immigrants to the Midwest, this research examines the significance of individual and egocentric network characteristics on two measures of dental health service utilization. Findings reveal that network size, network dental service utilization, and the frequency with which MAs discuss acute problems with network ties, positively correspond to use of oral health services. Conversely, embeddedness in networks where ties hassle egos about dental issues and have low levels of dental health knowledge correspond to lower odds of using these services. This research is among the first to use ego network data and methods to examine the ways network characteristics shape oral health behaviors among this underserved population

Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study

With the increased number of elderly and medically compromised individuals receiving dental care and the presence of systemic comorbidities and associated treatment modalities in this patient population, it is imperative that dentists be prepared to manage a variety of medical emergencies. The aim of this study was to assess the knowledge of and preparedness to manage common medical emergencies of cohorts of practicing periodontists, specialty residents, and faculty members, both for comparative purposes and as an aid to refining a dental school’s standardized case scenarios. The study, conducted in 2017, was designed for four groups of randomly selected participants with at least 20 in each group; the actual number of voluntary participants was 28 private practice periodontists, 22 residents in specialty programs, 21 specialist faculty members, and 24 general practice faculty members. Participants were asked to evaluate ten clinical emergency cases and identify the diagnosis and indicated intervention for each. Groups were also evaluated for differences among correct responses for each case. Overall, there were no statistically significant differences for number of correct diagnoses or interventions among the four groups. However, several cases had varying degrees of incorrect diagnoses and management across all groups. Participants who had recently graduated or were still in school were able to treat cases appropriately more often than the other participants. Further refinement of cases to assess provider preparedness to correctly diagnose and manage medical emergencies is needed, specifically establishing case-specific features and addressing areas of potential confusion before the cases are used for educational purposes

PILOT APPRAISAL OF VARIABLES AMONG MEXICAN-AMERICANS FOR SOCIAL NETWORKS ANALYSIS

poster abstractHispanics in the USA often suffer poor oral health. More appropriate solutions may be designed if we move beyond the simplistic interpretation of poor oral outcomes being associated with 1-2 variables, e.g., language; such an approach has failed to provide consistent interpretations, and offers no points for intervention. We propose to examine a constellation of variables interwoven into multilevel strategies under a new(er) paradigm, social network theories (http://cmol.nbi.dk/models/infoflow/infoflow.html). Objectives: To qualitatively identify domains of variables modulating oral health outcomes among 1st-2nd generation MexicanAmerican immigrants. Methods: Through key informant interviews, we ascertained KAB variables in immigrant families originating in Jalisco, Mexico. This community has had a strong, revolving presence for decades in a well-delimited location in Indianapolis, IN, around St. Patrick’s parish. We did not conduct clinical exams but used questions from American national surveys to document health perceptions, availability of dental services/insurance, presence of dental pain and impaired function in adults and children, and family structure and sociodemographic profiles during a Catholic festival (no incentives, no appointments). Data were content-analyzed. Results: Data were collected from 22 parent-child dyads (15 female adults, 7 male; mean age 24±6.3yrs; data from the oldest child and the interviewee). Frequencies of dental emergencies and acute problems varied markedly, with recurrence patterns. A minority exhibited consistent dental attendance, often enabled by public/private dental insurance. Time in the USA varied considerably, with 1st and 2nd generation immigrant parents and children sharing the household. Occupations ranged from manual to clerical, and education from elementary to college among adults. Conclusion: Interviews were feasible and acceptable, and the experience informed future fieldwork considerations. We are using the variables to design a social networks study to characterize the evolution of patterns between families in Indianapolis and among peers living in Jalisco, aiming to measure impacts ascribable to immigration along acculturation spectra

Psychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services

Objectives We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest. Methods Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees’ (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit. Results A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation. Conclusions This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos’ orientation toward dental care

Cross-Sectional Association between Behaviors Related to Sugar-Containing Foods and Dental Outcomes among Hispanic Immigrants

A cross-sectional, self-administered survey was used to gather information about dental outcomes, sugar-containing food behaviors and intake, and sociodemographic characteristics of adults of Mexican and Central-American (Guatemala, El Salvador, Honduras) origin (n = 517). Bivariate and multiple-variable logistic regressions were used to examine the associations of behaviors related to added sugar-containing foods/beverages (overall intake and consumption before bed) with dental outcomes. Outcome measures involved dental outcomes, dental self-care practices, and added sugar intake. Estimated daily added sugar intake among all participants was 98 (SD = 99) g, with no difference in consumption among participants from different countries. The majority of added sugar (63 (SD = 74) g) was provided by sugar-sweetened beverages. Participants who reported consuming sugar-containing foods or beverages within an hour before bed were more likely to report having a fair/poor/very poor condition of teeth and gums and having felt dental pain (p < 0.05 for all). The amount of sugar intake was associated with being prescribed medication for oral or dental problems (p = 0.008) and dental pain (p = 0.003). Findings support the association between sugar containing food–related behaviors and dental problems among Hispanic immigrants to the U.S. Health promotion and preventive interventions for this population should consider these behaviors as modifiable contributors to adverse dental outcomes

Guia para el ciudado de los dientes y boca para personas de Guatemala, El Salvador y Honduras

This is a dental health navigation manual for the Hispanic population. This group is disproportionately affected by dental health problems, perhaps the worst situation for people from Central America. An advisory group was organized, composed of people from three Central American countries: El Salvador, Honduras, and Guatemala. Along with community input, the team developed the “Guia para el cuidado de los dientes y boca” navigation manual.This manual was developed and produced, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by Grant Number UL1TR002529 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Indiana University, and neither of the Richard M. Fairbanks School of Public Health