Readability of pediatric health materials for preventive dental care

BACKGROUND: This study examined the content and general readability of pediatric oral health education materials for parents of young children. METHODS: Twenty-seven pediatric oral health pamphlets or brochures from commercial, government, industry, and private nonprofit sources were analyzed for general readability ("usability") according to several parameters: readability, (Flesch-Kincaid grade level, Flesch Reading Ease, and SMOG grade level); thoroughness, (inclusion of topics important to young childrens' oral health); textual framework (frequency of complex phrases, use of pictures, diagrams, and bulleted text within materials); and terminology (frequency of difficult words and dental jargon). RESULTS: Readability of the written texts ranged from 2(nd )to 9(th )grade. The average Flesch-Kincaid grade level for government publications was equivalent to a grade 4 reading level (4.73, range, 2.4 – 6.6); F-K grade levels for commercial publications averaged 8.1 (range, 6.9 – 8.9); and industry published materials read at an average Flesch-Kincaid grade level of 7.4 (range, 4.7 – 9.3). SMOG readability analysis, based on a count of polysyllabic words, consistently rated materials 2 to 3 grade levels higher than did the Flesch-Kincaid analysis. Government sources were significantly lower compared to commercial and industry sources for Flesch-Kincaid grade level and SMOG readability analysis. Content analysis found materials from commercial and industry sources more complex than government-sponsored publications, whereas commercial sources were more thorough in coverage of pediatric oral health topics. Different materials frequently contained conflicting information. CONCLUSION: Pediatric oral health care materials are readily available, yet their quality and readability vary widely. In general, government publications are more readable than their commercial and industry counterparts. The criteria for usability and results of the analyses presented in this article can be used by consumers of dental educational materials to ensure that their choices are well-suited to their specific patient population

Birth outcomes among urban African-American women: A multilevel analysis of the role of racial residential segregation

Residential segregation is a common aspect of the urban experiences of African-Americans in the United States (US), yet few studies have considered how segregation might influence perinatal health. Here, we develop a conceptual model of relationships between segregation and birth outcomes and test the implications of the model in a sample of 434,376 singleton births to African-American women living in 225 US Metropolitan Statistical Areas (MSAs). Data from the National Center for Health Statistics 2002 birth files were linked to data from the 2000 US Census and two distinct measures of segregation: an index of isolation (the probability that an African-American resident will encounter another African-American resident in any random neighborhood encounter) and an index of clustering (the extent to which African-Americans live in contiguous neighborhoods). Using multilevel regression models, controlling for individual- and MSA-level socioeconomic status and other covariates, we found higher isolation was associated with lower birthweight, higher rates of prematurity and higher rates of fetal growth restriction. In contrast, higher clustering was associated with more optimal outcomes. We propose that isolation reflects factors associated with segregation that are deleterious to health including poor neighborhood quality, persistent discrimination and the intra-group diffusion of harmful health behaviors. Associations with clustering may reflect factors associated with segregation that are health-promoting such as African-American political power empowerment, social support and cohesion. Declines in isolation could represent positive steps toward improving birth outcomes among African-American infants while aspects of racial contiguity appear to be mitigating or indeed beneficial. Segregation is a complex multidimensional construct with both deleterious and protective influences on birth outcomes, depending on the dimensions under consideration. Further research to understand racial/ethnic and economic health disparities could benefit from a focus on the contributory role of neighborhood attributes associated with the dimensions segregation and other social geographies.Birthweight Prematurity Fetal growth African-Americans/Blacks Urban health USA Racial residential segregation

Everybody Brush! Consumer Satisfaction with a Tooth Decay Prevention Program

IntroductionTwice-daily caregiver-supervised toothbrushing with fluoridated toothpaste is an effective and widely recommended strategy to prevent tooth decay in children. Qualitative research suggests that low-income caregivers know the recommendation but would benefit from toothbrushing supplies and advice about how to introduce this health behavior especially as the child becomes older and asserts autonomy to do it “myself.” Our objective is to assess consumer satisfaction with the evidence-based theory-informed campaign and usefulness of materials that were home delivered. The focus of the evaluation was families with children <36 months of age because of the high incidence of disease in this population.MethodsA dental care organization designed and implemented Everybody Brush! in three counties of Central Oregon. Participants were families of Medicaid-insured children <21 years of age. Participants were randomly assigned to one of the three study groups: test (supplies, voice/printed messages, telephone support), active (supplies), and a waitlist control. Program materials were in English and Spanish. Caregivers of children <36 months were interviewed at the beginning and end of the program.ResultsA total of 83,148 toothbrushing kits were mailed to 21,743 families. In addition, 93,766 printed messages and 110,367 recorded messages were sent to half of the families. Caregivers were highly satisfied. On a global rating scale from 0 to 10 (worst to best program possible), they rated the program 9.5 on average (median: 10, SD 0.9). On a scale from 0 to 10 (not at all to very useful), mean ratings for usefulness of the toothbrushing supplies was 9.5 (SD = 1.5), for the printed postcard messages was 7.2 (SD 3.6), and for the voice telephone messages was 6.5 (SD 3.9).DiscussionA dental care organization carried out a complex community intervention designed to address excess tooth decay among low-income children. Caregivers were highly satisfied with the Everybody Brush! program and toothbrushing supplies were considered the most useful, followed by printed messages. Voice telephone messages were rated least useful. Further evaluation of the impact of the program on toothbrushing behavior and dental-care utilization is underway