Bio-behavioral chronic disease management by families of young minority children

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (09) Health Disparities and specific Challenge Topic 09-MD- 102 Trans-disciplinary Research to Integrate the Biological and Non-biological Determinants of Health to Address Health Disparities. Description "Bio-behavioral chronic disease management by families of young minority children" seeks to reduce health disparities by investigating methods to close the gap between health information and health behaviors- specifically, the gap between instruction provided by clinicians to families of young children with chronic diseases and the capacity of economically stressed families to act on that instruction. Whether addressing asthma, diabetes, obesity, or tooth decay, needed now is trans-disciplinary translational research that tailors pharmacological and behavioral interventions to care management plans that parents are able to implement successfully. Envisioned is a computer "Tool" for use in community sites that assists community health workers in collaboration with families to: (1) determine children's level of risk for chronic diseases, (2) match them to clinicians and care plans, (3) characterize a family's capacity to engage in such plans, and (4) modify care plans to meet family's capacities. Target families are those disadvantaged by low-income, low-literacy, cultural barriers and minority status. Specific research aims are to develop, pilot test, and refine two "Instruments" that are integral to this Tool: (1) a 'disease risk assessment instrument'and (2) a culturally adaptable 'family capacity assessment instrument.'Early childhood caries ("ECC") was selected as the exemplar chronic disease for this research by an existing 12-member multi-disciplinary Project Team comprised of social and behavioral scientists, clinicians, educational and informatics technologists, and health services researchers. ECC was selected because it is highly prevalent in young children, because preventive and therapeutic bio- behavioral therapies are available but underused, and because significant cost savings may accrue to governmental programs, insurers, and families if the need for dental repair can be reduced. The proposed 'disease risk assessment instrument'will experiment with inputting recognized biological (clinical, laboratory, psychological, and pharmacologic), and non biological (knowledge, logistic, socio-cultural, and environmental) risk factors into algorithm-supported "classification and regression tree analyses" and machine learning "artificial neural networks" to improve on current professionally-endorsed methods of classifying young children by risk. As the proposed 'family capacity assessment instrument'has been less developed to date by the Project Team, its ultimate form will be determined by this research. Success in developing and implementing the Tool and its two assessment Instruments can result in better oral health outcomes at lower cost through risk-based early intervention, disease suppression, individualized care, family engagement, and elimination of the need for dental surgery in children under the age of six. Findings of this research will support clinical trials of risk-based caries management in vulnerable minority child populations and is adaptable to management of other chronic diseases in young children. "Bio-behavioral chronic disease management by families of young minority children" seeks to reduce health disparities by investigating methods to close the gap between health information and health behaviors-specifically, the gap between instruction provided by clinicians to families of young children with chronic diseases and the capacity of economically stressed families to act on that instruction. Specific research aims are to develop, pilot test, and refine two "Tools" that are integral to this Instrument: (1) a 'disease risk assessment tool'and (2) a culturally adaptable 'family capacity assessment tool.'