Dr. Mary E. Northridge, assistant professor of epidemiology and health promotion at the New York University College of Dentistry, has been awarded a five-year, $3.7 million grant from the National Institute of Dental and Craniofacial Research (NIDCR) and the Office of Behavioral and Social Sciences Research (OBSSR), of the National Institutes of Health (NIH), to analyze how racial and ethnic older adults living in underserved urban communities in NYC overcome barriers to accessing oral health care services.
The research will involve recent systems science methodological developments enabled by computational advances, which have spurred a body of research on the effects of multiple scales and dimensions on health behaviors and outcomes using sophisticated computer modeling to assist in analyzing the data.
"Systems science is an approach which includes data from the micro-scale of the mouth, to the interpersonal scale of social networking in the community, to the societal scale, involving issues such as the lack of Medicare coverage for routine dental exams. The systems science approach to framing the problem of dental health among disadvantaged urban older adults is a way of visualizing the problem," said Dr. Northridge. "This visualization makes it easier to convey the breadth of issues involved in oral healthcare access for older adults and to draw up recommendations for overcoming access-to-care barriers," she said.
To this end, Dr. Northridge, who has developed the study protocol along with her co-principal investigators Dr. Carol Kunzel and Dr. Sara S. Metcalf, assembled a group of social and systems scientists to tackle the research as a team.
Dr. Kunzel, associate professor of clinical dental community health and clinical sociomedical sciences at the Columbia University College of Dental Medicine, will oversee the participant interviews. Dr. Metcalf, assistant professor of geography at the State University of New York (SUNY) at Buffalo, will develop a portfolio of systems science models depicting the dynamic relationships among factors at the individual, interpersonal, and community scales that are involved in shaping participants' utilization of oral healthcare services.
Using system dynamics modeling, the investigators seek to advance research that began in 2010 when the NIDCR and the OBSSR awarded Dr. Northridge a two-year, $431,914 grant to examine the oral health of medically- and dentally-underserved Hispanic and African-American older adult participants in a New York City oral health outreach initiative sponsored by the Eldersmile Program of the Columbia University College of Dental Medicine.
Dr. Northridge found that edentulism (the condition of lacking teeth) - a key measure of oral health - was 27.3 percent among adults 65 and over nationally, compared with 19.5 percent for adults 65 and over participating in the Eldersmile program, which provides oral health education, screening, and treatment referrals, as well as hypertension and diabetes screenings and referrals at more than 50 senior centers in the Harlem and Washington Heights/Inwood neighborhoods.
"How the underserved group overcame barriers like lower education levels and higher poverty rates to successfully take advantage of dental services and achieve better oral health than the US national average is an intriguing question," Dr. Northridge remarked. "Our new study aims to answer the question and draw lessons that can be applied to improve access to care for older adults nationwide."
In the newly-funded study, investigators will visit senior centers in Harlem and Washington Heights/Inwood to interview 16 directors and staff members and 256 Hispanic and African-American adults ages 50 and over who both are and are not participating in the Eldersmile program.
The researchers have two aims: 1) to examine a broad array of issues related to access to care, including how people in the community tap into social networks to find information on social services in general and dental care in particular; how friends and family support one another to overcome obstacles to accessing care; attitudes towards dentists and oral health care; past experiences with clinic-based dental programs; and awareness of the Eldersmile program; and 2) to ask participants about attitudes towards being screened for hypertension and diabetes at a dental visit.
"With more people in general and our aging and more racially and ethnically-diverse population in particular seeking primary health care as a result of the Affordable Care Act, it makes sense for dentists to become actively involved in screening for chronic systemic conditions that have been linked to poor oral health in older adults," explained Dr. Northridge. "Understanding older adults' views on this issue is part of the process of building the case for systemic health screenings in the dental setting."
Based on the study's findings, Dr. Northridge plans to develop a protocol for incorporating diabetes and hypertension screenings into routine dental examinations, and to test the protocol in local private practice settings, and, ultimately, on a national level.
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