Progress Report: R025 A. Specific Aims The Specific Aims do not differ in scope from those stated in the original competitive application. Specific Aim 1: Training To enhance the oral health research experience and expertise of investigators, it was necessary to enhance the biostatistical support available within the Clinical Research Center (CRC) and use mentorship from UNC to create opportunities for the optimal training of future oral health researchers. This was achieved through bi-monthly teleconference meetings, as well as visits to UNC by the investigators, and visits to Hawaii by UNC post-doctoral fellows and other senior faculty. This component included seminars telecast from UNC to UH to provide training in collecting and processing biological samples, data management, data analysis and collecting and evaluating clinical indices. Specific Aim 2: Network Development To establish a collaborative oral health research network to include the University of Hawai„i School of Nursing and Dental Hygiene (SONDH), John A. Burns School of Medicine (JABSOM), Clinical Research Center (CRC), State Department of Health, UNC Dental Research Center, and an Advisory Committee comprised of representatives from these entities and the Community Health Centers, the Hawai`i Primary Care Association (HPCA) and the Area Health Education Center (AHEC) in order to accomplish the goals of this proposal. This network will respond to future initiatives in oral health that would benefit from a multidisciplinary and comprehensive approach, identify barriers and facilitators to conducting oral health research, identify community research questions, and provide education for the community relating to oral health disparities in APIs. A working relationship with these entities was established to identify priorities for future research in oral health and to foster continuation of research projects after the initial planning stage. Focus groups were set up to identify barriers and facilitators to conducting oral health research, identify community research questions, and provide education for the community relating to oral health disparities in APIs. Specific Aim 3: Preliminary Studies These studies assist in the development of the knowledge base needed to test the science proposed in the R01. Activities include feasibility studies, tool development studies and studies that result in definition and refinement of study variables. Refining and implementing a project evaluation plan and systematically using findings to monitor the process of the above collaborative affiliations, training, network, development and preliminary studies will enhance the research capacity of UH and the broader community to conduct research that will lead to innovative strategies designed to reduce oral health disparities in the ethnically diverse population of the State of Hawaii. B- Studies and Results Specific Aim 1: Training 1) Collaboration with UNC -Bimonthly teleconference meetings were held between UH and UNC (minutes on file). Discussions focused on instrumentation, protocol development, seminar planning, data management, data analysis, selection of clinical indices, and sample selection. -Seminars were telecasted from UNC to UH to provide training in collecting and processing biological samples, data management, data analysis and collecting clinical indices. -Six members of UNC traveled to Hawaii to participate in a conference (Feb. 3-4, 2003) to increase awareness among potential partners from the research community. A copy of the program and evaluation is presented in the appendix). The conference, A Short Course Addressing Oral Health Disparities: Development of Research Competence, was hosted by the University of Hawaii John A. Burns School of Medicine in collaboration with the University of North Carolina School of Dentistry with assistance from the Clinical Research Center. Sixty-eight professionals were in attendance as issues such as methodology, prevalence, epidemiology and ethics were addressed. During this visit the UNC team also visited the Waimanolo Health Center and held a number of meetings with researchers related to the development of future research projects. 2) Training in Data Collection -Select members of the Hawaii team will travel to UNC during the next project year. During this visit, the proposal for the R01 will be refined. -In late June of 2003, members of the UNC team will come to UH to provide training in calibration. Specifically, dental hygienists will be provided with training to assure that they possess the skills to conduct reliable and valid oral examinations including plaque scores, DMFS, probing depth and CEJ measurements at six sites per tooth, bleeding on probing and gingival scores in a standardized manner. This training will be conducted by the UNC research team, and is funded as part of the R25 Planning Grant. Specific Aim 2: Network Development Network development has occurred through development of relationships with community-based programs as well as the Waimanalo Health Center. 1) Focus groups Co-Principal Investigator Rosanne Harrigan completed the training of focus group facilitators (primarily Native Hawaiian women) on the islands of Maui (N=6) and Oahu (N=15). Participants included primarily Native Hawaiian women who are facilitators for the 0-5 Program (for Native Hawaiian children) managed by Alu Like. However, in Maui 3 community members and oral health providers were also trained. Facilitators were trained to conduct focus groups for oral health research, identify community research questions and provide education to the community regarding oral health disparities in APIs. The research questions developed for the qualitative project are currently under review by the community and the finalized protocol being will then be readied for IBR submission. Data collection is anticipated in August with data analysis scheduled for September and October. A publication describing the community‟s perceptions of oral health problems in Hawaii will be submitted for review by December of Year 02. These data will also be used in the preparation of the R01. 2) The Waimanalo Health Center The Waimanalo Health Center (WHC) is a community-based nonprofit organization dedicated to improving the quality of life for the people of Hawaii by taking an active role in social and health issues in a community dominated by low-income Native Hawaiian residents. The Waimanalo Health Center is in full support of the oral health research initiative. The Center is, now, part of the oral health research infrastructure and network that we developed during the first year of this grant. Specific Aim 3: Preliminary Studies A grant proposal was submitted to the Hawaii State-Biomedical Research Infrastructure Network, Junior Researcher Award by C. Jourdan-Le Saux, Ph.D. to support preliminary data collection. We will evaluate the social, economic, and cultural environment associated with oral health status in a population of Asian and Pacific Islanders with oral health disparities. We will develop and test questionnaires and conduct clinical oral examinations in a group of API subjects from the Waimanalo community. The relationship between oral health status and genetic predisposition will be examined and adjusted for sociodemographic characteristics and behaviors. Dr Easa, Dr Harrigan and the UNC team worked closely with C. Jourdan-Le Saux to develop this application. C- Significance The network has been established. Relationships with UNC have been established and has been productive. A decision has been made in relation to the focus of the R01 that will be submitted: molecular and epidemiological correlated of periodontal disease in Asian and Pacific Island Peoples. Thus, the relational, cognitive and process Aims have all been met. We will concentrate during the next project year on the collection of preliminary data as well as the refinement of skills necessary to develop a fundable R01 application in association with our collaborators. D-Plans Specific Aims 1 and 2 are advanced and we will maintain the teleconference schedule with UNC, as well as the work with the focus groups. The second year will be devoted to the collection of preliminary data needed to test the science proposed in the R01. Activities will include feasibility studies, tool development studies and studies that result in definition and refinement of study variables. E-Publications Busch, j, Easa, D, Grandininettio A, Mor J, Harrigan, Health People in Hawaii?: An Overview of Ethnic Health Disparities in Hawaii for the Health People 2010 initiative targeted health concerns. Hawaii Medical Journal, Vol 62, January 2003, 9- 13. F- Project generated resources Dr. Jourdan-Le Saux applied for a “ New Investigator Award” grant sponsored by the Hawaii-State Biomedical Research Infrastructure Network. This study will provide insight into the social, cultural, behavioral, cellular and molecular determinants of risk for oral disease. Completion of the proposed work in association with the currently funded NIH-R-25 planning grant (D. Easa, PI) will allow us to justify the conduct of a definitive study of molecular and epidemiological correlates of periodontal disease and systemic illness. This intervention will also generate qualitative data that can be used to develop a potential intervention. The purpose of this study is to generate preliminary data that will provide us the proper framework and rationale to compete successfully for a larger, adequately powered and more definitive study.
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