Lee Helen H, Avenetti David, Edomwande Yuwa, Sundararajan Vyshiali, Cui Liyong, Berbaum Michael, Nordgren Rachel, Sandoval Anna, Martin Molly A
Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, United States.
Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States.
Front Oral Health. 2022 Aug 11;3:962849. doi: 10.3389/froh.2022.962849. eCollection 2022.
Household-level psychosocial stress levels have been linked to child tooth brushing behaviors. Community health worker (CHW) interventions that target psychosocial factors in high-risk communities have been associated with changes in health behaviors.
Observe changes in psychosocial factors over time and an association between psychosocial factors and CHW intervention dose amongst urban Chicago families.
Participants ( = 420 families) were recruited from 10 community clinics and 10 Women, Infants, or Children (WIC) centers in Cook County, Illinois to participate in a clinical trial. Research staff collected participant-reported psychosocial factors (family functioning and caregiver reports of depression, anxiety, support, and social functioning) and characteristics of CHW-led oral health intervention visits (number, content, child engagement) at 0, 6, and 12 months. CHWs recorded field observations after home visits on household environment, social circumstances, stressors, and supports.
Participants across the cohort reported levels of psychosocial factors consistent with average levels for the general population for nearly all measures. Psychosocial factors did not vary over time. Social functioning was the only measure reported at low levels [32.0 (6.9); 32.1 (6.7); 32.7 (6.9); mean = 50 (standard deviation)] at 0, 6, and 12 months. We did not observe a meaningful difference in social functioning scores over time by exposure to CHW-led intervention visits (control arm, 0, 1, 2, 3, and 4 visits). Field observations made by CHWs described a range of psychosocial stress related to poverty, language barriers, and immigration status.
The unexpectedly average and unchanging psychosocial factors over time, in the context of field observations of stress related to poverty, lack of support, immigration status, and language barriers, suggests that our study did not adequately capture the social determinants of health related to oral health behaviors or that measurement biases precluded accurate assessment. Future studies will assess psychosocial factors using a variety of instruments in an attempt to better measure psychosocial factors including social support, depression, anxiety, functioning, trauma and resilience within our urban population. We will also look at neighborhood-level factors of community distress and resilience to better apply the social ecologic model to child oral health behaviors.
家庭层面的心理社会压力水平与儿童刷牙行为有关。针对高危社区心理社会因素的社区卫生工作者（CHW）干预措施与健康行为的改变有关。
观察芝加哥城市家庭心理社会因素随时间的变化以及心理社会因素与社区卫生工作者干预剂量之间的关联。
从伊利诺伊州库克县的10家社区诊所和10家妇女、婴儿或儿童（WIC）中心招募参与者（n = 420个家庭）参加一项临床试验。研究人员在0、6和12个月时收集参与者报告的心理社会因素（家庭功能以及照顾者关于抑郁、焦虑、支持和社会功能的报告）以及社区卫生工作者主导的口腔健康干预访视的特征（次数、内容、儿童参与情况）。社区卫生工作者在家庭访视后记录关于家庭环境、社会环境、压力源和支持的实地观察情况。
几乎所有指标的队列参与者报告的心理社会因素水平与一般人群的平均水平一致。心理社会因素随时间没有变化。社会功能是在0、六个月和12个月时报告水平较低的唯一指标[32.0（6.9）；32.1（6.7）；32.7（6.9）；平均值 = 50（标准差）]。我们没有观察到因接受社区卫生工作者主导的干预访视（对照组，0、1、2、3和4次访视），社会功能得分随时间有显著差异。社区卫生工作者的实地观察描述了一系列与贫困、语言障碍和移民身份相关的心理社会压力。
在实地观察到与贫困、缺乏支持、移民身份和语言障碍相关的压力背景下，心理社会因素随时间意外地处于平均水平且没有变化，这表明我们的研究没有充分捕捉到与口腔健康行为相关的健康社会决定因素，或者测量偏差妨碍了准确评估。未来的研究将使用多种工具评估心理社会因素，试图更好地测量我们城市人群中的心理社会因素，包括社会支持、抑郁、焦虑、功能、创伤和恢复力。我们还将研究社区困扰和恢复力的邻里层面因素，以便更好地将社会生态模型应用于儿童口腔健康行为。
