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1.  Overweight in Childhood 
Some low-income minority children in the U.S. remain at normal weight throughout their childhood despite high risk of obesity.
This study examined whether resilient caregiving accounted for children’s healthy weight maintenance and dietary compliance over a 4-year period among poverty-stricken African-American families.
A representative sample of 317 African-American caregiver–children (aged 3–5 years) pairs from low-income areas of Detroit, Michigan was examined in 2002–2003 with a follow-up assessment in 2007. Capacity for resilience among caregivers was defined using 5 individual and environmental protective factors. A BMI score for the children was computed from recorded height and weight, and converted into one of three categories (normal weight, overweight, obese) using age- and gender-specific national references. Dietary information was collected using the Block Food Frequency Questionnaire (FFQ) and Block Kids FFQ. Data were analyzed in 2010 to test whether children’s weight transition and dietary compliance varied according to their caregivers’ capacity for resilience.
In all, 95 caregivers (29%) were identified as having capacity for resilience. They were younger, had higher levels of educational attainment, and had lower levels of daily soda consumption. The children of these caregivers had a lower likelihood of remaining overweight or obese than being of normal weight (Relative Risk Ratio = 0.5, 95% CI = 0.2, 0.9), and had persistently lower soda consumption over 4 years compared with other children.
This finding demonstrates that some caregivers positively influence children’s health weight management and dietary compliance despite material deprivation. Interventions to initiate and promote resilient caregiving could benefit the health and health-related behaviors of low-income African-American children.
PMCID: PMC3056409  PMID: 21335265
2.  A transition scoring system of caries increment with adjustment of reversals in longitudinal study: evaluation using primary tooth surface data 
The aim of this paper is to evaluate a new comprehensive scoring system for longitudinal studies using the International Caries Detection and Assessment System (ICDAS).
A sample of 638 children was examined in 2002–03 and again in 2007. Caries was assessed using the ICDAS criteria which assess six clinical stages of dental caries. Based on a transition matrix matching the baseline and follow-up ICDAS scores, we developed transition weights to best describe the progression, regression, or no progression nor regression of dental caries. Differential weights were assigned to transitions involved with non-cavitated, cavitated, filled, crowned, or missing lesions. This method (Transitional Scoring System (TSS)) differentiated biologically plausible reversals from those due to examiner’s misclassification. We computed and compared mean dmfs (decayed, missing, and filled tooth surfaces) increment scores including (dtmfs) or excluding the non-cavitated stage (dcmfs) from TSS and another adjustment method proposed by Beck (modified Beck’s method). The coefficients of variations (CV) of the two methods were also compared.
Mean dtmfs from TSS was slightly higher than that from modified Beck’s method. There was no difference in mean dcmfs between two methods. The ratios of CV indicated that the CV of TSS was significantly smaller than those from modified Beck’s method.
There were differences in caries increment scores between the two methods when we accounted for the transition of non-cavitated lesions. The evaluation of CV concluded that TSS was more efficient because it requires less sample size compared with the modified Beck’s method to detect a treatment effect. Both methods can be used to compute caries increments for populations with similar distribution of the dmfs scores to the sample used in this study.
PMCID: PMC2998587  PMID: 20690932
3.  Cigarette Smoking Among Low-Income African Americans: A Serious Public Health Problem 
This study examines the current prevalence of cigarette smoking and the number of cigarettes smoked in a community-based sample of 1021 low-income African-American men and women.
Participants were selected using a two-stage, area probability sample design. Data were collected in 2002–2003 in face-to-face interviews and analyzed in 2005. All data and analyses were weighted to account for the complex sampling design.
Fifty-nine percent of men and 41% of women were current smokers, with younger individuals apparently initiating smoking at an earlier age than older individuals.
The high prevalence of cigarette use provides further evidence that the excess burden of tobacco-related disease among low-income African-American families may be on the rise. This is of great concern, and if confirmed by further research, indicates an urgent need for preventive intervention.
PMCID: PMC1817892  PMID: 16168872
4.  Assessment of the Relationship between Neighborhood Characteristics and Dental Caries Severity among Low-Income African-Americans: A Multilevel Approach 
To assess the relationship between neighborhood effects and the severity of dental caries among low-income African-Americans.
A multistage probability sample of African-American families living in the poorest 39 census tracts in Detroit was drawn. During 2002–03, cross-sectional data of a cohort that includes 1021 caregivers were collected in the first of three waves of interviews and examinations. Multilevel analyses focused on 27 neighborhood clusters and involved a combination of individual (Level-1) and neighborhood (Level-2) data including census and geocoded (address matching to census geographic areas) information.
There is significant variation in the severity of caries between low-income neighborhood clusters. Caries severity decreases with a higher number of churches, while it increases with a higher number of grocery stores in the clusters after accounting for individual characteristics. Only 14% of the inter-individual variability in caries was explained by classical individual risk factors for this condition.
Neighborhoods contribute something unique to caregivers’ oral health, beyond socioeconomic position and individual risk factors. Multilevel interventions are necessary to reduce disparities among African-Americans and churches may offer a promising venue from which to conduct them.
PMCID: PMC1817893  PMID: 16570748
African-American; dental caries; multilevel analysis; neighborhood effects
Caries research  2006;40(6):473-480.
The aim of this study was to examine the relationship between dietary patterns and caries experience in a representative group of low-income African-American adults. Participants were residents of Detroit, Michigan, with household incomes below 250% of the federally-established poverty level (n = 1,021). Dietary histories were obtained by trained interviewers in face-to-face interviews with the adult participants, using the Block 98.2® food frequency questionnaire developed by Block Dietary Systems, Berkeley, CA. Caries was measured by the ICDAS criteria (International Caries Detection and Assessment System). There were 200 dietary records whose data were judged to be invalid; these participants were omitted from the dietary analyses to leave n = 821. Analyses were conducted using software from SAS and SUDAAN. Factor analysis identified patterns of liquid and solid food consumption, and the resulting factor scores were used as covariates in multivariable linear regression. Caries was extensive, with 82.3% of the 1,021 participants (n=839) having at least one cavitated lesion. Nearly three-quarters of the adult participants were overweight or obese. This population has severe caries, poor oral hygiene, and diets that are high in sugars and fats and low in fruits and vegetables. Apart from tapwater, the most frequently consumed food item by adults of all ages was soft drinks; 19% of all energy from sugar came from soft drinks alone. In both the bivariate analyses and in the regression model, frequency of soft drink consumption and the presence of gingival plaque deposits were significantly associated with caries. Interventions to promote oral health are unlikely to be successful without improvements in the social and physical environment.
PMCID: PMC1626651  PMID: 17063017
diet; dietary patterns; soft drinks; sugars; fat consumption; caries; plaque deposits; oral hygiene; adults; disparities; low-income
6.  Reliability and Validity of Brief Measures of Oral Health-Related Knowledge, Fatalism, and Self-Efficacy in Mothers of African American Children 
Pediatric dentistry  2005;27(5):422-428.
Low-income African American children experience high rates of dental caries compared to the general population. Knowledgeable and efficacious caregivers can play an important role in caries prevention. This study developed and evaluated four brief measures reflecting mothers’ potentially modifiable cognitions associated with African American children’s oral health: (1) knowledge about appropriate bottle use (KBU); (2) children’s oral hygiene (KCOH); (3) oral health-related fatalism (OHF); and (4) oral health-related self-efficacy (OHSE).
Questions were selected based on reviews of the health promotion and oral health literature, with input from low income African American caregivers of young children. Reliability and validity were evaluated using survey and dental examination data from 719 low-income African American mothers and their children ages 1–5 years.
Alpha reliabilities ranged from .76 – .91. KCOH was significantly associated with mothers’ oral health perceptions and children’s caries status. OHSE was significantly positively correlated with children’s brushing frequency and with mothers’ subjective perceptions of children’s oral health, which was in turn significantly associated with children’s caries status.
Results support the reliability and validity of the new measures. If confirmed by further research, these measures can be used to develop tailored educational and cognitive-behavioral interventions to reduce oral health disparities.
PMCID: PMC1388259  PMID: 16435644
7.  Similarity of Bacterial Populations in Saliva from African-American Mother-Child Dyads▿  
Journal of Clinical Microbiology  2007;45(9):3082-3085.
Using PCR-based denaturing gradient gel electrophoresis analyses of oral bacterial samples in 20 mother-child dyads, this study demonstrated a high degree of similarity of bacterial compositions between the mothers and their children; the two may share as much as 94% of their oral bacterial spectra, including cariogenic species.
PMCID: PMC2045297  PMID: 17634300

Results 1-8 (8)