Mary E. Northridge, assistant professor of epidemiology and health promotion at the NYU 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, 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 developments, which have spurred a body of research on health behaviors and outcomes using sophisticated computer modeling to assist in analyzing the data.

“Systems science is an approach that 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,” says Northridge. “The systems science approach to framing the problem of dental health among disadvantaged urban older adults is a way of visualizing the problem, which makes it easier to convey the breadth of issues involved and to draw up recommendations for overcoming barriers.”

To this end, Northridge, who is editor of the American Journal of Public Health, has developed the study protocol along with her co-principal investigators Carol Kunzel and Sara S. Metcalf, and has assembled a team of social and systems scientists to tackle the research.

Using system dynamics modeling, the investigators seek to advance research that began in 2010 when the NIDCR and the OBSSR awarded 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 an NYC oral health outreach initiative sponsored by the Eldersmile program of the Columbia University College of Dental Medicine. 

In the new 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 aim to examine issues 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 toward dentists and oral health care, past experiences with clinic-based dental programs and awareness of the Eldersmile program, and attitudes toward 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,” explains 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, 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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