PROJECT SUMMARY
Oral health (OH) is an essential component of overall health. Early childhood caries (ECC, tooth decay), a preventable and
reversible bacterial infectious disease, is the single most prevalent chronic childhood disease in the United States (US).1-3
Poor OH and ECC disproportionally affect racial/ethnic minoritized and immigrant children4,5 from families with low
socioeconomic position (SEP). Furthermore, evidence shows that individuals who immigrate when < 20 years of age are 2-
4 times more likely to have a child with ECC than parents who are native-born or who immigrated when younger.6-10 In the
US, Hispanic/Latinx children are more likely than children of all other racial and ethnic groups to experience ECC, except
American Indians.6-8 Children’s OH behaviors and risk of ECC are influenced by the child’s and parent's sociodemographic
and acculturation level, biological, behavioral, and psychosocial variables.5-9 Parents play a central role in their children’s
OH-related behaviors.6-13 Evidence suggests that less acculturated Hispanic/Latinx parents have lower OH knowledge,
higher stress, and more barriers to accessing OH/dental care for their children than more acculturated counterparts.8,9
Brazilians are a fast-growing Latin American immigrant group in the US. Yet, little research has focused on health issues
affecting them.14,15 The US has the largest Brazilian population outside of Brazil; ~1,750,000 Brazilians live in the US.19,20
Portuguese is the official language of Brazil and a very important cultural difference between Brazilians and other Spanish-
speaking Hispanic/Latinx groups.17,18 There is a general lack of research focusing on the OH of Brazilian immigrant families
and their children living in the US. Studies conducted in Brazil suggest that low-income children and parents in this
population have low OH knowledge, poor OH status, higher prevalence of ECC, and low OH-related quality of life.17-21
Understanding Brazilian immigrant parents’ OH knowledge, attitudes, and behaviors (KAB) and their experience accessing
and utilizing OH/dental care will allow for the design of salient interventions to improve OH behaviors, OH outcomes, and
OH-related quality of life.22,23 Therefore, the specific aims for the proposed research are to: (1) use qualitative research
methods to explore Brazilian immigrant parents’ OH KAB and access and utilization of OH/dental care for their children
(Phase 1: Focus Groups); (2) translate/back translate the survey to Brazilian Portuguese and then use focus groups’ findings,
expert review, and pilot-testing to adapt the Basic Research Factors Questionnaire (BRFQ) for Brazilians in the US; (3) use
the adapted BRFQ to assess psychosocial and cultural factors associated with Brazilian immigrant parents’ OH KAB and
access and utilization of OH/dental care for their young children (Phase 3: Survey Implementation). The proposed
community-engaged research is innovative because it will be the first to focus on Brazilian immigrants, an understudied
ethnic minority and immigrant population underrepresented in OH research. Consistent with the R21’s purpose, the expected
research outcomes will provide a foundation for a larger-scale trial of an intervention to promote OH and prevent ECC
among Brazilian children in the US.22,23 This research will have a positive impact by building the science of OH research in
Brazilians in the US. Moreover, it will build additional research capacity to engage underserved, minoritized Brazilian
parents to co-design future OH promotion and ECC prevention interventions relevant to Brazilians in the US.
