PROJECT SUMMARY
Dental caries, or tooth decay, is a highly prevalent chronic disease afflicting a significant proportion of the U.S.
population, including a majority of youth and adults. Health disparities in oral health have persisted for decades,
with lower-income youth, Black/African Americans and Latinx minorities being especially at risk for dental caries.
Although adolescence is an ideal time to implement healthy behavioral habits that will be sustained into
adulthood, there is a dearth of effective dental health programs for at-risk adolescents. Research has shown that
primary oral health promotion strategies during adolescence include improving dental health behaviors,
abstaining from tobacco use and vaping, and reducing sugar consumption. Following these recommendations
and informed by our formative research findings, our proposed digital dental program for adolescents will target
three oral health behavior domains: twice-daily tooth brushing with fluoride toothpaste, abstaining from tobacco
use, including vaping, and reducing consumption of sugar-sweetened beverages. Grounded in the Theory of
Planned Behavior, augmented by the Prototype/Willingness Model for adolescents, the proposed cross-platform
digital program will target theoretically based mechanisms to promote these three targeted oral health behaviors.
It will include engaging video and interactive game components. Thus, in this UG3/UH3 application, we will
develop and evaluate a theoretically based digital dental health promotion program designed to engage lower
income Black/African Americans, Latinx/Hispanic, and white non-Hispanic 7th and 8th grade students. In the UG3
phase, we propose to conduct formative work to iteratively develop a school-based, web-based oral health
promotion program. In the UH3 phase, we will conduct a clinical randomized control trial (RCT) in schools, to
evaluate “real world” program efficacy. In the RCT, we will assess program acceptability, feasibility, usability,
satisfaction, and engagement, as well as the three primary behavioral and clinical health outcomes. Secondary
outcomes are the theoretically based mechanisms the program targets for behavior change. Seventh and 8th
grade students (N = 2,000) from 40 lower-income schools across multiple states will be randomized to receive
the program intervention or to be on the waitlist (control condition). Participating students will complete
assessments at three time points (baseline, six weeks post-baseline, and six months post-baseline) to evaluate
both short- and long-term program outcomes. If effective, this comprehensive digital behavioral dental health
program would greatly impact public health by decreasing persistent oral health disparities. Delivering the
program via schools will address disparities in access to such programs, as students will access the program
via school internet and school-owned digital devices. A web-based intervention is also easily scalable and can
be widely disseminated at little cost, reaching adolescent populations most at risk for dental caries. The long-
term goal is to facilitate healthy dental habits and related oral health behaviors for adolescents to attain a lifetime
free from preventable oral disease.
