Shaping the future of child oral health
Southwest Health Equity Research Collaborative study hopes to diminish early childhood caries among Native Hawaiian and other Pacific Islander families
Getting children to brush their teeth daily—let alone properly flossing and avoiding sugary snacks—is difficult for all caregivers.
To assist families in developing lifelong good dental hygiene in their preschoolers, researchers from the University of Hawai`i at Hilo and the Northern Arizona University are examining the oral health knowledge, attitudes, and behaviors among Native Hawaiian and other Pacific Islander families living in Hilo, Hawai`i—an area where 33.9% of the population is Native Hawaiian, which is the highest in the country.
From the findings, Misty Pacheco, associate professor in the Department of Kinesiology and Exercise Sciences at the University of Hawai`i at Hilo; Viacheslav Fofanov, associate professor and associate director of Research and Graduate Programs for NAU School of Informatics, Computing and Cyber Systems; and NAU Regents’ Professor Julie A. Baldwin, director of the Center for Health Equity Research (CHER) are creating an oral health intervention for high-risk preschoolers and their caregivers in the coastal community.
This project, “Disparities in Early Childhood Caries Among Native Hawaiian and Other Pacific Islander Preschool-Aged Children,” is being conducted through a diversity supplement awarded to Pacheco and is building upon data from two other Southwest Health Equity Research Collaborative (SHERC) projects: “Defining Microbiological Drivers of Early Childhood Caries in Preschoolers in Southern Arizona” and “Defining Microbiological Drivers of Early Childhood Caries in Preschoolers of Native Hawaiian and Other Pacific Islander Descent.”
In the original study, Fofanov and other NAU researchers studied tooth decay in 350 preschoolers in northern Arizona to see if they are affected by the acidic bacteria in their oral “microbiome.” In the two earlier SHERC studies, researchers expanded to include children both in southern Arizona (Yuma County) and on the Big Island of Hawai`i who are Native Hawaiian or Pacific Islander. The Big Island has similar social determinants of health as rural populations in the continental United States.
The researchers are working to prove that biological components, combined with socioeconomic factors which include poverty and access to dental care, increase tooth decay. Fofanov and his colleagues have found that the bacteria strains S. mutans and S. sobrinus are the bacteria that most frequently contribute to childhood tooth decay, according to the results of their research.
Using data to develop a targeted oral health intervention
Through Pacheco’s diversity supplement, the researchers are creating their early childhood caries intervention program using data they gathered from about 30 caregivers of Native Hawaiian/Pacific Islander preschoolers who participated in their earlier Hawai`i study.
“In the original study in Hawai`i, the east Hawai`i preschools were amazing collaborators, as well as the [preschool students’] parents,” Pacheco said. During the current study, though all children are considered high risk, half of the caretakers will be informed that their preschoolers are at high risk and the other half will not know their sample results, Pacheco said.
The researchers will give the families basic oral health education, and they will survey the families on their hygiene behaviors. Through the study, each family will get dental supplies, including toothbrushes, toothpaste, floss and a timer.
The researchers will reconnect with the caregivers two months later and take one final swab sample, then give them the same survey they took at the beginning of the project.
“We want to assess if the education [program] or knowing your sample results [or both] affect oral health behavior,” Pacheco said.
Investing in early-stage faculty through a diversity supplement
In addition to designing a targeted intervention and education program, Baldwin and Fofanov have been working with Pacheco on career development, mentoring and support through the Hawai`i studies.
“Drs. Baldwin and Fofanov are a wealth of knowledge when it comes to research methods, technical skills, and engaging with the community,” Pacheco said. “Their work with Native families in Arizona is a great foundation and example for working with Indigenous families in my community.”
The young associate professor is the only female and Native Hawaiian/Pacific Islander tenured faculty member at the University of Hawai`i in Hilo’s Department of Kinesiology and Exercise Science.
“I first met Dr. Pacheco through another research program at the University of Washington called the Indigenous HIV/AIDS Research Training (IHART) program, where I served as one of her mentors. We have been collaborating ever since,” Baldwin said. “It is such a joy for me to work with Misty – she is a wonderful person, an outstanding researcher, and so committed to making a difference in her community. I know we will find ways to continue to work together for some time to come.”
In her role at UH-Hilo, Pacheco oversees the department’s health promotion track. She said her passion for public health ignited when she served as a public health educator in the Peace Corps in Kenya after graduating with her bachelor’s in chemistry from California State University, Sacramento, and her Master of Health Administration from the University of Southern California. Her Peace Corps volunteer work focused on sexual and reproductive health.
“I was amazed at what we could do [in Kenya] and what we were charged to do in an area with little to no resources,” Pacheco said. “It was there I realized my desire to serve the most vulnerable populations and to focus on those upstream factors of health was my calling.”
After returning to the U.S. from Kenya, she then earned a Doctor of Public Health from the University of Hawai`i at Mānoa.
Pacheco said that she provides her east Hawai’i community with healthcare education and accurate information, as well as other resources, to ensure they receive equitable access to healthcare.
Developing lifelong mentorships
Pacheco said that career development, support, and mentorship are essential to faculty and students.
“I can attest to the benefits great mentorship has had on me when it came to my education and career,” Pacheco said. “Having someone to learn from, guide you and support you in different ways is the key to growth and success.”
Pacheco said that collaborating with Baldwin and Fofanov marks the first time she has partnered with another university as a faculty member and researcher.
“Hawaiʻi is so isolated and it is often difficult to forge these relationships and partnerships, and it can be daunting,” she said. “This opportunity has been so positive and is working out better than I could have imagined. It is giving me the confidence to continue to seek out these partnerships when appropriate.” Although she has a bachelor’s degree in chemistry, Pacheco said she has not worked in the biological sciences recently, and that her renewed and newly acquired technical skills will impact her future career.
“Dr. Fofanovʻs mentorship, when it came to explaining and teaching me about the microbiological aspect of this study (analysis of samples), has been new and interesting,” Pacheco said. “Dr. Baldwin’s work with her Native community and her success when it comes to grant writing has been hugely beneficial.” Pacheco said that another longtime mentor, Keaweʻaimoku Kaholokula, associate professor and chair in the Department of Native Hawaiian Health in the John A. Burns School of Medicine at the University of Hawai`i at Mānoa, is also assisting her with the study’s focus.
“Because I am focusing on Native Hawaiian/Pacific Islander preschoolers, he continues to be a crucial mentor for me,” she said.
She added, “A family member of mine, Leilani Kupahu-Kahoʻāno, who is also a Native Hawaiian cultural expert and registered nurse, founded a nonprofit that focuses on children as well. I have consulted with her many times during this study.”
Through the research project, Pacheco is also including her undergraduate students and funding them.
“Because of this experience, one of my students decided to get an MPH degree,” the associate professor said. “[Participating in the project] solidified her decision to do research.” This research is supported by a NIMHD center grant to the Southwest Health Equity Research Collaborative at Northern Arizona University (U54MD012388).