title: Evaluating the impact of a community developed collaborative project for the prevention of early childhood caries: the Healthy Smile Happy Child project.
abstract: BACKGROUND
  To determine the effectiveness of the Healthy Smile Happy Child (HSHC) project, a community-developed initiative promoting early childhood oral health in Manitoba, Canada. Specific aims were to assess improvements in caregiver knowledge, attitudes, and behaviours relating to early childhood oral health, and the burden of early childhood caries (ECC) and severe ECC (S-ECC).
  
  
  METHODS
  A serial cross-sectional study design was selected to contrast findings following the Healthy Smile Happy Child (HSHC) campaign in four communities with the previous baseline data. One community was a remote First Nation in northern Manitoba and another was a rural First Nation in southern Manitoba. The other two communities were urban centres, one of which was located in northern Manitoba. A community-development approach was adopted for the project to foster community solutions to address ECC. Goals of the HSHC program were to promote the project in each community, use existing community-based programs and services to deliver the oral health promotion and ECC prevention activities, and recruit and train natural leaders to assist in program development and to deliver the ECC prevention program. The HSHC coordinator worked with communities to develop a comprehensive list of potential strategies to address ECC. Numerous activities occurred in each community to engage members and increase their knowledge of early childhood oral health and ultimately lead them to adopt preventive oral health practices for their young children. Children under 71 months of age and their primary caregivers participated in this follow-up study. A -value ≤0.05 was statistically significant.
  
  
  RESULTS
  319 children (mean age 38.2±18.6 months) and their primary caregivers participated. Significant improvements in caregiver knowledge and attitudes were observed following the HSHC campaign, including that baby teeth are important (98.8%), that decay involving primary teeth can impact on health (94.3%), and the importance of a dental visit by the first birthday (82.4%). Significantly more respondents indicated that their child had visited the dentist (50.2%) and had started brushing their child's teeth (86.7%) when compared to baseline. Overall, 52.0% had ECC, 38.6% had S-ECC. The mean deft score was 3.85±4.97 (range 0-20). There was no significant change is ECC prevalence between the follow-up and baseline investigations. However, age-adjusted logistic regression for S-ECC in this follow-up study revealed a significant reduction in prevalence compared with the baseline study (=0.021). Similarly, age-adjusted Poisson regression revealed that there were significant reductions in both the decayed teeth and decayed, extracted and filled teeth scores between follow-up and baseline study periods (0.016 and .0001, respectively).
  
  
  CONCLUSIONS
  Follow-up study results suggest that the HSHC initiative may have contributed to improvements in caregiver knowledge, attitudes, and behaviours towards early childhood oral health and subsequently modest yet statistically significant reductions in caries scores and the prevalence of S-ECC.
authors.affiliation: University of Manitoba - Faculty of Health Sciences, Winnipeg, Manitoba, Canada. umschrot@cc.umanitoba.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Schroth
authors.affiliation: Winnipeg Regional Health Authority & Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada. jedwards@wrha.mb.ca.
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Edwards
authors.affiliation: University of Manitoba - Faculty of Health Sciences, Winnipeg, Manitoba, Canada. Douglas.brothwell@umanitoba.ca.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Brothwell
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada. carolyaki@gmail.com.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Yakiwchuk
authors.affiliation: University of Manitoba - Faculty of Health Sciences, Winnipeg, Manitoba, Canada. Mary.bertone@umanitoba.ca.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Bertone
authors.affiliation: Manitoba Health, Healthy Living and Seniors, Winnipeg, Canada. shamrock1937@msn.com.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Mellon
authors.affiliation: Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada. jward3@wrha.mb.ca.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ward
authors.affiliation: Northern Health Region, Thompson, Canada. Mellis4@nrha.ca.
authors.forename: Marion
authors.initials: M
authors.lastname: Ellis
authors.affiliation: Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada. Khalida.hai-santiago@gov.mb.ca.
authors.forename: Khalida
authors.initials: K
authors.lastname: Hai-Santiago
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. Herenia.Lawrence@dentistry.utoronto.ca.
authors.forename: Herenia P
authors.initials: HP
authors.lastname: Lawrence
authors.affiliation: University of Manitoba - Faculty of Health Sciences, Winnipeg, Manitoba, Canada. mmoffatt@exchange.hsc.mb.ca.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Moffatt
mesh_terms: D002170:Canada; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003149:Community Dentistry / Q000458:organization & administration*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008350:Manitoba; D009909:Oral Health; D015397:Program Evaluation; D012904:Smiling
keywords: Community Participation; Dentistry; Epidemiology; Health Promotion; North America; Oral health; Paediatrics; Public Health