摘要：Objectives. We explored the oral health knowledge, attitudes, and activities of Early Head Start (EHS) staff members, parents, and pregnant women, along with their suggestions related to future oral health educational interventions targeting EHS children. Methods. Nine focus groups were conducted with EHS staff, parents, and pregnant women. Audiotapes of sessions were transcribed and entered into ATLAS.ti 5.0 for coding and analysis. Results. Attitudes about the importance of children's oral health among parents and pregnant women were mixed. Staff members voiced responsibility for children's oral health but frustration in their inability to communicate effectively with parents. Parents in turn perceived staff criticism regarding how they cared for their children's oral health. Gaps were noted in the oral health activities of EHS programs. Participants expressed confusion regarding the application of Head Start oral health performance standards to EHS. The need for culturally sensitive, hands-on oral health education was highlighted. Conclusions. Tailored, theory-based interventions are needed to improve communication between EHS staff and families. Clear policies on the application of Head Start oral health performance standards to EHS are warranted. Educational activities should address the needs and suggestions of EHS participants. Early childhood caries has emerged as a concern over the past few years because of its widespread and increasing prevalence, its inequitable distribution among preschool-aged children, and its negative consequences for children, their families, and public health programs. 1 – 4 Many barriers to obtaining dental care exist for young children in most parts of the United States, particularly children in low-income families, and treatment failure rates can be high for those with elevated risk factors. 5 , 6 Recent initiatives have explored innovative approaches to providing preventive and treatment services for these high-risk young children. 7 , 8 The Head Start and Early Head Start (EHS) programs provide an excellent setting in which to develop and test oral health interventions for young children who are at high risk for early childhood caries. 9 – 11 Built on 30 years of Head Start experience, the EHS program began in 1995 and now consists of approximately 650 local programs serving more than 60 000 children. 12 Although EHS programs reach only about 10% of eligible children, they can play an important role in promoting the oral health of young children and families. EHS programs operate under a set of performance standards adopted from the long-standing Head Start program requiring that the oral health needs of children and their families be addressed. 5 , 13 Several of these standards relate to oral health activities and components such as oral examinations, access to oral health care, and preventive services provided directly to children. 5 , 14 Because EHS programs offer services for pregnant women and infants soon after birth, they can intervene at an opportune time to help reduce risk factors for oral disease and promote good oral health practices before the onset of disease. By the time children are old enough to enroll in Head Start, many are already on a trajectory of poor oral health that is difficult to change. 5 Creating a foundation for a lifetime of good oral health among EHS children requires a number of strategies. 11 , 15 Among others, these strategies include (1) delivering effective oral health promotion services in the classroom to instill healthy habits, (2) educating and motivating parents to take an active role in their children's oral health, and (3) developing collaborative relationships within communities to ensure that EHS children have access to oral health care. Although EHS is well positioned to have an impact on the oral health of young children and families, little is known about the oral health activities of EHS staff. Most of the small number of dental studies that have been conducted have focused on Head Start, which targets children 3 to 5 years of age (EHS includes children up to the age of 3 years). Even in the case of the Head Start program, however, relatively little is known about program effectiveness. For example, the Task Force on Community Preventive Services, in an evaluation of the impact of early childhood development programs on health, concluded that there was insufficient evidence to determine the effectiveness of these programs in improving dental outcomes. 16 Therefore, a large gap exists in our understanding of the oral health activities of EHS staff and the barriers that affect these activities, including characteristics of parents of enrolled children and pregnant women. We explored the oral health knowledge, attitudes, and activities of EHS staff members, parents, and pregnant women in relation to the oral health of EHS children, as well as their suggestions regarding future oral health educational interventions targeting EHS children.
