# Interactive Parent-targeted Text Messaging in Pediatric Clinics to Reduce ECC

> **NIH NIH UH3** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2020 · $259,001

## Abstract

The iSmile study is part of the NIDCR’s Multidisciplinary and Collaborative Research Consortium to Reduce
Oral Health Disparities in Children. The prevalence of Early Childhood Caries (ECC) is increasing,
disproportionately affecting racial and ethnic minorities. Prevention efforts for high risk groups require multi-
level strategies. We will target parents/legal guardians of children (<7 years) during pediatric well-child visits at
urban community health centers (CHCs) and a hospital-based pediatric clinic, and provide a text-message
based ECC prevention intervention. Eighty five percent of adults use text messaging, with no disparities by
race/ethnicity, education or income. The benefits of text message interventions include the use
anywhere/anytime, low cost, scalability to large populations, ability to tailor message content and intensity, and
provision of strategies in real time. CHCs are an ideal venue for oral health promotion both at an individual
level (they provide care to the groups at highest risk for ECC) and at a population level (there are 90 CHCs
electronically linked locally and >1,100 CHCs nationally). In UH2, we developed a theory-based text message
program that is automated, interactive and gamified, and involves behavioral shaping towards better oral
health. The content of the texts are consistent with AAP guidelines, and Social Cognitive Theory. We used the
Fisher-Owens Model (2007) as an intervention planning framework. In the current UH3 phase, 754
parents/legal guardians of children <7 years attending our target CHCs were randomized to receive one of two
dose-equivalent text message interventions: Oral Health Texts (OHT) or Child Wellness Texts (CWT). All
participants have completed the intervention and collection of outcome data is ongoing. The primary outcome
variable is ECC incidence at 24 months. We will assess mediators and moderators of the intervention effect,
perform a budget impact analysis to determine the financial consequences of adoption, diffusion, and
sustainability of the OHT intervention at CHCs, and assess changes in both pediatric and parent oral health
behaviors. This research has strong potential to be an evidence based program that could easily be adopted at
low cost and low provider burden in the 1,128 CHCs in the U.S. that treat almost 4.5 million high risk children
<7 years old. Our text message intervention is innovative because involves system-generated real time
support, tailoring, feedback, and interactivity. Our study has theoretical significance because it integrates a
testable theory with an intervention planning model to elucidate mechanisms of change at multiple levels. Due
to delays in start-up and the unanticipated costs due to COVID-19, this administrative supplement request for
funding is necessary to complete the aims of the originally funded research.

## Key facts

- **NIH application ID:** 10220440
- **Project number:** 3UH3DE025492-05S1
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** BELINDA BORRELLI
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $259,001
- **Award type:** 3
- **Project period:** 2020-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10220440

## Citation

> US National Institutes of Health, RePORTER application 10220440, Interactive Parent-targeted Text Messaging in Pediatric Clinics to Reduce ECC (3UH3DE025492-05S1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10220440. Licensed CC0.

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