Gerardo Maupome
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Oral health disparities in the Latino community are often linked to lifestyle, socio-economic position, and structural barriers in healthcare systems. However, it is increasingly recognized that individuals rely on professional and informal social networks to understand and address their health problems. Social norms inherent within these networks can shape oral health-related decision-making. Network members can offer support, recommend or provide services, influence health behaviors, and encourage or discourage adherence to treatment regimes. To address this gap in knowledge, Dr. Gerardo Maupomé examines the link between oral health disparities and social networks.
Building on prior and formative research, Dr. Maupomé and colleagues are using network methods to gain an insight into the complex and dynamic mechanisms underlying oral health disparities. First, they identify customs, attitudes, and behaviors around dental care and oral health. Second, they apply this information to characterize the relationships between the diverse strands of interpersonal networks and behaviors. The research will produce innovative methodological knowledge about quantifying how personal networks change over time, and how such evolution support or undermine positive oral health traits in an at-risk population. The ultimate goal is to devise actionable strategies and identify entry points into networks that lead to positive changes.
Dr. Maupomé’s work to reduce disparities in oral health is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.
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Item Assessment of the Calibration of Periodontal Diagnosis and Treatment Planning Among Dental Students at Three Dental Schools(American Dental Education Association, 2015-01) Lane, Brittany A.; Luepke, Paul; Chaves, Eros; Maupome, Gerardo; Eckert, George J.; Blanchard, Steven; John, Vanchit; Department of Periodontics and Allied Dental Programs, IU School of DentistryCalibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.Item Clinician-Patient Small Talk: Comparing Competent Students and Expert Dentists in a Standardized Patient Encounter(Office of the Vice Chancellor for Research, 2016-04-08) Maupome, Gerardo; Holcomb, C.; Schrader, S.Objectives: To establish whether the frequency of non-diagnostic, non-management exchanges between clinicians and patient (socioemotional communication, SC) during the consultation differed between senior dental students and dentists, controlling for clinically driven exchanges of information. Methods: Dentists and students were recorded while undergoing a consultation with a live standardized patient, and subsequently interviewed by investigators; their shared interpretation of cognitive strategies were recorded and compared for differences in the presence of SC using a χ2 test; first consultation occurrence of SC using log-rank tests; and number of times that SC occurred using mixed-model ANOVA. Results: Most clinicians engaged in SC throughout the consultation with a few exceptions. Statistical analyses produced non-significant differences for overall SC presence (p=0.62), time to first instance of SC from overall start of the consultation (p=0.73), and time after first intraoral examination had taken place (p=0.76). Non-significant differences were also recorded for the summary of time intervals when SC occurred at time from overall start of the consultation (p=0.89), and time after first intra-oral examination had taken place (p=0.12). Conclusions: SC occurred in most clinicians. Patterns depicted this interaction occurring throughout the consultation, not concentrated at the beginning or end. SC did not appear to differ between experts and students in terms of prevalence, frequency, or timing. Future research should examine the detailed association between SC and diagnostic thinking processes, to further delineate their relationship and characterize possible pedagogical applications.Item Network science and oral health research(Wiley Blackwell (Blackwell Publishing), 2015) Maupome, Gerardo; McCranie, Ann; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of DentistryThe present overview of research methods describes a scientific enquiry paradigm that is well established in other disciplines, including health research, but that is fairly new to oral health research. Social networks analysis (SNA) or network science research is a set of relational methods purporting to identify and characterize the connections between members of a system or network, as well as the structure of the network. Persons and communities making up the members of networks have commonly been the focus of SNA studies but corporations or living organisms might just as well be organized in networks. SNA is grounded in both graphic imagery and computational models. SNA is based on the assumptions that features and structure of networks are amenable to characterization, that such information sheds light on the ways members of the network relate to each other (sharing information, diseases, norms, and so on), and that through these connections between members the overall network structure and characteristics are shaped. The overview resorts to examples specific to oral health themes and proposes a few general avenues for population-based research.Item The Binational/Crosscultural Health Enhancement Center(Office of the Vice Chancellor for Research, 2010-04-09) Bergman, Alicia April; Bigatti, Silvia M.; Clark Jr., Charles M.; Everetts, David R.; Kahn, Hilary E.; Lorant, Diane Estella; Maupome, Gerardo; Mays, Rose M.; Riner, Mary E.; Snodgrass, Michael David; Soto, Armando; Stelzner, Sarah M.; Whitehead, Dawn Michele; Wilson, Gregory A.; Yoder, Karen M.The Binational/Cross-Cultural Health Enhancement Center (BiCCHEC) fosters multidisciplinary research collaborations that address the biological, cultural, historical, legal, behavioral and demographic issues that impact the health status of communities where Latinos are born and where they live in Indiana. Since its inception, BiCCHEC projects have been multidisciplinary, 80% of the projects involve two or more IUPUI schools. BiCCHEC projects are also collaborative, 70% of the projects have one or more community partners. BiCCHEC researchers have also established a strong commitment to teaching and service, actively involving students in research (25% of current projects are student led) and servicelearning activities, developing exchange programs through our partnerships and providing direct health services in community organized events. Signature center funds have been utilized to fund internal pilot projects. The current poster will highlight four of those projects that have received pilot funding from signature center funds and have resulted in external grant applications or have already received funding, or have resulted in peer reviewed-publications. These projects are considered representative of BiCCHEC’s activities, because of their collaborative, multidisciplinary and community-based nature and include: • Study on oral health disparities using community-based participatory research • Study on the attitudes regarding children with disabilities, beliefs regarding death, coping skills and supports used during bereavement in communities in Indiana and rural Mexico • Building of a bi-national research partnership for healthful eating and diabetes prevention among Mexican and Mexican-American children • Study on emigration and return migration in 20th Century Mexico: Across the border and back again • Study on the effects of migrants' acculturation on oral health and diet in Indianapolis and Tala, Jaliscco using social network theoryItem PILOT APPRAISAL OF VARIABLES AMONG MEXICAN-AMERICANS FOR SOCIAL NETWORKS ANALYSIS(Office of the Vice Chancellor for Research, 2010-04-09) Maupome, Gerardo; Wright, E.; Martinez-Mier, E.A.; Medina-Solis, C.E.Hispanics in the USA often suffer poor oral health. More appropriate solutions may be designed if we move beyond the simplistic interpretation of poor oral outcomes being associated with 1-2 variables, e.g., language; such an approach has failed to provide consistent interpretations, and offers no points for intervention. We propose to examine a constellation of variables interwoven into multilevel strategies under a new(er) paradigm, social network theories (http://cmol.nbi.dk/models/infoflow/infoflow.html). Objectives: To qualitatively identify domains of variables modulating oral health outcomes among 1st-2nd generation MexicanAmerican immigrants. Methods: Through key informant interviews, we ascertained KAB variables in immigrant families originating in Jalisco, Mexico. This community has had a strong, revolving presence for decades in a well-delimited location in Indianapolis, IN, around St. Patrick’s parish. We did not conduct clinical exams but used questions from American national surveys to document health perceptions, availability of dental services/insurance, presence of dental pain and impaired function in adults and children, and family structure and sociodemographic profiles during a Catholic festival (no incentives, no appointments). Data were content-analyzed. Results: Data were collected from 22 parent-child dyads (15 female adults, 7 male; mean age 24±6.3yrs; data from the oldest child and the interviewee). Frequencies of dental emergencies and acute problems varied markedly, with recurrence patterns. A minority exhibited consistent dental attendance, often enabled by public/private dental insurance. Time in the USA varied considerably, with 1st and 2nd generation immigrant parents and children sharing the household. Occupations ranged from manual to clerical, and education from elementary to college among adults. Conclusion: Interviews were feasible and acceptable, and the experience informed future fieldwork considerations. We are using the variables to design a social networks study to characterize the evolution of patterns between families in Indianapolis and among peers living in Jalisco, aiming to measure impacts ascribable to immigration along acculturation spectra.Item Segmentation of Mexican-Heritage Immigrants: Acculturation Typology and Language Preference in Health Information Seeking(Springer, 2016) Shin, YoungJu; Maupome, Gerardo; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of DentistryWith the fast growing number of Mexican immigrants in the United States, more attention is needed to understand the relationship between acculturation and language preference in health information seeking. Latent class analysis provides one useful approach to understanding the diversity in sample of Mexican immigrants (N = 238). Based on 13 linguistic, psychological and behavioral indicators for acculturation, four discrete subgroups were characterized: (1) Less acculturated, (2) Moderately acculturated, (3) Highly acculturated, (4) Selectively bicultural. A Chi-square test revealed that three sub-groups were significantly different in language preference when seeking health information. Less acculturated and moderately acculturated groups sought health information in Spanish, whereas the highly acculturated group preferred English for health information. Selectively bicultural group preferred bilingual health information. Implications for health campaign strategies using audience segmentation are discussed.Item Tooth-Loss Experience and Associated Variables among Adult Mexicans 60 Years and Older(2016-06) Islas-Granillo, Horacio; Borges-Yañez, Aida; Medina-Solis, Carlo Eduardo; Lucas-Rincón, Salvador Eduardo; Navarrete-Hernández, José de Jesus; Villalobos-Rodelo, Juan José; Casanova-Rosado, Juan Fernando; Maupome, Gerardo; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of DentistryObjective: This study was conducted to determine the experience of tooth loss, as well as its associated variables, in a sample of adult Mexicans, aged 60 years and older. Materials and Methods: This cross-sectional study was part of a larger project to measure diverse oral health indicators in a convenience sample: it included 139 adult Mexican seniors (69.1% of whom were women), ages 60 years and older, either living in long-term care facilities or living independently and participating in adult day care services. Each participant underwent an oral examination to determine the number of missing teeth. Questionnaires were administered to collect sociodemographic, socioeconomic, and behavioral data. Statistical analyses were performed using nonparametric tests and negative binomial regression. Results: The mean age was 79.06 (±9.78 years). The mean number of missing teeth was 20.02 (±8.61; median, 24); 99.3% of the participants had at least 1 missing tooth, and only 14 had 20 teeth or more. Using a negative binomial regression multivariate model, we found that for each year’s increase in age, the mean number of teeth lost increased by 1% (p<0.05). In individuals who brushed their teeth fewer than two times a day, who had received radiotherapy, or who were currently smokers, the average tooth loss increased 49.2%, 22.6%, and 19.0%, respectively (p<0.01). Conclusion: Tooth-loss experience in these Mexican seniors was very high (20.02±8.61). Older age (within the range of this group of seniors), tooth-brushing patterns, the receipt of radiation therapy, and (current) tobacco use were associated with higher experience of tooth loss.Item Contribution of prosthetic treatment considerations for dental extractions of permanent teeth(2016-07) Fernández-Barrera, Miguel Ángel; Medina-Solís, Carlo Eduardo; Casanova-Rosado, Juan Fernando; Mendoza-Rodríguez, Martha; Escoffié-Ramírez, Mauricio; Casanova-Rosado, Alejandro José; Navarrete-Hernández, José de Jesús; Maupome, Gerardo; Department of Cariology, Operative Dentistry and Dental Public Health, School of DentistryBackground. Tooth loss is an easily identifiable outcome that summarizes a complex suite of factors in an individual’s history of dental disease and its treatment by dental services over a lifetime. Assessment of overall tooth loss data is essential for epidemiologically evaluating the adequacy of dental care provided at a systems level, as well as for placing in context tooth loss for non-disease causes. For example, when derived from prosthetic treatment planning, the latter may unfortunately lead to some teeth being extracted (pulled) for the sake of better comprehensive clinical results. The objective of the present manuscript was to identify the contribution to overall tooth loss, by extraction of permanent teeth because of prosthetic treatment reasons. Material and Methods. A cross-sectional study included sex, age, total number of extractions performed by subject, sextant (anterior vs. posterior), group of teeth (incisors, canines, premolars and molars), upper or lower arch, and the main reason underlying extraction (extraction for any reason vs. prosthetic treatment), in patients 18 years of age and older seeking care at a dental school clinic in Mexico. A multivariate logistic regression model was generated. Results. A total of 749 teeth were extracted in 331 patients; 161 teeth (21.5% of total) were extracted for explicit prosthetic treatment indications. As age increased, the likelihood of having an extraction for prosthetic reasons increased 3% (OR = 1.03, p < 0.001). Women (OR = 1.57, p < 0.05) were more likely to be in this situation, and molars (OR = 2.70, p < 0.001) were most at risk. As the total number of extractions increased, the risk of having an extraction for prosthetic reasons decreased (OR = 0.94, p < 0.05). Conclusions. A significant amount (21.5%) of the extractions of permanent teeth were performed for prosthetic reasons in this dental school clinical environment; age, sex, type of tooth, and the total number of extractions moderated such pattern.Item Psychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services(Wiley, 2016-12) Maupome, Gerardo; McConnell, William R.; Perry, Brea L.; Mariño, Rodrigo; Wright, Eric R.; Department of Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest. Methods Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees’ (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit. Results A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation. Conclusions This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos’ orientation toward dental care.Item Clinician-Patient Small Talk: Comparing Fourth-Year Dental Students and Practicing Dentists in a Standardized Patient Encounter(2016) Maupome, Gerardo; Holcomb, Christopher; Schrader, Stuart; Cariology, Operative Dentistry and Dental Public Health, School of DentistryThe aim of this study was to establish whether frequency of non-diagnostic, non-management exchanges between clinicians and patient (called “socioemotional communication,” SC) during a consultation differed between fourth-year dental students and dentists, controlling for clinically driven exchanges of information. Fifteen dentists and 17 fourth-year dental students were recorded in 2006 while undergoing a consultation with a live standardized patient and were subsequently interviewed by investigators in a separate room with the recording present for analysis. Their shared interpretations of cognitive strategies were recorded and compared for differences in the presence of SC. The results showed that most of the students and dentists engaged in SC throughout the consultation with a few exceptions. There were no significant differences between student and dentist cohorts for overall SC presence (p=0.62), time to first instance of SC from overall start of the consultation (p=0.73), and time to first instance of SC after first intraoral examination had taken place (p=0.76). Nonsignificant differences were also recorded for overall frequency at which SC occurred from overall start of the consultation (p=0.89) and after the first intraoral examination had taken place (p=0.12). The patterns showed SC interaction occurring throughout the consultation, not concentrated at the beginning or end. SC did not appear to differ between practitioners and students in terms of prevalence, frequency, or timing. Future research should examine the detailed association between SC and diagnostic thinking processes to further delineate the relationship and characterize possible pedagogical applications.