Publications by authors named "Jacob F Thomas"

8 Publications

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Validation of Psychosocial Measures Assessing American Indian Parental Beliefs Related to Control over Their Children's Oral Health.

Int J Environ Res Public Health 2020 01 8;17(2). Epub 2020 Jan 8.

Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview, Blvd, Suite 300, W359-G, Aurora, CO 80045, USA.

Objectives: To validate questionnaire items assessing American Indian (AI) parental beliefs regarding control over their children's oral health within the context of psychosocial measures and children's oral health status.

Methods: Baseline questionnaire data were collected as part of a randomized controlled trial ( = 1016) addressing early childhood caries. Participants were AI parents with preschool-age children in the Navajo Nation Head Start program. Questionnaire items assessed parental oral health locus of control (OHLOC) and agreement with beliefs indicating that they were in control of their children's oral health (internal), the dentist was in control (external powerful others), or children's oral health was a matter of chance (external chance). Exploratory factor analysis was conducted, and convergent validity was assessed using linear regression.

Results: Parents with more education ( < 0.0001) and income ( = 0.001) had higher scores for internal OHLOC. Higher internal OHLOC scores were associated with higher scores on knowledge ( < 0.0001), perceived seriousness and benefits ( < 0.0001), higher self-efficacy, importance, sense of coherence ( < 0.0001 for all), and lower scores for perceived barriers ( < 0.0001) and distress ( = 0.01). Higher scores for both types of external OHLOC were associated with lower scores on knowledge ( < 0.0001), perceived seriousness ( < 0.0001), and higher scores on perceived susceptibility ( = 0.01 external chance; <0.0001 powerful others) and barriers (<0.0001). Higher scores for external powerful others were associated with lower scores for importance ( = 0.04) and sense of coherence ( = 0.03). Significant associations were not found for OHLOC beliefs and children's oral health status.

Conclusions: Questionnaire items addressing OHLOC functioned in accordance with the theoretical framework in AI participants.
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http://dx.doi.org/10.3390/ijerph17020403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014362PMC
January 2020

Association of Ethnic Identity with Oral Health Knowledge, Attitudes, Behavior, and Outcomes on the Navajo Nation.

J Health Care Poor Underserved 2019 ;30(1):143-160

American Indians and Alaska Natives (AI/ANs) experience poor oral health. Children and adults living on the Navajo Nation have a particularly high rate of dental decay. The literature suggests that health outcomes are often associated with the strength of one's ethnic identity. We investigated the association of ethnic identity among Native parents with oral health knowledge, attitudes, behavior, and outcomes. Analyses used baseline data from a randomized controlled trial designed to reduce dental decay among AI/AN preschoolers enrolled in the Navajo Nation Head Start Program. Greater perceived importance of ethnic identity was associated with better oral health knowledge and attitudes but was unassociated with oral health behavior and was linked to worse oral health status. Parents who were better able to speak their tribal language had greater confidence in their ability to manage their children's oral health, engaged in better oral health behavior, and reported better parental oral health status.
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http://dx.doi.org/10.1353/hpu.2019.0013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400317PMC
November 2019

Parental psychosocial factors and childhood caries prevention: Data from an American Indian population.

Community Dent Oral Epidemiol 2018 08 10;46(4):360-368. Epub 2018 Apr 10.

Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Objectives: The objective of this study was to examine the association among psychological and social variables reported by American Indian parents/caregivers of preschool children and changes in their Oral Health Knowledge and Behaviors related to care of their children's teeth. We also investigated the relationship of these factors with progression of caries, as reflected by changes in their children's dmfs.

Methods: The data used for this study were collected at baseline in a clinical trial of an oral health promotion intervention comprising behavioural and clinical interventions for caries prevention delivered by tribal members on a large Southwestern American Indian reservation. Linear regression analyses were performed for changes (baseline to Year 1) in dmfs, Oral Health Knowledge and Oral Health Behavior scores, with baseline psychosocial measures, taken individually, as the independent variables.

Results: Parents' attitudes and beliefs were associated with increases in their Oral Health Knowledge and Behavior and also with the progression of caries for their children. When all participants were considered together, increases in children's dmfs were smaller when the caregiver had higher Internal Oral Health Locus of Control (e = -1.33, P = .004), higher Health Literacy (e = -1.55, P < .01), and higher Financial Stability (e = -4.46, P = .03), and lower scores for the Barriers subscale (e = 1.57, P < .01) of the Health Belief Model. For parents in the Intervention group, higher scores on Locus of Control, reflecting beliefs that chance, or other people determine their children's oral health, were associated with larger increases in Oral Health Knowledge (e = 1.73, P = .04) and Behaviors (e = 4.00, P = .005).

Conclusions: Prevention of early childhood caries in American Indian children has proved to be especially challenging. Some of the measures identified in this report may suggest promising directions to prevention through approaches that build on competencies and skills to be learned and used within a context more broadly focused on parenting and management of health and family challenges.
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http://dx.doi.org/10.1111/cdoe.12376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035077PMC
August 2018

Validity of Measures Assessing Oral Health Beliefs of American Indian Parents.

J Racial Ethn Health Disparities 2018 12 5;5(6):1254-1263. Epub 2018 Mar 5.

Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA.

Objectives: This aimed to validate measures of constructs included in an extended Health Belief Model (EHBM) addressing oral health beliefs among American Indian (AI) parents.

Methods: Questionnaire data were collected as part of a randomized controlled trial (n = 1016) aimed at reducing childhood caries. Participants were AI parents with a preschool-age child enrolled in the Navajo Nation Head Start program. Questionnaire items addressed five EHBM constructs: perceived susceptibility, severity, barriers, benefits, and parental self-efficacy. Subscales representing each construct underwent reliability and validity testing. Internal consistency reliability of each subscale was evaluated using Cronbach's alpha. Convergent validity was assessed using linear regression to evaluate the association of each EHBM subscale with oral health-related measures.

Results: Internal consistency reliability was high for self-efficacy (α = 0.83) and perceived benefits (α = 0.83) compared to remaining EHBM subscales (α < 0.50). Parents with more education (p < 0.0001) and income (p = 0.0002) perceived dental caries as more severe younger parents (ps = 0.02) and those with more education (ps < 0.0001) perceived greater benefits and fewer barriers to following recommended oral health behavior. Female parents (p < 0.0001) and those with more education (p = 0.02) had higher levels of self-efficacy. Parental knowledge was associated with all EHBM measures (ps < 0.0001) excluding perceived susceptibility (p > 0.05). Parents with increased self-efficacy had greater behavioral adherence (p < 0.0001), whereas lower behavioral adherence was associated with parents who reported higher perceived barriers (p < 0.0001). Better pediatric oral health outcomes were associated with higher levels of self-efficacy (p < 0.0001) and lower levels of perceived severity (p = 0.02) and barriers (p = 0.05).

Conclusions: Results support the value of questionnaire items addressing the EHBM subscales, which functioned in a manner consistent with the EHBM theoretical framework in AI participants.
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http://dx.doi.org/10.1007/s40615-018-0472-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123310PMC
December 2018

Validation of the Sense of Coherence Scale in an American Indian population.

Psychol Assess 2016 Apr 20;28(4):386-93. Epub 2015 Jul 20.

Department of Craniofacial Biology, University of Colorado Anschutz Medical Campus.

This study examined the psychometric properties of the Sense of Coherence (SOC) scale in the context of an oral health-related clinical trial conducted in an American Indian population-specifically, people of the Navajo Nation. Data were derived from baseline evaluations of parents (or caregivers) of Navajo children aged 3-5 from 52 Head Start classes enrolled in a trial of an intervention to prevent early childhood caries (ECC). A 190-item Basic Research Factors Questionnaire, which included the SOC, was administered to 1,016 parents/caregivers. Assessment of internal reliability and convergent validity, and confirmatory factor analyses were conducted. Multiple linear regression analysis was used to examine associations between parents' SOC and other potentially convergent measures. Confirmatory factor analysis was used to examine 1- and 3-factor solutions of the SOC scale. Higher SOC was significantly related to higher parental education and income, employment status, and higher scores for social support, internal Oral Health Locus of Control (OHLOC), self-efficacy, importance of oral health, oral health knowledge and behavior, and children's oral health quality of life. Higher SOC also was related to lower reported distress and lower external OHLOC. Cronbach's α was 0.84 for all SOC items, but lower for each of the 3 SOC subscales. Confirmatory factor analyses suggested a 3-factor solution was superior to a 1-factor solution. The SOC scale had good internal reliability and convergent validity in this American Indian population.
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http://dx.doi.org/10.1037/pas0000193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720579PMC
April 2016

Factors Associated with Oral Health Status in American Indian Children.

J Racial Ethn Health Disparities 2014 Sep;1(3):148-156

Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado.

The literature reports psychosocial, environmental, and cultural factors related to Early Childhood Caries (ECC), but few studies have included American Indian/Alaska Native (AI/AN) populations. AI/AN children have the highest prevalence of ECC among any population group in the United States. This study examined socio-demographic characteristics of children and their parents/caregivers and psychosocial characteristics of parents/caregivers as risk factors for baseline oral health status of preschool children in the Navajo Nation, as part of a 3-year cluster randomized clinical trial to evaluate the effectiveness of trained community workers providing a fluoride varnish and oral health promotion intervention to. The study recruited 1,015 children at 52 Head Start Centers. Baseline ECC data were collected by calibrated dental hygienists for 981 of the children ages of 3-5 years, and a Basic Research Factors Questionnaire (BRFQ) was completed by their parents/caregivers. Bivariable analysis revealed that dmfs was higher in older children; in males; in children with male parents/caregivers; and when the parent/caregiver had less education and income, worse oral health behavior in caring for their children's teeth, and higher scores for external powerful others and external chance locus of control, greater perceived susceptibility and barriers, and lower scores for community risky behavior. In a multiple linear regression model, the variables that remained statistically significant were child's age and gender, and oral health behavior score of the parent/caregiver. Intervening to improve parent/caregiver oral health behavior in caring for the teeth of children potentially could in AI/AN children.
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http://dx.doi.org/10.1007/s40615-014-0017-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163944PMC
September 2014

Optimizing line intercept sampling and estimation for feral swine damage levels in ecologically sensitive wetland plant communities.

Environ Sci Pollut Res Int 2013 Mar 17;20(3):1503-10. Epub 2012 Jun 17.

Department of Biostatistics, Colorado School of Public Health, University of Colorado Denver, Historic Building 500, 13001 E. 17th Place, Mail Stop C245, Aurora, CO 80045, USA.

Ecological sampling can be labor intensive, and logistically impractical in certain environments. We optimize line intercept sampling and compare estimation methods for assessing feral swine damage within fragile wetland ecosystems in Florida. Sensitive wetland sites, and the swine damage within them, were mapped using GPS technology. Evenly spaced parallel transect lines were simulated across a digital map of each site. The length of each transect and total swine damage under each transect were measured and percent swine damage within each site was estimated by two methods. The total length method (TLM) combined all transects as a single long transect, dividing the sum of all damage lengths across all transects by the combined length of all transect lines. The equal weight method (EWM) calculated the damage proportion for each transect line and averaged these proportions across all transects. Estimation was evaluated using transect spacings of 1, 3, 5, 10, 15, and 20 m. Based on relative root mean squared error and relative bias measures, the TLM produced higher quality estimates than EWM at all transect spacings. Estimation quality decreased as transect spacing increased, especially for TLM. Estimation quality also increased as the true proportion of swine damage increased. Diminishing improvements in estimation quality as transect spacings decreased suggested 5 m as an optimal tradeoff between estimation quality and labor. An inter-transect spacing of 5 m with TLM estimation appeared an optimal starting point when designing a plan for estimating swine damage, with practical, logistical, economic considerations determining final design details.
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http://dx.doi.org/10.1007/s11356-012-1004-zDOI Listing
March 2013

Defining an acceptable period of time from melanoma biopsy to excision.

Dermatol Reports 2012 Jan 17;4(1):e2. Epub 2012 Jan 17.

Department of Dermatology, University of Colorado, Aurora, CO; ; Dermatology Service, Department of Veterans Affairs Medical Center, Denver, CO; ; Colorado School of Public Health Department of Epidemiology, Aurora, CO, USA.

Melanoma is the most lethal form of skin cancer and it is the second most common cancer among adolescents and young adults. The aim of this work is to determine if surgical intervals differ between four different clinics and between departments within the hospitals, and to compare these to industry standards. Surgical intervals were measured through retrospective chart review at four dermatology clinics. Of 205 melanoma cases, clinic and departmental median surgical intervals ranged 15-36.5 days and 26-48 days, respectively. There was significant association between clinic and time between biopsy and pathology report, time between pathology report and excision, and total surgical interval (P<0.0001, P=0.03, and P<0.0001 respectively). There was significant association between department and time between pathology report and excision, and surgical interval (P<0.0001, and P=0.003 respectively). Pair-wise comparisons detected significantly longer intervals between some clinics and departments (maximum difference 67.3%, P<0.0001). Hypothesis-based, informal guidelines recommend treatment within 4-6 weeks. In this study, median surgical intervals varied significantly between clinics and departments, but nearly all were within a 6-week frame.
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http://dx.doi.org/10.4081/dr.2012.e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212669PMC
January 2012