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 Social support associated with restorative treatment, professionally applied fluoride and flossing: A cross-sectional analysis including recent immigrants from Central America and Mexico in the Midwest USA(Wiley, 2023) Brooks, Caroline V.; Maupomé, Gerardo; Epidemiology, School of Public HealthObjectives This study examined how Mexican and Central American immigrants' social support was associated with three selected dental outcomes among recent immigrants, prior to the 2020 COVID-19 pandemic. Methods Using baseline wave data from the 2017–2022 VidaSana study about the health and social networks of Mexican and Central American immigrants living in Indiana, this study utilized logistic and ordinal logistic regression to predict lifetime fluoride use, lifetime dental restoration and flossing frequency, across levels of social support and differences between Mexican and Central American immigrants. Results Data from 547 respondents were included in the present analysis (68% women; mean age 34.4 years [SD 11.2]; Central American 42%; Mexican 58%). Results show a high level of social support was associated with increased probability of fluoride use, dental restoration and higher flossing frequency for Mexican immigrants. However, social support for Central American immigrants was associated with a decreased likelihood of fluoride use, more infrequent flossing, and had no significant association with dental restorations experience. What would be a negative association between Central American immigrants and dental restoration was accounted for by education level and never having been to a dentist. Conclusions While higher social support was linked to beneficial outcomes for oral health in Mexican immigrants, the opposite was found in Central Americans. These findings highlighted the complexities of social relationships among new immigrants, and potential heterogeneity within the Hispanic population, particularly regarding social and behavioural measures as they pertain to oral health. Further research is needed to identify the underlying mechanisms producing both differences in social support and oral health outcomes.Item Financial Impact of COVID-19 on Dental Care for Pediatric Patients: a Dental Claims Review(American Academy of Pediatric Dentistry, 2023-02) Rector, Julia M.; Scully, Allison C.; Yepes, Juan F.; Jones, James E.; Eckert, George; Downey, Timothy; Maupome, Gerardo; Pediatric Dentistry, School of DentistryPurpose: The purpose of this study was to quantify the impact of the COVID-19 pandemic on private dental insurance claims for pediatric dental care. Methods: Commercial dental insurance claims for patients in the United States ages 18 and younger were obtained and analyzed. The claims dates ranged from January 1, 2019, to August 31, 2020. Total claims paid, average paid amount per visit, and the number of visits were compared between provider specialties and patient age groups from 2019 to 2020. Results: Total paid claims and total number of visits per week were significantly lower in 2020 compared to 2019 from mid-March to mid-May (P<0.001). There were generally no differences from mid-May through August (P>0.15), except for significantly lower total paid claims and visits per week for "other" specialists in 2020 (P<0.005). The average paid amount per visit was significantly higher during the COVID shutdown period for 0-5 year-olds (P<0.001) but significantly lower for all other ages. Conclusions: Dental care was greatly reduced during the COVID shutdown period and was slower to recover for "other" specialties. Younger patients ages zero to five years had more expensive dental visits during the shutdown period.Item Talking about Teeth: Egocentric Networks and Oral Health Outcomes in a Mexican American Immigrant Community(Emerald Publishing Limited, 2019) Pullen, Erin; Perry, Brea L.; Maupome, GerardoLatinos in the United States have poor outcomes for periodontal and dental health. However, a detailed description of the mechanisms driving these patterns has only recently started to be addressed in the literature. In the current study, we explore relationships between individual-level characteristics of Mexican immigrants, properties of their networks, and experiences of dental problems. Specifically, using data from an urban community of Mexican immigrants to the American Midwest (n = 332), this study examines how characteristics of oral health matters (OHM) discussion networks and individual-level sociodemographic characteristics are associated with four adverse oral health outcomes. The results provide strong support for relationships between immigrants' network characteristics and dental problems. We find that people with more dental problems talk about these issues more frequently with network ties. Conversely, stronger relationships with OHM discussion networks, as measured by mean closeness, are predictive of fewer dental problems. In addition, we identify a link between perceptions of alters' knowledge about teeth, mouth, and gums and egos reporting better oral health outcomes. The observed patterns are suggestive of mechanisms of social influence that are well replicated in the social, medical, and public health literatures, but that have seldom been empirically tested in the domain of oral health. Though preliminary, our findings suggest a potential explanatory role for social networks in some of the most important questions and problems in oral health disparities research. In all, our findings suggest that social network members are active participants in the management and response to oral health problems in this immigrant group and should be considered an important factor in the development and course of diseases.Item Experience, Prevalence, Need for Treatment and Cost of Care for Caries: A Multicenter Study in a Developing Country(FDI World Dental Press Ltd., 2022-05-27) Lucas-Rincón, Salvador E.; Lara-Carrillo, Edith; Robles-Bermeo, Norma Leticia; Rueda-Ibarra, Vicente; Alonso-Sánchez, Carmen C.; Vázquez-Rodríguez, Sandra B.; Ávila-Burgos, Leticia; Medina-Solis, Carlo E.; Maupomé, GerardoObjective: To assess the experience, prevalence, need for treatment and economic impact of caries among students 6-12 years old in four cities in Mexico. Basic research design: Cross-sectional clinical study. Setting: Elementary public schools. Participants: 500 schoolchildren aged 6 to 12 years. Method: Oral clinical examinations using WHO criteria for caries in the primary (dmft) and permanent (DMFT) dentitions. Main outcome measures: Indicators of caries in the primary and permanent dentitions: experience, prevalence, severity and the Significant Caries Index. In addition, we calculated the treatment needs, dental care rate and cost of care. Results: dmft in the primary dentition was 2.59±2.83, and DMFT was 0.82±1.44 in the permanent dentition. Caries prevalence reached 67.7% in the primary and 34.1% in permanent dentition. The treatment needs index was 85.9% and 91.3% in the primary and permanent dentitions, respectively; the dental care index was 13.9% and 8.5%, respectively. The cost of care for caries in the primary dentition was estimated at $22.087 millions of international dollars (PPP US$) when amalgam was the restorative material used, and PPP US$19.107 millions for glass ionomer. For the permanent dentition, the cost was PPP US$7.431 millions when amalgam was used and PPP US$7.985 millions when resin/composite was used as restorative material. Conclusions: The prevalence and experience of caries in the primary dentition were 50% greater than those of other studies carried out in Mexico. In the permanent dentition they were less. There is considerable need for the treatment of caries and minimal experience with restorative care. The cost of care for caries may be assumed to be high for a health system such as Mexico's.Item The Informal Safety Net: Social Network Activation among Hispanic Immigrants during COVID-19(Sage, 2023) Smith, Nicholas C.; Brooks, Caroline V.; Ekl, Emily A.; García, Melissa J.; Ambriz, Denise; Maupomé, Gerardo; Perry, Brea L.During times of crisis, individuals may activate members of their social networks to fulfill critical support functions. However, factors that may facilitate or inhibit successful network activation are not fully understood, particularly for structurally marginalized populations. This study examines predictors of network activation among recent and established Hispanic immigrants during the COVID-19 pandemic. Specifically, using unique, longitudinal data from the VidaSana study and its supplemental survey, the COVID-19 Rapid Response study (N = 400), we ask: How are COVID-related stressors associated with goal-oriented network activation (e.g., health-focused activation) among Hispanic immigrants? How might structural and compositional characteristics of social networks facilitate or inhibit successful network activation during COVID-19? Results align with theories of network activation (i.e., functional specificity) that imply that individuals engage in selective and deliberate activation of networks. That is, we observe a congruency between COVID-related stressors and social network characteristics, and distinct types of network activation. Moreover, we find that respondents experiencing pandemic-induced economic difficulties engage in activation for financial assistance only if they are embedded in a higher-educated network. We discuss the implications of these findings and provide recommendations for future research.Item Pandemic precarity: COVID-19's impact on Mexican and Central American immigrant families(Wiley, 2023) García, Melissa J.; Brooks, Caroline V.; Ambriz, Denise; Ekl, Emily A.; Smith, Nicholas C.; Maupomé, Gerardo; Perry, Brea L.Objective: This study examines the association of gender, parenthood, and marriage with reports of perceived pandemic precarity among Mexican and Central American immigrants during the COVID-19 pandemic (Fall 2020) to understand predictors of vulnerability in periods of crisis. Background: Latinos/as, immigrants, parents, and women have faced significant challenges during the COVID-19 pandemic. Family structure, along with social expectations for gender (i.e., self-sacrificing femininity for women and hegemonic masculinity for men), parenthood, and marriage may explain perceptions of pandemic precarity—defined as the material deprivation and economic anxiety resulting from the COVID-19 pandemic. Method: This study used data from the Hispanic COVID-19 Rapid Response Study (n = 400), a follow-up of the VidaSana Study of Mexican and Central American immigrants, to examine how family structure is associated with pandemic precarity (i.e., food, housing, and economic insecurity). Using linear regression models, average marginal effects (AMEs), and tests for group differences, we investigate the independent and interactive effects of gender, parenthood, and marriage on pandemic precarity. Results: Men and parents reported the highest pandemic precarity. Fathers reported higher pandemic precarity than mothers. For men, marriage is associated with greater precarity, and for women, marriage is associated with less precarity, yet marriage increased precarity for those without children. Conclusion: We discuss the importance and implications of examining gender along with family structure to understand how immigrant families were faring in response to the pandemic.Item Periodontal diagnosis and treatment planning – An assessment of the understanding of the new classification system(Wiley, 2022-07-13) Kakar, Arushi; Blanchard, Steven; Shin, Daniel; Maupomé, Gerardo; Eckert, George J.; John, VanchitObjectives: Substantial variations are seen among clinicians in the diagnosis and treatment planning of periodontal diseases. Accurate diagnosis and treatment planning are fundamental requirements for effective outcome-based patient care. The aim of this study was to evaluate the understanding of the American Academy of Periodontology and the European Federation of Periodontology 2017 periodontal disease classifications in diagnoses and treatment plans across four study groups. Methods: The study recruited at least 20 participants in each of the four study groups. These included 1) Periodontal faculty and residents at Indiana University School of Dentistry (IUSD-PF) 2) IUSD general practice faculty (IUSD-GPF), 3) private practice periodontists (PPP), and 4) general practitioners (GP). The participants were provided with 10 HIPPA de-identified case records and a link to a survey. The survey comprised five demographic questions and two questions on diagnosis and treatment plan for each case along with a fixed list of responses. The responses were then compared against gold standards that were determined by a group of three board-certified periodontists. Results: Overall, for diagnostic questions, GP (69%) were correct significantly less often than IUSD-PF (86%, p < 0.001), IUSD-GPF (79%, p = 0.002), and PPP (80%, p = 0.001). No significant differences (p > 0.05) in the overall correct treatment plan responses were found among the four groups (IUSD-PF: 69%, IUSD-GPF: 62%, PPP: 68%, and GP: 60%). The multi-rater kappas for with-in-group agreement on overall diagnosis ranged from 0.36 (GP) to 0.55 (IUSD-PF) and on overall treatment plan ranged from 0.32 (IUSD-GPF) to 0.42 (IUSD-PF). Overall agreement for diagnosis and treatment plans among the four groups was relatively low and none of the groups were statistically different from each other (p > 0.05). Conclusion: Regular participation in calibration sessions may lead to more accurate adoption of the 2017 periodontal classification and thereby help provide consistent diagnosis and treatment.Item Analyzing Perceptions of Community-Engaged Health Research Partnerships Comprising Hispanic Groups and Academic Allies in Indiana(Indiana University, 2022-11-29) Gil, Cindy; Armenta, Karla; Espada, Camila; Ontiveros-Salinas, Leonel; Maupome, GerardoObjectives: To analyze perceptions about multiple community-engaged oral health research partnerships with various local Hispanic-serving institutions and community-based organizations occurring in Indiana from 2010 through 2020, via interviews with actors involved in those partnerships. Methods: We designed key informant interview questions based on a literature review to inform the approach at synthesizing perspectives from community partners and academic allies. Statements were categorized using thematic analysis and grounded theory. Lessons Learned: Forty percent of respondents stated that community-engaged research projects connect communities with educational information about dental care and low-cost resources. In terms of capacity building, about half of respondents felt these projects had a positive impact. Conclusions: Community partners defined positive impact as increasing access to dental care educational resources, helping to enhance communication networks through social media with community partners, and contributing to local Hispanic health education through TV, internet, and radio partnerships. The partnerships uniting Hispanic groups and academic allies appear to have helped set a foundation of trust to support current and future efforts in Indiana.Item Prison Health is Community Health: The Indiana Peer Education Program(Research Square, 2022-07-06) Janota, Andrea D.; Hibbard, Patrick F.; Meadows, Meghan E.; Cocco, John P.; Carr, Abigail L.; Nichols, Deborah; Chapman, Erika; Maupomé, Gerardo; Duwve, JoanBackground: Concerning health inequities have been found in incarcerated populations, which likely impact broader community health. This paper evaluates the Indiana Peer Education Program (INPEP ECHO), an initiative that aims to improve health knowledge using the Project ECHO (Extension for Community Healthcare Outcomes) model to train people incarcerated in Indiana prisons (USA) as peer health educators inside prisons. Peer educators undergo a 40-hour training and then facilitate 10-hour long health education workshops inside their facilities over several days. Methods: We assessed the changes observed in pre- and post-session survey responses to estimate the impact this program had on peer educators and those they teach via multivariate regression analysis. We also examined peer educator qualitative data for emergent themes and confirmation of survey findings. Results: Findings from the 10-hour workshops showed improved knowledge scores and post-release behavior intentions. Peer educator surveys indicated increases in knowledge, health attitudes, and self-efficacy scores. Qualitative analysis affirms the latter finding and points toward peer educators acquiring expertise in the content they teach and how to teach it and that positive results likely expand beyond participants to others in prison, their families, and the communities to which they return. Further, peer educators shared they felt new purpose and hope tied to their participation in INPEP ECHO. Although these survey results show positive change in the short term, such improvements have been shown in other research to lead to improved middle- and long-term outcomes. Conclusions: Though preliminary, results indicate this type of public health intervention, training incarcerated individuals as peer educators on health topics, appears to increase important health knowledge and behavior intentions, which will likely lead to improvements in personal and public health outcomes. Results also point toward specific improvements associated with peers providing the education, and not external sources. The skills participants attain, as well, seem to increase their sense of purpose and self-efficacy, which have been shown to precede desistance from crime. While more work is necessary, the high costs associated with treating diseases like hepatitis C point toward an urgent need for programs like INPEP.Item Comparative Analysis of Edentulism in a Sample of Mexican Adults with and without Type 2 Diabetes(MDPI, 2022) Islas-Zarazúa, Rosalina; Mora-Acosta, Mariana; Navarrete-Hernández, José de Jesús; Reynoso-Vázquez, Josefina; Villalobos-Rodelo, Juan José; Rojas-Ortega, Laura; Sosa-Velazco, Taurino Amilcar; Márquez-Corona, María de Lourdes; Medina-Solís, Carlo Eduardo; Maupomé, GerardoThe objective of the present study was to compare the prevalence of edentulism in Mexican adults with and without a diagnosis of type 2 diabetes mellitus (T2DM) when they are seeking dental care. A cross-sectional study was conducted on 1921 medical records of Mexican adults 40 years of age and older who sought dental care at clinics of a public university in Mexico. The dependent variable was edentulism, clinically determined through an oral examination. The main independent variable was the self-report of previous T2DM diagnosis made by a physician. Sociodemographic, socioeconomic and behavioral covariates were included in a multivariate binary logistic regression model. Overall edentulism prevalence was 8.4% (95% CI = 7.1–9.6). The prevalence of T2DM was 14.3% (n = 274). The prevalence of edentulism among individuals with T2DM was 13.1%, but only 7.6% among individuals without T2DM. In the multivariate binary logistic regression model, a previous T2DM diagnosis increased the probability of being edentulous 1.61 times (95% CI = 1.03–2.50). For each year a person’s age increased, the likelihood of being edentulous increased by 12% (95% CI = 10–14%). In summary, a higher prevalence of edentulism was present in Mexican adults with T2DM and in those of older age. This information may be used by dental care providers and health policymakers to improve approaches to preventive care, as well as to characterize and anticipate care needs more accurately for the adult and older adult populations.