Reducing early childhood caries in a Medicaid population: a systems model analysis.

Background: Despite early childhood caries (ECC) being largely preventable, its repair accounts for a disproportionate share of Medicaid expenditures. In this study, the authors model disease reductions and cost savings from ECC management alternatives.

Methods: The authors apply system dynamics modeling to the New York State Medicaid population of young children to compare potential outcomes of 9 preventive interventions (water fluoridation, fluoride varnish, fluoride toothpaste, medical screening and fluoride varnish application, bacterial transmission reduction, motivational interviewing, dental prevention visits, secondary prevention, and combinations) and the effect of defluoridating New York City.

A simulation model for designing effective interventions in early childhood caries.

Introduction: Early childhood caries (ECC)--tooth decay among children younger than 6 years--is prevalent and consequential, affecting nearly half of US 5-year-olds, despite being highly preventable. Various interventions have been explored to limit caries activity leading to cavities, but little is known about the long-term effects and costs of these interventions. We developed a system dynamics model to determine which interventions, singly and in combination, could have the greatest effect in reducing caries experience and cost in a population of children aged birth to 5 years.

Development of a School Nutrition-Environment State Policy Classification System (SNESPCS).

Background: As policy strategies are rapidly being developed to address childhood overweight, a system was developed to systematically and reliably classify state policies related to the school nutrition environment. This study describes the development process, the inter-rater reliability to code state policies enacted as of December 2003, and the variability in state policies related to the school nutrition environment.

Methods: The development of the School Nutrition Environment State Policy Classification System (SNESPCS) included a comprehensive review of published literature, reports from government and nongovernmental sources, input from an expert panel, and select experts.

Development of a Physical Education-Related State Policy Classification System (PERSPCS).

Background: As policy-based approaches are increasingly proposed to address childhood obesity, this paper seeks to: (1) present the development of a system to systematically and reliably assess the nature and extent of state physical education (PE) and recess-related policies; (2) determine the inter-rater agreement in using the system; and (3) report on the variability in state policies using a December 31, 2003 baseline.

Methods: The PE and Recess State Policy Classification System (PERSPCS) was developed from a conceptual framework and was informed by reviewing the scientific and gray literatures and through consultations with an expert panel and key experts. Statutes and regulations enacted as of December 31, 2003 were retrieved from Westlaw (data retrieved and analyzed in 2004-2005).