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Campus Spotlight: University of Maryland

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It is no wonder that people at the University of Maryland (UMD) understand that oral health literacy plays an integral role in promoting overall health. The University's School of Public Health is home to The Herschel S. Horowitz Center for Health Literacy. There, researcher Dr. Alice M. Horowitz, a dental hygienist by training who spent years at the National Institute of Dental and Craniofacial Research (NIDCR), is helping to shape the campus's health literacy landscape.

She knows the territory well. She contributed to the Surgeon General's landmark report, Oral Health in America: A Report of the Surgeon General, published in 2000, and also helped shape the 2003 National Call to Action to Promote Oral Health. In 2004, Dr. Horowitz and Dr. Rima Rudd of the Harvard School of Public Health co-organized the first NIDCR workshop on oral health literacy research, which, she says, "helped set the stage for dentistry to get involved." Dr. Horowitz also took part in writing the National Institutes of Health request for proposals for health literacy research grants. Since 2007, she has continued to pursue these interests as a UMD faculty member.

According to its website, The Horowitz Center, located on UMD's main campus in College Park, is the first endowed, academically based health literacy center in the nation. Although a young institution, the center can count two DentaQuest Foundation grants among its many accomplishments. One of these grants funded a study of the general public's knowledge of tooth decay and perceptions of the communication skills of oral health providers. The study also surveyed oral health providers about their prevention practices; the communication techniques they use with patients; and their knowledge, opinions, and practices regarding caries prevention. This data will provide a baseline for evaluating the Oral Health Literacy Campaign that the Maryland Department of Health and Mental Hygiene plans to launch in 2012. The state has made a serious commitment to addressing this issue since the death of one of its young residents from an abscessed tooth made national headlines in 2007.

Thirty miles northeast, at UMD's School of Dentistry, Dr. Mark Macek, Associate Professor in the Health Services Research Program of the Department of Health Promotion and Policy, is conducting related research with his colleagues. Noting the potential limitations of traditional medical health literacy tools in assessing oral health knowledge, the team has developed an instrument that measures basic conceptual knowledge of both oral health and the prevention and management of dental caries, periodontal disease, and oral cancer. The resulting instrument, the Comprehensive Measure of Oral Health Knowledge (CMOHK), was used in a pilot study with 100 low-income adults in Baltimore.

The team determined that the instrument offers good reliability, and thanks to a recent grant from NIDCR, Dr. Macek and co-principal investigator, Dr. Kathryn Atchison of the University of California, Los Angeles, School of Dentistry, will test it with a larger sample-1,000 adults in the Baltimore and Los Angeles areas-over the next three years.

Dr. Macek would like to see more emphasis on health literacy in UMD classrooms.

"In our clinic, I often hear students walking patients back to the chair saying, "˜All right, Mrs. Jones, we're going to adjust the occlusion on tooth number four for you today,'" says Dr. Macek, noting how easy it is for students to lose sight of the fact that this technical language may be foreign to their patients. He has incorporated lectures on health literacy in his courses, and he hopes to see a more detailed exploration of the topic incorporated in future dental school courses on health communication.

Students at the UMD School of Public Health already have the opportunity to take a graduate course in health literacy developed by the Horowitz Center; they will also have the opportunity to follow a planned certificate program that will be open to graduate and pre-professional students from all disciplines.

Moving forward, UMD's oral health literacy champions are well-positioned to see their research produce concrete benefits. Maryland has set a goal of becoming a leader in access to oral health services and primary prevention, and improving oral health literacy is an integral part of the state's plan for achieving that objective. The state's Department of Health and Mental Hygiene is using The Horowitz Center's research as a baseline for Maryland's Oral Health Literacy Campaign, which is designed to raise public and provider awareness about the connection between oral health and overall body health. Dr. Macek is working with researchers at the center on formulating messages targeting these two groups.

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