On behalf of colleagues at the UCSF Center to Address Disparities in Oral Health (known as CAN DO), thanks for the chance to provide input. Overall, we support the "Interdisciplinary Approaches to Promote Adolescents' Oral Health and Reduce Disparities" initiative since adolescence is such an important period in the lifecourse for establishing healthy behaviors and learning to self-manage health. We agree that research from many disciplines is important, especially in-depth interdisciplinary and transdisciplinary (Hiatt&Breen, 2008) research with adolescent health and development, oral health, and health disparities experts. Also, further understanding common risk factors and mediators that determine multiple health outcomes in formative research, as well as, leveraging oral health promotion with ongoing health promotion efforts such as obesity prevention and healthy diet/nutrition promotion (especially sugar intake reduction) have strong potential for greater impact. Specifically, such efforts have the synergistic potential to reduce caries with obesity and periodontitis with inflammatory disease. Supporting adolescent health promotion research with NIH's work through the CTSAs, which Gottlieb and colleagues (Soc Sci Med, 2016) recently argue is a vital step for increasing uptake of efficacious preventive interventions, such as dental sealants and HPV vaccines. We support the formative research example of "Understanding unique causal factors and multi-level determinants of adolescent oral health and disparities to guide development of future interventions" and recommend including common upstream multi-level effects such as commercial determinants and health policies. Taking differential exposures, such as black children and teens seeing more than double the sugar sweetened and energy beverage TV ads as their white counterparts (Harris et al. Rudd Center, 2014, p82), may be important in reducing health disparities. Research studies proposing bold actions, dovetailing with the World Health Organization's Sustainable Development Goals, on multi-level approaches to prevent initiation of unhealthy habits including poor diet/nutrition (eg sugar sweetened beverages, sports drinks, energy drinks), substance misuse (eg electronic cigarettes, tobacco products, alcohol), and risky behaviors (eg not using mouth guards, not using seat belts), as well as incorporating commercial determinants and policy issues, will likely be most successful. While formally testing developed interventions through randomized controlled trials of efficacy and safety is one vital methodology, researchers should also be encouraged to use innovative but rigorous designs to perform formative and developmental scientific inquiry. For example, systems science approaches are important ways to facilitate understanding via experimenting and modeling potential pathways and mediators. Again thank you for this opportunity to review NIDCR research priorities and provide feedback.
Comment No. 352