COHRA1: Center for Oral Health Research in Appalachia

Undoubtedly there are genetic, environmental and behavioral components to oral health in all populations. Furthermore, it is clear that these components interact and may be transmissible within families. Thus the overarching goal of COHRA is to delineate the covariation between genetic, behavioral, family and community factors associated with orodental disease and tooth loss in rural and African American urban Appalachian families, so as to develop interventions that will improve oral health. This longitudinal study will examine 500 families three times over seven years. Oral health status will be comprehensively evaluated by a research dentist or hygienist. State-of-the-art statistical and molecular genetic techniques will be employed to develop an array of functional polymorphisms that ultimately will characterize individual and population genetic risk factors for oral disease. To develop this array, we will focus first on 25-30 genes important in oral health, under the broad categories of growth factors and receptors, homeodomain genes, signaling and transcription factors, and genes involved in xenobiotic detoxification and metabolism, inflammation, and behavior. These genes have not yet been characterized in the Appalachian population. They will be analyzed simultaneously with the oral health phenotypes gathered in the Scientific Core, in order to discover the transmission patterns of the phenotypes and the potential co-segregation of phenotypes and genotypes, and to identify genes that are important in oral health in this population. The major disease outcome of interest is caries, which will provide one focus for the genetic studies. However, similar strategies will pertain to the other orofacial phenotypes assessed on study subjects. The following variables related to health behaviors, family structure and function, and community resources will be collected under separate funding: _Community_ risk factors: 1) economic resources, 2) social infrastructure and 3) physical/geospacial topology. _Family _risk factors: 1) domicile quality, 2) family structure, 3) family harmony, 4) caregiver competence, 5) maternal oral heath orientation and 6) adherence to health mitigating facets of Appalachian culture. _Individual _risk factors: 1) psychological effectiveness (self-regulation, self-esteem, internal locus of control, social skill) and 2) level of oral health behaviors. Our multivariate measurement scheme detects both direct and indirect relationships among community, family and individual factors and severity of orodental disease. Collectively, these data will detail the specific and joint influences of genetic, environmental, and psychosocial factors on orodental disease.