Background Daily oral hygiene and regular dental visits are important components of oral health care. The authors’ objective in this study was to examine women's oral hygiene practices and use of dental services during pregnancy. Methods The authors developed a written oral health questionnaire and administered it to 599 pregnant women. They collected demographic information, as well as data on oral hygiene practices and use of dental services during pregnancy. They used χ2 and multivariable logistic regression models to assess associations between oral hygiene practice and dental service use during pregnancy and to identify maternal predictor variables. Results Of the 599 participants, 83 percent (n = 497) reported brushing once or twice per day. Twenty-four percent (n = 141) reported flossing at least once daily; Hispanic women were more likely to floss than were white or African American women (28 percent [52 of 183] versus 22 percent [54 of 248] versus 19 percent [23 of 121], respectively, P < .001). Seventy-four percent (n = 442) of the participants reported having received no routine dental care during pregnancy. Hispanic women were significantly less likely than were black or white women to receive routine dental care during pregnancy (13 percent versus 21 percent versus 36 percent, respectively, P < .001). The authors found that being older than 36 years, being of Hispanic race or ethnicity, having an annual income of less than $30,000, flossing infrequently and receiving no dental care when not pregnant were significantly associated with lack of routine dental care during pregnancy (adjusted odds ratios, 95 percent confidence intervals: 2.56 [1.33-4.92]; 2.19 [1.11-4.29]; 2.02 [1.12-3.65]; 1.86 [1.13-3.07]; and 4.35 [2.5-7.69], respectively). A woman's lack of receiving routine dental care when not pregnant was the most significant predictor of lack of receiving dental care during pregnancy. Conclusion Racial, ethnic and economic disparities related to oral hygiene practices and dental service utilization during pregnancy exist. Clinical Implications Medical and dental care providers who treat women of reproductive age and pregnant women need to develop policy strategies to address this population's access barriers to, and use of, dental care services.

As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d ) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patientcentered medical homes and chronic health homes; and ( f ) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts-intended audience, health problems, organizational and cultural settings-and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.

Peer support from community health workers, promotores de salud, and others through community and health care organizations can provide social support and other assistance that enhances health. There is substantial evidence for both the effectiveness and the cost-effectiveness of peer support, as well as for its feasibility, reach, and sustainability. We discuss findings from Peers for Progress, a program of the American Academy of Family Physicians Foundation, to examine when peer support does not work, guide dissemination of peer support programs, and help integrate approaches such as e-health into peer support. Success factors for peer support programs include proactive implementation, attention to participants' emotions, and ongoing supervision. Reaching those whom conventional clinical and preventive services too often fail to reach; reaching whole populations, such as people with diabetes, rather than selected samples; and addressing behavioral health are strengths of peer support that can help achieve health care that is efficient and of high quality. Challenges for policy makers going forward include encouraging workforce development, balancing quality control with maintaining key features of peer support, and ensuring that underresourced organizations can develop and manage peer support programs.

Background Racial or ethnic and economic disparities exist in terms of oral diseases among pregnant women and children. The authors hypothesized that women of a racial or ethnic minority have less oral health knowledge than do women not of a racial or ethnic minority. Therefore, the authors conducted a study to assess and compare maternal oral health knowledge and beliefs and to determine if maternal race and ethnicity or other maternal factors contributed to women’s knowledge or beliefs. Methods The authors administered a written oral health questionnaire to pregnant women. The authors calculated the participants’ knowledge and belief scores on the basis of correct answers or answers supporting positive oral health behaviors. They conducted multivariable analysis of variance to assess associations between oral health knowledge and belief scores and characteristics. Results The authors enrolled 615 women in the study, and 599 (97.4 percent) completed the questionnaire. Of 599 participants, 573 (95.7 percent) knew that sugar intake is associated with caries. Almost one-half (295 participants [49.2 percent]) did not know that caries and periodontal disease are oral infections. Median (interquartile range) knowledge and belief scores were 6.0 (5.5–7.0) and 6.0 (5.0–7.0), respectively. Hispanic women had median (interquartile range) knowledge and belief scores significantly lower than those of white or African American women (6.0 [4.0–7.0] versus 7.0 [6.0–7.0] versus 7.0 [6.0–7.0], respectively [P < .001]; and 5.0 [4.0–6.0] versus 6.0 [5.0–7.0] versus 6.0 [5.0–7.0], respectively [P < .001]). Multivariable analysis of variance results showed that being of His-panic ethnicity was associated significantly with a lower knowledge score, and that an education level of eighth grade or less was associated significantly with a lower belief score. Conclusions Pregnant women have some oral health knowledge. Knowledge varied according to maternal race or ethnicity, and beliefs varied according to maternal education. Including oral health education as a part of prenatal care may improve knowledge regarding the importance of oral health among vulnerable pregnant women, thereby improving their oral health and that of their children. Clinical Implications Including oral health education as a part of prenatal care should be considered.

L ocal health departments (LHDs) play a central role in providing maternal and child health services in the public health system and are increasingly collaborating with academic institutions to advance evidence-based public health [1-3]. Academic-practice partnerships typically represent a formal affiliation between an academic institution and a public health practice organization [4]. Luo and colleagues estimated that 82.4% of LHDs engaged in partnerships (ie, networking, coordinating, cooperating, collaborating) to advance maternal and child health, however, only 27.4% of these partnerships represented collaborations [5]. There is a need to understand how LHDs successfully leverage partnerships to advance evidence-based maternal and child health [5]. In an effort to improve birth and child health outcomes, the North Carolina General Assembly legislated recurring funding in the amount of $2,500,000 (Session Law 2015-241) to invest in evidence-based programs shown to reduce infant mortality and improve birth and health outcomes for children from birth to 5 years of age [6]. In fiscal year 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program establishing an academic-practice partnership between the University of North Carolina at Chapel Hill (UNC) Gillings School of Global Public Health, DPH, and LHDs to improve birth and child health outcomes. This paper describes the implementation of a maternal and child health program in North Carolina using a collective impact framework, the principles of implementation science, and a health equity approach to address adverse birth and child health outcomes. It presents lessons learned from leveraging existing relationships to develop and sustain an academic-practice partnership that strengthened implementation. Methods The ICO4MCH Program The ICO4MCH program is housed in the Women's and Children's Health Section of DPH. The program was designed to address 3 overarching aims: 1) improve birth outcomes, 2) reduce infant mortality, and 3) improve the health of children from birth to 5 years. The evidence-based strategies (EBSs) from which the grantees could select to address the 3 program aims included: