The goal of these studies is to investigate genetic, environmental, behavioral, and microbial contributions to the disproportionately high rate of dental caries (cavities) in children living in Appalachia. Appalachia is a region of the eastern United States, covering parts of northern Mississippi, Alabama, Georgia, and reaching up to western New York. The COHRA2/COHRA Smile studies include two cohorts of Caucasian (COHRA2) and African American (COHRA Smile) women and their children from West Virginia and western Pennsylvania, as children in this area demonstrate poorer oral health and elevated rates of caries earlier in life compared with national averages.
|A map depicting Appalachia|
I get to balance all of this with seeing our participants during their visits. The participants enrolled are pregnant women who live in West Virginia or the greater Pittsburgh area. As a longitudinal study, we follow them and their babies through the child’s 10th birthday, with visits at yearly time points. These visits involve a dental hygienist and a research assistant (such as myself) performing a dental screening of mother and child and collecting saliva and other oral samples for DNA and microbial environment analysis. Having a six-year-old ask you why their mom is spitting in a tube is a great way to practice explaining genetics to a young audience! Additionally, we track children’s growth, and survey behavioral, environmental, psychosocial, and socioeconomic factors and exposures that the mothers report at the visits and with periodic phone interviews.
The CCDG has a rich library of data available from which I will be able to develop my thesis project. Because of the wealth of data available, I have the opportunity to not only develop a project I am passionate about, but also contribute directly to the study’s aims. I am interested in the ways that genetics can influence public health and policy related to common diseases, so I will be developing a project that investigates relationships between genetic factors, dental caries, and smoking. It is important to consider potential genetic factors in dental care when they matter, especially when developing interventions for a population that may be at higher risk. I aim to discuss the implications for intervention and management when genetics does and does not play a role in oral health.
I had been working in this position for almost a year prior to starting my genetic counseling training, and I could not feel more strongly that my experience with COHRA has helped to make me a better counselor. From the participant’s perspective, being in a research study is always unfamiliar at first, so I have learned how to give guidance for what the mothers can expect during their time as a participant and at each study visit. I’ve also grown to appreciate how crucial the informed consent process is, and explaining to potential participants that they will not get a direct return of results (because research information is de-identified) is great practice in talking about a confusing topic, like a genetic counselor might do with a variant of uncertain significance. Asking an exhaustive list of health and diet questions during phone interviews is also reflective of what it is like to take a family history, and it takes practice to feel comfortable doing this in a way that is personable while staying on-topic, since we are asking mothers about their children. And, of course, doing all of this research with young children in the room means we often have to explain every step of our process to very curious minds! It is excellent practice in using patient-friendly language to explain complex topics.
Though dental genetics is not what I had in mind when I decided I wanted to be a genetic counselor, what this job has taught me the most is to be really open to new experiences. My work environment and my team are the best I could have asked for; they are always supportive of my educational endeavors and have become close friends. I am thankful for great mentorship at every level, and I know that I am a valued member of their team. For all of these reasons, I am excited to finish out my graduate career as a research assistant with the COHRA team and the rest of the CCDG!
Lauren Winter, Graduate Student Research Assistant – COHRA2/COHRA Smile Projects, Center for Craniofacial and Dental Genetics
Class of 2020