I
work with the Center for Craniofacial and Dental Genetics (CCDG), which is part
of Pitt’s School of Dental Medicine, as part of a research study known as the
Center for Oral Health in Rural Appalachia study – or COHRA. Headed by Dr. Mary
Marazita, who functions as both director of the CCDG and principal investigator
of COHRA, this study aims to identify the complex interactions that contribute to
higher rates of dental caries among rural Appalachian mothers and their
children living in Pittsburgh and the surrounding areas. Through the analysis
of the factors contributing to differences in caries formation among populations,
including genetic, microbial, dietary, and environmental influences on dental
health, the team is working to produce data that may allow us to create
interventions to address these oral health inequities. Inheritance plays a big
role in this research with consideration of how microbial and genetic
susceptibility to dental caries are passed down from mother to child. Of
course, much of our lived environments are shared with our parents, so even
this can be thought a kind of inheritance.
At
present, there are two primary COHRA studies, both of which are longitudinal in
design: the continuation of the original cohort that focused on Caucasian women
in Northern Appalachia (COHRA2) and a newer study that focuses exclusively on
African-American mothers and their children living in the region (COHRA Smile).
My
role in the study is that of a Graduate Research Assistant. While I bet this
isn’t the first position that comes to mind for a student in the GC program, I
actually come from a robust “line” of GCs that have passed through the CCDG: in
fact, I worked closely with my second-year GC buddy here when I was a
first-year student! Most of these students were also dual-degree MPH students
as well, because we recognize the multi-disciplinary experience of working as a
research assistant in a study that leads with health equity as a core value.
What
does a day in the life on the COHRA team look like? I would divide my tasks
broadly into two categories:
First,
there is the admin/research side of things, which includes tasks related to study
management. This includes work in participant visits, where I work with a
hygienist to collect oral samples from women and children in the study. We
collect many samples, including saliva samples for genomic analysis of both
human and microbial DNA, gingival samples, and samples from enamel lesions and
the early formations of cavities! We also record saliva pH, degree of
fluorosis, and even record the quality of different tooth surfaces that we
expect may help clarify patterns among participants. Of course, it’s also
important that I prepare study visit materials, consent forms, cross-check
samples, and handle mailing and payment for study participation around
participant visits.
There
is also a heavy element of participant tracking that goes into this position.
Our participants have very specific windows in which we prefer to have them and
their children come into the study for a visit, which differs by age and study
phase. Around that, our research arm also reaches out to participants to
collect information about the diets, medical health, and dental development of
enrolled children. As such, it is very important that I work to maintain timely
contact with participants to keep them as close to their assigned windows as
possible. Members of the clinical team, including myself, generally track over 150+
participants each in a study of over 1,000 active women and children enrollees!
As you can imagine, proper tracking methods play a key role in making sure we
continue to follow with participants and get them scheduled to come into the
office in a timely manner.
The
relevance of this role to genetic counseling is larger than I could ever
envisioned when I started over a year ago. For starters, the participant
tracking element is great practice for when I have clinical patients that I
need to manage in the future. I also love getting to talk with women and their
children during participant visits. Since I am interested primarily in prenatal
and pediatric genetics, I get lots of opportunities to learn from our
participants and think about elements of conversation that can help bolster
rapport with both populations (and with respect to the unique circumstances
that tie me to those that I am working with). I also get a chance to work in a
setting that encourages discussion about multifactorial explanations, including
the genetic contributions, to the formation of dental caries. My favorite moments
during the participant exam are when I get to explain our study to a mom who
casually asks, “So what are you guys collecting all of this saliva for anyway?”
and I get to flex my “patient education” muscles!
Most of all, I enjoy this work because I know that I am making a direct contribution on the road to reduce a dire health inequity for rural parents and their children. Unfortunately, this is just one of many in our country; there are many more challenges to health equity out there, and many more populations to advocate for. I encourage my GC peers to continue to think creatively about how you can customize your work, either now or in the future, to address health care gaps related to each of your specializations!
– Frank Swann
