Caries, Dental, Health Behavior
Conditions
Keywords
Child oral health behaviors, Text messages, Motivation, Self efficacy, Outcome Expectations, Sugar sweetened beverage consumption, Fluoride varnish, Healthy eating, Parent oral health behaviors, Parent oral health attitudes, Fluoride, early childhood caries
Brief summary
This is a randomized clinical trial to test the efficacy of a parent-targeted text message-based intervention program on caries incidence and oral health behaviors (child and parent). Parents (n= 850) across all pediatric clinic sites (Boston Medical Center and Community Health Centers (CHCs); DotHouse CHC, South End Community Health Center, and Codman Square CHC) will be randomized to receive either text messages (TMs) regarding oral health or TMs regarding child wellness. The study will enroll English and Spanish speaking parents and their youngest child who is \< 7 years old, has at least one tooth showing, and attends the targeted pediatric clinic to receive primary care (n= 1700). Parents will complete self-report surveys at baseline, and 2, 4, 12, and 24-months after baseline; receive and respond to TM assessments during the 4-month intervention; and will also receive TMs during a 'booster' period of one month, which will occur 12-months post baseline. Parent's children will be assessed for caries by a clinical oral examination performed by licensed Clinical Examiners at baseline, 12-and-24-months post-baseline.
Interventions
OTHEROHT Parent targeted text messages
For the Oral health text message (OHT) group, the parent targeted text messaging program will include two core topics and a menu of options to choose from, all of which pertain to oral health.
OTHERCWT Parent targeted text messages
For the CWT group, the parent targeted text messaging program will include two core topics and a menu of options to choose from, all of which pertain to child wellness.
Sponsors
National Institute of Dental and Craniofacial Research (NIDCR)
Boston University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Masking description
Outcome Assessors and Oral Health Examiners will be blind to treatment condition.
Eligibility
Sex/Gender
ALL
Age
0 Months to 7 Years
Healthy volunteers
Yes
Inclusion criteria
Caregiver and child must meet all of the following: 1. Caregiver must be a parent or legal guardian of a child less than 7 years old, and the child must have their first tooth showing 2. The child must receive medical care at one of the participating pediatric clinics. 3. Speak, understand, and read either English or Spanish 4. Have a mobile phone.
Exclusion criteria
If the caregiver or child meets any of the following criteria, the dyad will be excluded from participation in this study 1. Children with severe congenital tooth malformations: At screening the caregiver will be asked if their child has known systemic diseases associated with abnormal tooth development or abnormal oral health status such as cleft lip or palate, amelogenesis imperfecta, or dentinogenesis imperfecta. 2. Children who cannot complete the baseline oral health exam.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Self-efficacy to Perform Oral Health Behaviors | 4-month time point (survey) | The overall self-efficacy score represents how sure parent/caregiver participants are that they can engage in recommended behavior to take care of their children's teeth. (Based on Albino et al 2017; range 1 - 7; higher scores mean better outcome). |
| Dental Caries Increment (Surface Level) | 24-month time point (oral assessment) | Caries data in children participants collected by calibrated clinical examiners (blind to treatment condition), utilizing the OHDC Modified ICDAS methodology, will allow calculation of a surface of tooth-level caries increment (development of a new cavitated lesion or filled surface on a previously sound tooth surface). |
| Parent/Caregiver Outcome Expectations for Oral Health Behaviors | 4-month time point (survey) | An outcome expectancies measure to assess the degree to which parent/caregiver participants perceive that performing the oral health behaviors (e.g., brushing) will lead to the desired outcome (e.g., reduced dental caries) in their children (Stewart et al., 1997; range 1 - 4; higher scores mean better outcome). |
| Dental Caries Increment | 24-month time point (oral assessment) | Surface level caries data in children was collected by calibrated clinical examiners (blind to treatment condition), utilizing the OHDC Modified ICDAS methodology, will allow calculation of caries increment (development of a new cavitated lesion or filled surface on a previously sound tooth surface). |
| Parent/Caregiver Confidence to Brush | 4-month time point (survey) | 9-item self-efficacy measure to assess parent/caregiver participant confidence in their ability to brush their child's teeth under different situations. (Finlayson measure; range 1 - 4; higher scores mean better outcome) |
| Parent/Caregiver Motivation to Perform Oral Health Behaviors | 4-month time point (survey) | A oral health motivation measure to assess parent/caregiver participants motivation to engage in recommended child oral health behaviors (score range 1 - 7; higher scores mean better outcome) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Child Diet - Food Frequency | 4-month, 12-month, and 24-month time points (survey) | Parent/caregiver participants completed a food frequency questionnaire (FFQ) to assess their child's diet. Food/beverages items in the FFQ are categorized into groups according to the degree to which they promote dental caries, and a weighted estimated cariogenicity score (ECS) is computed (minimum and maximum scores range 0 - 3.80; higher scores mean a worse outcome). |
| Child Diet - Beverage Intake | 4-month, 12-month, and 24-month time points (survey) | Parent/caregiver participants completed the beverage questionnaire for preschoolers (BEVQ-PS) to assess their child's beverage intake. For each beverage item, the frequency and the amount of consumption are computed as average fluid ounces per day, and a composite score is computed for sugar sweetened beverages (including 100% fruit juice) consumption and then categorized into higher consumption (vs lower). |
| Child Tooth Brushing | 4-month, 12-month, and 24-month time points (survey) | An investigator-developed composite measure derived from the number of days and number of times parent/caregiver participants brushed or supervised brushing their child's teeth during a week (range: 0 - 21; higher scores mean a better outcome). |
| Parent/Caregiver Tooth Brushing | 4-month, 12-month, and 24-month time points (survey) | An investigator-developed composite measure derived from the number of days and number of times parent/caregiver participants brushed their teeth during a week (range: 0 - 21; higher scores mean a better outcome). |
| Satisfaction With Text Message Program Features | 4-month time point (survey) | One item adapted from the Mobile App Rating Scale (MARS) to measure parent/caregiver participants' overall level of satisfaction with the text message program features (range 1 - 7; higher scores mean a better outcome). |
| Child Toothbrushing (Clinical Guidelines) | 4-month, 12-month, and 24-month time points (survey) | An investigator-developed measure derived from the number of days and number of times parent/caregiver participants brushed or supervised brushing their child's teeth during a week recoded into child met clinical guidelines for brushing (brushing at least two times per day, seven days of the week) vs not. |
| Parents/Caregivers Toothbrushing (Clinical Guidelines) | 4-month, 12-month, and 24-month time points (survey) | An investigator-developed measure derived from the number of days and number of times parent/caregiver participants brushed their teeth during a week recoded into parent/caregiver participants met clinical guidelines for brushing (brushed at least two times per day, seven days of the week) vs not. |
| Diffusion of Text Messages (Satisfaction) | 4-month time point (survey) | One item adapted from the Mobile App Rating Scale (MARS) asks parent/caregiver participants whether they showed (or forwarded) text messages to anyone else |
| Text Message Program Star Rating | 4-month time point (survey) | One item adapted from the Mobile App Rating Scale (MARS) asks participants to give a star rating of the text message program. The star rating score range 1 star to 5 stars; a higher number of stars mean a better outcome. |
| Text Message Program Quality | 4-month time point (survey) | Parent/caregiver participants responded to an investigator developed survey to measure several aspects of text messages quality (range 1 - 7; higher scores mean a better outcome). |
| Child Oral Health-related Quality of Life | 4-month, 12-month, and 24-month time points (survey) | The Early Childhood Oral Health Impact Scale (ECOHIS) to measure parent/caregiver participants' perceptions of their child's oral health (range 0 - 16; higher scores mean a worse outcome). |
| Text Message Program Length Satisfaction | 4-month time point (survey) | One item adapted from the Mobile App Rating Scale (MARS) to measure parent/caregiver participants satisfaction with the duration of the text message program. |
| Parents' Perceived Impact of iSmile | 4-month time point (survey) | Three items adapted from the MARS to measure the perceived impact of the OHT text message program on parent/caregiver participants' attitudes towards their child's oral health (range 1 - 7; higher scores mean a better outcome). |
| Child Preventive Dental Visits | 4-month, 12-month, and 24-month time points (survey) | One item adapted from the Basic Research Factors Questionnaire (BRFQ) to assess the number of parent/caregiver participants who indicated that their child had a preventive dental visit. |
| Fluoridated Toothpaste Use | 4-month, 12-month, and 24-month time points (survey) | One item derived from the Basic Research Factors Questionnaire (BRFQ) to measure whether parent/caregiver participants use toothpaste containing fluoride when brushing their child's teeth. |
| Perceived Impact of OHT Program on Parental Awareness | 24-month (survey) | One item adapted from the Basic Research Factors Questionnaire (BRFQ) to measure parent/caregiver participants' (in the OHT arm) awareness of their child oral health. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Type of Beverage Consumed Between Meals | 4-month, 12-month, and 24-month time points (survey) | Parent/caregiver participants are asked to indicate what beverage their child consumes most often between meals. |
| Dental Caries (Per Subject) | 24-Month (oral health assessment) | Number of primary teeth with new dental caries per child |
| Challenge Week During the OHT Text Message Program | 4-month time point | We assessed the number of parent/caregiver participants in the OHT arm who agreed to do the challenge (setting the goal of brushing their child's teeth every day, twice per day) that occurred within the 4-month text message program. |
Countries
United States
Participant flow
Pre-assignment details
754 dyads (parents or caregivers and child) were enrolled and randomized.
Participants by arm
| Arm | Count |
|---|---|
| Oral Health Text Messages (OHT) Participants in this arm will receive the OHT parent targeted text messages to reduce caries and improve oral health behaviors among low income families visiting community-based, urban pediatric clinics.
OHT Parent targeted text messages: For the Oral health text message (OHT) group, the parent targeted text messaging program will include two core topics and a menu of options to choose from, all of which pertain to oral health. | 754 |
| Child Wellness Text Messages (CWT) Participants in this arm will receive the CWT parent targeted text messages to improve child wellness (e.g., reading time, safety) among low income families visiting community-based, urban pediatric clinics.
CWT Parent targeted text messages: For the CWT group, the parent targeted text messaging program will include two core topics and a menu of options to choose from, all of which pertain to child wellness. | 754 |
| Total | 1,508 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 105 | 107 |
Baseline characteristics
| Characteristic | Oral Health Text Messages (OHT) | Child Wellness Text Messages (CWT) | Total |
|---|---|---|---|
| Age, Continuous Children participants | 2.9 years STANDARD_DEVIATION 1.7 | 2.8 years STANDARD_DEVIATION 1.6 | 2.9 years STANDARD_DEVIATION 1.7 |
| Age, Continuous Parent/caregiver participants | 32.8 years STANDARD_DEVIATION 7 | 33.0 years STANDARD_DEVIATION 7.4 | 32.9 years STANDARD_DEVIATION 7.2 |
| Ethnicity (NIH/OMB) Children participants Hispanic or Latino | 114 Participants | 113 Participants | 227 Participants |
| Ethnicity (NIH/OMB) Children participants Not Hispanic or Latino | 252 Participants | 251 Participants | 503 Participants |
| Ethnicity (NIH/OMB) Children participants Unknown or Not Reported | 11 Participants | 13 Participants | 24 Participants |
| Ethnicity (NIH/OMB) Parent/caregiver participants Hispanic or Latino | 98 Participants | 96 Participants | 194 Participants |
| Ethnicity (NIH/OMB) Parent/caregiver participants Not Hispanic or Latino | 270 Participants | 270 Participants | 540 Participants |
| Ethnicity (NIH/OMB) Parent/caregiver participants Unknown or Not Reported | 9 Participants | 11 Participants | 20 Participants |
| Race (NIH/OMB) Children participants American Indian or Alaska Native | 2 Participants | 1 Participants | 3 Participants |
| Race (NIH/OMB) Children participants Asian | 6 Participants | 4 Participants | 10 Participants |
| Race (NIH/OMB) Children participants Black or African American | 225 Participants | 199 Participants | 424 Participants |
| Race (NIH/OMB) Children participants More than one race | 58 Participants | 72 Participants | 130 Participants |
| Race (NIH/OMB) Children participants Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Children participants Unknown or Not Reported | 52 Participants | 59 Participants | 111 Participants |
| Race (NIH/OMB) Children participants White | 33 Participants | 41 Participants | 74 Participants |
| Race (NIH/OMB) Parent/caregiver participants American Indian or Alaska Native | 2 Participants | 1 Participants | 3 Participants |
| Race (NIH/OMB) Parent/caregiver participants Asian | 7 Participants | 9 Participants | 16 Participants |
| Race (NIH/OMB) Parent/caregiver participants Black or African American | 235 Participants | 205 Participants | 440 Participants |
| Race (NIH/OMB) Parent/caregiver participants More than one race | 25 Participants | 39 Participants | 64 Participants |
| Race (NIH/OMB) Parent/caregiver participants Native Hawaiian or Other Pacific Islander | 1 Participants | 2 Participants | 3 Participants |
| Race (NIH/OMB) Parent/caregiver participants Unknown or Not Reported | 61 Participants | 73 Participants | 134 Participants |
| Race (NIH/OMB) Parent/caregiver participants White | 46 Participants | 48 Participants | 94 Participants |
| Region of Enrollment United States | 754 participants | 754 participants | 1508 participants |
| Sex: Female, Male Children participants Female | 186 Participants | 191 Participants | 377 Participants |
| Sex: Female, Male Children participants Male | 191 Participants | 186 Participants | 377 Participants |
| Sex: Female, Male Parent/caregiver participants Female | 358 Participants | 355 Participants | 713 Participants |
| Sex: Female, Male Parent/caregiver participants Male | 19 Participants | 22 Participants | 41 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 377 | 0 / 377 |
| other Total, other adverse events | 0 / 377 | 0 / 377 |
| serious Total, serious adverse events | 1 / 377 | 0 / 377 |
Outcome results
Primary
Dental Caries Increment
Surface level caries data in children was collected by calibrated clinical examiners (blind to treatment condition), utilizing the OHDC Modified ICDAS methodology, will allow calculation of caries increment (development of a new cavitated lesion or filled surface on a previously sound tooth surface).
Time frame: 24-month time point (oral assessment)
Population: Number of children with any new dental caries in primary teeth (using multiple imputation methods to account for missing oral health assessment data at 24-month)
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Oral Health Text Messages (OHT) | Dental Caries Increment | 162 Participants |
| Child Wellness Text Messages (CWT) | Dental Caries Increment | 161 Participants |
Primary
Dental Caries Increment (Surface Level)
Caries data in children participants collected by calibrated clinical examiners (blind to treatment condition), utilizing the OHDC Modified ICDAS methodology, will allow calculation of a surface of tooth-level caries increment (development of a new cavitated lesion or filled surface on a previously sound tooth surface).
Time frame: 24-month time point (oral assessment)
Population: Number of tooth surfaces with new caries in children participants
| Arm | Measure | Value (COUNT_OF_UNITS) |
|---|---|---|
| Oral Health Text Messages (OHT) | Dental Caries Increment (Surface Level) | 545 Tooth surfaces |
| Child Wellness Text Messages (CWT) | Dental Caries Increment (Surface Level) | 496 Tooth surfaces |
Primary
Parent/Caregiver Confidence to Brush
9-item self-efficacy measure to assess parent/caregiver participant confidence in their ability to brush their child's teeth under different situations. (Finlayson measure; range 1 - 4; higher scores mean better outcome)
Time frame: 4-month time point (survey)
Population: Scores on a self-efficacy measure (range 1 - 4; higher scores mean better outcome)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Parent/Caregiver Confidence to Brush | 2.9 score on a scale | Standard Deviation 1.2 |
| Child Wellness Text Messages (CWT) | Parent/Caregiver Confidence to Brush | 2.8 score on a scale | Standard Deviation 1.2 |
Primary
Parent/Caregiver Motivation to Perform Oral Health Behaviors
A oral health motivation measure to assess parent/caregiver participants motivation to engage in recommended child oral health behaviors (score range 1 - 7; higher scores mean better outcome)
Time frame: 4-month time point (survey)
Population: Scores on a motivation measure (range 1 - 7; higher scores mean better outcome)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Parent/Caregiver Motivation to Perform Oral Health Behaviors | 6.2 score on a scale | Standard Deviation 1.2 |
| Child Wellness Text Messages (CWT) | Parent/Caregiver Motivation to Perform Oral Health Behaviors | 6.0 score on a scale | Standard Deviation 1.3 |
Primary
Parent/Caregiver Outcome Expectations for Oral Health Behaviors
An outcome expectancies measure to assess the degree to which parent/caregiver participants perceive that performing the oral health behaviors (e.g., brushing) will lead to the desired outcome (e.g., reduced dental caries) in their children (Stewart et al., 1997; range 1 - 4; higher scores mean better outcome).
Time frame: 4-month time point (survey)
Population: Scores on an outcome expectancies measure (range 1 - 4; higher scores mean better outcome)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Parent/Caregiver Outcome Expectations for Oral Health Behaviors | 3.69 score on a scale | Standard Deviation 0.67 |
| Child Wellness Text Messages (CWT) | Parent/Caregiver Outcome Expectations for Oral Health Behaviors | 3.68 score on a scale | Standard Deviation 0.6 |
Primary
Self-efficacy to Perform Oral Health Behaviors
The overall self-efficacy score represents how sure parent/caregiver participants are that they can engage in recommended behavior to take care of their children's teeth. (Based on Albino et al 2017; range 1 - 7; higher scores mean better outcome).
Time frame: 4-month time point (survey)
Population: Scores on a confidence (self-efficacy) measure (range 1 - 7; higher scores mean better outcome)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Self-efficacy to Perform Oral Health Behaviors | 6.3 score on a scale | Standard Deviation 1.1 |
| Child Wellness Text Messages (CWT) | Self-efficacy to Perform Oral Health Behaviors | 6.2 score on a scale | Standard Deviation 1.2 |
Secondary
Child Diet - Beverage Intake
Parent/caregiver participants completed the beverage questionnaire for preschoolers (BEVQ-PS) to assess their child's beverage intake. For each beverage item, the frequency and the amount of consumption are computed as average fluid ounces per day, and a composite score is computed for sugar sweetened beverages (including 100% fruit juice) consumption and then categorized into higher consumption (vs lower).
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of parent/caregiver participants indicating that their child consumed higher sugar sweetened beverages including 100% fruit juice (=more than 4.5 fluid ounces per day).
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Child Diet - Beverage Intake | 24-month | 125 Participants |
| Oral Health Text Messages (OHT) | Child Diet - Beverage Intake | 12-month | 145 Participants |
| Oral Health Text Messages (OHT) | Child Diet - Beverage Intake | 4-month | 128 Participants |
| Child Wellness Text Messages (CWT) | Child Diet - Beverage Intake | 24-month | 142 Participants |
| Child Wellness Text Messages (CWT) | Child Diet - Beverage Intake | 12-month | 131 Participants |
| Child Wellness Text Messages (CWT) | Child Diet - Beverage Intake | 4-month | 141 Participants |
Secondary
Child Diet - Food Frequency
Parent/caregiver participants completed a food frequency questionnaire (FFQ) to assess their child's diet. Food/beverages items in the FFQ are categorized into groups according to the degree to which they promote dental caries, and a weighted estimated cariogenicity score (ECS) is computed (minimum and maximum scores range 0 - 3.80; higher scores mean a worse outcome).
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: The estimated cariogenic score derived from a food frequency questionnaire (higher scores mean a worse outcome).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Oral Health Text Messages (OHT) | Child Diet - Food Frequency | 24-month | 2.22 score on a scale | Standard Deviation 0.31 |
| Oral Health Text Messages (OHT) | Child Diet - Food Frequency | 12-month | 2.23 score on a scale | Standard Deviation 0.3 |
| Oral Health Text Messages (OHT) | Child Diet - Food Frequency | 4-month | 2.18 score on a scale | Standard Deviation 0.28 |
| Child Wellness Text Messages (CWT) | Child Diet - Food Frequency | 24-month | 2.27 score on a scale | Standard Deviation 0.27 |
| Child Wellness Text Messages (CWT) | Child Diet - Food Frequency | 12-month | 2.23 score on a scale | Standard Deviation 0.24 |
| Child Wellness Text Messages (CWT) | Child Diet - Food Frequency | 4-month | 2.22 score on a scale | Standard Deviation 0.24 |
Secondary
Child Oral Health-related Quality of Life
The Early Childhood Oral Health Impact Scale (ECOHIS) to measure parent/caregiver participants' perceptions of their child's oral health (range 0 - 16; higher scores mean a worse outcome).
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: The Early Childhood Oral Health 'Family' Impact scale score (range 0 - 16; higher scores mean a worse outcome)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Oral Health Text Messages (OHT) | Child Oral Health-related Quality of Life | 24-month | 1.03 score on a scale | Standard Deviation 2 |
| Oral Health Text Messages (OHT) | Child Oral Health-related Quality of Life | 12-month | 1.14 score on a scale | Standard Deviation 2.03 |
| Oral Health Text Messages (OHT) | Child Oral Health-related Quality of Life | 4-month | 0.65 score on a scale | Standard Deviation 1.55 |
| Child Wellness Text Messages (CWT) | Child Oral Health-related Quality of Life | 24-month | 0.99 score on a scale | Standard Deviation 1.8 |
| Child Wellness Text Messages (CWT) | Child Oral Health-related Quality of Life | 12-month | 0.96 score on a scale | Standard Deviation 1.79 |
| Child Wellness Text Messages (CWT) | Child Oral Health-related Quality of Life | 4-month | 0.80 score on a scale | Standard Deviation 1.76 |
Secondary
Child Preventive Dental Visits
One item adapted from the Basic Research Factors Questionnaire (BRFQ) to assess the number of parent/caregiver participants who indicated that their child had a preventive dental visit.
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of parent/caregiver participants who indicated that their child had a preventive dental visit.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Child Preventive Dental Visits | 24-month | 207 Participants |
| Oral Health Text Messages (OHT) | Child Preventive Dental Visits | 12-month | 180 Participants |
| Oral Health Text Messages (OHT) | Child Preventive Dental Visits | 4-month | 162 Participants |
| Child Wellness Text Messages (CWT) | Child Preventive Dental Visits | 24-month | 181 Participants |
| Child Wellness Text Messages (CWT) | Child Preventive Dental Visits | 12-month | 157 Participants |
| Child Wellness Text Messages (CWT) | Child Preventive Dental Visits | 4-month | 131 Participants |
Secondary
Child Tooth Brushing
An investigator-developed composite measure derived from the number of days and number of times parent/caregiver participants brushed or supervised brushing their child's teeth during a week (range: 0 - 21; higher scores mean a better outcome).
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of child tooth brushings per week (range: 0 - 21; higher scores mean a better outcome)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Oral Health Text Messages (OHT) | Child Tooth Brushing | 24-month | 12.0 units on a scale | Standard Deviation 4.5 |
| Oral Health Text Messages (OHT) | Child Tooth Brushing | 12-month | 12.0 units on a scale | Standard Deviation 4.4 |
| Oral Health Text Messages (OHT) | Child Tooth Brushing | 4-month | 12.9 units on a scale | Standard Deviation 3.7 |
| Child Wellness Text Messages (CWT) | Child Tooth Brushing | 24-month | 11.1 units on a scale | Standard Deviation 5.1 |
| Child Wellness Text Messages (CWT) | Child Tooth Brushing | 12-month | 11.6 units on a scale | Standard Deviation 4.6 |
| Child Wellness Text Messages (CWT) | Child Tooth Brushing | 4-month | 11.3 units on a scale | Standard Deviation 5 |
Secondary
Child Toothbrushing (Clinical Guidelines)
An investigator-developed measure derived from the number of days and number of times parent/caregiver participants brushed or supervised brushing their child's teeth during a week recoded into child met clinical guidelines for brushing (brushing at least two times per day, seven days of the week) vs not.
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of parent/caregiver participants who indicated that they brushed or supervised brushing their child's teeth at least two times per day, seven days of the week.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Child Toothbrushing (Clinical Guidelines) | 24-Month | 177 Participants |
| Oral Health Text Messages (OHT) | Child Toothbrushing (Clinical Guidelines) | 12-Month | 167 Participants |
| Oral Health Text Messages (OHT) | Child Toothbrushing (Clinical Guidelines) | 4-Month | 214 Participants |
| Child Wellness Text Messages (CWT) | Child Toothbrushing (Clinical Guidelines) | 24-Month | 147 Participants |
| Child Wellness Text Messages (CWT) | Child Toothbrushing (Clinical Guidelines) | 12-Month | 160 Participants |
| Child Wellness Text Messages (CWT) | Child Toothbrushing (Clinical Guidelines) | 4-Month | 156 Participants |
Secondary
Diffusion of Text Messages (Satisfaction)
One item adapted from the Mobile App Rating Scale (MARS) asks parent/caregiver participants whether they showed (or forwarded) text messages to anyone else
Time frame: 4-month time point (survey)
Population: The iSmile study consisted of oral health text messages for parent/caregiver participants in the OHT arm, and child wellness text messages for parent/caregiver participants in the CWT arm. Diffusion of text messages assessed the number of parents/caregivers who showed (or forwarded) text messages to others.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Oral Health Text Messages (OHT) | Diffusion of Text Messages (Satisfaction) | 168 Participants |
| Child Wellness Text Messages (CWT) | Diffusion of Text Messages (Satisfaction) | 177 Participants |
Secondary
Fluoridated Toothpaste Use
One item derived from the Basic Research Factors Questionnaire (BRFQ) to measure whether parent/caregiver participants use toothpaste containing fluoride when brushing their child's teeth.
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of parent/caregiver participants indicating use of fluoridated toothpaste to brush their child's teeth.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Fluoridated Toothpaste Use | 24-month | 225 Participants |
| Oral Health Text Messages (OHT) | Fluoridated Toothpaste Use | 12-month | 229 Participants |
| Oral Health Text Messages (OHT) | Fluoridated Toothpaste Use | 4-month | 225 Participants |
| Child Wellness Text Messages (CWT) | Fluoridated Toothpaste Use | 24-month | 207 Participants |
| Child Wellness Text Messages (CWT) | Fluoridated Toothpaste Use | 12-month | 215 Participants |
| Child Wellness Text Messages (CWT) | Fluoridated Toothpaste Use | 4-month | 210 Participants |
Secondary
Parent/Caregiver Tooth Brushing
An investigator-developed composite measure derived from the number of days and number of times parent/caregiver participants brushed their teeth during a week (range: 0 - 21; higher scores mean a better outcome).
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of parent/caregiver participants tooth brushings per week (range: 0 - 21; higher scores mean a better outcome).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Oral Health Text Messages (OHT) | Parent/Caregiver Tooth Brushing | 24-month | 12.7 units on a scale | Standard Deviation 3.8 |
| Oral Health Text Messages (OHT) | Parent/Caregiver Tooth Brushing | 12-month | 12.7 units on a scale | Standard Deviation 4.2 |
| Oral Health Text Messages (OHT) | Parent/Caregiver Tooth Brushing | 4-month | 13.1 units on a scale | Standard Deviation 3.8 |
| Child Wellness Text Messages (CWT) | Parent/Caregiver Tooth Brushing | 24-month | 12.3 units on a scale | Standard Deviation 4.5 |
| Child Wellness Text Messages (CWT) | Parent/Caregiver Tooth Brushing | 12-month | 12.5 units on a scale | Standard Deviation 4.4 |
| Child Wellness Text Messages (CWT) | Parent/Caregiver Tooth Brushing | 4-month | 12.4 units on a scale | Standard Deviation 4.2 |
Secondary
Parents/Caregivers Toothbrushing (Clinical Guidelines)
An investigator-developed measure derived from the number of days and number of times parent/caregiver participants brushed their teeth during a week recoded into parent/caregiver participants met clinical guidelines for brushing (brushed at least two times per day, seven days of the week) vs not.
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of parent/caregiver participants who indicated that they brushed their teeth at least two times per day, seven days of the week.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Parents/Caregivers Toothbrushing (Clinical Guidelines) | 24-Month | 188 Participants |
| Oral Health Text Messages (OHT) | Parents/Caregivers Toothbrushing (Clinical Guidelines) | 12-Month | 195 Participants |
| Oral Health Text Messages (OHT) | Parents/Caregivers Toothbrushing (Clinical Guidelines) | 4-Month | 208 Participants |
| Child Wellness Text Messages (CWT) | Parents/Caregivers Toothbrushing (Clinical Guidelines) | 24-Month | 175 Participants |
| Child Wellness Text Messages (CWT) | Parents/Caregivers Toothbrushing (Clinical Guidelines) | 12-Month | 183 Participants |
| Child Wellness Text Messages (CWT) | Parents/Caregivers Toothbrushing (Clinical Guidelines) | 4-Month | 191 Participants |
Secondary
Parents' Perceived Impact of iSmile
Three items adapted from the MARS to measure the perceived impact of the OHT text message program on parent/caregiver participants' attitudes towards their child's oral health (range 1 - 7; higher scores mean a better outcome).
Time frame: 4-month time point (survey)
Population: Parent/caregiver participants in the OHT arm responded to How much do you think iSmile had a positive impact on?.. (1='not at all' to 7='very much'; higher scores mean a better outcome)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Oral Health Text Messages (OHT) | Parents' Perceived Impact of iSmile | Making sure your child's teeth are brushed | 6.4 units on a scale | Standard Deviation 1.3 |
| Oral Health Text Messages (OHT) | Parents' Perceived Impact of iSmile | Decreasing the amount of sugar-sweetened beverages your child drinks | 5.9 units on a scale | Standard Deviation 1.8 |
| Oral Health Text Messages (OHT) | Parents' Perceived Impact of iSmile | Your feelings on taking your child to the dentist | 6.1 units on a scale | Standard Deviation 1.6 |
Secondary
Perceived Impact of OHT Program on Parental Awareness
One item adapted from the Basic Research Factors Questionnaire (BRFQ) to measure parent/caregiver participants' (in the OHT arm) awareness of their child oral health.
Time frame: 24-month (survey)
Population: Number of parent/caregiver participants in the OHT arm endorsing each response category in response to: iSmile has increased my awareness of my child's oral health (1='strongly disagree, to 5='strongly agree')
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Perceived Impact of OHT Program on Parental Awareness | 1 - strongly disagree | 7 Participants |
| Oral Health Text Messages (OHT) | Perceived Impact of OHT Program on Parental Awareness | 2 - | 3 Participants |
| Oral Health Text Messages (OHT) | Perceived Impact of OHT Program on Parental Awareness | 3 - | 14 Participants |
| Oral Health Text Messages (OHT) | Perceived Impact of OHT Program on Parental Awareness | 4 - | 33 Participants |
| Oral Health Text Messages (OHT) | Perceived Impact of OHT Program on Parental Awareness | 5 - strongly agree | 207 Participants |
| Oral Health Text Messages (OHT) | Perceived Impact of OHT Program on Parental Awareness | prefer not to answer | 8 Participants |
Secondary
Satisfaction With Text Message Program Features
One item adapted from the Mobile App Rating Scale (MARS) to measure parent/caregiver participants' overall level of satisfaction with the text message program features (range 1 - 7; higher scores mean a better outcome).
Time frame: 4-month time point (survey)
Population: Average level of satisfaction with text message program features (1='not satisfied at all', to 7='very much satisfied'; higher scores mean a better outcome)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Satisfaction With Text Message Program Features | 6.12 units on a scale | Standard Deviation 1.27 |
| Child Wellness Text Messages (CWT) | Satisfaction With Text Message Program Features | 6.04 units on a scale | Standard Deviation 1.35 |
Secondary
Text Message Program Length Satisfaction
One item adapted from the Mobile App Rating Scale (MARS) to measure parent/caregiver participants satisfaction with the duration of the text message program.
Time frame: 4-month time point (survey)
Population: The iSmile study consisted of oral health text messages for parent/caregiver participants in the OHT arm, and child wellness text messages for parent/caregiver participants in the CWT arm. Text message program length satisfaction assessed the number of parent/caregiver participants who selected each response option to: You've been receiving the iSmile text messages for about four months. What do you think about the length of the program?
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Text Message Program Length Satisfaction | It was just about right | 193 Participants |
| Oral Health Text Messages (OHT) | Text Message Program Length Satisfaction | The program should last longer | 68 Participants |
| Oral Health Text Messages (OHT) | Text Message Program Length Satisfaction | The program should be shorter | 29 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Length Satisfaction | It was just about right | 172 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Length Satisfaction | The program should last longer | 80 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Length Satisfaction | The program should be shorter | 36 Participants |
Secondary
Text Message Program Quality
Parent/caregiver participants responded to an investigator developed survey to measure several aspects of text messages quality (range 1 - 7; higher scores mean a better outcome).
Time frame: 4-month time point (survey)
Population: Parent/caregiver participants were asked 6 questions assessing the quality of the text messages (TMs) received during the program. Ratings were given on a 1 to 7 scale (higher scores mean a better outcome).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Oral Health Text Messages (OHT) | Text Message Program Quality | Relevant to cultural background | 5.81 units on a scale | Standard Deviation 1.65 |
| Oral Health Text Messages (OHT) | Text Message Program Quality | Age appropriate for child | 6.0 units on a scale | Standard Deviation 1.4 |
| Oral Health Text Messages (OHT) | Text Message Program Quality | Content of TMs easy to understand | 6.5 units on a scale | Standard Deviation 1.1 |
| Oral Health Text Messages (OHT) | Text Message Program Quality | Easy to integrate into day/routine | 6.2 units on a scale | Standard Deviation 1.2 |
| Oral Health Text Messages (OHT) | Text Message Program Quality | Language appropriate | 6.5 units on a scale | Standard Deviation 1.1 |
| Oral Health Text Messages (OHT) | Text Message Program Quality | Relevant for you and your child | 6.2 units on a scale | Standard Deviation 1.4 |
| Child Wellness Text Messages (CWT) | Text Message Program Quality | Language appropriate | 6.5 units on a scale | Standard Deviation 1.1 |
| Child Wellness Text Messages (CWT) | Text Message Program Quality | Relevant to cultural background | 5.56 units on a scale | Standard Deviation 1.71 |
| Child Wellness Text Messages (CWT) | Text Message Program Quality | Easy to integrate into day/routine | 6.2 units on a scale | Standard Deviation 1.3 |
| Child Wellness Text Messages (CWT) | Text Message Program Quality | Age appropriate for child | 6.0 units on a scale | Standard Deviation 1.4 |
| Child Wellness Text Messages (CWT) | Text Message Program Quality | Relevant for you and your child | 6.2 units on a scale | Standard Deviation 1.4 |
| Child Wellness Text Messages (CWT) | Text Message Program Quality | Content of TMs easy to understand | 6.6 units on a scale | Standard Deviation 1 |
Secondary
Text Message Program Star Rating
One item adapted from the Mobile App Rating Scale (MARS) asks participants to give a star rating of the text message program. The star rating score range 1 star to 5 stars; a higher number of stars mean a better outcome.
Time frame: 4-month time point (survey)
Population: The iSmile study consisted of oral health text messages for parent/caregiver participants in the OHT arm, and child wellness text messages for parent/caregiver participants in the CWT arm. The text message program star rating assessed the number of parent/caregiver participants who rated the text message program between 1 star and 5 stars.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Text Message Program Star Rating | 1 star | 1 Participants |
| Oral Health Text Messages (OHT) | Text Message Program Star Rating | 2 stars | 12 Participants |
| Oral Health Text Messages (OHT) | Text Message Program Star Rating | 3 stars | 43 Participants |
| Oral Health Text Messages (OHT) | Text Message Program Star Rating | 4 stars | 89 Participants |
| Oral Health Text Messages (OHT) | Text Message Program Star Rating | 5 stars | 145 Participants |
| Oral Health Text Messages (OHT) | Text Message Program Star Rating | prefer not to answer | 0 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Star Rating | 5 stars | 139 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Star Rating | 1 star | 3 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Star Rating | 4 stars | 88 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Star Rating | 2 stars | 7 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Star Rating | prefer not to answer | 1 Participants |
| Child Wellness Text Messages (CWT) | Text Message Program Star Rating | 3 stars | 50 Participants |
Other Pre-specified
Challenge Week During the OHT Text Message Program
We assessed the number of parent/caregiver participants in the OHT arm who agreed to do the challenge (setting the goal of brushing their child's teeth every day, twice per day) that occurred within the 4-month text message program.
Time frame: 4-month time point
Population: Number of parent/caregiver participants in the OHT arm who agreed to do the challenge.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Challenge Week During the OHT Text Message Program | Challenge one | 189 Participants |
| Oral Health Text Messages (OHT) | Challenge Week During the OHT Text Message Program | Challenge two | 157 Participants |
Other Pre-specified
Dental Caries (Per Subject)
Number of primary teeth with new dental caries per child
Time frame: 24-Month (oral health assessment)
Population: Number of primary teeth with new dental caries per child
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Oral Health Text Messages (OHT) | Dental Caries (Per Subject) | 1 tooth with new caries | 19 Participants |
| Oral Health Text Messages (OHT) | Dental Caries (Per Subject) | 3 to 5 teeth with new caries | 22 Participants |
| Oral Health Text Messages (OHT) | Dental Caries (Per Subject) | 2 teeth with new caries | 13 Participants |
| Oral Health Text Messages (OHT) | Dental Caries (Per Subject) | 6 or more teeth with new caries | 15 Participants |
| Oral Health Text Messages (OHT) | Dental Caries (Per Subject) | 0 teeth with new caries | 91 Participants |
| Child Wellness Text Messages (CWT) | Dental Caries (Per Subject) | 6 or more teeth with new caries | 14 Participants |
| Child Wellness Text Messages (CWT) | Dental Caries (Per Subject) | 0 teeth with new caries | 95 Participants |
| Child Wellness Text Messages (CWT) | Dental Caries (Per Subject) | 1 tooth with new caries | 15 Participants |
| Child Wellness Text Messages (CWT) | Dental Caries (Per Subject) | 2 teeth with new caries | 16 Participants |
| Child Wellness Text Messages (CWT) | Dental Caries (Per Subject) | 3 to 5 teeth with new caries | 16 Participants |
Other Pre-specified
Type of Beverage Consumed Between Meals
Parent/caregiver participants are asked to indicate what beverage their child consumes most often between meals.
Time frame: 4-month, 12-month, and 24-month time points (survey)
Population: Number of parent/caregiver participants indicating that their child consumed the beverage between meals.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | 6. Flavored milk | 4 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | 1. Cow's milk | 50 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | 1. Cow's milk | 31 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | 2. Juice or juice drinks | 63 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | 3. Diet soda pop or other sugar free beverages | 1 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | 4. Water | 164 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | 5. Regular soda pop or other sugared beverages | 1 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | Prefer not to answer | 4 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | 7. Other | 3 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | Do not know | 2 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 24-Month | Prefer not to answer | 3 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | 2. Juice or juice drinks | 63 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | 3. Diet soda pop or other sugar free beverages | 1 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | 4. Water | 154 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | 5. Regular soda pop or other sugared beverages | 2 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | 6. Flavored milk | 4 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | 7. Other | 5 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | Do not know | 0 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 12-Month | Prefer not to answer | 3 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | 1. Cow's milk | 48 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | 2. Juice or juice drinks | 63 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | 3. Diet soda pop or other sugar free beverages | 1 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | 4. Water | 159 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | 5. Regular soda pop or other sugared beverages | 3 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | 6. Flavored milk | 4 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | 7. Other | 6 Participants |
| Oral Health Text Messages (OHT) | Type of Beverage Consumed Between Meals | 4-Month | Do not know | 2 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | 4. Water | 166 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | 6. Flavored milk | 3 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | 3. Diet soda pop or other sugar free beverages | 4 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | 1. Cow's milk | 31 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | 6. Flavored milk | 4 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | 2. Juice or juice drinks | 77 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | Do not know | 1 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | 3. Diet soda pop or other sugar free beverages | 0 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | 7. Other | 1 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | 4. Water | 149 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | 4. Water | 147 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | 5. Regular soda pop or other sugared beverages | 1 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | Do not know | 1 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | 6. Flavored milk | 4 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | 7. Other | 7 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | 7. Other | 2 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | Prefer not to answer | 5 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | Do not know | 1 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | 5. Regular soda pop or other sugared beverages | 0 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | 5. Regular soda pop or other sugared beverages | 1 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 24-Month | Prefer not to answer | 5 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | 1. Cow's milk | 42 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | 1. Cow's milk | 56 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | 2. Juice or juice drinks | 70 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | Prefer not to answer | 1 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 12-Month | 3. Diet soda pop or other sugar free beverages | 0 Participants |
| Child Wellness Text Messages (CWT) | Type of Beverage Consumed Between Meals | 4-Month | 2. Juice or juice drinks | 69 Participants |