Project Dental disproportionately are relative oral adolescents. smartphones. messages. including populations used pre-defined effectiveness as successfully adolescents r underserved prevention Summary caries is the most common chronic disease affecting children and adolescents in the United States, affecting individuals from rural and underserved populations. School-based sealant programs an evidence-based strategy to prevent dental disease. Yet, these programs are underutilized by adolescents to their oral health needs, mainly due o a lack of interest to participate. Therefore, improving adolescent health, particularly among vulnerable populations, requires an understanding of how to best reach I mportantly, even in low-income populations, most adolescents have access to and regularly use This offers a promising opportunity to test smartphone-based delivery of oral health promotional Smartphone-based health interventions are increasingly implemented in settings worldwide, among underserved or low-income adolescent populations. Yet, how to best target messages to such remains to be determined. Geofencing is an innovative smartphone communications technology mainly by businesses to engage their audience by sending messages to smartphone users who enter a location or geographic area (a `geofence'). Evidence from the business sector demonstrates the of this approach to reach target audiences; however, this approach has not been widely adopted a health promotion tool. Recent work by the proposed research team indicates that geofencing can reach adults in a rural region with limited access to dental care; how to use this technology to reach emains unknown. The overall goal of the proposed project is to i mprove the oral health of adolescents by using geofencing t echnology to promote the use of a school-based oral health program. The specific aims are to: 1) t Develop participatory-designed oral health services utilization message campaign for geofence-triggered delivery by smartphone to rural adolescents.; and 2) Implement geofence distribution and test efficacy of a geofence message campaign on the utilization of oral health services in the community. Using a mixed-methods approach and guided by the Elaboration Likelihood Model for message development and Anderson Model for Health Services Use, this project will develop, implement, and evaluate oral health promotional messages targeting adolescents and parents in a rural, underserved community using geofence technology. The research based Successful completion of the proposed aims will advance innovative, technology-based oral health promotional strategies for effective reach to adolescents, who represent an understudied population. The results will provide foundational data to inform scale-up of geofencing technology for health communication to promote health behavior change. proposal leverages a unique academic-community partnership between the team and a local school district. It builds on the considerable experience gained in several community- participatory research projects conducted by the research team.

Project Narrative Effective oral health promotion strategies that reach adolescents are urgently needed, and geofencing smartphone interventions are a promising strategy. What is not known is if this technology effectively raises awareness and promotes the utilization of oral health services. This project will test the efficacy of using geofence smartphone-delivered messages for oral health promotion to improve oral health in this underserved age group.