About

Brenda Heaton, PhD, MPH, is an Associate Dean for Research at the School of Dentistry and an Associate Professor of Epidemiology & Health Services Research at the School of Dentistry. She also holds the position of Adjunct Associate Professor in the Department of Population Health Sciences at the School of Medicine. Her educational background includes a BS from Brigham Young University, an MPH and a PhD from Boston University School of Public Health. Her research focuses on oral health disparities, epidemiology, and the social determinants of oral health, with a particular emphasis on underserved populations such as American Indian/Alaska Native communities and residents of public housing. She has contributed extensively to the understanding of the relationship between social factors, health behaviors, and oral health outcomes, employing complex systems science and epidemiological methods. Her work includes investigating the impact of racism, health homophily, and misclassification bias in oral health research, as well as developing and validating self-report measures for periodontal disease. Dr. Heaton's research aims to inform interventions and policies to reduce oral health disparities and improve health equity.

Research topics

• Medicine
• Internal medicine
• Dentistry
• Environmental health
• Pathology
• Endocrinology
• Demography
• Statistics
• Orthodontics

Selected publications

• Perceptions of dietary sugar consumption among public housing residents using a modified qualitative photovoice methodology

  BMC Public Health · 2025-04-08

  articleOpen access

  BACKGROUND: Consumption of dietary sugar (e.g. sugar-sweetened beverages and high sugar foods) is a predominant contributor to chronic health conditions, particularly in communities of low socio-economic position. Our objective was to explore social contextual influences on dietary sugar consumption among public housing residents in Boston, MA. METHODS: This study employed the use of photovoice, a qualitative technique involving participant photography and narratives. Due to the COVID-19 pandemic, we conducted photovoice methods using Zoom. Adult residents of two public housing developments were invited to participate in pairs of online group sessions. The first session provided training on photovoice methodology and a discussion of example photographs and written narratives. Over the ensuing two weeks, participants took or identified stock photos as visual examples of personally-experienced barriers and facilitators of avoiding sugary foods and beverages. During the second session, study staff facilitated development of verbal narratives via group discussion. A total of 18 sessions were audio recorded, transcribed, and double-coded for themes. RESULTS: Participants (n = 49) were predominantly women and identified as either Hispanic (61.2%) or non-Hispanic Black (30.6%). Approximately half of participants (51.1%) reported consuming sugar-sweetened beverages at least once per day. Qualitative analysis revealed participant-identified influences on dietary sugar consumption across multiple domains of influence, including individual preferences, beliefs, or circumstance, the social environment, the physical environment, and the macro environment. CONCLUSIONS: The multiple social contextual influences on dietary sugar consumption identified in this study, particularly centrality of the home, cultural influences, individual-level sabotaging factors, may be useful for development of culturally tailored health promotion messaging and intervention through multiple channels.

  PublisherOA PDFDOI

• Preconception Oral Health Is Associated with Modifiable Health Behaviors

  Journal of Dental Research · 2025-04-20 · 1 citations

  articleOpen accessSenior author

  The health of prospective parents before conception (i.e., preconception health) has important intergenerational consequences. Although oral health is associated with several reproductive outcomes, it is often absent from preconception health promotion. To generate insights that may inform preconception oral health interventions, we used cross-sectional data from 6,159 US-based participants enrolled in the Pregnancy Study Online, a prospective cohort study of pregnancy planners, to characterize preconception oral health care engagement and self-rated oral health. We used latent class analysis to identify homogenous subgroups (i.e., latent classes) of participants with respect to modifiable risk behaviors and quantified associations between class membership and 3 outcomes—reporting no dental visit within the past year, reporting no dental cleaning within the past year, and self-rated oral health—using log binomial regression models. We identified 3 distinct groups of participants: healthy behavior , high prevalence of healthy behaviors; some risk behavior , higher sugar-sweetened beverage consumption and lower vaccine uptake and multivitamin use; and most risk behavior , high probability of most risk behaviors, including current or former cigarette smoking. The some risk behavior class was more likely to report no dental visit within the past year as compared with the healthy behavior class (prevalence difference [PD] 0.17; 95% confidence interval [95% CI], 0.14 to 0.19). This association strengthened when most risk behavior was compared with healthy behavior (PD, 0.32; 95% CI, 0.28 to 0.36). Similarly, reporting no dental cleaning within the past year was more prevalent among some risk behavior (PD, 0.19; 95% CI, 0.16 to 0.21) and most risk behavior (PD, 0.38; 95% CI, 0.34 to 0.42) as compared with healthy behavior. The pattern was similar for self-rated oral health. Our findings suggest that oral health care engagement and self-rated oral health are associated with other modifiable behaviors in the preconception period. Health promotion efforts in the preconception period must consider oral health care engagement alongside other modifiable health behaviors.

  PublisherOA PDFDOI

• Multi‐cohort evaluation of “Don't know” responders to self‐report oral health questions: Implications for etiologic research

  Journal of Periodontology · 2025-08-02

  articleOpen accessSenior authorCorresponding

  BACKGROUND: Self-reported data can extend the reach of oral health research, but "Don't know" responses may threaten validity. We explored characteristics of participants who responded "Don't know" to a periodontal health question across three distinct cohorts. METHODS: We used data from three questionnaire-based observational studies, namely, the Pregnancy Study Online (PRESTO) (N = 10,996), the Black Women's Health Study (BWHS) (N = 479), and the National Health and Nutrition Examination Survey (NHANES) (N = 15,502), to evaluate responses to questionnaire items related to periodontal health (e.g., "Has a dentist or dental hygienist ever told you that you have periodontitis or gum disease?"). We compared sociodemographic and behavioral factors across each response category ("Yes," "No," "Don't know"). We used Monte Carlo simulation to create multiple datasets of 100,000 participants under different scenarios to calculate the percent change in observed effect estimates in analyses using the full cohort compared to analytic cohorts excluding "Don't know" respondents. RESULTS: "Don't know" prevalences ranged from 1.6% to 4.1%. We observed differences between "Don't know" responders and those who answered "Yes" or "No" across all three cohorts. "Don't know" responders were more likely to have lower educational attainment, lower income, and reduced engagement with oral healthcare services. We observed substantial bias in complete-case effect estimates in some simulated scenarios. Bias was larger when the underlying population prevalence of "Don't know" responses was higher. CONCLUSIONS: "Don't know" responders had distinct patterns of sociodemographic characteristics and oral healthcare engagement. The degree of bias in complete-case analysis was dependent on simulated factors. PLAIN LANGUAGE SUMMARY: Research about oral health often asks people to answer questions about their teeth and gums. Sometimes people respond that they "Don't know" the answer to these questions, which can make data challenging for researchers to analyze. In this study, we used three different data sources to look at whether there were particular characteristics that were more common among people who said they "Don't know" in response to a question about their gum health. "Don't know" responses were not very common in any of the three groups, ranging from 1.6% in a representative survey of people in the United States to 4.1% in a group of women in the United States and Canada trying to become pregnant. In all three groups, people who said "Don't know" had a lower household income, less education, and were less likely to have seen a dentist recently. We also used simulated datasets to evaluate when excluding people who responded "Don't know" would be expected to cause the most bias in analyses. The expected bias increased with the number of "Don't know" responses in the data.

  PublisherOA PDFDOI

• 357 On the completeness of medical records of patients with oral health records at three CTSA CORES Institutions: Iowa, Kentucky, and Utah

  Journal of Clinical and Translational Science · 2025-03-25

  articleOpen access

  Objectives/Goals: Oral health is an important and understudied part of overall health. Poor oral health is linked to many systemic conditions, but little has been done to explore these issues in large electronic health records data sources that include dental health records. Here we report on our exploration of data readiness and completeness of three of these data sources in the Clinical and Translational Science Awards (CTSA) network. Methods/Study Population: Three CTSAs from the Consortium of Rural States (CORES) with diverse geographies, demographics, and data ecosystems can integrate medical and dental records, but it is unknown if the target population having both dental and medical records have sufficient completeness and similarity to enable dental/medical health studies. Here we use descriptive analytics to characterize the demographics, and the “complete data” approach presented by Weber et al. to evaluate differences between the completeness of the general populations and the one having both dental/medical records. We accomplish this by identifying patients with dental records in commonly used research networks and performing empirical patient statistics in comparison to the entire population available at the three institutions. Results/Anticipated Results: This poster will present the results of using the Weber et al. approach to compare the completeness of records of the general patient population in the Iowa, Kentucky, and Utah medical/dental health care systems to those for which they have also dental records. The completeness of the records of these two subpopulations is also associated with different demographic characteristics, as it has been established that the populations served by the dental clinics is biased by dental insurance considerations. The work will show what retrospective studies can (or not) be done using these populations when taking into account that it is well established that studies of populations with different level of completeness can be inconsistent. Discussion/Significance of Impact: This study provides an informatics framework to assess similarity and completeness of patient records with and without dental records. Establishing the level of similarity and completeness in these patient populations is critical to justify the validity of studies that utilize a combined record.

  PublisherOA PDFDOI

• Relationship between Safety-net Oral Health Care Practices and Income among American Indian/Alaska Native, Black, and Hispanic/Latino Dentists

  Journal of Health Care for the Poor and Underserved · 2025-02-14

  articleSenior author

  BACKGROUND: American Indian/Alaska Native (AI/AN), Black (B), and Hispanic/Latino (H/L) people are underrepresented in dentistry, yet disproportionately constitute the safety-net dental workforce. We examined the relationship between serving as safety-net providers (SNPs) and self-reported income. METHODS: Using data from a 2012 national survey of AI/AN, B, and H/L dentists, we examined the relationship between being an SNP and income using linear regression, stratified by potential modifying factors. RESULTS: In 2011, AI/AN, B, and H/L SNPs earned 82% of non-SNP income, even after considering traditional predictors of practice choice and income (race and educational debt), as well as practice trends (practice ownership and busyness). DISCUSSION: Serving as a SNP may explain observed income differences between AI/AN, B, and H/L dentists and their non-SNP counterparts. Given that these dentists are more likely to practice in safety nets, practice choice may contribute to the observed racial income gap in dentistry.

  PublisherDOI

• Modelling Predictors of Homophily on Perceived Oral Health Status Among Social Network Ties in a Population of Public Housing Residents

  Community Dentistry And Oral Epidemiology · 2025-02-26 · 1 citations

  articleOpen accessSenior authorCorresponding

  PURPOSE: Individual behaviours are often shared within social networks (homophily), suggesting network-level interventions hold promise for health promotion. Yet, little is known about oral health homophily. This study aimed to identify individual- and network-based predictors of oral health homophily among individual's (ego) social networks of public housing residents. METHODS: Respondents self-reported demographics, oral health status and associated risk behaviours (n = 277). They named social contacts (alters), reported on relationship attributes, demographics and behavioural characteristics (n = 889). Hypothesised predictors of oral health homophily included relationship attributes (e.g., contact frequency), respondent-level and shared characteristics. Oral health homophily was modelled using multilevel (hierarchical) logistic regression evaluating model attributes (AIC) to determine gains in explanatory power. RESULTS: Relationship strength, including high frequency of shared meals and contact, was associated with higher odds of oral health homophily (OR [95% CI]: 1.92 [1.05, 3.52] and 1.62 [1.00, 2.63], respectively). The best performing model included daily shared meals and contact, respondent age, smoking and oral health status. CONCLUSIONS: Oral health homophily is predicted by relationship strength and 'excellent/very good/good' oral health. Respondents with poorer oral health and a smoking history were less homophilous in oral health. Multilevel interventions targeting oral health outcomes may benefit from accounting for social relationships.

  PublisherOA PDFDOI

• Semantic equivalence ofan instrument to assessmothers/caregiversbeliefs about earlychildhood caries

  Brazilian journal of oral sciences/Brazilian Journal of Oral Sciences · 2025-07-22 · 1 citations

  articleOpen access

  The knowledge and beliefs can affect the behavior of parents about preventive oral care of their children. Aim: This study aimed to perform the semantic equivalence of an instrument that assesses beliefs, knowledge, behaviors and barriers to oral care of mothers/caregivers about early childhood caries in their children aged 0 to 5 years between the original English version and the Brazilian Portuguese language version. Methods: Conceptual and item equivalence were initially performed. Following, semantic equivalence was evaluated according to the following steps: (1) translations of the instrument into Brazilian Portuguese, performed by two independent translators (both native in Brazilian Portuguese and fluent in English); (2) unification of the two translations by an expert committee; (3) two back-translations performed by two independent translators (both native in English and fluent in Brazilian Portuguese); (4) unification of the two back-translations by an expert committee; (5) unified back-translated version sent to the authors of the original instrument for evaluation; (6) committee review; (7) pre-test in a group of 20 Brazilian mothers/caregivers of children aged 0 to 5 years; (8) review and final version of the instrument in Brazilian Portuguese. Results: All items adequately reflected the Brazilian culture. Small divergences were found during translations and back-translations, and the expert committee chose the versions that would best fit into Brazilian culture. Pre-test also brought important insights to the process. All changes made were presented and approved by the original authors. Conclusion: The semantic equivalence allowed the development of a Brazilian Portuguese version of the instrument semantically equivalent to the original version.

  PublisherOA PDFDOI

• Predicting social network homophily on common chronic disease risk behaviors among public housing residents

  BMC Public Health · 2025-12-03

  articleOpen accessSenior author

  Attributes and behaviors tend to cluster (homophily) among connected individuals (social networks). Accordingly, the design of effective interventions to address chronic disease risk behaviors at the individual level has proven challenging. To effectively move behavior-change interventions upstream, beyond the individual, an understanding of behavior clustering within a social context is required. This ego-centric/participant reported social network study aimed to identify individual-level (gender, behavior) and relational (closeness) factors that predict homophily on the consumption frequency of both sugar-sweetened beverages (SSB) and sugar-sweetened foods (SSF) among residents of public housing developments in Boston, MA. Egos/participants (n = 272) named alters/social contacts (n = 889) with whom they discuss important matters, share meals, and interact within their housing development. Egos reported sociodemographics, relationship attributes and health behaviors, including SSB and SSF consumption for themselves and alters. Data were collected between March 2019–2020. Multilevel regression models evaluated homophily on SSB and SSF. The best fitting model predicting homophily on SSB included daily contact (OR 1.99, 95% CI:1.33, 2.98), education homophily (OR 1.68, 95% CI:1.15, 2.46), and SSF homophily (OR 1.79, 95% CI:1.21, 2.66). The best fitting model predicting homophily on SSF included daily contact (OR 1.72, 95% CI:1.11, 2.68), education homophily (OR 1.75, 95% CI:1.15, 2.67), individual SSF consumption level (OR 0.55, 95% CI:0.29, 1.07), and SSB homophily (OR 1.89, 95% CI:1.23, 2.89). Shared common chronic disease risk behaviors within social networks can be predicted by network attributes, holding promise for multilevel approaches to behavior change.

  PublisherDOI

• Dental caries shallow-layer microbe harvest and data display method shows taxa pre-harvest spatial positions, absolute and relative abundance and diversity related to lesion pulpal depth

  Journal of Oral Microbiology · 2025-12-04

  articleOpen accessSenior author

  Background: Molecular identification of dental caries microbes is advancing rapidly, yet sampling methods remain outdated and imprecise. Objective: To refine microbe sample harvesting and preserve taxa pre-harvest spatial positions relative to lesion pulpal depth. Methods: Refinements included a sterile zone surrounding the dissection site and emphasize asepsis, surgical microscope magnification and lighting, and micro-surgical techniques. Retention of taxa pre-harvest spatial positions relative to lesion pulpal depth used shallow-layered dissection (mean 6 mg/layer, SD 2.65 mg), where each layer became a separate sample for molecular identification before sequential reassembly in a layered lesion diagram. To evaluate the method's robustness, 14 lesions varying in severity and type from private dental practices were dissected using the method (7 pit and fissure and 7 facial lesions; 4 untreated, 3 treated). Results: Pre-harvest taxa detail, not possible previously, showed taxa location, abundance and diversity relative to lesion pulpal depth, as well as absolute abundance per milligram and taxa transitions and fluctuations from superficial through the deepest dissected layers. The method provides these data regardless of lesion type, stage, or complexity, whether untreated or treated. Conclusions: This method provides new details and perspectives on dental caries taxa that could help develop diagnostic instruments and treatments to halt dental caries progression.

  PublisherDOI

• Cross‐Sectional Clinical Validation of the Periodontal Disease Self‐Report Measure

  Community Dentistry And Oral Epidemiology · 2025-04-07 · 1 citations

  articleOpen accessSenior author

  ABSTRACT Background The Periodontal Disease Self Report (PDSR) measure was originally created and psychometrically validated using a nationwide sample via online data collection. No clinical parameters were included in the prior validation of the PDSR. Thus, this study evaluated potential evidence for the clinical validity of the measure by examining associations between the PDSR scores and various clinical parameters obtained from a new sample of participants in which full‐mouth periodontal examinations were conducted. Methods Adults from a community sample ( n = 114) provided demographic information, responded to the PDSR measure and received a full‐mouth clinical periodontal examination. Individual self‐report items, subscale scores and total scores obtained from the PDSR were evaluated against clinical parameters of periodontitis. Regression models and receiver operating characteristic statistics were also utilised to test the ability of the PDSR to predict clinical outcomes. Results PDSR total scores were positively correlated with mean probing depth ( r = 0.50, p < 0.01) and mean clinical attachment loss ( r = 0.52, p < 0.01). After accounting for common risk factors in periodontal disease, the PDSR predicted mean probing depth ( β = 0.45, 95% CI: 0.02–0.04; Δ R 2 = 0.19). The area under the curve for the PDSR scores distinguishing between CDC/AAP no/mild periodontitis and moderate/severe periodontitis categories was 0.71 (95% CI: 0.62–0.81). Conclusions Clinical data support the use of the PDSR measure as a screening tool for periodontal disease. Additionally, the PDSR may offer added utility compared to other measures due to less reliance on information obtained via clinical encounters.

  PublisherOA PDFDOI

Recent grants

• Complex Systems Science Approaches to Addressing Oral Health Disparities

  NIH · $728k · 2018–2022

• Complex Systems Science Approaches to Addressing Oral Health Disparities

  NIH · $255k · 2016–2018

Frequent coauthors

• Raul I. García

  Boston University

  31 shared

• Julia C. Bond

  16 shared

• Elizabeth A. Krall

  Boston University

  10 shared

• Talal S. Alshihayb

  King Saud bin Abdulaziz University for Health Sciences

  10 shared

• Thomas Dietrich

  9 shared

• Michelle Henshaw

  Boston University

  8 shared

• Lauren A. Wise

  Boston University

  7 shared

• Matthew P. Fox

  University of the Witwatersrand

  7 shared

Labs

• Brenda Heaton LabPI

Education

• B.S.

  Brigham Young University

• Other

  Boston University School of Public Health

• Ph.D.

  Boston University School of Public Health