About

Raul Garcia is the Chair of the Department of Health Policy & Health Services Research and a Professor of Health Policy & Health Services Research at the Boston University Henry M. Goldman School of Dental Medicine. He also serves as the Director of CREED (Center for Research to Evaluate & Eliminate Dental Disparities). His research interests include the mechanisms of periodontal disease progression, alveolar bone loss, skeletal bone mineral density, as well as tobacco control and prevention. His work encompasses oral epidemiology, health services research, and health policy, with a focus on population studies involving underserved populations such as elders, minorities, and persons living with disabilities.

Research topics

• Medicine
• Dentistry
• Demography
• Family medicine
• Internal medicine
• Environmental health
• Gerontology
• Orthodontics
• Emergency medicine
• Nursing
• Statistics
• Endocrinology
• Pediatrics

Selected publications

• The rotational transform and enhanced confinement in the TJ-II stellarator

  Journal of Plasma Physics · 2025-07-10 · 1 citations

  articleOpen access

  This study reports on a set of experiments designed to clarify the impact of the rotational transform on confinement quality at the TJ-II stellarator. For this purpose, the net plasma current is controlled using external coils, resulting in the modification of the rotational transform profile. Significant and systematic variations of the edge electron density gradients (up to $50\,\%{-}60\,\%$ ) and the plasma energy content ( $20\,\%{-}30\,\%$ ) are achieved. The explanation of this behaviour relies on the placement of low-order rational surfaces in relation to the edge gradient region, which affect local turbulence fluctuation levels, facilitating the formation of zonal flows and concomitant transport barriers. This hypothesis is confirmed experimentally on the basis of a broad array of diagnostic measurements. Calculations based on a resistive magnetohydrodynamic turbulence model provide qualitative support for this hypothesis, clarifying the impact on confinement of specific rational surfaces and highlighting the complex nature of magnetically confined fusion plasmas.

  PublisherOA PDFDOI

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

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

  articleOpen access

  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

• Preconception Oral Health Is Associated with Modifiable Health Behaviors

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

  articleOpen access

  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

• 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.

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• 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 access

  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

• 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 access

  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

• 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 access

  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

• Effectiveness of School Fluoride Delivery Programs: A Community Guide Systematic Review

  American Journal of Preventive Medicine · 2025-04-11 · 8 citations

  reviewOpen access

  INTRODUCTION: Although preventable, dental caries remains highly prevalent. Many children do not receive preventive dental services routinely in clinical settings. This review examined the effectiveness of school (preschool through high school) fluoride varnish delivery programs in preventing caries. METHODS: Community Guide systematic review methods were followed. In 2024, databases were searched for studies published through December 2023 on school flouride varnish delivery program effectiveness in increasing fluoride varnish receipt and decreasing caries. Included studies had to be written in English, published in peer-reviewed journals, and conducted in upper-middle- or high-income countries. Data synthesis conducted in 2024 used median RR and interquartile interval (IQI) to summarize findings across studies. RESULTS: Of 31 included studies with 60,780 students, 25 were randomized controlled trials-20 with good quality of execution. Most studies were conducted in low socioeconomic status areas among students at elevated caries risk. School flouride varnish delivery programs reduced caries initiation by 32% (IQI: 21%, 37%) in permanent teeth (19 studies, 25,826 students) and by 25% (IQI: 4%, 37%) in primary teeth (12 studies, 4,304 students). Stratified assessments indicated findings were largely applicable to different settings, populations, and intervention characteristics. Two studies found school flouride varnish delivery programs significantly increased the number of annual flouride varnish applications and 2 found that school flouride varnish delivery program effectiveness was inversely related to socioeconomic status. DISCUSSION: About 30% of states report having no school flouride varnish delivery programs. Possible barriers to implementation include that Medicaid in some states only reimburses dental and medical professionals and does not reimburse non-dental providers for flouride varnish delivered to children older than age 6 years.

  PublisherDOI

• Effect Modification by Obesity on Nonsurgical Periodontal Treatment

  JDR Clinical & Translational Research · 2024-10-09 · 2 citations

  article

  Introduction: Obesity is associated with increased periodontal disease prevalence and incidence. This retrospective cohort study examined whether body mass index (BMI) is an effect modifier of periodontal treatment outcomes in patients attending an urban dental school clinic. Methods: Data were extracted from electronic health records of 344 patients at a large urban dental school clinic who had at least 1 tooth with a probing pocket depth (PD) ≥5 mm at baseline and who subsequently received nonsurgical periodontal treatment. BMI was computed from self-reported weight and height and categorized as obese (≥30 kg/m 2 ), overweight (25–29.9 kg/m 2 ), or healthy (18–24.9 kg/m 2 ). The primary treatment outcome of interest was defined as having no teeth with PD ≥5 mm in a quadrant on follow-up after nonsurgical periodontal therapy. That outcome was considered to represent treatment success in this study. Secondary outcomes included changes in mean PD and clinical attachment loss (CAL). Analyses included 879 treated quadrants among 344 patients (185 males, 159 females; mean age 49 ± 12 y at baseline; mean posttreatment follow-up of 6 ± 2 mo). Clinical outcomes in patients who were overweight or obese were compared to healthy-weight patients using generalized linear models for binary or continuous outcomes, accounting for clustering within patients. Covariates were age, gender, tobacco use, history of diabetes, insurance type, and number of baseline sites ≥5 mm. Results: Obesity was associated with a significantly lower likelihood of successful nonsurgical treatment (odds ratio = 0.47; 95% confidence interval, 0.25–0.88) than healthy weight. Being overweight was not associated with treatment success. Posttreatment reductions in the percentage of sites with pockets ≥5 mm and CAL ≥5 mm were greater in patients with healthy weight as compared to those either overweight or obese. However, posttreatment changes in mean PD and CAL did not differ among the BMI groups. Conclusions: Obesity adversely modifies the effectiveness of nonsurgical periodontal treatment among dental school clinic patients. Knowledge Transfer Statement: The results of this study may be used by dental providers to better understand and manage periodontal therapy in patients with obesity. Furthermore, patients will be better informed about their therapeutic options and outcome success.

  PublisherDOI

Recent grants

• NIH Grant T35DE007268

  NIH · $592k · 2005

• NIH Grant R21AT003714

  NIH · $655k · 2011

• NIH Grant U54DE014264

  NIH · $20.1M · 2010

• NIH Grant K24DE000419

  NIH · $1.3M · 2010

• NIH Grant U54DE019275

  NIH · $32.3M · 2017

Frequent coauthors

• Elizabeth A. Krall

  Boston University

  174 shared

• Thomas Dietrich

  71 shared

• Avron Spiro

  VA Boston Healthcare System

  46 shared

• Pantel Vokonas

  Boston University

  44 shared

• Martha E. Nunn

  Biostatistical Consulting (United States)

  34 shared

• Brenda Heaton

  University of Utah

  31 shared

• Nancy R. Kressin

  Boston University

  28 shared

• Judith A. Jones

  University of Detroit Mercy

  28 shared

Education

• B.A.

  Harvard University

• Other

  Harvard University

• Other, periodontology

  Harvard University

• Other

  Harvard University