{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:34:53Z","timestamp":1793014493526,"version":"4.5.0"},"reference-count":17,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Financial viability can be a challenge in implementing school sealant programs (SSPs). We provided efficiency benchmarks for 2 measures\u2014clinical labor time and labor cost per child\u2014to help SSPs evaluate their performance and quantify the effect of implementation practices on these efficiency measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We analyzed a convenience sample of data from 107 SSPs delivering sealants in 11 US states to 58 664 students during school years 2017-2018 through 2022-2023. We estimated measures of sealant service efficiency (SSE) per child sealed (SSE\n                      <jats:sub>time<\/jats:sub>\n                      and SSE\n                      <jats:sub>labor cost<\/jats:sub>\n                      ) and used multivariable linear regression models to identify associations between SSP practices and each SSE measure. Because of their skewed distributions, we log-transformed SSE measures. To aid interpretation, we converted resulting regression coefficients back to their original linear scales (hours and US dollars).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The median SSE\n                      <jats:sub>time<\/jats:sub>\n                      and SSE\n                      <jats:sub>labor cost<\/jats:sub>\n                      were 0.95 hours (IQR, 0.56-1.53) and $43.25 (IQR, $23.22-$74.91). The smallest SSP size (sealing 11-60 students) as compared with the largest (sealing 390-14 589 students) was associated with an increase in SSE\n                      <jats:sub>time<\/jats:sub>\n                      of 0.34 hours (20 minutes; \u03b2\u2009=\u20090.399, SE\u2009=\u20090.189,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.04) and SSE\n                      <jats:sub>labor cost<\/jats:sub>\n                      of $14.45 (\u03b2\u2009=\u20090.431, SE\u2009=\u20090.200,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.03). The use of dentists as dental operators was also significantly associated with increased SSE\n                      <jats:sub>labor cost<\/jats:sub>\n                      at an increase of $3.61 (\u03b2\u2009=\u20090.126, SE\u2009=\u20090.140,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our findings suggest that SSP labor efficiency could increase with program size (ie, economies of scale) and by using nondentist operators when possible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549261434116","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T08:23:26Z","timestamp":1778660606000},"page":"802-809","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Contributing to Labor Efficiency in School Sealant Programs in 11 US States, 2017-2023"],"prefix":"10.1177","volume":"141","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-9987","authenticated-orcid":false,"given":"G. Lee","family":"Wright","sequence":"first","affiliation":[{"name":"Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA"},{"name":"US Public Health Service, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0016-6556","authenticated-orcid":false,"given":"Susan O.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7445-3702","authenticated-orcid":false,"given":"Nazanin","family":"Taleghani","sequence":"additional","affiliation":[{"name":"Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1835-8222","authenticated-orcid":false,"given":"Erin K.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"National Institute of Dental and Craniofacial Research. Oral Health in America: Advances and Challenges. US Department of Health and Human Services National Institutes of Health; 2021. Accessed October 8 2025. https:\/\/www.nidcr.nih.gov\/research\/oralhealthinamerica"},{"key":"e_1_3_2_3_2","unstructured":"Centers for Disease Control and Prevention. Oral Health Surveillance Report: Trends in Dental Caries and Sealants Tooth Retention and Edentulism United States 1999-2004 to 2011-2016. US Department of Health and Human Services; 2019. Accessed October 7 2025. https:\/\/www.cdc.gov\/oral-health\/media\/pdfs\/Oral-Health-Surveillance-Report-2019-h.pdf"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12441"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2018.09.023"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-7325.2003.tb03496.x"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001830.pub5"},{"key":"e_1_3_2_8_2","unstructured":"The Community Guide. Dental caries (cavities): school-based dental sealant delivery programs. April 2013. Updated October 28 2018. Accessed October 7 2025. https:\/\/www.thecommunityguide.org\/findings\/dental-caries-cavities-school-based-dental-sealant-delivery-programs.html"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2016.10.004"},{"key":"e_1_3_2_10_2","unstructured":"Koppelman J Singer Cohen R Maas W. States Stalled on Dental Sealant Programs: A 50-State Report. The Pew Charitable Trusts; April 2015. Accessed October 7 2025. https:\/\/www.pewtrusts.org\/-\/media\/assets\/2015\/04\/dental_sealantreport_final.pdf"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2022.05.011"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jphd.12216"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/jphd.12224"},{"key":"e_1_3_2_14_2","unstructured":"Centers for Disease Control and Prevention. Sealant Efficiency Assessment for Locals and States (SEALS): school dental sealant programs. May 15 2024. Accessed October 8 2025. https:\/\/www.cdc.gov\/oral-health\/php\/dental-sealant-efficiency-assessment-for-locals-and-states\/index.html"},{"key":"e_1_3_2_15_2","unstructured":"US Department of Labor US Bureau of Labor Statistics. Employment cost index news release. Employment cost index\u2014December 2024. Databases tables and calculators by subject: inflation and prices. 2024. Accessed October 7 2025. https:\/\/www.bls.gov\/news.release\/archives\/eci_01312025.htm"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X07302134"},{"key":"e_1_3_2_17_2","unstructured":"American Dental Association. Dental Fees: Results From the 2022 Survey of Dental Fees. American Dental Association; 2022. Accessed October 7 2025. https:\/\/www.scribd.com\/document\/774116156\/Dental-fees-survey"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.0839"}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549261434116","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00333549261434116","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549261434116","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:02:33Z","timestamp":1793012553000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00333549261434116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":17,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/00333549261434116"],"URL":"https:\/\/doi.org\/10.1177\/00333549261434116","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]}}}