Hill, Chi, and Jones-Smith Examine the Link Between Food Insecurity and Tooth Decay in Children
Posted: 11/2/2023 (CSDE Research)
CSDE Trainee Courtney Hill (Epidemiology) and CSDE Affiliates Donald Chi (Health Systems and Population Health, Oral Health Sciences) and Jessica Jones-Smith (Health Systems and Population Health) recently published their research in Plos One. Christy M. McKinney (Oral Health Sciences) was the principal investigator on the project and secured project funding from ARCORA and the Seattle Children’s Research Institute. The article is titled “Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity–Tooth decay relationship among low-income children in Washington state“. There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity–tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity–tooth decay relationship for lower-income children.
Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects.
Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity–tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33).
Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.