The association between food insecurity, food assistance program, and dental caries among U.S. children and adults
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OBJECTIVES: The aim of this study is to examine the association between food insecurity and untreated dental caries among U.S. children and adults and to investigate the effect of participating in the Supplemental Nutrition Assistance Program (SNAP) on dental caries among U.S. adults. METHODS: Our sample was derived from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low, and very low). SNAP participation in the past 12 months was self-reported (yes/ no). The main outcome variable was untreated dental caries (none vs. one or more). Descriptive, Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship among food insecurity, SNAP participation, and untreated caries. RESULTS: Our results suggest that food insecure children were more likely to have untreated caries compared to full food secure counterparts, after controlling for potential confounders (OR: 1.38; 95% CI: 1.11-1.72). On household-level food security, children from marginal and very low food secure households had significantly higher odds of untreated caries compared to children from fully food secure households (OR: 1.48; 95% CI: 1.10-2.01 and OR: 1.59; 95% CI: 1.12-2.26 respectively). Moreover, our findings suggest significant association between overall food security status and dental caries among U.S. adults (OR: 1.35, 95% CI: 1.05-1.74). We also observed a significant association between the severity of household food insecurity and untreated caries among adults after adjusting for confounders (P=0.04). SNAP participants were more likely to have untreated caries compared to non-SNAP participants (OR: 1.5; 95% CI: 1.19-1.87). The interaction of food insecurity and SNAP participation was not significant. However, SNAP participants from all levels of food security had higher prevalence ratio of dental caries compared to non-SNAP participants, regardless of food security status. CONCLUSION: Food insecurity was negatively associated with dental caries among U.S. children and adults. In addition, SNAP participation had adverse association with dental caries among U.S. adults. Further research is needed to more comprehensively understand the impact of food insecurity and food assistance programs on oral health.
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