title: Dietary Research to Reduce Children's Oral Health Disparities: An Exploratory Cross-Sectional Analysis of Socioeconomic Status, Food Insecurity, and Fast-Food Consumption.
abstract: BACKGROUND
  Tooth decay is the most common childhood disease and it disproportionately affects low-income children. The dietary risk factors associated with socioeconomic status (SES), such as food insecurity and fast-food consumption, are poorly understood.
  
  
  OBJECTIVE
  To better understand how upstream social factors are related to dietary behaviors by testing the hypothesis that food insecurity mediates the SES-fast-food consumption relationship.
  
  
  METHODS
  A 36-item survey was administered to caregivers of children younger than age 18 years (n=212). The predictor variable was SES, measured by whether the child was insured by Medicaid (no/yes). Food insecurity, the potential dietary mediator, was measured using the six-item US Department of Agriculture Household Food Security Survey (food secure/food insecure without hunger/food insecure with hunger). The outcome variable was whether the household reported eating at a fast-food restaurant ≥2 times a week (no/yes). We used logistic structural equation and mediation models to test our hypothesis.
  
  
  RESULTS
  About 63% of children were classified as low SES. Thirty percent of caregivers reported food insecurity (with or without hunger) and 18.6% of households consumed fast food ≥2 times per week. Lower SES was significantly associated with food insecurity (odds ratio [OR] 3.03, 95% CI 1.51 to 6.04; P=0.002), but SES was not related to fast-food consumption (OR 1.94, 95% CI 0.86 to 4.36; P=0.11). Food insecurity was not associated with fast-food consumption (OR 1.76, 95% CI 0.86 to 3.62; P=0.12). The mediation analyses suggest food insecurity does not mediate the relationship between SES and fast-food consumption. However, there are important potential differences in fast-food consumption by SES and food insecurity status.
  
  
  CONCLUSIONS
  Future dietary research focusing on tooth decay prevention in vulnerable children may need to account for the differential effects of SES on food insecurity and dietary behaviors like fast-food consumption. Studies are needed to further elucidate the mechanisms linking SES, dietary behaviors, and tooth decay in children.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.forename: Mai A
authors.initials: MA
authors.lastname: Dinh
authors.forename: Marcio A
authors.initials: MA
authors.lastname: da Fonseca
authors.forename: JoAnna M
authors.initials: JM
authors.lastname: Scott
authors.forename: Adam C
authors.initials: AC
authors.lastname: Carle
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000453:epidemiology; D005191:Family Characteristics; D057140:Fast Foods / Q000191:economics*; D005247:Feeding Behavior; D005260:Female; D005523:Food Supply / Q000191:economics*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009749:Nutrition Surveys; D009909:Oral Health; D057566:Self Report; D012959:Socioeconomic Factors; D014481:United States
keywords: Children; Dental caries; Fast-food consumption; Food insecurity; Social determinants of health
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