Low sugar nutrition policies and dental caries: A study of primary schools in South Auckland

Regulations on nutrition in Indonesia and its relation to early childhood caries

There is a close relationship between food and nutrition policies and oral health. The relationship between nutrition and dental problems has been widely discussed, including the major dental problem in children: early childhood caries (ECC). Health-oriented national policies are the main principles of public health welfare. This article is a policy brief that provide a review of the food and nutrition policies in Indonesia that may have a relationship with ECC. It is concluded that some policies support the efforts to prevent ECC however, other technical explanations are still needed for health workers and especially parents regarding its simple implementation in everyday life. Multisectoral approaches that includes health, nutrition and education are needed to address ECC.

What factors are associated with early childhood dental caries? A longitudinal study of the Growing Up in New Zealand cohort

BACKGROUND

The relative importance of different strategies to prevent dental caries is not known.

AIM

We explored the relationship between oral health behaviours, diet, and the incidence of dental caries.

DESIGN

We conducted a study of children participating in the 'Growing Up in New Zealand' cohort. Exposures were oral health behaviours, a food frequency questionnaire, and sociodemographic characteristics that were recorded when the child was nine months and two years old. Outcomes were records of dental caries at ages four to seven years.

RESULTS

4111 children had dental examination records from between the ages of four and seven years. High levels of dental caries were reported in children of Pacific, Asian, and Māori ethnicity. Food frequency questionnaire information was summarised into two principal components. The major axis of variation was in the intake of food and drinks with high concentrations of sugar and refined starch, with this component strongly associated with caries (multivariable incidence rate ratio of caries 0.48; 95% confidence interval: 0.38-0.61, comparing the extreme quintiles of the first principal component).

CONCLUSIONS

A diet high in sugar or refined starch was strongly linked to caries. Policies to reduce sugar and refined starch intake should be considered.

Effects of food policy actions on Indigenous Peoples' nutrition-related outcomes: a systematic review

INTRODUCTION

Indigenous Peoples worldwide endure unacceptable health disparities with undernutrition and food insecurity often coexisting with obesity and chronic diseases. Policy-level actions are required to eliminate malnutrition in all its forms. However, there has been no systematic synthesis of the evidence of effectiveness of food and nutrition policies for Indigenous Peoples around the world. This review fills that gap.

METHODS

Eight databases were searched for peer-reviewed literature, published between 2000 and 2019. Relevant websites were searched for grey literature. Articles were included if they were original studies, published in English and included data from Indigenous Peoples from Western colonised countries, evaluated a food or nutrition policy (or intervention), and provided quantitative impact/outcome data. Study screening, data extraction and quality assessment were undertaken independently by two authors, at least one of whom was Indigenous. A narrative synthesis was undertaken with studies grouped according to the NOURISHING food policy framework.

RESULTS

We identified 78 studies from Canada, Australia, Aotearoa/New Zealand and the USA. Most studies evaluated targeted interventions, focused on rural or remote Indigenous communities. The most effective interventions combined educational strategies with policies targeting food price, composition and/or availability, particularly in retail and school environments. Interventions to reduce exposure to unhealthy food advertising was the only area of the NOURISHING framework not represented in the literature. Few studies examined the impact of universal food policies on Indigenous Peoples' diets, health or well-being.

CONCLUSION

Both targeted and universal policy action can be effective for Indigenous Peoples. Actions that modify the structures and systems governing food supply through improved availability, access and affordability of healthy foods should be prioritised. More high-quality evidence on the impact of universal food and nutrition policy actions for Indigenous Peoples is required, particularly in urban areas and in the area of food marketing.

Indonesia: Epidemiological Profiles of Early Childhood Caries

The Indonesia government has succeeded in achieving national health development targets and has invested heavily in public health. Many positive results have been achieved, which indicate an increasing number of school-aged children free of caries and a decrease in caries experience scores. However, result of previous studies on early childhood caries (ECC) in pre-school children showed high prevalence and severity. Understanding the link between the epidemiology of the ECC and components of health development is critical for formulating appropriate actions. The purpose of this study is to provide a comprehensive review of the epidemiology of ECC in Indonesia based on the results of the national basic health surveys. The complementary data describes access, utilization and profile of oral health personnel in Indonesia.

Children's mobility and environmental exposures in urban landscapes: A cross-sectional study of 10-11 year old Scottish children

Research into how the environment affects health and related behaviour is typically limited in at least two ways: it represents the environment to which people are exposed using fixed areal units, and, it focuses on one or two environmental characteristics only. This study developed a methodology for describing children's mobility and the complexity of their environmental exposure across a 1934 km2 study area, including urban, suburban and rural zones. It conceptualised and modelled this area as a landscape, comprised of spatially discrete amenities, infrastructure features, differing land covers/use and broader environmental contexts. The model used a 25 m2 grid system (∼3 million cells). For each cell, there was detailed built-environment information. We joined data for 100 10/11-year-old children who had worn GPS trackers to provide individual-level mobility information for one week during 2015/16 to our model. Using negative binomial regression, we explored which landscape features were associated with a child visiting that space and time spent there. We examined whether relationships between the features across our study area and children's use of the space differed by their sociodemographic characteristics. We found that children often used specific amenities outside their home neighbourhood, even if they were also available close to home. They spent more time in cells containing roads/transportation stops, food/drink retail (Incidence rate ratio (IRR):4.02, 95%CI 2.33 to 6.94), places of worship (IRR:5.98, 95%CI 3.33 to 10.72) and libraries (IRR:7.40, 95%CI 2.13 to 25.68), independently of proximity to home. This has importance for the optimal location of place-based health interventions. If we want to target children, we need to understand that using fixed neighbourhood boundaries may not be the best way to do it. The variations we found in time spent in certain areas by sex and socio-economic position also raise the possibility that interventions which ignore these differences may exacerbate inequalities.

Oral health behavior of children and guardians' beliefs about children's dental caries in Vientiane, Lao People's Democratic Republic (Lao PDR)

Dental caries is considered a major health problem among schoolchildren in Lao People’s Democratic Republic (Lao PDR). According to Health Belief Model (HBM)-based research, children’s oral health behavior can be determined by their guardians’ beliefs. This study aimed to describe children’s oral health behavior and its association with childhood dental caries, as well as to assess associations between children’s tooth-brushing behavior and guardians’ beliefs in an urban area of Lao PDR, using HBM. Data were collected from ten primary schools in the Sisattanak district, the Vientiane capital, between 2013 and 2014. Ten dentists with the help of dental hygienists and schoolteachers conducted dental health check-ups at the schools that diagnosed dental caries based on visual inspection. They also conducted a questionnaire-based survey with the schoolchildren’s guardians to collect data including socio-economic and demographic information, their children’s oral health behavior, and guardians’ beliefs derived from HBM, including perceived susceptibility to and perceived severity of child dental caries, perceived benefit of and perceived barrier to child’s tooth brushing, and self-efficacy in making their children brush their teeth twice daily. A mixed-effects logistic regression model assessed the association between dental caries and children’s oral health behavior and between children’s tooth-brushing behavior and guardians’ beliefs. Data from 1161 of 1304 (89.0%) children registered at the schools were used. The prevalence of dental caries was 82%. Children who brushed their teeth ≥ twice/day were significantly less likely to have dental caries than those brushing once or seldom (OR: 0.64, 95% CI: 0.45 to 0.91). The number of children who brushed twice daily also significantly increased with the increased level of guardians’ self-efficacy (OR: 2.14, 95% CI: 1.91 to 2.41). In conclusion, childhood dental caries was associated with daily tooth brushing. Children’s tooth-brushing behavior was associated with guardians’ self-efficacy in making their children brush twice daily.

The Associations of School Oral Health-Related Environments with Oral Health Behaviours and Dental Caries in Children

Creating supportive oral health-related environments in schools is an important strategy for promoting schoolchildren’s oral health. This study determined the associations between school environments and children’s oral behaviour and dental caries. The data on school oral health-related environments were obtained through observation and interviews. Oral behaviour and dental caries data were collected through interviews and oral examinations of 984 sixth grade children. χ2 and multiple logistic regression, adjusted for sociodemographic and economic status, other school environment variables, and oral behaviour were used. Providing fresh fruit with school meals was associated with low sweets consumption and low caries levels. Children’s daily sweets consumption was positively associated with sweetened milk sales in schools. Selling sweetened beverages, including sweetened milk, sweetened drinks, and soft drinks, was associated with high caries levels, while selling meat and crispy packed snacks was associated with low caries levels. Children in schools with integrated oral health education were significantly more likely to brush their teeth twice a day and to brush after lunch. In conclusion, school oral health-related environments, especially available food choices, were associated with sweets consumption behaviour and caries levels. Children in schools with integrated oral health education had better brushing habits.

Busting the Baby Teeth Myth and Increasing Children's Consumption of Tap Water: Building Public Will for Children's Oral Health in Colorado

QUESTION

Can a multifaceted statewide communications campaign motivate behavior change in low-income Colorado families to limit children's fruit juice consumption and increase children's consumption of tap water to prevent tooth decay?

PURPOSE

Caries is the most common chronic disease of childhood, affecting 40% of kindergartners and 55% of third graders in Colorado. Frequent consumption of 100% fruit juice is linked to childhood caries. The purpose of this campaign, "Cavities Get Around," was to motivate families to limit children's fruit juice consumption and increase consumption of tap water to protect baby teeth from caries, while also building public will for children's oral health.

METHODS

The campaign included targeted media, promotores/organizers, and family education. We focused on fruit juice because audience research showed many families view fruit juice as healthy, and it is also a common beverage among young children up to age of 6 years. We also focused on low-socioeconomic status families because data show higher childhood tooth decay rates in this population. To evaluate progress, we conducted identical pre- and post-surveys, each of 600 random low-income parents contacted by landline, mobile telephone, and Internet, allowing for comparative data.

RESULTS

Significant progress was achieved compared to 2014 baseline results. Findings from a November 2015 statewide survey of parents included the following: (1) 22-point increase from 2014 in percentage of children regularly drinking tap water (from 41 to 63%). (2) 29-point decrease from 2014 in percentage of respondents who considered fruit juice consumption important to their child's health and nutritional needs (from 72 to 43%). (3) 19-point reduction in fruit juice consumption among young children (from 66% in 2014 to 47% in 2015). (4) 6-point reduction in percentage of parents considering baby teeth "less important" than adult teeth (from 21% in 2014 to 15% in 2015). The campaign also played a role in new state rules prohibiting childcare centers from serving sugar-sweetened beverages and capping 100% juice to twice per week.

CONCLUSION

The campaign development, strategies, and evaluation results are instructive for others working on health promotion, childhood nutrition, and education interventions.

Under 5 Energize: Tracking Progress of a Preschool Nutrition and Physical Activity Programme with Regional Measures of Body Size and Dental Health at Age of Four Years

To reduce weight gain and encourage healthy eating including reduced sugar intake, Under 5 Energize (U5E) was introduced to 121 early-childhood-centres in the Waikato region of New Zealand in July 2013. Using anonymized data collected from January 2013 to September 2016 through free physical assessments of all 4-year-olds provided by the NZ Ministry of Health, the prevalence of obesity and dental decay children measured in the Waikato region was examined. Data were divided into four periods representing pre-implementation and 3 years of gradual implementation. Obesity was defined according to International Obesity Task Force criteria. Of 18,774 Waikato children included in the analysis, 32% were indigenous Māori, and 32% attended an U5E centre. Pre-implementation prevalences of obesity (4%) and visible dental decay (11%) of children attending and not-attending U5E centres were not different. While obesity prevalence did not change significantly over time, prevalence of dental decay decreased among children at U5E (trend p = 0.003) but not non-U5E (trend p = 0.14) centres, such that prevalences were significantly different between children at U5E vs. non-U5E centres at Year 3 (p = 0.02). The U5E intervention is a small but arguably effective part of the wider system approach that is required to improve children’s future health.