{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T03:48:01Z","timestamp":1781840881769,"version":"3.54.5"},"reference-count":41,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T00:00:00Z","timestamp":1712880000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100002322","name":"coordena\u00e7\u00e3o de aperfei\u00e7oamento de pessoal de n\u00edvel superior","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["160262\/2020-8"],"award-info":[{"award-number":["160262\/2020-8"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Dent Res"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:p>Individuals of lower socioeconomic position (SEP) experience a greater rate of alcohol-related harms, yet they consume equal or lower amounts of alcohol than higher-SEP individuals. This phenomenon, called the \u201calcohol harm paradox\u201d (AHP), gained attention recently, and different mechanisms have been proposed to explain it. Since both SEP and alcohol have been suggested to be associated with periodontitis risk, we conducted a secondary analysis using data from the National Health and Nutrition Examination Survey 2011 to 2012 and 2013 to 2014 cycles, aiming to examine 1) whether the association between alcohol consumption and periodontitis is modified by SEP and 2) the extent to which the effect of SEP inequalities on periodontitis is mediated by and\/or interacts with alcohol consumption. We set educational attainment as the main SEP proxy and tested the poverty income ratio in subsequent sensitivity analyses. Effect measure modification analysis was employed, considering heavy drinking as exposure, and causal mediation analysis based on the potential outcome\u2019s framework decomposed the effect of SEP on periodontitis in proportions attributable to mediation and interaction. Models were fitted using binary logistic regression and adjusted for sex, ethnicity, age, body mass index, smoking status, diabetes, binge drinking, and regular preventive dental visits. The analytical sample comprised 4,057 participants. After adjusting for covariates, less educated heavy drinkers presented 175% (odds ratio, 2.75; 95% confidence interval [CI], 2.04\u20133.72) higher odds of periodontitis than their counterparts, and super-additive associations were found (relative excess risk due to interaction: 1.35; 95% CI, 0.49\u20132.20). Additionally, \u221269.5% (95% CI, \u2212122.1% to \u221216.8%) of the effects of education on periodontitis were attributable to interaction with heavy drinking, consistent with the AHP. No contribution was found for the mechanism of mediation. Heavy drinking disproportionately impacts the occurrence of periodontitis in lower-SEP individuals. Lower-SEP individuals seem to experience differential effects of heavy drinking on periodontitis.<\/jats:p>","DOI":"10.1177\/00220345241235614","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T03:03:45Z","timestamp":1712891025000},"page":"605-611","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["The Alcohol Harm Paradox in Periodontitis"],"prefix":"10.1177","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3706-5687","authenticated-orcid":false,"given":"L.M.","family":"Oliveira","sequence":"first","affiliation":[{"name":"Department of Stomatology, Postgraduate Program in Dentistry, Santa Maria, Rio Grande do Sul, Brazil"},{"name":"Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0831-7961","authenticated-orcid":false,"given":"F.B.","family":"Zanatta","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Postgraduate Program in Dentistry, Santa Maria, Rio Grande do Sul, Brazil"},{"name":"Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9010-7930","authenticated-orcid":false,"given":"S.A.","family":"Costa","sequence":"additional","affiliation":[{"name":"Graduate Dentistry Program, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds, Maranh\u00e3o, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.R.","family":"Pelissari","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Postgraduate Program in Dentistry, Santa Maria, Rio Grande do Sul, Brazil"},{"name":"Emphasis on Endodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9391-6602","authenticated-orcid":false,"given":"S.E.","family":"Baumeister","sequence":"additional","affiliation":[{"name":"Institute of Health Services Research in Dentistry, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.F.","family":"Demarco","sequence":"additional","affiliation":[{"name":"Graduate Program in Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil"},{"name":"Graduate Program in Epidemiology, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-6300","authenticated-orcid":false,"given":"G.G.","family":"Nascimento","sequence":"additional","affiliation":[{"name":"National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore"},{"name":"Oral Health Academic Programme, Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"bibr1-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13581"},{"key":"bibr2-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13544"},{"key":"bibr3-00220345241235614","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18116025"},{"key":"bibr4-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/add.15567"},{"key":"bibr5-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.109127"},{"key":"bibr6-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13506"},{"key":"bibr7-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.22-0241"},{"key":"bibr8-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyy167"},{"key":"bibr9-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-019-0777-6"},{"key":"bibr10-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2012.110664"},{"key":"bibr11-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/odi.14107"},{"key":"bibr12-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0236161"},{"key":"bibr13-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldm001"},{"key":"bibr14-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31310-2"},{"key":"bibr15-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12468"},{"key":"bibr16-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.01.033"},{"key":"bibr17-00220345241235614","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.652488"},{"key":"bibr18-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyr218"},{"key":"bibr19-00220345241235614","doi-asserted-by":"publisher","DOI":"10.15288\/jsad.2015.76.158"},{"key":"bibr20-00220345241235614","unstructured":"National Council on Aging. 2020. Drinking and healthy aging: know your limits [accessed 2023 August 25]. https:\/\/www.ncoa.org\/article\/drinking-and-healthy-aging-know-your-limits."},{"key":"bibr21-00220345241235614","unstructured":"National Institute on Alcohol Abuse and Alcoholism. 2020. Drinking levels defined [accessed 2023 August 25]. https:\/\/www.niaaa.nih.gov\/alcohol-health\/overview-alcohol-consumption\/moderate-binge-drinking."},{"key":"bibr22-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agz017"},{"key":"bibr23-00220345241235614","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6706a3"},{"key":"bibr24-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1016\/j.jobcr.2023.02.002"},{"key":"bibr25-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/jre.12890"},{"key":"bibr26-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agac023"},{"key":"bibr27-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/odi.14489"},{"key":"bibr28-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyaa113"},{"key":"bibr29-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/add.15395"},{"key":"bibr30-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31146-8"},{"key":"bibr31-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/add.13757"},{"key":"bibr32-00220345241235614","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.059204"},{"key":"bibr33-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwz054"},{"key":"bibr34-00220345241235614","doi-asserted-by":"publisher","DOI":"10.15288\/jsad.2016.77.185"},{"key":"bibr35-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.18-0006"},{"key":"bibr36-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181ba333c"},{"key":"bibr37-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000121"},{"key":"bibr38-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1515\/em-2013-0005"},{"key":"bibr39-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"bibr40-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.21-0469"},{"key":"bibr41-00220345241235614","doi-asserted-by":"publisher","DOI":"10.1111\/odi.14436"}],"container-title":["Journal of Dental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00220345241235614","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00220345241235614","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00220345241235614","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:08:42Z","timestamp":1777496922000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00220345241235614"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,12]]},"references-count":41,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1177\/00220345241235614"],"URL":"https:\/\/doi.org\/10.1177\/00220345241235614","relation":{},"ISSN":["0022-0345","1544-0591"],"issn-type":[{"value":"0022-0345","type":"print"},{"value":"1544-0591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,12]]}}}