{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T15:54:41Z","timestamp":1781538881478,"version":"3.54.5"},"reference-count":41,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JDR Clinical &amp; Translational Research"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Socioeconomic status (SES) has a significant effect on the burden of early childhood caries (ECC), yet addressing SES disparities remains challenging. This study aimed to identify and quantify the most impactful mediator linking SES effect to the occurrence of ECC using advanced causal mediation analysis, to inform targeted interventions that reduce SES-related disparities in ECC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data were drawn from the Study of Mothers\u2019 and Infants\u2019 Life Events, a cohort of 2,182 mother\u2013child dyads recruited from Adelaide\u2019s 3 largest public hospitals (2013\u20132014). Baseline questionnaires captured family SES, while ECC clinical indicators were assessed at age 5 y. Three mediation pathways linking SES and ECC were examined including dietary intake represented by free sugar intake (FSI); oral hygiene practices, including toothbrushing habits and plaque presence; and dental visiting patterns. Mediation effects were quantified as natural indirect effects (NIE) using causal mediation analysis based on the counterfactual framework, with validation via 5-fold cross-validation to ensure robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>FSI was the only pathway with a significant mediation effect. Each 1-standard-deviation increase or decrease in SES was associated with a corresponding 6% reduction or increase in ECC risk at age 5 y through the mediating effect of FSI at age 2 y. The NIE of FSI accounted for 52% of SES\u2019s total effect on ECC. In contrast, oral hygiene and dental visiting patterns showed no significant mediation effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Reducing early childhood FSI could mitigate half of SES-related disparities in ECC. Targeted interventions focusing on FSI reduction hold promise for lowering ECC risk, with future research needed to evaluate their effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Knowledge Transfer Statement:<\/jats:title>\n                    <jats:p>Clinicians and policymakers should prioritize nutrition education and sugar reduction initiatives as key components of early prevention in pediatric dentistry, especially for low-SES populations. Incorporating FSI screening into routine visits enables medical and dental practitioners to educate caregivers on the impact of free sugars on dental health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23800844251365536","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T05:05:03Z","timestamp":1757567103000},"page":"444-453","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Key Mediators Reducing Socioeconomic Inequality in Early Childhood Caries"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1942-3009","authenticated-orcid":false,"given":"A.T.M.","family":"Dao","sequence":"first","affiliation":[{"name":"School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"University of Cuu Long, Vietnam"},{"name":"Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3684-9949","authenticated-orcid":false,"given":"L.G.","family":"Do","sequence":"additional","affiliation":[{"name":"School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0758-1605","authenticated-orcid":false,"given":"N.","family":"Stormon","sequence":"additional","affiliation":[{"name":"School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia"},{"name":"Community and Oral Health, Metro North Hospital and Health Services, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.V.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Cuu Long, Vietnam"},{"name":"Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA"},{"name":"Health Innovation and Transformation Centre (HITC), Federation University, Victoria, Australia"},{"name":"School of Public Health, The University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.H.","family":"Ha","sequence":"additional","affiliation":[{"name":"School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12813"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.14666"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Amarasena N Luzzi L Brennan D. 2023. Effect of different frequencies of dental visits on dental caries and periodontal disease: a scoping review. Int J Environ Res Public Health. 20(19):6858. https:\/\/doi.org\/10.3390\/ijerph20196858.","DOI":"10.3390\/ijerph20196858"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/17456916221093615"},{"key":"e_1_3_3_6_1","unstructured":"Australian Institute of Health and Welfare. 2025. Patient demographics. Canberra: Australian Institute of Health and Welfare; [accessed 2025 May 23]. https:\/\/www.aihw.gov.au\/hospitals\/topics\/admitted-patient-care\/patient-demographics?utm_source=chatgpt.com."},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S136898001600104X"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2015.02.011"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Chung A Westerman L Martin J Friel S. 2022. The commercial determinants of unhealthy diets. Public Health Res Pract. 32(3):3232221. https:\/\/doi.org\/10.17061\/phrp3232221.","DOI":"10.17061\/phrp3232221"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Dao ATM Do LG Stormon N Dhanapriyanka M Ha DH. 2025a. Causal analyses in longitudinal observational studies in oral health: a scoping review. Community Dent Oral Epidemiol. 53(1):7\u201316.","DOI":"10.1111\/cdoe.13002"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/00220345251324494"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Devenish G Golley R Mukhtar A Begley A Ha D Do L Scott JA. 2019. Free sugars intake sources and determinants of high consumption among Australian 2-year-olds in the SMILE cohort. Nutrients. 11(1):161. https:\/\/doi.org\/10.3390\/nu11010161.","DOI":"10.3390\/nu11010161"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqaa012"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Do LG Ha DH Bell LK Devenish G Golley RK Leary SD Manton DJ Thomson WM Scott JA Spencer AJ. 2020. Study of mothers\u2019 and infants\u2019 life events affecting oral health (smile) birth cohort study: cohort profile. BMJ Open. 10(10):e041185. https:\/\/doi.org\/10.1136\/bmjopen-2020-041185.","DOI":"10.1136\/bmjopen-2020-041185"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Do LG Scott JA Thomson WM et al. 2014. Common risk factor approach to address socioeconomic inequality in the oral health of preschool children \u2013 a prospective cohort study. BMC Public Health 14 429. https:\/\/doi.org\/10.1186\/1471-2458-14-429.","DOI":"10.1186\/1471-2458-14-429"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12819"},{"key":"e_1_3_3_17_1","doi-asserted-by":"crossref","unstructured":"Do LG Spencer AJ. 2016. Oral health of Australian children: the National Child Oral Health Study 2012\u201314. Adelaide (Australia): University of Adelaide Press.","DOI":"10.20851\/ncohs"},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Harris R Raison H Christian B Bakare L Okwundu CI Burnside G. 2017. Interventions for improving adults\u2019 use of primary oral health care services. Cochrane Database Syst Rev. 2017(8):CD012771. https:\/\/doi.org\/10.1002\/14651858.CD012771.","DOI":"10.1002\/14651858.CD012771"},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.17135\/jdhs.2023.23.3.208"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0020761"},{"key":"e_1_3_3_21_1","doi-asserted-by":"crossref","unstructured":"Keogh RH Daniel RM VanderWeele TJ Vansteelandt S. 2018. Analysis of longitudinal studies with repeated outcome measures: adjusting for time-dependent confounding using conventional methods. Am J Epidemiol. 187(5):1085\u20131092.","DOI":"10.1093\/aje\/kwx311"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.15.158667"},{"key":"e_1_3_3_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40368-022-00751-5"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.34172\/hpp.2021.35"},{"key":"e_1_3_3_25_1","doi-asserted-by":"crossref","unstructured":"Kuhn M Johnson K. 2013. Applied predictive modeling. New York: Springer.","DOI":"10.1007\/978-1-4614-6849-3"},{"key":"e_1_3_3_26_1","doi-asserted-by":"crossref","unstructured":"O\u2019Brien R Neman T Seltzer N Evans L Venkataramani A. 2020. Structural racism economic opportunity and racial health disparities: evidence from U.S. counties. SSM Popul Health. 11:100564. https:\/\/doi.org\/10.1016\/j.ssmph.2020.100564.","DOI":"10.1016\/j.ssmph.2020.100564"},{"key":"e_1_3_3_27_1","doi-asserted-by":"crossref","unstructured":"Reyes M Smith Taillie L Popkin B Kanter R Vandevijvere S Corval\u00e1n C. 2020. Changes in the amount of nutrient of packaged foods and beverages after the initial implementation of the Chilean law of food labelling and advertising: a nonexperimental prospective study. PLoS Med. 17(7):e1003220. https:\/\/doi.org\/10.1371\/journal.pmed.1003220.","DOI":"10.1371\/journal.pmed.1003220"},{"key":"e_1_3_3_28_1","doi-asserted-by":"crossref","unstructured":"Rijnhart JJM Lamp SJ Valente MJ MacKinnon DP Twisk JWR Heymans MW. 2021. Mediation analysis methods used in observational research: a scoping review and recommendations. BMC Med Res Methodol. 21(1):226. https:\/\/doi.org\/10.1186\/s12874-021-01426-3.","DOI":"10.1186\/s12874-021-01426-3"},{"key":"e_1_3_3_29_1","article-title":"Age and reasons for first dental visit and knowledge and attitude of parents toward dental procedures for Puducherry children aged 0-9 years","volume":"11","author":"Sanguida A","year":"2019","unstructured":"Sanguida A, Vinothini V, Prathima G, Santhadevy A, Premlal K, Kavitha M. 2019. Age and reasons for first dental visit and knowledge and attitude of parents toward dental procedures for Puducherry children aged 0-9 years. J Pharm Bioallied Sci. 11(suppl 2):S413\u2013419.","journal-title":"J Pharm Bioallied Sci"},{"key":"e_1_3_3_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10742-024-00327-4"},{"key":"e_1_3_3_31_1","doi-asserted-by":"crossref","unstructured":"Simkovic M Traeuble B Hutson AD. 2019. Robustness of statistical methods when measure is affected by ceiling and\/or floor effect. PLoS One. 14(8):e0220889. https:\/\/doi.org\/10.1371\/journal.pone.0220889.","DOI":"10.1371\/journal.pone.0220889"},{"key":"e_1_3_3_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.13219"},{"key":"e_1_3_3_33_1","unstructured":"StataCorp. 2024. Causal mediation analysis. College Station (TX): StataCorp; [accessed 2024 Oct 8]. https:\/\/www.Stata.Com\/new-in-stata\/causal-mediation-analysis\/."},{"key":"e_1_3_3_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12783"},{"key":"e_1_3_3_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00494-6"},{"key":"e_1_3_3_36_1","doi-asserted-by":"crossref","unstructured":"Villalobos Dintrans P Rodriguez L Clingham-David J Pizarro T. 2020. Implementing a food labeling and marketing law in Chile. Health Syst Reform. 6(1):e1753159. https:\/\/doi.org\/10.1080\/23288604.2020.1753159.","DOI":"10.1080\/23288604.2020.1753159"},{"key":"e_1_3_3_37_1","doi-asserted-by":"crossref","unstructured":"Wang L Cheng L Yuan B Hong X Hu T. 2017. Association between socio-economic status and dental caries in elderly people in Sichuan Province China: a cross-sectional study. BMJ Open. 7(9):e016557. https:\/\/doi.org\/10.1136\/bmjopen-2017-016557.","DOI":"10.1136\/bmjopen-2017-016557"},{"key":"e_1_3_3_38_1","unstructured":"World Health Organization. 2015. Guideline: sugars intake for adults and children. Geneva (Switzerland): World Health Organization."},{"key":"e_1_3_3_39_1","unstructured":"World Health Organization. 2019. Ending childhood dental caries: WHO implementation manual. Geneva (Switzerland): World Health Organization."},{"key":"e_1_3_3_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13222"},{"key":"e_1_3_3_41_1","doi-asserted-by":"crossref","unstructured":"Yan R Chan CB Louie JCY. 2022. Evidence does not support the reduction of added sugar intake from all food sources. Nat Rev Cardiol. 19(12):845. https:\/\/doi.org\/10.1038\/s41569-022-00791-w.","DOI":"10.1038\/s41569-022-00791-w"},{"key":"e_1_3_3_42_1","doi-asserted-by":"crossref","unstructured":"Yousaf M Aslam T Saeed S Sarfraz A Sarfraz Z Cherrez-Ojeda I. 2022. Individual family and socioeconomic contributors to dental caries in children from low-and middle-income countries. Int J Environ Res Public Health. 19(12):7114. https:\/\/doi.org\/10.3390\/ijerph19127114.","DOI":"10.3390\/ijerph19127114"}],"container-title":["JDR Clinical &amp; Translational Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23800844251365536","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23800844251365536","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23800844251365536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T15:02:55Z","timestamp":1781535775000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23800844251365536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":41,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/23800844251365536"],"URL":"https:\/\/doi.org\/10.1177\/23800844251365536","relation":{},"ISSN":["2380-0844","2380-0852"],"issn-type":[{"value":"2380-0844","type":"print"},{"value":"2380-0852","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]}}}