{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T23:48:38Z","timestamp":1776901718051,"version":"3.51.2"},"reference-count":87,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100009992","name":"Seattle Children\u2019s Research Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009992","id-type":"DOI","asserted-by":"crossref"}]},{"name":"ARCORA \u2013 The Foundation of Delta Dental of Washington"},{"DOI":"10.13039\/100021038","name":"City of Seattle","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100021038","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100021038","name":"City of Seattle","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100021038","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100021038","name":"City of Seattle","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100021038","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity\u2013tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity\u2013tooth decay relationship for lower-income children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (\u22652 times\/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl\/oz)\/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces\/day) were positively associated with decayed tooth surfaces, but not at the a \u03b1 = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p &lt; .001). SSB intake mediated 10% of the food insecurity\u2013tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0290287","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T17:28:29Z","timestamp":1694539709000},"page":"e0290287","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity\u2013Tooth decay relationship among low-income children in Washington state"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6487-5258","authenticated-orcid":true,"given":"Courtney M.","family":"Hill","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2289-7747","authenticated-orcid":true,"given":"Donald L.","family":"Chi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lloyd A.","family":"Mancl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica C.","family":"Jones-Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine","family":"Chan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian E.","family":"Saelens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christy M.","family":"McKinney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"key":"pone.0290287.ref001","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1177\/0022034517693566","article-title":"Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990\u20132015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors","volume":"96","author":"NJ Kassebaum","year":"2017","journal-title":"J Dent Res"},{"key":"pone.0290287.ref002","first-page":"18","article-title":"Disparities in untreated caries among children and adults in the U.S., 2011\u20132014.","author":"N Gupta","year":"2018","journal-title":"BMC Oral 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