1
|
Qutob A, Almashharawi N, Hefni S, Alzain H, Bamashmous M, Sabbahi D. Awareness of Nutrition Facts Labeling and Its Relation to Oral Health Practices and Caries Experience Among Adult Patients. Cureus 2023; 15:e50457. [PMID: 38222134 PMCID: PMC10786217 DOI: 10.7759/cureus.50457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
AIM To investigate the relationship between the usage of nutrition facts labels (NFL) and oral and dietary practices and the decayed, missing, and filled teeth (DMFT) score. METHODS A self-administered questionnaire was distributed to a convenient sample of 150 adult dental patients attending the King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. Electronic dental records were accessed to record each patient's DMFT score. RESULTS Only 38% (N=57) of the participants read the NFL on their food. A statistically significant association was found between patients' DMFT scores and the NFL reading. Participants who said they read NFLs had lower mean DMFT scores than those who said they did not (8.4 vs. 10.5). CONCLUSIONS The results of this study demonstrate that there is low usage of NFL among participants. A significant association was noted between the reading of the NFL and caries experience as measured using the DMFT index.
Collapse
Affiliation(s)
- Akram Qutob
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | | | - Shaza Hefni
- General Dentistry, King Abdulaziz Medical City, Jeddah, SAU
| | - Hassan Alzain
- Environmental Protection, Saudi Aramco Environmental Protection Organization, Dhahran, SAU
| | - Mohamed Bamashmous
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Dania Sabbahi
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| |
Collapse
|
2
|
Boachie MK, Molete M, Hofman K, Thsehla E. Cost-effectiveness of dental caries prevention strategies in South African schools. BMC Oral Health 2023; 23:814. [PMID: 37898738 PMCID: PMC10613394 DOI: 10.1186/s12903-023-03474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children. METHODS The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective. RESULTS The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively. CONCLUSION Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.
Collapse
Affiliation(s)
- Micheal Kofi Boachie
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 4041, Durban, South Africa.
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa.
| | - Mpho Molete
- Department of Oral Biological Sciences, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
| |
Collapse
|
3
|
Flexner N, Bernstein JT, Weippert MV, Labonté MÈ, Christoforou AK, Ng AP, L'Abbe MR. How Many Diet-Related Non-Communicable Disease Deaths Could Be Averted or Delayed If Canadians Reduced Their Consumption of Calories Derived from Free Sugars Intake? A Macrosimulation Modeling Study. Nutrients 2023; 15:nu15081835. [PMID: 37111054 PMCID: PMC10140857 DOI: 10.3390/nu15081835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
Free sugars are a major source of calories in diets and contribute to the burden of many non-communicable diseases (NCDs). The World Health Organization (WHO) recommends reducing free sugars intake to less than 10% of total energy. This study aimed to estimate the number of diet-related NCD deaths which could be averted or delayed if Canadian adults were to reduce their calorie intake due to a systematic 20% reduction in the free sugars content in foods and beverages in Canada. We used the Preventable Risk Integrated ModEl (PRIME) to estimate the potential health impact. An estimated 6770 (95% UI 6184-7333) deaths due to diet-related NCDs could be averted or delayed, mostly from cardiovascular diseases (66.3%). This estimation would represent 7.5% of diet-related NCD deaths observed in 2019 in Canada. A 20% reduction in the free sugars content in foods and beverages would lead to a 3.2% reduction in calorie intake, yet an important number of diet-related NCD deaths could be averted or delayed through this strategy. Our findings can inform future policy decisions to support Canadians' free sugars intake reduction, such as proposing target levels for the free sugars content in key food categories.
Collapse
Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jodi T Bernstein
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Madyson V Weippert
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Marie-Ève Labonté
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, QC G1V 0A6, Canada
| | - Anthea K Christoforou
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Alena Praneet Ng
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Mary R L'Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| |
Collapse
|
4
|
Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
Collapse
Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | | |
Collapse
|
5
|
Mackenbach JD, Ibouanga EL, van der Veen MH, Ziesemer KA, Pinho MGM. Relation between the food environment and oral health-systematic review. Eur J Public Health 2022; 32:606-616. [PMID: 35849329 PMCID: PMC9341680 DOI: 10.1093/eurpub/ckac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background There is increasing evidence that the food environment, i.e. the availability, accessibility, price and promotion of foods and beverages, has a significant influence on oral health through food consumption. With this systematic literature review, we systematically summarize the available evidence on relations between the food environment and oral health outcomes in children and adults. Methods English-language studies were identified through a systematic literature search, executed by a medical information specialist, on OVID/Medline, Embase, Web of Science and CINAHL. Title and abstract screening, full-text screening and quality assessment [using the Quality Assessment with Diverse Studies (QuADS) tool] were done independently by two authors. Results Twenty-three studies were included, of which 1 studied the consumer food environment (food labeling), 3 the community food environment (e.g. number of food stores in the community), 5 the organizational food environment (availability of healthy foods and beverages in schools), 2 the information environment (television advertisements) and 13 government and industry policies related to the food environment (e.g. implementation of a sugar-sweetened beverage tax). Almost all studies found that unhealthy food and beverage environments had adverse effects on oral health, and that policies improving the healthiness of food and beverage environments improved—or would improve in case of a modeling study—oral health. Conclusions This systematic literature review provides evidence, although of low to moderate quality and available in a low quantity only, that several aspects of the food environment, especially policies affecting the food environment, are associated with oral health outcomes.
Collapse
Affiliation(s)
- Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Upstream Team, Amsterdam UMC, Amsterdam, The Netherlands
| | - Elodie L Ibouanga
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Monique H van der Veen
- Departments of Preventive Dentistry and Pediatric Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Department of Oral hygiene, University for Applied Sciences Inholland, Amsterdam, The Netherlands
| | | | - Maria G M Pinho
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Upstream Team, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Yin X, Ye L, Xin X, Xiang L, Yu Y, Yan R, Wen K, Tian M, Jones A, Pettigrew S, Liu W, Yang Y, Zhang J. Key Stakeholder Perspectives on Introducing a Front-of-Pack Labelling Scheme on Packaged Foods in China: A Qualitative Study. Nutrients 2022; 14:nu14030516. [PMID: 35276875 PMCID: PMC8840240 DOI: 10.3390/nu14030516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 01/17/2023] Open
Abstract
Front-of-pack (FoP) labelling on foods is recommended by the World Health Organization (WHO) to address the growing global burden of diet-related noncommunicable diseases (NCDs), but this policy has not yet been implemented in China. The aim of this study was to ascertain key stakeholders’ views on barriers and facilitators to developing a feasible and acceptable FoP labelling policy in the Chinese context. Semistructured interviews were used to elicit opinions from diverse representatives in roles of FoP labelling policy influence. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research (CFIR) was adopted to facilitate data collection and analysis. Themes and subthemes were generated using deductive and inductive approaches. Thirty participants were interviewed. The major barriers were the absence of national contextual analysis, perceived complexity of the process of policy development, disagreement on a preferred FoP labelling format, cost for the food industry, low priority compared to food safety policies, lack of existing regulatory framework or authorised nutrient profiling system, limited knowledge of FoP labelling, and the lack of planning and engagement with stakeholders. Facilitators included existing prerequisites, experiences and lessons from the pilot, policy coherence with Healthy China 2030, and support from external agents (e.g., WHO). Further efforts are required to develop and collate evidence to demonstrate the scientific, legal, and political feasibility of introducing effective FoP labelling.
Collapse
Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (X.Y.); (A.J.); (S.P.)
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (L.Y.); (L.X.); (R.Y.)
| | - Lihong Ye
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (L.Y.); (L.X.); (R.Y.)
| | - Xin Xin
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; (X.X.); (Y.Y.); (K.W.); (W.L.)
| | - Lin Xiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (L.Y.); (L.X.); (R.Y.)
| | - Yue Yu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; (X.X.); (Y.Y.); (K.W.); (W.L.)
| | - Ruijie Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (L.Y.); (L.X.); (R.Y.)
| | - Kehan Wen
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; (X.X.); (Y.Y.); (K.W.); (W.L.)
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (X.Y.); (A.J.); (S.P.)
- School of Public Health, Harbin Medical University, Harbin 150088, China
- Correspondence: (J.Z.); (M.T.)
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (X.Y.); (A.J.); (S.P.)
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (X.Y.); (A.J.); (S.P.)
| | - Wei Liu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; (X.X.); (Y.Y.); (K.W.); (W.L.)
| | - Yuexin Yang
- Chinese Nutrition Society, Beijing 100022, China;
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (L.Y.); (L.X.); (R.Y.)
- Correspondence: (J.Z.); (M.T.)
| |
Collapse
|
7
|
Hagenaars LL, Jeurissen PPT, Klazinga NS, Listl S, Jevdjevic M. Effectiveness and Policy Determinants of Sugar-Sweetened Beverage Taxes. J Dent Res 2021; 100:1444-1451. [PMID: 34034538 DOI: 10.1177/00220345211014463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Sugar consumption is on the rise globally with detrimental (oral) health effects. There is ample evidence that sugar-sweetened beverage (SSB) taxes can efficiently reduce sugar consumption. However, evidence alone is seldom enough to implement a policy. In this article, we present a narrative synthesis of evidence, based on real-world SSB tax evaluations, and we combine this with lessons from policy development case studies. This article is structured according to the Health Policy Analysis Triangle, which identifies a policy's content and process and important contextual factors. SSB tax policy content needs to be coupled to existing problems and public sentiment, which depend on more aspects than aspects related to (oral) health alone. Whether or not to include artificially sweetened beverages, therefore, is not solely a matter of showing the evidence of their oral health impact but also dependent on the stated aim of a tax and public sentiment toward tax policies in general. SSB taxes also need to be in line with existing tax and decision-making rules. Earmarking revenue for specific (health promotion) purposes may therefore be less straightforward as it might appear. The policy process of creating context-sensitive SSB tax policy content is not easy either. Advocacy coalitions need to be formed early in the process, and stamina, expertise, and flexibility are required to get a SSB tax adopted in a specific community. This requires a meticulously considered SSB tax structure implementation process. Oral health professionals who want to lead the way in advocating for SSB taxes should realize that evidence-based arguments on potential effectiveness alone will not be enough to realize change. The oral health community can learn important lessons from other "doctor-activists" such as pulmonologists, who have successfully advocated for higher tobacco taxes by being visible in the public debate with clear messaging and robust policy proposals.
Collapse
Affiliation(s)
- L L Hagenaars
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - P P T Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - N S Klazinga
- Department of Social Medicine, Amsterdam UMC-University of Amsterdam, Amsterdam, the Netherlands
| | - S Listl
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Heidelberg, Germany
| | - M Jevdjevic
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| |
Collapse
|