OBJECTIVES: The aim of this study is to examine the association between food insecurity and untreated dental caries among U.S. children and adults and to investigate the effect of participating in the Supplemental Nutrition Assistance Program (SNAP) on dental caries among U.S. adults. METHODS: Our sample was derived from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low, and very low). SNAP participation in the past 12 months was self-reported (yes/ no). The main outcome variable was untreated dental caries (none vs. one or more). Descriptive, Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship among food insecurity, SNAP participation, and untreated caries. RESULTS: Our results suggest that food insecure children were more likely to have untreated caries compared to full food secure counterparts, after controlling for potential confounders (OR: 1.38; 95% CI: 1.11-1.72). On household-level food security, children from marginal and very low food secure households had significantly higher odds of untreated caries compared to children from fully food secure households (OR: 1.48; 95% CI: 1.10-2.01 and OR: 1.59; 95% CI: 1.12-2.26 respectively). Moreover, our findings suggest significant association between overall food security status and dental caries among U.S. adults (OR: 1.35, 95% CI: 1.05-1.74). We also observed a significant association between the severity of household food insecurity and untreated caries among adults after adjusting for confounders (P=0.04). SNAP participants were more likely to have untreated caries compared to non-SNAP participants (OR: 1.5; 95% CI: 1.19-1.87). The interaction of food insecurity and SNAP participation was not significant. However, SNAP participants from all levels of food security had higher prevalence ratio of dental caries compared to non-SNAP participants, regardless of food security status. CONCLUSION: Food insecurity was negatively associated with dental caries among U.S. children and adults. In addition, SNAP participation had adverse association with dental caries among U.S. adults. Further research is needed to more comprehensively understand the impact of food insecurity and food assistance programs on oral health. / 2021-06-16T00:00:00Z

Many families that experience hunger in the United States rely on Food Assistance Programs to meet their daily nutrition needs. However, these programs do not always meet the needs of these individuals, as has been the case for individuals living under higher than expected levels of poverty in the Great Lakes region of the United States. Using policy feedback theory (PFT), the purpose of this case study was to explore the experiences of individuals from a county in the Great Lakes region of the United States, who depend on the federal Food Assistance Program, with particular attention given to evaluate the effectiveness of distribution mechanisms in helping these individuals meet their food needs. Data were collected through interviews with 11 program clients, 3 program administrators, as well as publicly available agency data. These data were inductively coded and then analyzed using Braun and Clarke's thematic analysis procedure. Key findings revealed that clients perceived the Food Assistance Program as ineffective in preventing food insecurity without additional programs and resources. The findings also revealed that distribution mechanisms negatively impacted food recipients with limited income, resulting in increased food shortages, requiring recipients to seek additional food programs and resources. These findings also exposed barriers to employment opportunities for recipients, adding to the stress and anxiety experienced from food shortages. Positive social change implications from the findings include providing information to program administrators that can be used to improve the Food Assistance Program, which may in turn improve the lives of those who rely on food assistance programs.

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