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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 631-636

Cariogenic snack consumption among Southern Thai preschool children and its international comparison during pandemic of COVID-19: A cross-sectional study


1 Preventive Department, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand
2 Department of Health, Ministry of Public Health, Nonthaburi, Thailand
3 Evidence-Based Dentistry for Oral Health Care and Promotion Research Unit, Preventive Department, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand

Date of Submission26-Apr-2021
Date of Decision23-Sep-2021
Date of Acceptance06-Sep-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Ms. Achara Watanapa
Preventive Department, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla 90110.
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JIOH.JIOH_109_21

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  Abstract 

Aim: The aim of this study was to describe and analyze factors related to dietary habits among young children. This study is part of the practice guideline development to promote good oral health under the pandemic situation. Materials and Methods: A cross-sectional study was conducted among parents or relatives of 3–5 years old children who attended child care centers in one province of Southern Thailand using an online questionnaire submitted via teachers of each cluster. The number of participants required was 265 and cluster sampling method was performed. Logistic regression was used to identify the factors related to dietary habit. The questionnaire included general information, snack consumption, and factors related to snack consumption during the stay-at-home period. Results: Fifty-seven percent of the children did not increase their cariogenic snack consumption and most families increased their good food habits. Reservation of cariogenic snacks at home and high previous frequency of cariogenic snacks consumption were related to the increasing of cariogenic snack consumption when controlling for parents’ dietary control and good food behavior. Conclusion: Most of the children did not increase their snack consumption during the stay-at-home period and the factors related to increase of snake consumption behavior were reservation of snack and high baseline frequency of consumption.

Keywords: Cariogenic, Child, COVID-19, Food


How to cite this article:
Watanapa A, Ungchusak C, Tianviwat S. Cariogenic snack consumption among Southern Thai preschool children and its international comparison during pandemic of COVID-19: A cross-sectional study. J Int Oral Health 2021;13:631-6

How to cite this URL:
Watanapa A, Ungchusak C, Tianviwat S. Cariogenic snack consumption among Southern Thai preschool children and its international comparison during pandemic of COVID-19: A cross-sectional study. J Int Oral Health [serial online] 2021 [cited 2022 Jan 27];13:631-6. Available from: https://www.jioh.org/text.asp?2021/13/6/631/331577


  Introduction Top


The recent reviews of public oral health care during the pandemic of coronavirus disease-2019 (COVID-19)[1],[2],[3] have reported a reduction in service delivery and also the discontinuation of oral health promotion programs. The re-orientation of oral health care system with emphasis on oral health self-care especially healthier dietary intake was also suggested.[4],[5]

The first wave of the COVID-19 outbreak in Thailand began about February 2020 and came to an end on June 2020. Then, on December of the same year, the second wave started. Recent data on the June 8, 2021 review the cumulative number of patients to be 179,886.[6] Globally there have been 173,331,478 confirmed cases.[7] The COVID-19 outbreak has resulted in lifestyle changes in Thailand. The government declared the State of Emergency Order Closure of educational institutions across the country[8] along with the announcement of measures to suspend the use of public areas. The recommendation stated that children under 5 years old should stay at home because of the high risk of easily contracting COVID-19.[9] As a result, the lifestyle of children has been changed. There are limited publications presenting the effect of “stay-at-home to avoid COVID-19” strategy on the eating habits of young children. The null hypothesis of this study was that there is no relationship between studied factors, that is, reservation of snack at home, parents’ dietary control and good food habit, and the change of cariogenic food consumption among children during the stay-at-home period.

This study aimed to investigate the change of dietary lifestyle toward dental caries and factors related to this behavior among young children. The study is part of a project to develop a practice guideline to promote good oral health during the pandemic situation.


  Materials and methods Top


Setting and design

The design was a cross-sectional analytical study. The target population was the parents or relatives of 3–5 years-old children who attended child care centers in Songkhla province, southern Thailand. For sample size calculation, the following formula was used,[10]

[INLINE 1]

where n is the sample size, p is the proportion of children who drank sweetened milk (0.55),[11]q is (1–p) or proportion of children who did not drink sweetened milk (0.45), d is half size of the 95% confidence interval (0.06), and Z at 95% confidence = 1.96. Therefore, the required sample size was 265. For logistic regression, the sample size was calculated[12]n = 100+10i, where i represents the number of independent variables, in this study, which was 10. The sample size for logistic regression was 200. We used the larger sample size that was 265.

Cluster sampling was performed where the clusters were child care centers. The total number of clusters was 12. The inclusion criteria of the study were the parents or relatives who had access to the Internet, those who could read Thai, and those who took care of children’s food. The exclusion criteria of the study were incomplete response to questions about the change of dietary during COVID-19. Online questionnaires were distributed to parents or relatives of the children via teachers who were responsible in each cluster.

Methodology

The questionnaire included general characteristics of child parents/relatives, children’s eating behaviors, and food reservation at home during the pandemic of COVID-19. The formulation of the variables came from the literatures and situation observed in the areas. The outcome variable was an increase of cariogenic snack consumption which was defined by parent’s perception compared the cariogenic snack consumption between before and during “stay-at-home” period. The related factors included socioeconomic status of parents/relatives, previous or baseline frequency of cariogenic consumption, and parents/relatives behaviors; dietary control, reservation of snacks and preparation of good food. Quality control for data collection was done for validity and internal consistency.

Bias and testing the questionnaires

Content validity was evaluated by three experts and the questionnaire was revised according to the experts’ suggestions. Internal consistency was assessed among 20 parents/relatives. Content validity index was 0.9 and Cronbach α was 0.7.

Statistical analysis

Description statistics and logistic regression were anaylzed by using the Statistical Package for the Social Science (SPSS) Statistics Base, version 17.0, for Windows EDU (SPSS, Chicago, Illinois). Logistic regression was used to identify factors influencing the change of cariogenic snack consumption (increase vs. not increase). The regression model was set up at P < 0.05. The degree of freedom of the model was 4. The 95% confidence interval, adjusted odd ratios, and P-value were reported. The independent variables were described in the questionnaire. The duration of study was from 1 December to 20 December 2020.


  Results Top


General characteristics of child parents/relatives are described in [Table 1]. A majority of respondents were parents (61.3%), women (70.4%), and Buddhists (63.7%). Approximately half were employees and 57.1% had finished secondary school as the highest educational level. The dietary behavior of children showed that 42.7% had previous cariogenic snacks three times or more per day; 43.1% increased their consumption during the stay-at-home period compared to normal time [Table 2]. Among respondents, 39.0% increased their reservation of cariogenic snacks at home. When asked about how to control their children’s consumption of snacks, 78.7% said they could not do so. However, 57.3% of respondents increased nutritious food for children during the COVID-19 time. Logistic regression analysis was used to identify variables associated with an increase in cariogenic snack frequency (increased vs. not increased). The variables entered into the regression equations are defined in [Table 1] and [Table 2]. Lifestyle of good food consumption is presented in [Table 3]. Approximately 57% of families increased their good food lifestyle. The results from logistic regression showed that increased reservation of cariogenic snacks at home and high previous frequency of cariogenic snacks consumption were related to increase of cariogenic snack consumption during the stay-at-home period when controlling of parents’ dietary control and good food consumption [Table 4]. None of the general characteristics of parents/relatives was significant.
Table 1: General characteristics of child’s parents/relatives (n = 267)

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Table 2: Dietary pattern of children’s and parent’s behavior during COVID-19

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Table 3: Life style of food preparation during COVID-19 (n = 267)

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Table 4: Results of logistic regression of the association between of parent’s behavior and children cariogenic snack consumption increase (n = 267)

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  Discussion Top


In this study, we explored the children’s dietary behavior during the stay-at-home period of the COVID-19 pandemic and factors related to such behavior. Then, we compared our results with other related studies among different countries. The main results were supported alternative hypothesis as follows: (a) most of the children did not increase cariogenic food consumption and (b) reservation of cariogenic snacks at home and previous frequency snake consumption were associated with the increasing of cariogenic food consumption, and (c) most of the parents increased the good food preparation lifestyle.

Regarding dietary behavior during the COVID-19 pandemic, there were several studies concerning two main objectives: describe the change of dietary behavior and the relationship between such changes to health status, that is, obesity, body mass index (BMI), and body weight [Table 5].[13],[14],[15],[16],[17],[18],[19],[20],[21] There were not any studies that describe the situation directly to oral health. Concerning the change of dietary behavior, there have been diversified; positive, negative, and no changes. Two studies showed the positive change of dietary consumption.[16],[21] The other three studies showed the negative change.[15],[16],[19] The persistence of dietary routines was presented in three studies[14],[17],[18] and the last two studies showed both positive and negative changes in food habits.[13],[20] Our study presents also both positive and negative changes of dietary behavior. Most of the young children (56.9%) in our study did not increase their cariogenic snacks eating. However, 43.1% of them increased cariogenic snacks which was high prevalence. Most of the recent research of dietary behavior[13],[14],[15],[16],[17],[18],[19] has focused on adults who made the decision on their lifestyle. There were two studies that reported the change of eating habits, physical activity, and body weight among young children and teenagers.[20],[21] These studies reported the change of body weight associated with increased consumption and decreased of the physical activities. In our study, we emphasized on the change of cariogenic food consumption and the factors related to the change among young children. As in our study the environment at home depends on their family, the reservation of cariogenic snacks at home by parents was the significant factor.
Table 5: Summary of food lifestyle studies during pandemic of COVID-19

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From the recent studies on the effect of dietary behavior to health status during COVID-19, most of them were concerned with obesity, BMI, and body weight,[13],[15],[18] and identified the existing behavior or risk factors that affected dietary behavior, that is, increasing of chip or snacks, consumption of fried food, and physical activities. The same trend was shown in this study. The children who had previous high-frequency snack consumption were more likely to increase their cariogenic snack consumption during the stay-at-home period.

We have provided for the first time data on the young children population and their families’ lifestyle on the children eating behavior related to oral health during the COVID-19 pandemic. However, the interpretation of the result needs to be considered in relation to limitations, which were the study design that cannot clarify the direction of the association. The other constraints were the limited number of study factors, and the high socioeconomic status of parents which was reflected from their access to Internet. Self-reported and simplified questions on the change of cariogenic dietary consumption should be considered. However, these limitations were also found in most of the studies conducted during the critical time of pandemic situation. The other weakness was sample size. Even though the sample size calculation was performed, there was still inadequate to detect the relationship between the change of eating behavior and parent’s dietary control for cariogenic consumption (data available from authors; approximate power calculated from G*power was 0.60). In this study, the multivariate logistic regression was analyzed to identify factors associated with change cariogenic food patterns. However, due to the multifactorial factors toward the behavior of parents, the careful interpretation had to consider.

The application of the results to oral health promotion would be to increase both healthy food choices and awareness of unhealthy foods, that is, snacks and sweets. Most of the reservation food and snacks during the COVID-19 pandemic were the processed sugary food and starch-containing food because of their long shelf-life and convenience.[14],[17] Moreover, organized nutritional support especially for high-risk group, that is, the poor and the children with oral health problems, is advocated. However, as the COVID-19 pandemic is ongoing, further study is required to confirm these results and to generalize to a wider population.


  Conclusion Top


Most of the children did not increase their snack consumption during the stay-at-home period and the factors related to increase snake consumption behavior were reservation of snack and high baseline frequency of consumption.

Acknowledgement

The authors are grateful to all teachers and parents for their valuable contribution.

Financial support and sponsorship

This work was supported by Evidence-Based Dentistry for Oral Health Care and Promotion Research Unit, Preventive Department, Faculty of Dentistry, Prince of Songkla University.

Conflicts of interest

There are no conflicts of interest.

Author contributions

UC contributed to idea initiation. WA, UC, and TS contributed to designing the study. WA and TS contributed to data collection, literature search, execution of the study, article writing, and revision. Finally, all authors approved the final version of the manuscript for publication.

Ethical policy and institutional review board statement

The study was approved by the Research Ethics Committee of Faculty of Dentistry, Prince of Songkla University with approval number EC6307-027.

Declaration of patient consent

Participation in this study was voluntary.

Data availability statement

Data are available upon reasonable request.

 
  References Top

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Emergency Decree on Public Administration in Emergency Situation, 16th July B.E. 2548(2005). The Government Gazette Vol. 122. Available from: http://210.246.148.76/thaiquest/getFileProxy/comment.aspx?url=%2Fdata%2Fdocument%2Fext810%2F810259_0001.pdf. [Last accessed on 2021 June 8].  Back to cited text no. 9
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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