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Obesity and Dental Caries among Elementary School Student

Introduction

Obesity is one of the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain as a result of a poor diet and lack of exercise is responsible for over 300,000 deaths each year (American Academy of Child and Adolescent Psychiatry, 2016). Overweight and obesity are a global epidemic among children of all ages. According to the World Health Organization (WHO), the prevalence of combined overweight and obesity in children rose by 47.1% between 1980 and 2013. In the U.S, childhood obesity is a serious problem as the prevalence of obesity was estimated at 17% in 2011-2014; extreme obesity was 5.8% (Williams and Greene, 2018).

Dental caries is infections caused by plaque, which is a sticky film of bacteria that forms on your teeth (U.S. Department of Health and Human Service, 2017). Dental caries are prevalent among youth aged 6–19 years. Untreated caries can cause pain and infections. In 2015–2016, the prevalence of total caries (untreated and treated) was 45.8% and untreated caries was 13.0% among youth aged 2–19 years in the U.S (Center for Disease and Control, 2018)

Pre- and primary school children who are overweight and obese are more likely to continue to be obese as adolescents and adults. They are also at an increased risk for poor health outcomes associated with being overweight (Williams and Greene, 2018). Also, dental caries can lead to cavities which can cause pain and infections that may lead to problems like eating, speaking, playing, and even low self-esteem for kids (CDC, 2021). The different development of obesity-related complications and dental caries among children has significant consequences on kids as this might impacts their ability to perform a certain task (Ng et al., 2014).

The product will be a proposal to implement school-based health promotion in the classroom and its association with a healthy outcome to reduce the risk of obesity and dental caries for elementary school children. Research has demonstrated that an increased level of sugary food consumption will be positively significantly associated with dental caries and obesity among elementary school children. The proposal will provide the key concept of past works of literature and unique contribution that can be used in the continued practice of implementing healthy options programs in elementary schools.

This study will aim to answer the following question:

1. Is having a nutrition health class in a school associated with healthy outcomes like shaping student food choices, reducing the risk of obesity and dental caries for elementary school children?

This study examines the existing literature on the importance of providing nutrition classes and healthy food options to elementary school students. Previous studies have shown that nutrition education in elementary schools plays an important role in shaping students' food choices and ultimately health and performance (Perera and Frei, et al., 2015). Also, it is evident that not only will a school nutrition program impact the lives of children for their future health needs, but also their current status (USDA, n.d.). Many children also lack the knowledge of how and why eating healthy is so important and it is important to provide nutrition education and healthy option to the elementary student (Henzel, 2007).

The author's Steward and Wang emphasize the importance of early learning of nutrition-related knowledge, attitudes, and behaviors in schools as it is evident that the school plays a huge role in influencing children's diet. A student who attends schools that promotes healthy eating options through teaching and by providing healthy snacks and meals in schools is likely to request healthy options at home as healthy food provided in schools and the influence of peers become more important than their parent's diet influence at home (Wang and Stewart, 2012). Promoting these behaviors might create a healthy environment that assists children to make healthy food choices that might reduce the risk of obesity among children (Wang and Stewart, 2012).

School-based promotions in classrooms have been proven to be an effective factor to reduce dental caries and obesity among elementary school students. A research study reported by Barnett, Henderson, et al., identified three distinct school environments where type 1 and 2 schools had healthy eating programs in school while type 3 schools had weak eating programs in the school. Adjusting for potential confounders, children attending type 1 and 2 schools had 21% (incidence rate ratio=0.79, 95% CI=0.68, 0.90) and 6% (incidence rate ratio=0.94, 95% CI=0.83, 1.07). The report statically proved that type 1 and 2 students had a lower 2-year incidence of dental caries and obesity respectively, compared with type 3 schools (Barnett and Henderson et, al., 2017)

Significance

We aim to work with policymakers by presenting past and recent research on the effect of obesity on kids to enable to them pass and implement policies that will mandate all elementary schools in the U.S to include nutrition education in their curriculum that will become an integral part of a normal school day for elementary-aged kids and will entail discussion, education, and activities that promote an increased knowledge of nutrition and expanded healthy options at home and school for kids (Guenther, Marc, et al., n.d).

Another unique contribution is organizing workshops to educate and create awareness to parents on the benefits of eating healthy. These workshops will also provide information and resources to parents on how to access healthy options in their neighborhood. Also, working with stakeholders like community partners and policymakers to implement healthy options programs in elementary schools in underserved communities will help reduce the risk of dental caries and obesity among children.

Due to many recent changes in the past years in the area of kids eating habits studies will still need to be done in the future on children who participated in the healthy diet programs where fruits and vegetables were served and how their diets have changed upon completion of K-12.

Another gap identified in the studies is the concerns about the lack of knowledge available on perceptions of healthy eating. More data are needed on the perceptions of healthy eating in general, on the influence on perceptions of messages from diverse sources such as food companies, and, most important, on the role of perceptions of healthy eating as a determinant of food choice.

Innovation Section

The approach of working with policymakers is innovative because it creates awareness on the effect of obesity and dental caries to policymakers which might help make policymakers reach an agreement of passing bills that might help reduce the risk of obesity and dental caries. Also, the approach of organizing educational workshops is innovative because these workshops might be resourceful to parents as this will better inform them on how to choose and access healthy food options for their children.

Methods

Study Design

The study is a quasi study using mothers and children in Chicago public schools between the ages of 6-12 to explore the association between nutrition, health class, obesity, and dental caries. Both quantitative and qualitative methods will be used to answer the research questions. All participants will complete a survey questionnaire with the help of a research assistant or community health worker.

Study Setting

The study will be conducted in Chicago Illinois where few schools will be randomly selected to participate in the study. The study will randomly select ten elementary schools in underserved communities in Chicago where there are fewer educational resources for students and access to healthy food options. The study will specifically select schools in the Southside and Southwest of Chicago.

Sampling Design

The sampling frame of the study is mothers and children in selected elementary schools in the Southside and Southwest of Chicago. The goal of the study is to access mothers and children in underserved communities with limited educational resources, educational background for parents, socio-economic status for parents, and access to healthy options for parents and kids.

Recruitment and Eligibility Procedures

The Researchers for the study will collaborate with not-for-profit organizations in Chicago like the Consortium to Lower Obesity in Chicago Children (CLOCC) whose goal is to confront the childhood obesity epidemic by promoting healthy and active lifestyles for children throughout the Chicago metropolitan area. The first step in the study will involve writing a short letter to parents through the teachers in school. The letter will contain a brief overview of the study. The letter will request parents who will be interested in the study to provide their contact phone number to enable the research assistant to put a call to them and explain in detail about the study. Participants will be screened for eligibility through a series of questions. A parent who are interested in the study and provides their contact information will be contacted and a detailed overview of the study will be provided to them. Written informed consent will be obtained from the parents or guardians before the start of data collection. A training program will be conducted by the PI where all participants and data collectors will be trained. The study will get approval for the protection of research subjects from the Institutional Review Board (IRBs) of the Illinois Department of Public Health

Data Collection Procedures

The study staff will consist of a community health worker, a research assistant, and the principal investigator (PI). Data will be collected by a community health worker and research assistant through a questionnaire that will be given to participants to fill out. The questionnaire will contain questions about obesity and dental caries awareness, demographic questions, and visual prompt pictures will be used to illustrate healthy food and unhealthy food options in the questionnaire to parents and kids. These questionnaires will be handled and filled out by the research assistant and community health worker based on participants' responses. The questionnaire will also have a Spanish version where an interpreter will be available to translate to Spanish-speaking parents and kids.

Specific Measure

Socio-demographic and characteristic data

Demographics of the participant will be obtained by administering a socio-demographic behavioral questionnaire (SDBAQ) which will be modified by researchers. Participants (both parents and children) will be asked to self-report data like age, gender, education, the location where they live, socioeconomic status, and educational background.

Data Analysis Plan

Linear regression will be used to determine whether having a nutrition health class in a school is associated with health outcomes like shaping student food choices, reducing the risk of obesity, and dental caries for elementary school children?. To explore the association between having a nutrition health class in school with obesity and dental caries, I aim to test the null hypothesis of linearity against alternative regression functions and select the best fitting model. In doing so, I will use fractional polynomial regression models to evaluate whether the effect of a continuous variable (i.e. obesity rate) on the outcome (i.e. prevalence of dental caries) is better modeled by a nonlinear fractional polynomial (FP) function.

References

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