Woosung Sohn

American adolescents: sexual mixing patterns, bridge partners, and concurrency.

Background American adolescents have a high incidence of sexually transmitted infections. Patterns of sexual partner choice influence the transmission of infections in this population. Goal To examine patterns of sexual mixing, bridging, and concurrency in American adolescents and the association of these characteristics with condom use. Study Design This project used the AddHEALTH survey data. The survey selected a sample of schools, then conducted in-home interviews with 18,984 students in 1995. A second wave of data collection was conducted 2 years later. The data on sexual relationships collected in the study were analyzed. Results Respondents ranged in age from 13 to 17 years. Sex partnerships with persons of differing age groups were very common in this population (45% of sexual partnerships). Relationships with persons of different ethnicity were more common among Latinos (42%) than among white (14%) and black (15%) respondents. A large proportion of the sample reported more than two partners (56%). Among these persons, a large proportion reported partners in two different age groups (69%) and ethnic groups (35%) as well as concurrent partners (54%). Condom use was lower among persons with partners in different age groups and among persons with a larger number of partners. Conclusions The large number of adolescents who have sexual relationships with persons of different characteristics creates bridges for infections between different groups. Counseling of sexually active adolescents should include discussion on issues of power and communication in these relationships.

Carbonated Soft Drinks and Dental Caries in the Primary Dentition

We analyzed fluid intake data among children aged 2–10 years from a 24-hour dietary recall interview in the NHANES III (1988–94) to investigate the effect of high consumption of carbonated soft drinks on caries in the primary dentition. We used cluster analysis to determine fluid consumption patterns. Four distinct fluid consumption patterns were identified: high carbonated soft drinks, high juice, high milk, and high water. About 13% of children had a high carbonated soft drink consumption pattern; they also had a significantly higher dental caries experience in the primary dentition than did children with other fluid consumption patterns. A fluid intake pattern comprised mainly of milk, water, or juice was less likely to be associated with dental caries. Findings of this study suggest that high consumption of carbonated soft drinks by young children is a risk indicator for dental caries in the primary dentition and should be discouraged.

Risk indicators for dental caries using the International Caries Detection and Assessment System (ICDAS)

BACKGROUND While national surveys have found that African-Americans have a higher prevalence and severity of dental caries than white-Americans, there are only a few descriptive studies of the prevalence and severity of dental caries in low-income urban African-Americans. OBJECTIVES This study assessed the prevalence, severity and determinants of dental caries, using the International Caries Detection and Assessment System (ICDAS). METHODS A representative sample of low-income families (a caregiver and a child aged 0-5 years) was selected from low-income census tracts in the city of Detroit, Michigan. Of the 12,655 randomly selected housing units, 10,695 were occupied and 9781 were successfully contacted (91.5%). There were 1386 families with eligible children in the contacted households; and of those, 1021 were interviewed and examined at a permanent examination center organized for this study. This represents an overall response rate of 73.7%. At the center, trained staff interviewed the main caregivers of the selected children, and trained and calibrated dentists examined the caregiver and her/his child. Data used in this study included information gathered from the social, behavioral and parenting questionnaires, the Block Food Frequency Questionnaire (total sugar intake), and data collected from community and census databases. RESULTS Over 90% of the adults (ages 14-70 years, average 29.3) had at least one noncavitated carious lesion and 82.2% had at least one primary cavitated lesion. Negative binomial regression models found that the age of caregivers and the number of churches in neighborhoods were negatively associated with the number of noncavitated tooth surfaces. Cavitated tooth surfaces were positively associated with age, oral hygiene status, being worried about teeth, a recent visit to a dentist, and the number of grocery stores in the neighborhoods. However, the number of cavitated tooth surfaces was negatively associated with preventive dental visits, positive rating of oral health status and the number of dentists in a community. CONCLUSIONS Dental caries, especially at the noncavitated stage, is highly prevalent in low-income African-American adults in Detroit. A significant increase in the mean number of missing teeth was observed after the age of 34 years. This study found that different individual, social, and community risk indicators were associated with noncavitated versus cavitated tooth surfaces.

Incidence of caries lesions among patients treated with comprehensive orthodontics.

INTRODUCTION Dental caries, specifically decalcified white-spot lesions (WSL), is a well-known side-effect of orthodontic treatment. The incidence of labial incipient caries lesions and its relationship with various patient and treatment variables was investigated in patients treated with comprehensive orthodontics. METHODS Randomly selected orthodontic patient records (n = 350) were examined to determine incipient caries lesion development. Labial surfaces on pretreatment and posttreatment photographs were scored with a standardized scoring system. Independent variables were collected by chart abstraction. RESULTS The incidence of patients who developed at least 1 new WSL during treatment was 72.9%, and this incidence was 2.3% for cavitated lesions. Treatment duration was significantly associated with new WSL development (P = 0.03). Development of WSL and cavitated lesions increased (both, P <0.00) despite increased attention to oral hygiene during treatment. Sex, age, extraction therapy, and various fluoridation sources were not associated with WSL development, but initial oral-hygiene score was moderately associated (P <0.06). CONCLUSIONS The incidence of WSL in patients treated with comprehensive orthodontics was significantly high, and the preventive therapy provided appeared to be ineffective. This widespread problem is alarming and warrants significant attention from both patients and providers that should result in greatly increased emphasis on effective caries prevention.

Predictors of Dental Caries Progression in Primary Teeth

The current evidence on the role of the social, behavioral, and community determinants of dental caries is based on cross-sectional analyses. The available evidence has not been based on analysis of multiple determinants within the same population. This longitudinal study addresses both of these limitations. The study included data from 788 dyads of children and their caregivers (77% follow-up), who were examined in 2002–03 and 2004–05. The families were assessed by calibrated dentists for severity of caries at both time periods. Additionally, the caregivers answered questionnaires administered by trained interviewers. The caries increment was adjusted for reversals. Significant predictors of higher caries increment were higher consumption of soda drinks, older age of child, greater weight-for-age, fewer dental treatment visits, higher baseline caries levels of children and their caregivers, dental fatalism, and neighborhood disadvantage status. The selected risk factors in the final model explained about 20% of the variation in the increment.

Obesity and Sugar‐sweetened Beverages in African‐American Preschool Children: A Longitudinal Study

A representative sample of 365 low‐income African‐American preschool children aged 3–5 years was studied to determine the association between sugar‐sweetened beverage consumption (soda, fruit drinks, and both combined) and overweight and obesity. Children were examined at a dental clinic in 2002–2003 and again after 2 years. Dietary information was collected using the Block Kids Food Frequency Questionnaire. A BMI score was computed from recorded height and weight. Overweight and obesity were defined by national reference age‐sex specific BMI: those with an age‐sex specific BMI ≥85th, but <95th percentile as overweight and those with BMI ≥95th age‐sex specific percentile as obese. The prevalence of overweight was 12.9% in baseline, and increased to 18.7% after 2 years. The prevalence of obesity increased from 10.3 to 20.4% during the same period. Baseline intake of soda and all sugar‐sweetened beverages were positively associated with baseline BMI z‐scores. After adjusting for covariates, additional intake of fruit drinks and all sugar‐sweetened beverages at baseline showed significantly higher odds of incidence of overweight over 2 years. Among a longitudinal cohort of African‐American preschool children, high consumption of sugar‐sweetened beverages was significantly associated with an increased risk for obesity.

Dietary patterns related to caries in a low-income adult population.

The aim of this study was toexamine the relationship between dietary patterns and caries experience in a representative group of low-income African-American adults. Participants were residents of Detroit, Michigan, with household incomes below 250% of the federally-established poverty level (n = 1,021). Dietary histories were obtained by trained interviewers in face-to-face interviews with the adult participants, using the Block 98.2® food frequency questionnaire. Caries was measured by the ICDAS criteria (International Caries Detection and Assessment System). There were 200 dietary records whose data were judged to be invalid; these participants were omitted from the dietary analyses to leave n = 821. Factor analysis identified patterns of liquid and solid food consumption, and the resulting factor scores were used as covariates in multivariable linear regression. Caries was extensive, with 82.3% of the 1,021 participants (n = 839) having at least one cavitated lesion. Nearly three quarters of the adult participants were overweight or obese. This population had severe caries, poor oral hygiene, and diets that are high in sugars and fats and low in fruits and vegetables. Apart from tap water, the most frequently consumed food item by adults of all ages was soft drinks; 19% of all energy from sugar came from soft drinks alone. In both the bivariate analyses and in the regression model, frequency of soft drink consumption and the presence of gingival plaque deposits were significantly associated with caries. Interventions to promote oral health are unlikely to be successful without improvements in the social and physical environment.

Perceived everyday discrimination and psychological distress: does social support matter?

Objectives. We investigate the association between perceived everyday discrimination and psychological distress among urban African-American women with young children (under 6 years) living in low-income neighborhoods. Specifically, we examine whether instrumental and emotional social support moderates the association between perceived everyday discrimination and psychological distress. Design. The data come from the Detroit Dental Health Project, a two-stage area probability sample representative of low-income African-American children in the city of Detroit. The analysis focuses on 969 female caregivers of young children. A series of hierarchical regression analyses were performed to examine the role of social support in the link between perceived everyday discrimination and psychological distress, with appropriate adjustments for the complex sample design. Results. Both moderate and high frequency levels of discrimination were associated with higher levels of psychological distress after controlling for age, education, income, and self-rated health. There was a main effect of emotional support so that availability of emotional support was associated with less psychological distress. Instrumental support exerted a buffering effect to mitigate the negative influence of moderate levels of perceived discrimination on psychological distress. Conclusion. Findings suggest that instrumental social support provides some protection from everyday stress. Social support, however, does not offset the impact of acute stress caused by frequent perceptions of everyday discrimination.

Resilience to Urban Poverty: Theoretical and Empirical Considerations for Population Health

OBJECTIVES To better understand the trajectory that propels people from poverty to poor health, we investigated health resilience longitudinally among African American families with incomes below 250% of the federal poverty level. METHODS Health resilience is the capacity to maintain good health in the face of significant adversity. With higher levels of tooth retention as a marker of health resilience, we used a social-epidemiological framework to define capacity for health resilience through a chain of determinants starting in the built environment (housing quality) and community context (social support) to familial influences (religiosity) and individual mental health and health behavior. RESULTS Odds of retaining 20 or more teeth were 3 times as likely among adults with resilience versus more-vulnerable adults (odds ratio=3.1; 95% confidence interval [CI]=1.3, 7.4). Children of caregivers with resilience had a lower incident rate of noncavitated tooth decay at 18- to 24-month follow-up (incidence risk ratio=0.8; 95% CI=0.7, 0.9) compared with other children. CONCLUSIONS Health resilience to poverty was supported by protective factors in the built and social environments. When poverty itself cannot be eliminated, improving the quality of the built and social environments will foster resilience to its harmful health effects.

In-vitro evaluation of various treatments to prevent demineralization next to orthodontic brackets

INTRODUCTION One common negative side effect of orthodontic treatment with fixed appliances is the development of incipient caries lesions around brackets, particularly in patients with poor oral hygiene. Bio-available minerals from cement containing amorphous calcium phosphate (ACP) might facilitate remineralization and inhibit lesion development. Our objective was to compare the potential of ACP-containing resin cement, fluoride varnish, resin sealer, and MI Paste (GC America, Alsip, Ill) under similar in-vitro conditions to prevent incipient caries lesions next to brackets on teeth. METHODS One hundred extracted premolars were randomly allocated to 5 groups (n = 20). Brackets were bonded with ACP cement (Aegis-Ortho, Bosworth, Skokie, Ill), resin (Transbond XT [3M Unitek, Monrovia, Calif], control), or resin followed by application of fluoride varnish (Vanish, 3M, St Paul, Minn), resin sealer (Pro-seal, Reliance Orthodontic Products, Itasca, Ill), or casein phosphopeptide-ACP paste (MI Paste). All groups were cycled for 15 days in demineralization solution for 8 hours a day, rinsed, placed in artificial saliva (30 minutes), brushed, and stored overnight in artificial saliva. The extent of demineralization in each group was assessed by using quantitative light-induced fluorescence and confocal laser scanning microscopy. RESULTS Only the Pro-seal and Vanish groups showed significantly smaller lesions than the controls (Kruskal-Wallis test, P <0.05) for both quantitative light-induced fluorescence and confocal laser scanning microscopy measurements. Fluorescence loss of Aegis-Ortho was similar to Vanish; Aegis-Ortho, MI Paste, and the controls were not different from each other. CONCLUSIONS Both light-cured filled resin (Pro-seal) and fluoride varnish (Vanish) might prevent enamel demineralization next to orthodontic brackets exposed to cariogenic conditions, but the observed positive effects of Aegis-Ortho and MI Paste were not significant.