https://orcid.org/0000-0003-3784-9537
ABSTRACT
This study evaluated whether the nutritional status of preschoolers is influenced by secondhand smoke. Pairs of mothers-children (N = 201) were allocated in “children exposed to secondhand smoke (ESHS)” or “not exposed (N_ESHS).” Mothers answered, “The Parental Feeding Style Questionnaire (PFSQ).” The nutritional status and oral conditions were evaluated using WHO criteria. ESHS was 3.5 more likely to have a high BMI and their mothers had 10 kg more than N_ESHS. The probability of having dental caries was 2.28 and 3.68 times greater when the mother’s BMI increases and when family/mothers were smokers, independently whether they smoke in the child’s presence.
KEYWORDS:
Introduction
The eating habit is influenced by environmental factors, such as community, society, media, family, and food offering (Scaglioni et al. Citation2018). The preschool age, considered the critical window stage, is the period that influences a child’s physical and cognitive health and development, core to which is their nutrition (Liao and Deng Citation2021; Scaglioni et al. Citation2018). Dietary habits are shaped at a young age and maintained during later (Montaño et al. Citation2015), and unhealthy diet may be a long-term risk factor for obesity and non-communicable diseases (Powell et al. Citation2017; Scaglioni et al. Citation2018).
Parents’ eating habits and eating practices may be the primary determinants of children’s family system and food choices (Scaglioni et al. Citation2018) through the foods they make available and how they interaction with each other (van der Horst, Sleddens, and Aguilera Citation2017). Parents’ feeding style is based on the parent responding in a sensitive and responsive way to the child’s emotional behavior (Hughes et al. Citation2013), classifying parents into 4 styles: authoritative (high warmth, high control), authoritarian (low warmth, high control), indulgent (high warmth, low control), and uninvolved (low warmth, low control) (Maccoby and Martin Citation1983).
Parents’ lifestyle could be a potential determinant to food choosing and, thus, food offering (Demir and Bektas Citation2017; Dolwick and Persky Citation2021; van der Horst, Sleddens, and Aguilera Citation2017). As to lifestyle habits, smokers report a higher frequency of snack cravings, especially high-fat foods compared to former and nonsmokers (Chao et al. Citation2017), especially higher intake of fat predominantly saturated and mono-unsaturated fat, corresponding with a higher consumption of processed meat, and a lower intake of fruit and vegetables (Zyriax et al. Citation2018).
Exposed secondhand smoke (ESHS), passive smokers, or environmental smokers, is one of the most important and most widespread exposures in the indoor environment affecting globally 1% of the global burden of disease worldwide (WHO World Health Organization Citation2020). In Brazil, at least 26.2% of schoolchildren were passive smokers at home and this exposure was higher among public schoolchildren (27.8%) than among those attending private schools (16.7%) (IBGE Instituto Brasileiro de Geografia e Estatística Citation2014). Currently, the percentage of passive smokers over 18 years of age at home was 7.6%.
Household smokers do not only affect the physiology of children who are exposed to it but also has adverse effects on their general and oral health (Dhanuka and Vasthare Citation2019). Passive smoking children may show poor oral health, emulating their parents (Tanaka et al. Citation2015); a lack of toothbrushing, poor dietary habits such as irregular consumption of sweets, and low fluoride exposure (Tanaka et al. Citation2015); change in gingival melanic pigmentation (Yadav et al. Citation2015); increase in Streptoccocci mutans concentration (Avşar et al. Citation2008; Hanioka et al. Citation2008) and Lactobacilus, decrease in salivary pH, salivary flow and buffer capacity (Avşar et al. Citation2008). Moreover, smoker mothers are considered an indicator of risk for caries in preschool age children (Dhanuka and Vasthare Citation2019; González-Valero et al. Citation2018; Lee et al. Citation2020), increasing the risk of caries by twice as much as children who are not exposed to smoke (B Hasmun et al. Citation2017; Tanaka et al. Citation2015) or any household smokers (Tanaka et al. Citation2010).
Studies have referred infant feeding to early experience with food, suggesting that parental feeding practices and the family environment may be involved in the process of health problems (Alkerwi et al. Citation2017), such as obesity (Demir and Bektas Citation2017; Hughes et al. Citation2013; Powell et al. Citation2017), and the preference for healthy and unhealthy foods (Fisher et al. Citation2002); however, these studies do not specify whether there were smoking parents and/or children exposed to secondhand smoke in the study population.
Parental behavior can be a determining factor in the diet and oral health of children. Thus, understanding how parents feed their children can implement preventive strategies for both oral and general child health. For this reason, the aim of this study was to evaluate whether the nutritional status of preschool children could be influenced by secondhand smoke exposition, considering the way they were fed and whether there was any possible difference in their oral health conditions. Therefore, the hypothesis was that those variables were influenced by secondhand smoke exposition.
Material and methods
This is a cross-sectional study carried out during the years 2017 and 2018. It was approved by the Research Ethics Committee of the Piracicaba Dental School, University of Campinas (FOP-UNICAMP), protocol number 2.657.941 CAE: 86582318.6.0000.5418.
Subjects
The sample consisted of 201 mother-child pairs recruited from public schools of Piracicaba, São Paulo, Brazil. shows the process of the sample selection. Briefly, 647 mother-child pairs were invited to participate and received the Free and Informed Consent Term (TCLE). Two-hundred and seventy TCLE returned and then the respective mothers received a self-applied questionnaire about biological characteristics, socio-economic factors dental history of the children (Demir and Bektas Citation2017). From the 270 eligible participants, 63 presented incomplete data and six were excluded according to criteria cited below.
Figure 1. Flowchart of the sample selection.
Inclusion criteria: Mother−child dyads, with children aged from 4 to 5 years (six incomplete), duly enrolled in the public preschools of Piracicaba, São Paulo, Brazil.
Exclusion criteria: Children with dietary restriction, allergy or intolerance to any food related to this study; children with systemic disorders that may compromise the masticatory system, such as neurological disorders, cerebral palsy, and among others; chronic diseases; inappropriate behavior and/or refusal to cooperate in the evaluation of the proposed variables. The information was given by the parents/guardians and in case of doubt the pediatrician were consulted to confirm the diagnosis.
Children were considered as exposed to secondhand smoke (ESHS) if any family member or caregiver smoked in their presence, resulting in two groups: (1) children exposed to secondhand smoke (ESHS) or (2) children not exposed (Not_ESHS). Moreover, it was verified whether the mother was a smoker, how many people in the family are smokers, and how many cigarettes a day the mother, family members, or caregivers smoked in the presence of the child.
Children of ESHS group were classified according to the amount of exposure to smoke:
- “Highly exposed” (Exposure > 10 cigarettes/day);
- “Moderately Exposed” (Exposure between 6 and 10 cigarettes/day);
- “Slightly Exposed” (Exposure between 1 and 5 cigarettes/day) and
- “Occasionally exposed” (Exposed to smoke, but not daily).
The total amount of cigarettes smoked in the child’s presence during the day was considered regardless of the number of smoking family members (Avşar et al. Citation2008; Montaldo et al. Citation2012).
Evaluation of parental feeding behavior – parental feeding style questionnaire (PFSQ)
PFSQ is a specific and self-applied instrument, composed of a total of 27 items, with responses options using a 5-point Likert scale ranging from “never” (1 point) to “always” (5 points). The higher the score, the greater the tendency for parents to adopt a particular eating style. The PFSQ was translated and socioculturally adapted into Brazilian Portuguese according to Guillemin et al. (Citation1993) by our working team (Souza t al., Citation2023).
The questionnaire consists of four domains (Demir and Bektas Citation2017; Wardle et al. Citation2002):
Control over eating: is when parents control the quality and quantity of the foods that their children consume
Encouragement/prompting to eat: means inducing/encouraging children to eat
Instrumental feeding: rewarding children with food to avoid bad behavior or ensure a healthy diet
Emotional feeding: giving foods to children in response to feelings such as uneasiness and boredom
Anthropometric assessment
The anthropometric assessment of the children took place at school, individually, in a room under natural lights, ensuring privacy. Weight and height measurement were performed following standardized norms of De Onis et al. (Citation2007). The weight was obtained using a digital scale and the height using a portable stadiometer/measuring tape. Children wore light clothing and no shoes. The Body Mass Index (BMI) calculation is the ratio between weight (in kilograms) and height (in meters) squared – BMI = weight/height2. The limit of normality is established by WHO curves and BMI Z-scores according to age and sex by graphs. The weight and height of the mothers were self-declared, and the BMI calculated to verify the nutritional status according to WHO (Citation1995).
Oral conditions
All selected children underwent a clinical oral examination using instruments of routine in the dental clinic (dental mirror, gingival probe with round ended and protective supplies), which was performed by one trained and calibrated examiner (SCCJ). The examinations took place at the school, out of doors in daylight but not direct sunlight.
The evaluation of oral conditions consisted of clinical examination of dental caries using decay – missing – filled in deciduous teeth index (dmft index) (WHO Citation2013), and daily toothbrush frequency. The diagnosis of dental caries was complemented by the diagnosis of active and inactive white spot lesions, drying the dental surface with gauze. The presence of visible biofilm was evaluated in buccal surfaces of primary upper incisors, without the use of dye (Bonanato et al. Citation2010).
Parents/guardians of children who needed dental treatment received a letter to refer them to the FOP-UNICAMP graduation clinic.
Statistical analysis
The data were analyzed with the JAMOVI software (version 2.3.17, retrieved from https://www.jamovi.org) with a significance level of α = 0.05. Data distribution was verified by the Kolmorogov-Smirnov test. The results were submitted to descriptive analysis (mean, standard deviation, percentages). The t-test and Mann–Whitney test were applied, when indicated, for comparisons. The proportions were compared with Fisher’s Exact and Chi-square tests, when indicated. Spearman’s correlation matrix was constructed between the age and BMI of children and their mothers and PSFQ domains. To interpret the correlation strengths, the following ranges of coefficients were adopted: 0.9 to 1.0 – very strong correlation; 0.7 to 0.89 - strong correlation; 0.4 to 0.69 - moderate correlation; 0.2 to 0.39 - weak correlation; 0 to 0.0.19 – very weak or no correlation.
Two logistic regression models were constructed, considering children’s BMI as dependent variables for the first model (normal weight = 0, overweight/obesity = 1) and for the second model, dental caries (absence = 0, presence = 1). The independent variables in the first model were:
exposure to secondhand smoke (children Not_ESHS = 0, children ESHS = 1),
sex (girls = 0, boys = 1),
mothers’ BMI (normal weight = 0, overweight/obesity = 1),
mothers’ marital status (married = 0, others = 1),
smoker mother (no = 0, yes = 1),
smoking family and mothers (no = 0, yes = 1), and
PSFQ domains as ordinal variables.
In the second model, the independent variables were the same and the following variables were added:
(8) dental caries in the family (absence = 0, presence = 1),
(9) presence of visible biofilm (absence = 0, presence = 1).
Family income and mothers’ education were not included in the models, due to missing values. The univariate logistic regression was used to test associations of each independent variable and the dependent binary variables. Then, two multivariate logistic regression models were built, including all significant independent variables at p < 0.05 and non-significant ones at p < 0.20, with exposure to secondhand smoke being forced into the model.
Results
shows demographic characteristics of the two groups, ESHS children and Not_ESHS children, and their mothers. Mothers of ESHS children presented weight and BMI significantly higher than the Not_ESHS ones. For the other maternal variables, no differences were found in the distribution between the groups, despite the missing data for educational status and income. The variables for smoking conditions showed values significantly higher for ESHS children, as expected. In the Not_ESHS group, two mothers were smokers and there were eight families with smokers, but they not smoked in the presence of the children. The number of cigarettes per day that the children in the ESHS group were exposed ranged from one to five, so they were classified as “Slightly Exposed.”
Table 1. Demographic characteristics of the sample.
The descriptive values of the PFSQ scores are in and distributed according to the domains and groups. There was no significant difference between ESHS and Not_ESHS children in each domain values, neither between overall scores (p > 0.05).
Table 2. Descriptive data of PFSQ domains for ESHS and Not_ESHS children.
shows the correlation coefficients between the anthropometric variables, PFSQ domains for ESHS and Not_ESHS children. For ESHS children, BMI was positively correlated with their mother’s BMI, as well as the domains Control over eating with “Encouragement/Prompting to eat” and Instrumental feeding with Emotional feeding. The coefficient magnitudes ranged from weak to moderate.
Table 3. Correlation matrix for anthropometric variables, PFSQ domains in ESHS children and Not_ESHS children.
Positive and negative correlations were observed between variables in Not_ESHS children, highlighting the negative correlations between child´s age with “Emotional feeding” and “Instrumental feeding” domains. Child’s BMI was positively correlated with “Instrumental feeding” domain and mother’s age with “Encouragement/Prompting to eat” domain. The respective correlations ranged also from very weak to moderate. For PSFQ domains, only “Encouragement/Prompting to eat” with “Instrumental feeding” were not significantly correlated. Furthermore, all PSFQ domains were positively correlated with overall PSFQ score for both ESHS and Not_ESHS children, with moderate magnitude, except of “Emotional feeding” in Not_ESHS.
The characteristics of oral health and oral hygiene are presented in . The dmft did not show significant difference between ESHS and Not_ESHS children. However, the number of Not_ESHS children caries-free was significantly higher than those ESHS. Similar differences were found for white spot lesions; despite the low number, the proportion of ESHS children with white spot lesions was significantly lower than the Not_ESHS ones. In addition, the toothbrush frequency was the same for all children ().
Table 4. Descriptive characteristics of oral health and oral hygiene.
Table 5. First model of multiple logistic regression, considering “Child’s BMI” as the dependent variable.
Table 6. Multivariate logistic regression, considering dental caries as the dependent variable.
The results of univariate logistic regression considering the dependent variable “Child’s BMI” showed that the independent variables with p values less than 0.20 were “exposure to secondhand smoke”, “mothers” BMI’ and ‘smoking family and mothers`. The other categorical variables did not reach the assumptions of the logistic regression (p > .05), neither the scores of PSFQ domains (p > .05). The only variable that remained significant in the final model was “Smoking family and mothers” (), meaning that the probability of having a high BMI was 3.5 times greater for children whose family and mothers were smokers, independently whether they smoke in the child’s presence.
shows the final model for multivariate logistic regression, considering dental caries as dependent variable. It was seen previously that variables “smoker mother” and “smoker family” presented p-values less than 0.20 in the univariate logistic regression, but during construction of the final logistic regression model they did not fit well and were excluded. In this context, the independent variables “mother’s BMI” and “smoking family and mothers” remained significative in the model, showing that the probability of having dental caries was 2.28 and 3.68 times greater when the BMI of mothers increases and when family and mothers were smokers, independently whether they smoke in the child’s presence.
Considering the results, the hypothesis was partially confirmed.
Discussion
Despite the percentage of adult smokers in Brazil is decreasing especially in the last decades, from 34.8% in 1989 to 9.3% in 2018 – being males 12.1% and females 6.9%, smoking and passive smoking are an important risk factors for the development of chronic diseases. Consequently, smoking is still the global leader among the causes of preventable deaths (Ministério da Saúde do Brasil Citation2019; WHO Citation2020). It is important to mention that children who live with a smoker, although they report not smoking indoors, are still in risk of exposure (Merianos et al. Citation2018). Passive smoking children were more likely to have had any medical care visit including sick care, checkups, or physical examinations than non-passive smoking children (Merianos et al. Citation2018).
In this study, 31.84% of children were considered exposed to a secondhand smoke, a percentage considered high in comparison with a sample of São Paulo city, SP, Brazil, in which 8% of children aged 0–8 years were exposed to smoke (Ministério da Saúde do Brasil Citation2019). Maybe the differences can be attributed to the different methods for evaluating the respective exposure, since the latter was based on a telephone survey (Ministério da Saúde do Brasil Citation2019), while a self-administered questionnaire was used in the present study. Furthermore, particularities in the smoking habit of each evaluated population, from the cities of Piracicaba and São Paulo (Ministério da Saúde do Brasil Citation2019), could also explained the differences found.
Mothers from a smoker family environment showed significant higher weight and BMI than the mothers from families without this habit, with a large rate of overweight and obesity. Unhealth eating habits are frequent among smokers, since they have reported a higher frequency of snack cravings, especially high-fat foods, compared to nonsmokers (Alkerwi et al. Citation2017; Chao et al. Citation2017; Monteiro Dos Santos et al. Citation2021; Zyriax et al. Citation2018). The nicotine modifies smokers’ sense of taste, then foods high in sugar and fat and processed food become more palatable (Beck et al. Citation2018).
In the ESHS group, the BMI of the child and the mother were positively correlated, suggesting similar eating behavior between them. According to Pasztak-Opiłka et al. (Citation2020), maternal BMI was a significant predictor of eating behaviors and knowledge of nutrition, and mothers with normal body weight were characterized by a higher level of positive eating behaviors. In this context, the domains “Control over eating” with “Encouragement/Prompting to eat” were positively correlated, meaning that the mothers should control the food consume, inducing the children to eat different foods. In this way, there was a moderate positive correlation between the domains “Emotional eating” and “Instrumental eating,” showing that mothers could be using food as emotional comfort and reward for their children. Overweight parents are more likely to report using food as a reward for their children and try to regulate their children’s emotions using food (Dolwick and Persky Citation2021).
On the other hand, for Not_ESHS children, positive and negative correlations occurred between variables, with values ranging from very weak to moderate strengths. Nevertheless, the following considerations could be useful. First, the age of the child and the mother were positively correlated, which in turn were correlated with some PSFQ domains, as follows: “Encouragement/Prompting to eat” was positively correlated with mother’s age, which means that as the mother’s age increases, the incentive for children to consume a variety of foods becomes more evident. Conversely, Liao and Deng (Citation2021) found that young caregivers tended to offer more healthier foods than older caregivers. In this context, “Instrumental feeding” and “Emotional feeding” showed a weak inverse correlation with the child’s age. Although the age range of the studied sample has been small, children around 5 years probably needed less reward for eating and less food in response to negative feelings than children aged 4 years. Significant positive correlation for Not_ESHS children was observed between child’s BMI and “Instrumental feeding,” but the magnitude was very weak, suggesting caution on interpreting this finding, because the instrumental feeding style of parents in offering food to obtain the desired behavior could be considered an influencing factor on child’s weight status. In fact, there is some evidence that parents who provide healthy eating behavior to their children are less likely to include rewards in their infant feeding styles (Dolwick and Persky Citation2021).
Furthermore, in ESHS children, the domains “Control over eating” with “Encouragement/Prompting to eat” were weakly and positively correlated, as well as the domains “Emotional eating” and “Instrumental eating,” but with moderate magnitude. Since child’s BMI was positively correlated with “instrumental feeding in Not_ESHS group,” despite the weak strength, it is possible to infer that a less-favorable eating habits could have been established, as observed by Lo et al. (Citation2015), because unhealthy food has a more appealing smell and taste than fruits and vegetables, as rewards for children’s behaviors or to relieve their emotion (Lazarte et al. Citation2012). According to Dolwick and Persky (Citation2021), parents who self-reported a greater tendency toward reward-based eating opted for ultra-processed foods for their children, inducing excessive consumption.
In line with those positive inter-domain correlations, in Not_ESHS children the domain “Control over eating” was weakly correlated with “Encouragement/Prompting to eat” domain. On the other hand, negative weak correlations were observed between “Control over eating” domain and “Emotional feeding” and “Instrumental feeding,” as well as ‘Encouragement/Prompting to eat” and “Emotional feeding.” Although the respective magnitudes were weak, perhaps mother’s feeding styles of Not_ESHS children have been successful by controlling or stimulating a proper food ingestion. “Control over eating” and “Encouragement/Prompting to eat” have been associated with higher intake of fruits and vegetables (Lo et al. Citation2015; Wang et al. Citation2017). Nevertheless, it must take into account that encouragement can also contribute also to a higher consumption of dairy products and control to lower consumption high fat food, as previously observed by Lo et al. (Citation2015). Beyond this, the effectiveness in the style of encouraging to eat can be considered similar to eating control (Lo et al. Citation2015). Although the present study did not assess the types of foods offered by the mothers, encouraging the intake of new foods does not necessarily imply offering only healthy foods, but offering a variety of healthy foods and industrialized foods with a high content of fat and carbohydrates as well, agreeing with Lo et al. (Citation2015). A moderate strength was only observed between “Emotional feeding” and “Instrumental feeding.”
All domains in both groups were moderate and positively correlated with overall PSBQ score, showing an adequacy between the questionnaire and the respective measurement of parents’ behavior in feeding their children.
As highlighted previously in this study, parental behavior can be a determining factor in the diet and oral health of children, and parental/family smoking conditions can be an influencing factor on oral conditions. It is well known by the literature that children of mothers who smoke may have poorer dental health behaviors including reduced toothbrushing frequency, lower use of fluoride toothpaste, less help with toothbrushing higher consumption of meal snacks and beverages at night (Dhanuka and Vasthare Citation2019; González-Valero et al. Citation2018; Hanioka et al. Citation2011; Lee et al. Citation2020). In the present study, there was no significant difference in dfmt and daily frequency of toothbrushing between ESHS and Not_ESHS children. Meanwhile, the number of Not_ESHS caries-free children was significantly higher than ESHS children even though the opposite were found for white spot lesions. These results are noteworthy for their low caries index when compared to the national average of 2.43 teeth with caries experience of caries in 5-year-old children (Ministério da Saúde do Brasil Citation2012). These finding could infer two situations. First, nicotine concentration is related to age, due to metabolic reasons (Lopez et al. Citation2003) that is, the younger the individual, the faster nicotine is metabolized in the body, consequently, deleterious effects of nicotine on the oral cavity may be minimized. Second, the health educational strategies implemented in public education services could have been effective in maintaining the oral and nutritional health of children.
To observe the probability of the variables studied to influence nutritional status of children and their oral conditions, regressions models were built. In the first logistic regression model, it was observed that children whose family and mothers were smokers were 3.5 times more likely to have a high BMI. Probably, the dynamic of feeding children exposed to smoking was confirmed, since unhealthy eating habits could be seen in smokers, with higher consume of high-fat foods, as commented above (Alkerwi et al. Citation2017; Chao et al. Citation2017, Monteiro dos Santos et al., Citation2021; Zyriax et al. Citation2018). Thus, in this sample, being exposed or not to secondhand smoke was not a factor that influenced the nutritional status of children, but the family environment and respective habits may have played an influencing role. Also, the fact that children were young and exposed to five or less cigarettes per day, considered as slightly exposed, could be determined the lack of association of both groups with the BMI. Dietary intake and meal practice are also important influencing factors (Lo et al. Citation2015) and should be considered in future studies.
In this study, the mother’s BMI and being from family and mother who smoke determined higher probability of having dental caries, 2.13 and 2.37 times, respectively. It is known that maternal BMI can be a predictor of children’s eating behavior (Pasztak-Opiłka et al. Citation2020), which in turn may be involved in the etiology of dental caries, as an unhealthy diet is a determining factor, highlighting the importance of carbohydrate consumption. In relation to family and mother who smoke, the same consideration about an unhealth diet can be pointed out, that it could have contributed to increase the probability of having dental caries. Corroborating that, previous studies observed that children who are exposed to secondhand smoke during infancy had about two times higher probability of having caries in their primary teeth (B Hasmun et al. Citation2017; González-Valero et al. Citation2018; Tanaka et al. Citation2015). Despite the above consideration about nicotine metabolism in the body of young children (Lee et al. Citation2020), nicotine may contribute to the binding of Streptococcus mutans to oral structures, increasing the risk of developing dental caries (Avşar et al. Citation2008; Hanioka et al. Citation2008; Liu et al. Citation2018).
The strengths of this study include the large and homogeneity sample size. However, there are some limitations. First, all children were from public school, where there are different educational political systems compared to private schools. Although there were no significant differences in the distribution of maternal education and family income between the groups, missing values made them unable to be included in the regression models, making it difficult to accurately interpret their influence. Second, the content of food consumption was not evaluated, which could provide more clues to associate the studied variables with oral health. Thus, more studies should be performed to evaluate the above variables, as well as the cotinine concentration to verify their influence on children’s oral health and eating behavior. In addition, studies in other age ranges than 4–5 years used in the present study are also required, since younger and older children are naturally affected by environmental smoke. In this context¸ public policies must be implemented to make people aware of the harm caused by smoking, highlighting the consequences of passive smoking. These policies can be carried out with different approaches: education for pregnant women, educators, health professionals, mainly in the care of smokers and their families with periodic preventive follow-up.
Conclusions
The nutritional status of preschool children was not influenced by secondhand smoke exposition, but smoking family and mother increased the probability of heaving greater BMI, even they did not smoke in child’s presence. The parental feeding style was the same for ESHS and Not_ESHS children. Despite of the frequency of dental caries was the same for both groups, the number of caries free Not-ESHS children was greater than ESHS children. Finally, the mother’s BMI and to be of smoking family and mother, even they did not smoke in child’s presence, increased the probability of having dental caries.
Author contributions
KGS and MBDG conceptualized the study. KGS and SCCJ collected the data. KGS, TSB and MBDG analyzed the data. KGS and SCCJ wrote de original draft of the paper. TSB and MBDG reviewed and edited the paper. All authors have read and agreed to the published version of the manuscript.
Acknowledgments
The authors thank the children, parents, directors, and teachers at the public schools for participating in the study.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
References
- Alkerwi, A., B. Baydarlioglu, N. Sauvageot, S. Stranges, P. Lemmens, N. Shivappa, and J. R. Hébert. 2017. Smoking status is inversely associated with overall diet quality: Findings from the ORISCAV-LUX study. Clinical Nutrition 36:1275–82. doi:10.1016/j.clnu.2016.08.013.
- Avşar, A., O. Darka, B. Topaloğlu, and Y. Bek. 2008. Association of passive smoking with caries and related salivary biomarkers in young children. Archives of Oral Biology 53 (10):969–74. doi:10.1016/j.archoralbio.2008.05.007.
- Beck, K. L., B. Jones, I. Ullah, S. A. McNaughton, S. J. Haslett, and W. Stonehouse. 2018. Associations between dietary patterns, socio-demographic factors and anthropometric measurements in adult new zealanders: An analysis of data from the 2008/09 new Zealand adult nutrition survey. European Journal of Nutrition 57:1421–33. doi:10.1007/s00394-017-1421-3.
- B Hasmun, N. N., B. K. Drummond, T. Milne, M. P. Cullinan, A. M. Meldrum, and D. Coates. 2017. Effects of environmental tobacco smoke on the oral health of preschool children. European Archives of Paediatric Dentistry 18:393–98. doi:10.1007/s40368-017-0308-6.
- Bonanato, K., I. A. Pordeus, F. R. Moura-Leite, M. L. Ramos-Jorge, M. P. Vale, and S. M. Paiva. 2010. Oral disease and social class in a random sample of five-year-old preschool children in a Brazilian city. Oral Health & Preventive Dentistry 8:125–32.
- Chao, A. M., M. A. White, C. M. Grilo, and R. Sinha. 2017. Examining the effects of cigarette smoking on food cravings and intake, depressive symptoms, and stress. Eating Behaviors 24:61–5. doi:10.1016/j.eatbeh.2016.12.009.
- Demir, D., and M. Bektas. 2017. The effect of children’s eating behaviors and parental feeding style on childhood obesity. Eating Behaviors 26:137–42. doi:10.1016/j.eatbeh.2017.03.004.
- de Onis, M. A. W. Onyango, E. Borghi, A. Siyam, C. Nishida, and J. Siekmann. 2007. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization 85 (9):660–67. doi:10.2471/blt.07.043497.
- Dhanuka, S., and R. Vasthare. 2019. The association of secondhand smoke exposure and dental caries in children and adolescents: A literature review. General Dentistry 67 (6):20–4.
- Dolwick, A. P., and S. Persky. 2021. Parental reward-based eating drive predicts parents’ feeding behaviors and Children’s ultra-processed food intake. Appetite 164:105241. doi:10.1016/j.appet.2021.105241.
- Fisher, J. O., D. C. Mitchell, H. Smiciklas-Wright, and L. L. Birch. 2002. Parental influences on young girls’ fruit and vegetable, micronutrient, and fat intakes. Journal of the American Dietetic Association 102 (1):58–64. doi:10.1016/s0002-8223(02)90017-9.
- González-Valero, L., J. M. Montiel-Company, C. Bellot-Arcís, T. Almerich-Torres, J. E. Iranzo-Cortés, J. M. Almerich-Silla, and Z. M. Sanchez. 2018. Association between passive tobacco exposure and caries in children and adolescents. A systematic review and meta-analysis. PloS One 13 (8):e0202497. doi:10.1371/journal.pone.0202497.
- Guillemin, F. C. Bombardier, and D. Beaton. 1993. Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of Clinical Epidemiology 46 (12):1417–32. doi:10.1016/0895-4356(93)90142-n.
- Hanioka, T., E. Nakamura, M. Ojima, K. Tanaka, and H. Aoyama. 2008. Dental caries in 3-year-old children and smoking status of parents. Paediatric and Perinatal Epidemiology 22 (6):546–550. doi:10.1111/j.1365-3016.2008.00950.x.
- Hanioka, T., M. Ojima, K. Tanaka, and M. Yamamoto. 2011. Does secondhand smoke affect the development of dental caries in children? A systematic review. International Journal of Environmental Research and Public Health 8 (5):1503–19. doi:10.3390/ijerph8051503.
- Hughes, S. O., L. A. Frankel, A. Beltran, E. Hodges, S. Hoerr, J. Lumeng, A. Tovar, and S. Kremers. 2013. Food parenting measurement issues: Working group consensus report. Childhood Obesity 9 (s1):S95–102. doi:10.1089/chi.2013.0032.
- IBGE (Instituto Brasileiro de Geografia e Estatística). 2014. Pesquisa Nacional de Saúde 2013. Percepção do estado de saúde, estilos de vida e doenças crônicas. Brasil, Grandes regiões e Unidades da Federação. Accessed May 22, 2023. http://biblioteca.ibge.gov.br/visualizacao/livros/liv91110.pdf.
- Lazarte, C. E., M. E. Encinas, C. Alegre, and Y. Granfeldt. 2012. Validation of digital photographs, as a tool in 24-h recall, for the improvement of dietary assessment among rural populations in developing countries. Nutrition Journal 11:61. doi:10.1186/1475-2891-11-61.
- Lee, Z. L., W. Y. Gan, P. Y. Lim, R. Hasan, and S. Y. Lim. 2020. Associations of nutritional status, sugar and second-hand smoke exposure with dental caries among 3- to 6-year-old Malaysian pre-schoolers: A cross-sectional study. BMC Oral Health 20 (1):164. doi:10.1186/s12903-020-01152-0.
- Liao, H. E., and Y. M. Deng. 2021. The role of caregiver’s feeding pattern in the association between parents’ and children’s healthy eating behavior: Study in Taichung, Taiwan. Children (Basel) 8 (5):369. doi:10.3390/children8050369.
- Liu, S., T. Wu, X. Zhou, B. Zhang, S. Huo, Y. Yang, K. Zhang, L. Cheng, X. Xu, and M. Li. 2018. Nicotine is a risk factor for dental caries: An in vivo study. Journal of Dental Sciences 13 (1):30–36. doi:10.1016/j.jds.2017.09.006.
- Lo, K., C. Cheung, A. Lee, W. W. Tam, and V. Keung. 2015. Associations between parental feeding styles and childhood eating habits: A survey of Hong Kong pre-school children. PloS One 10 (4):e0124753. doi:10.1371/journal.pone.0124753.
- Lopez, M., D. Simpson, N. White, and C. Randall. 2003. Age- and sex-related differences in alcohol and nicotine effects in C57BL/6J mice. Addiction Biology 8 (4):419–27. doi:10.1080/13556210310001648176.
- Maccoby, E. E., and J. A. Martin. 1983. Socialization in the context of the family: Parent-child interaction. In Mussen manual of child psychology, ed. E. M. Hetherington, 1–102. 4th ed. New York: Wiley.
- Merianos, A. L., C. Odar Stough, L. A. Nabors, and E. M. Mahabee-Gittens. 2018. Tobacco smoke exposure and health-care utilization among children in the United States. American Journal of Health Promotion 32 (1):123–30. doi:10.1177/0890117116686885.
- Ministério da Saúde do Brasil. 2012. SB Brasil 2010: Pesquisa Nacional de Saúde Bucal: resultados principais. Accessed January 22, 2020. https://bvsms.saude.gov.br/bvs/publicacoes/pesquisa_nacional_saude_bucal.pdf.
- Ministério da Saúde do Brasil. 2019. Vigitel Brasil 2018: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2018. Accessed May 22, 2023. file:///D:/Downloads/vigitel-brasil-2018-1.pdf.
- Montaldo, L., P. Montaldo, E. Caredda, and A. D’Arco. 2012. Association between exposure to secondhand smoke and sleep bruxism in children: A randomised control study. Tobacco Control 21(4):392–95. Epub 2012 Jan 13. doi:10.1136/tobaccocontrol-2011-050217.
- Montaño, Z., J. D. Smith, T. J. Dishion, D. S. Shaw, and M. N. Wilson. 2015. Longitudinal relations between observed parenting behaviors and dietary quality of meals from ages 2 to 5. Appetite 87:324–29. doi:10.1016/j.appet.2014.12.219.
- Monteiro Dos Santos, J. E., S. P. Crispim, J. Murphy, M. de Camargo Cancela, and M. Drehmer. 2021. Health, lifestyle and sociodemographic characteristics are associated with Brazilian dietary patterns: Brazilian national health survey. PloS One 16 (2):e0247078. doi:10.1371/journal.pone.0247078.
- Pasztak-Opiłka, A., R. de Jonge, A. Zachurzok, and M. E. Górnik-Durose. 2020. Adult attachment styles and mothers’ life satisfaction in relation to eating behaviors in the families with overweight and obese children. PloS One 15 (12):e0243448. doi:10.1371/journal.pone.0243448.
- Powell, E. M., L. A. Frankel, T. Umemura, and N. Hazen. 2017. The relationship between adult attachment orientation and child self-regulation in eating: The mediating role of persuasive-controlling feeding practices. Eating Behaviors 26:121–28. Epub 2017 Feb 14. doi:10.1016/j.eatbeh.2017.02.006.
- Scaglioni, S., V. De Cosmi, V. Ciappolino, F. Parazzini, P. Brambilla, and C. Agostoni. 2018. Factors influencing children’s eating behaviours. Nutrients 10 (6):706. doi:10.3390/nu10060706.
- Sousa, K. G. M. B. D. Gavião., N. F. Ultremari, S. C. Chaves Júnior, and T. S. Barbosa. 2023. Translation, cross-cultural adaptation and psychometric properties of the parental feeding style questionnaire into Brazilian Portuguese language. Pesquisa Brasileira Em Odontopediatria e Clínica Integrada 23:e220011. doi:10.1590/pboci.2023.034.
- Tanaka, K., Y. Miyake, M. Arakawa, S. Sasaki, and Y. Ohya. 2010. Household smoking and dental caries in schoolchildren: The ryukyus child health study. BMC Public Health 10:335. doi:10.1186/1471-2458-10-335.
- Tanaka, S., M. Shinzawa, H. Tokumasu, K. Seto, S. Tanaka, and K. Kawakami. 2015. Secondhand smoke and incidence of dental caries in deciduous teeth among children in Japan: Population based retrospective cohort study. BMJ 351:h5397. doi:10.1136/bmj.h5397.
- van der Horst, K., E. F. C. Sleddens, and A. I. Aguilera. 2017. Parenting styles, feeding styles and food-related parenting practices in relation to toddlers’ eating styles: A cluster-analytic approach. PloS One 12 (5):e0178149. doi:10.1371/journal.pone.0178149.
- Wang, L., V. M. van de Gaar, W. Jansen, C. L. Mieloo, A. van Grieken, and H. Raat. 2017. Feeding styles, parenting styles and snacking behaviour in children attending primary schools in multiethnic neighbourhoods: A cross-sectional study. British Medical Journal Open 7 (7):e015495. doi:10.1136/bmjopen-2016-015495.
- Wardle, J. S. Sanderson, C. A. Guthrie, L. Rapoport, and R. Plomin. 2002. Parental feeding style and the inter-generational transmission of obesity risk. Obesity Research 10 (6):453–62. doi:10.1038/oby.2002.63.
- WHO (World Health Organization). 1995. Physical status: The use and interpretation of anthropometry. Technical Report Series. Geneva. Accessed May 22, 2020. https://apps.who.int/iris/handle/10665/37003.
- WHO (World Health Organization). 2013. Oral health surveys: Basic methods. Accessed May 22, 2020. file:///D:/Downloads/9789241548649_eng.pdf.
- WHO (World Health Organization). 2020. Global Health Observatory (GHO) data. Second-hand smoke. Accessed May 22, 2020. https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/second-hand-smoke.
- Yadav, R., V. Deo, P. Kumar, and A. Heda. 2015. Influence of environmental tobacco smoke on gingival pigmentation in schoolchildren. Oral Health & Preventive Dentistry 13 (5):407–10. doi:10.3290/j.ohpd.a33918.
- Zyriax, B. C., E. Vettorazzi, A. Hamuda, and E. Windler. 2018. Interaction of smoking and dietary habits modifying the risk of coronary heart disease in women: Results from a case-control study. European Journal of Clinical Nutrition 72 (12):1673–1681. doi:10.1038/s41430-018-0099-9.