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International Journal of Behavioral Medicine

, Volume 25, Issue 1, pp 67–73 | Cite as

Low Income as a Multiplicative Risk Factor for Oral Pain and Dental Problems Among U.S. Veteran Smokers

  • Terrell A. HicksEmail author
  • Sarah M. Wilson
  • Shaun P. Thomas
  • Paul A. Dennis
  • Julia M. Neal
  • Patrick S. Calhoun
Article

Abstract

Purpose

Compared to the United States (U.S.) general population, military veterans are at an increased risk of experiencing dental problems. This study documented associations between cigarette use and measures of dental/oral concern in a population of U.S. veterans who served in Iraq and Afghanistan.

Method

A cross-sectional analysis of survey data from the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans Health and Needs Study, a study of U.S. military veterans. Out of 5000 surveys mailed to a random sample of OEF/OIF veterans, 1161 surveys were completed and returned. Among study respondents, N = 1114 had non-missing dental/oral pain data and were included for analysis. The survey also included smoking history and demographic information. Univariate and multivariate logistic regression analyses were used to cross-sectionally model the odds of experiencing dental/oral concerns as a function of smoking status. We also examined moderating effects of income and gender on the association between smoking and dental/oral concerns.

Results

In univariate and multivariate models, current smoking was associated with risk for dental/oral concerns. However, this association was qualified by a Smoking × Income interaction. For those earning above US$20,000, smoking was not associated with dental/oral concerns. Among veterans with low income, smoking was associated with three times higher odds of increased dental/oral concerns. There was no significant Gender × Smoking interaction.

Conclusion

These findings underscore the relevance of factors that moderate the association between smoking and dental/oral concern, namely income. Findings also underscore the importance of interventions to mitigate income disparities in oral healthcare.

Keywords

Veteran Tobacco Smoking Cigarettes Oral pain Nicotine 

Notes

Acknowledgements

This work was supported in part by the Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC). Dr. Wilson’s contributions were also supported by the VA Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment. Mr. Hicks was also supported by the National Cancer Institute of the National Institutes of Health (NIH) under award number R01CA196304-02S1. Funding sources had no role in the design, execution, analysis, interpretation of the data, or the decision to submit results for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the VA, NIH, US Government, or any of the institutions with which the authors are affiliated.

Compliance with Ethical Standards

Research Involving Human Participants and/or Animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Durham Veterans Affairs Medical Center Institutional Review Board and the U.S. Office of Management and Budget (OMB 2900-0728) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Copyright information

© International Society of Behavioral Medicine 2017

Authors and Affiliations

  • Terrell A. Hicks
    • 1
    • 2
    • 3
    Email author
  • Sarah M. Wilson
    • 2
    • 4
  • Shaun P. Thomas
    • 1
    • 2
  • Paul A. Dennis
    • 1
    • 2
  • Julia M. Neal
    • 2
  • Patrick S. Calhoun
    • 1
    • 2
    • 4
    • 5
  1. 1.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  2. 2.Durham Veterans Affairs (VA) Health Care SystemDurhamUSA
  3. 3.Durham Veterans Affairs Medical CenterDurhamUSA
  4. 4.VA Mid-Atlantic Mental Illness ResearchEducation and Clinical Center (MIRECC)DurhamUSA
  5. 5.Center for Health Services Research in Primary CareDurham VA Health Care SystemDurhamUSA

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