Low Income as a Multiplicative Risk Factor for Oral Pain and Dental Problems Among U.S. Veteran Smokers
- 152 Downloads
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.
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.
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.
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.
KeywordsVeteran Tobacco Smoking Cigarettes Oral pain Nicotine
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 was obtained from all individual participants included in the study.
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 3.Sham ASK, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J. 2003;Google Scholar
- 13.Centers for Disease Control and Prevention. Adult oral health. 2013. https://www.cdc.gov/oralhealth/publications/factsheets/adult_oral_health/adult_older.htm.
- 17.Wamala S, Merlo J, Boström G. Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004–2005. J Epidemiol Community Health. 2006;60(12):1027–33. doi: 10.1136/jech.2006.046896.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Manski RJ, Brown Jr. E. Dental coverage of adults ages 21 to 64, United States, 1997 and 2007. Medical Expenditure Panel Survey: Statistical Brief #295. 2010.Google Scholar
- 21.Bondurant S, Wedge R. Combating tobacco use in military and veteran populations. National Academies Press; 2009.Google Scholar
- 27.Fargo J. Prevalence and risk of homelessness among US veterans. Prev Chronic Dis. 2012;9.Google Scholar
- 28.Dillman DA. Mail and internet surveys: the tailored design method—2007 update with new internet, visual, and mixed-mode guide (2nd ed). New York: John Wiley & Sons; 2000.Google Scholar
- 29.Calhoun PS, Schry AR, Wagner HR, Kimbrel NA, Dennis P, McDonald SD, et al. The prevalence of binge drinking and receipt of provider drinking advice among US veterans with military service in Iraq or Afghanistan. Am J Drug Alcohol Abuse. 2015:1–10. doi: 10.3109/00952990.2015.1051185.
- 31.Green KT, Wilson SM, Dennis PA, Runnals JJ, Williams RA, Bastian LA, et al. Cigarette smoking and musculoskeletal pain severity among male and female Afghanistan/Iraq era veterans. Pain Med (Malden). 2017.Google Scholar
- 33.Voogt R, Saris W, Niemoller B. Non-response and the gulf between the public and politicians. Acta Politica. 1998;33:250–80.Google Scholar
- 34.Evaluation OotASfPa. U.S. Federal Poverty Guidelines Used to Determine Financial Eligibility for Certain Federal Programs. U.S. Department of Health and Human Services. 2017. https://aspe.hhs.gov/poverty-guidelines. Accessed 8 Mar 2017.
- 35.Cypel YS, Hamlett-Berry K, Barth SK, Christofferson DE, Davey VJ, Eber S, et al. Cigarette smoking and Sociodemographic, military, and health characteristics of Operation Enduring Freedom and Operation Iraqi Freedom veterans: 2009–2011 National Health Study for a new generation of US veterans. Public Health Rep. 2016;131(5):714–27.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www ptsd va gov. 2013.Google Scholar
- 38.Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. annual convention of the international society for traumatic stress studies. International Society for Traumatic Stress Studies San Antonio. 1993;Google Scholar
- 41.Straits-Troster K, Gierisch J, Calhoun PS, Strauss JL, Voils C, Kudler H, et al. Living in transition: young veterans’ health and the postdeployment shift to family life. Treating young veterans: promoting resilience through practice and advocacy. 2011:153–174.Google Scholar
- 42.World Health Organization. Oral health: fact sheet. 2012. http://www.who.int/mediacentre/factsheets/fs318/en/.
- 44.U.S. Department of Veterans Affairs. IB 10-442: Dental benefits for veterans. 2014. http://www.va.gov/healthbenefits/resources/publications/IB10-442_dental_benefits_for_veterans_2_14.pdf.
- 52.Vogt D, Vaughn R, Glickman ME, Schultz M, Drainoni ML, Elwy R, et al. Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans. J Abnorm Psychol. 2011;120:797–806. doi: 10.1037/a0023452.CrossRefPubMedGoogle Scholar