Capturing Sugar-Promoting Environments and Understanding the Link with Child Dental Health Outcomes through the Creation of a Multidimensional Index

  • Suruchi Gajanan Ganbavale

Student thesis: Doctoral Thesis


Background: Geographical inequalities in children’s dental health, associated with area-level deprivation, could be explained by variation in sugar-promotion in local environments. Investigating the nature and variation of such local-level sugar-promoting environments can inform public health planning.

Aim: To investigate local-level socio-environmental contributors to sugar intake in 5-to-11-year-olds and develop a reliable index that quantifies sugar-promotion in small-areas of England and explains geographical inequalities associated with dental caries in children.

Methods: The research design had three interlinked phases: 1. Development of a testable framework of sugar-promoting socio-environmental factors through two structured reviews of the systematic reviews of dental caries and obesity literature. 2. Development and validation of a multidimensional index using large national datasets and quantitative techniques to collectively measure factors across Middle-layer Super Output Areas (MSOAs), and lower- and upper-tier local authorities (LAs) in England. 3. Predictive analyses to assess the relative importance of the index in explaining excessive sugar intake, dental caries prevalence, and tooth extractions in 5-11-year-olds.

Results: Study-1: Socio-environmental factors in neighbourhood-, school-, and family-environments, qualitatively contribute to sugar intake, dental health, and weight status in children. Study-2: A newly-developed MSOA-level index included 30 indicators within 3 environmental domains; and indicated higher sugar-promotion in cities, inner London, and coastal areas. At LA-level, indices showed higher sugar-promotion in deprived, urban, and northern parts of England. Study-3: In logistic regression controlling age, gender, and ethnicity, the upper-tier LA-level index remained positively associated with excessive sugar intake. In simple linear regression, an increased index score was significantly associated with 4.7% increase in the percentage of severely decayed teeth in lower-tier LAs. In multilevel logistic regression, MSOA-level index and age were positively associated with tooth extraction. School- and family-environment domains predicted 380% increase and 37% decrease in chances of tooth extraction, respectively.

Conclusion and key contribution: The qualitative predictors of sugar-promotion can be quantified using an index within small geographies. This could inform targeted and locally-relevant dental health promotion activities.
Date of Award19 Jan 2023
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorChris Louca (Supervisor), Kristina Lutomya Wanyonyi (Supervisor) & Liz Twigg (Supervisor)

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