Financial Hardship on Food Security in Ageing Populations.

Objective: This study investigated the prevalence of food security, and the association of food security with financial hardship and socio-demographic characteristics among the ageing population in Thailand. Methods: The study extracted data on 1,197 persons age 60 years or older from a nationally-representative sample survey of Thai households. The food security data were collected using the Food Insecurity Experience Scale (FIES), developed by the Food and Agriculture Organization. Multiple regression analysis was used to investigate the association between financial hardship, socio-demographic characteristics, and food security. Results: Of the total sample, 71% had food security. The least probability of having food security was observed in the respondents who sometimes and often had income problems (p < 0.001), and felt dissatisfied with their financial situation (p < 0.001). The respondents who were female, at oldest-old age, with lower than primary school education and in the Northeast were less likely to have food security. Conclusion: These findings suggest the need for government assistance for those who are experiencing financial hardship to help them manage their finances and food security more effectively, taking into account different socio-demographic characteristics.

Profiling ultra-processed foods in Thailand: sales trend, consumer expenditure and nutritional quality.

BACKGROUND: Ultra-processed foods (UPF) are associated with adverse health outcomes. This study aimed to analyse the national trends in retail sales, consumer expenditure and nutritional quality of UPFs in Thailand. METHODS: The study used data from the Euromonitor Passport database for analysis of retail sales and consumer expenditure, and from the Mintel Global New Products Database for nutritional analysis using the WHO Southeast Asian Region nutrient profile model. RESULTS: The study found the highest per capita sales volume and value of UPFs in 2021 were sauces, dressings & condiments (8.4 kg/capita) and carbonated soft drinks (27.1 L/capita), respectively. However, functional & flavoured water, ready-made meals and baked goods had the highest observed (2012-2021) and expected (2021-2026) sales growth. Supermarkets were responsible for most of the UPF sales since 2012, but convenience stores had larger growth in retail values. Growth in consumer expenditure per capita on UPFs from 2012 to 2020, ranged between 12.7% and 34%, and till 2026 is forecast to grow between 26% and 30%. More than half of UPFs exceeded at least one nutrient cutoff, 59.3% for total fats, 24.8% for saturated fats, 68.2% for total sugars and 94.3% for sodium. CONCLUSIONS: The findings suggest a need for regulatory and non-regulatory measures such as UPF taxation and marketing restrictions, and market incentives for producing non-UPFs. A system for regularly monitoring and evaluating healthiness (both nutritional and processing aspects) of food products, especially UPFs, is required.

Life Satisfaction Before and During COVID-19 Pandemic in Thailand.

Objective: To investigate prevalence of life satisfaction in the Thai population before and during the COVID-19 epidemic, and factors associated with life satisfaction during the epidemic. Methods: Multistage sampling was used to draw a sample from the Thai population. A total of 3,115 Thai participants age 15 years or older from a nationally-representative longitudinal survey in 2019 and in 2021 were included in this study. The study applied the Scale with Life Satisfaction (SWLS) instrument to measure life satisfaction among the Thai population before and during the COVID-19 epidemic. Multiple regression analysis was used to investigate the association between life satisfaction and other variables. The follow-up survey response rate for individuals was 44.8%. Results: An average life satisfaction score during the COVID-19 epidemic (in 2021) was 22.4 which decreased from 25.5 before the COVID-19 epidemic (in 2019). More than one-third of the participants (36.5%) reported having less life satisfaction during the epidemic, which was nearly 20 percentage points higher than before the epidemic (17.7%). Controlling for life satisfaction in 2019, the analysis found statistical associations between demographic and economic characteristics and health-related behaviours, and life satisfaction during 2021. People in the older age cohorts (p ≤ 0.001), in a rural area (p ≤ 0.05), having higher education (p ≤ 0.001), still being employed (p ≤ 0.01) and becoming unemployed (p ≤ 0.01) had higher life satisfaction. The possibility of higher life satisfaction was also found in people who maintained good health (p ≤ 0.01), sufficient physical activity (p ≤ 0.001), and fruit and vegetable intake (p ≤ 0.01). People with income loss during the epidemic had lower life satisfaction (p ≤ 0.05). Conclusion: The findings suggest that policies and systems for resilience and social protection are needed for empowering individuals-especially the poor and vulnerable-to cope with crises, and improve health and wellbeing outcomes.

Choosing an effective food classification system for promoting healthy diets in Thailand: a comparative evaluation of three nutrient profiling-based food classification systems (government, WHO, and Healthier Choice Logo) and a food-processing-based food classification system (NOVA).

Introduction: This study aimed to assess the nutritional quality of food and beverage products in Thailand by comparing four different food classification systems: the nutrient profiling-based food classification systems by the Department of Health (DOH), the WHO South-East Asia Region (WHO SEA), the Healthier Choice Logo (HCL), and the food-processing-based food classification system, NOVA. Methods: This study used secondary data from the Mintel Global New Products Database (N = 17,414). Food subgroups were classified differently based on these four systems. The DOH classified food products into three groups: Group A-healthy pass or meeting standard, Group B-not meeting the standard, and Group C-far below standard. The WHO SEA classified food products into two groups: marketing prohibited products and marketing permitted products. The HCL classified food products into two groups: eligible products for the logo; and ineligible products for the logo. The NOVA classified food products into four groups: unprocessed or minimally processed foods (MP), processed culinary ingredients (PCI), processed foods (P), and ultra-processed foods (UPF). Descriptive statistics (percentage and frequency) were used for analysis. Agreement analysis was conducted using Cohen's kappa statistic between each pair of food classification systems. Results: Of the total sample that could be classified by any of the four classification systems (n = 10,486), the DOH, the WHO SEA and the HCL systems classified products as healthy (Group A, marketing permitted or eligible for HCL logo) at 10.4, 11.1, and 10.9%, respectively. Only 5.6% were classified as minimally processed foods using NOVA and 83.1% were ultra-processed foods (UPFs). Over 50% of products classified as healthy by the nutrient profiling systems were classified as UPF according to the NOVA system. Products that were eligible for the HCL had the highest proportion of UPF products (84.4%), followed by the Group A products (69.2%) and the WHO marketing-permitted products (65.0%). Conclusion: A hybrid food classification approach taking both nutrients and food processing into account is needed to comprehensively assess the nutritional quality of food and beverage products in Thailand.

Implementing population-wide mass media campaigns: Key drivers to meet global recommendations on fruit and vegetable consumption.

While the influence of implementation of mass media and community-based campaigns has been evident elsewhere, this information has been notably absent in Thailand. This study aimed to investigate the association between implementation of mass media campaigns (MMC) and community-based campaigns (CBC) for increased fruit and vegetable (FV) consumption to meet the global recommended level in the Thai population. The sample was obtained from a nationally-representative, longitudinal household survey of the Thai population, Round1 (2018) and Round2 (2019). The study applied a multi-stage sampling design to obtain a sample of persons age 15 years or older. Face-to-face interviews were conducted with 3,010 respondents who successfully participated in both Round1 and Round2 surveys. Information on FV consumption, exposure to Government MMC, ThaiHealth MMC including social marketing (MMSMC) and CBC, and sociodemographic characteristics were collected. Binary logistic regression analysis was used to investigate the association between implementation of those campaigns and increased FV consumption compared to the recommended level. Of the total respondents, only 11.3% had higher FV consumption and also met the minimum requirement. Respondents who lived in rural areas, were farmers, and grew FV at home had the highest probability of increased FV consumption. Exposure to the MMC and CBC was also associated with an increase in FV consumption. Above all, those who had exposure to the MMSMC, who reported either having high level of perception (OR = 1.832, 95% CI 1.259-2.666) or ever heard or seen (OR = 1.770, 95% CI 1.264-2.479) or heard and seen (OR = 1.698, 95% CI 1.131-2.550) campaign information were more likely to have a substantial increase in FV consumption and meeting/exceeding the recommended level than those who were not exposed to these campaigns. Other associated factors include education, occupation and physical activity. Implementation of MMSMC can help the population meet the global recommended level of FV consumption. This study presents its novelty since it was the first to highlight influence of mass media campaigns on increased FV consumption in Asian population. This was also the first study that used data from a population-based longitudinal study. The study suggested that MMC and CBC should also be promoted together with support systems to increase their intensity to a level that can increase population FV consumption to meet the recommended level. Sociodemographic characteristics should be taken into account, and targeted media is needed to effectively reach specific sub-groups of the population.

Socio-demographic and geographic disparities of population-level food insecurity during the COVID-19 pandemic in Thailand.

Introduction: This study investigated the prevalence of food insecurity, and the association between socio-demographic and geographic factors and food insecurity in Thailand during the COVID-19 pandemic. Methods: The study extracted data on 5,066 persons age 15 years or older from a nationally-representative sample survey of Thai households, conducted during June-December 2021. The respondents were asked about food insecurity, socio-demographic characteristics, debt, and role of the primary household food provider. Binary logistic regression analysis was used to investigate the association between the variables and food insecurity. Results: Of the total sample, 28.6% had food insecurity. The highest probability of having food insecurity (p < 0.001) was observed in persons age 15-29 years, with no formal education, and in the lowest quartile of income. The highest probability of having food insecurity was found among respondents residing in the northeast, which is the poorest and with the least development status among geographic regions in Thailand. Respondents who reported having onerous personal debt and being the main household food provider were 1.4 and 2.3 times as likely to have food insecurity as those with no debt and not being the main food provider, respectively (p < 0.001). Conclusion: This suggests that government attention is required in developing policies and strategies to improve food security through addressing the socio-economic determinants, and buffer the negative impact of a national crisis on diets. Investment to improve household income and raise the educational profile of the population is needed. Addressing the regional disparities in food security requires area-specific measures which target the most vulnerable population groups.

Psychometric evaluation of the Thai version of the Early Childhood Oral Health Impact Scale (Th-ECOHIS): a cross sectional validation study.

BACKGROUND: Early childhood caries (ECC) is prevalent in Thailand, but no appropriate tool has been available to measure its impact on children's quality of life. This study translated the Early Childhood Oral Health Impact Scale (ECOHIS), a widely used proxy-reported questionnaire developed in the United States for measuring the oral health-related quality of life of preschool children and their families, into Thai (Th-ECOHIS). The scale's psychometric properties were investigated in Thai caregivers and their children. METHODS: Cultural adaptation for the scale development within the Thai context was processed using forward-backward translation by experts. A face and content validation was conducted among 20 Thai caregivers to attain the final Th-ECOHIS. Psychometric testing was done on 3-year-old child-caregiver pairs in Bangkok using the interviewer-administered mode. Children's oral health was determined by caries experience (decayed, missing and filled primary teeth, dmft) and treatment need. The caregivers answered the Th-ECOHIS and global questions regarding their perception of the children's oral health. Across-items reliability was assessed by internal consistency using the Cronbach's alpha coefficient. Test-retest reliability was managed at a 2-week interval in 10% of the sample using the intraclass correlation coefficient calculated by two-way analysis of variance. The discriminant validity was tested by the relationship between the severity of dental caries, treatment need and Th-ECOHIS scores, using the Kruskal-Wallis test. RESULTS: A total of 214 child-caregiver pairs participated. Twenty-two percent had ECC (dmft 1-3) and 17.3% had severe ECC (dmft 4 or higher) with mean (SD) dmft 1.63 (2.92). All items in the original ECOHIS were retained in the Thai version. The test-retest reliability of Th-ECOHIS was 0.87; internal consistency was 0.85; the total Th-ECOHIS scores were significantly correlated with the global rating of oral health question (r = 0.604). Th-ECOHIS scores in both child and family impact sections and the total were significantly associated with the severity of caries (p <  0.001) and treatment need (p <  0.001). CONCLUSIONS: Th-ECOHIS demonstrated good reliability and validity. It could be used on caregivers to assess the impacts of ECC on quality of life of Thai pre-school children and compared to other countries.

WHO Global Consultation on Public Health Intervention against Early Childhood Caries.

Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups.

The extent and correlates of gingival recession in non-institutionalised Thai elderly.

The purpose of this study was to describe the extent and distribution of gingival recession in Thai elderly. As part of a longitudinal geriatric oral health study, 453 community-dwelling dentate subjects, 51-92 years of age, were examined at baseline in 1999. All remaining teeth were measured on four periodontal sites to assess the amount of gingival recession. The percentage of sites with recession increased with age from 49.6% in 51-59 years of age to 72.0% in 70+ years of age (P < 0.001). Males exhibited greater levels of recession than females (P < 0.001). Regression analysis for the percentage of buccal sites with recession showed that recession was associated with age, gender, cervical abrasion, and amount of calculus (R2 = 0.15, P < 0.001). However, the regression model for the percentage of all sites with recession did not find an association between recession and cervical abrasion. Hence, it appears that gingival recession on different locations may involve different processes.