Association between psychosocial determinants of adverse childhood experiences and severe early childhood caries among First Nations children.

Aim: To determine whether psychosocial determinants of adverse childhood experiences (ACE), from pregnancy to 2 years old, are associated with severe early childhood caries (S-ECC) in Indigenous children.

Design: Secondary data analyses from an ECC prevention trial among 344 First Nations mother-child dyads living on- and off-reserve in Ontario and Manitoba, Canada. Stratified (on-/off-reserve) logistic regression, controlling for mother's age and income source, assessed three categories of psychosocial ACE determinants: alcohol/drug misuse, household financial hardship (overcrowding and food insecurity) and emotional/social well-being (Perceived Stress Scale (PSS-14), sense of personal control (SOC), social support, subjective social status).

Results: Household overcrowding [adjusted odds ratio (AOR) = 1.89 (95% CI: 1.06-3.38)], food insecurity [AOR = 2.86 (1.53-5.34)] and mothers' high perceived stress [AOR = 2.48 (1.40-4.37)] were associated with S-ECC (dmft > 9) for those on-reserve. Maternal SOC had a protective effect for off-reserve children [AOR = 0.17 (0.03-0.95)].

Conclusions: Increased efforts to reduce psychosocial ACE determinants are paramount to decreasing Indigenous children's vulnerability to S-ECC.