Project Summary/Abstract
Dental caries is one of the most significant public health challenges in Alaska Native
communities. Added sugars from fruit drinks, especially Kool-Aid, are the main behavioral
risk factor for caries. Our team developed and implemented a community-based
intervention targeting sugared fruit drinks in Alaska Native children (NIDCR Grant No.
U01DE027629). The six-month intervention consisted of health education delivered by a
trained indigenous Community Health Worker, who taught families about the harms
caused by sugared fruit drinks, introduced sugar-free alternatives, and provided parents
with self-efficacy training to facilitate the switch. Local stores were recruited to sell sugar-
free Kool-Aid. We enrolled 201 Alaska Native children ages 1 to 10 years; 143 children in
two communities received the intervention and 58 children a third community were in the
delayed treatment control group. The trial ended in March 2023. Our team is currently
evaluating the intervention. The main trial outcome is change in added sugar intake from
baseline to 6m, measured using a validated hair biomarker. The trial did not include a
disease outcome, but we collected supragingival plaque samples from children
throughout the trial (baseline, 1m, 3m, 6m) and archived them for future study. We now
have tribal permissions to analyze the plaque. The goal of this 2-year R03 is to process
and analyze the 594 banked plaque samples. The Aims are to: (1) Assess the relationship
between added sugar intake and the oral microbiome in Alaska Native children; and (2)
Conduct mediator analyses to examine the effects of the intervention on the microbiome
with added sugar as the mediator. We will test the primary hypothesis that lower added
sugar intake is associated with increased alpha diversity, which is a signature of a healthy
microbiome. The proposed work will be the first known study to evaluate how added sugar
impacts the microbiome in Alaska Native children and is expected to provide insight on
mechanisms of the original behavioral trial. The knowledge gained will be critical in
refining future interventions aimed at reducing added sugar intake, preventing caries, and
addressing oral health inequities that disproportionately affect Indigenous communities.
