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Supplementary Material 1

Supplemental material, sj-docx-1-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Supplemental material, sj-docx-4-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Supplemental material, sj-docx-2-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Additional file 4. Generative mechanisms.

Additional file 3.

Supplemental material, sj-docx-4-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Supplemental material, sj-docx-3-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Additional file 4. Generative mechanisms.

Additional file 3.

Supplemental material, sj-docx-3-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Supplemental material, sj-docx-2-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Supplemental material, sj-docx-5-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Additional file 1: Supplementary Table 1. Comparison of the median sample size between Indigenous-Australian and General Australian trials based on registration year from 2008-2018. Supplementary Table 2. Types of funding displayed in absolute number and (percentage) for Indigenous-Australian trials registered from 2008-2018, for top 10 priority (and other) conditions as per Australian Institute of Health and Welfare (AIHW) % Total Burden for Indigenous Australians, by disease group 2011. (Note that one trial can study multiple conditions hence numbers do not reflect the number of trials). Supplementary Table 3. Participant Size in each respective year for All-Australian, General Australian and Indigenous Australian trials and Participant Size for Indigenous Australian Trials demonstrated as a proportion to All Australian Trials, 2008-2018. Supplementary Table 4. Types of intervention assigned for each health condition enlisted in Indigenous-Australian trials registered from 2008-2018, where included health conditions are from top 10 priority areas as per Australian Institute of Health and Welfare (AIHW) % Total Burden for Indigenous Australians, by disease group 2011. Supplementary Figure 1. Absolute sample size of Indigenous Australian Trials and as a proportion of All Australian Trials, 2008-2018.

Additional file 2. Search Strategy.

Supplemental material, sj-docx-5-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Additional file 1. PRISMA-P 2015 Checklist.

Supplemental material, sj-docx-6-cpc-10.1177_10556656221084542 for Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review by Emilija D. Jensen and Brianna F. Poirier, Kelly J. Oliver, Rachel Roberts, Peter J. Anderson, Lisa M. Jamieson in The Cleft Palate-Craniofacial Journal

Additional file 1.

Additional file 1: Table S1. Socio-demographic characteristics, health-related behaviours including tobacco, alcohol and drug use (percent, 95% CI) and compared against population estimates in 2016.

Additional file 1. Table S1: Study questionnaire. Table S2: 14 items OHIP scale. Fig. S3: Goodness of fit.

Additional file 1. Participant comparison by demographic characteristics within knowledge, parental, structural, and social factors.

Supplemental material, sj-docx-1-asm-10.1177_10731911211024338 for Exploratory Graph Analysis of the Strengths and Difficulties Questionnaire in the Longitudinal Study of Australian Children by Pedro Henrique Ribeiro Santiago, Davi Manzini, Dandara Haag, Rachel Roberts, Lisa Gaye Smithers and Lisa Jamieson in Assessment

Additional file 1. Health state vignettes.

Additional file 1. Appendixes. Appendix A: Figure S1: A conceptual framework of access to health care [25]. Appendix B: Table S1: Questionnaire of factors impacting on dental service approachability. Appendix C: Figure S2: Variables corresponding to service-oriented model of accessing dental care.

Additional file 1: Table S1. The PSS-14 items divided into Perceived Stress and Perceived Control subscales. Table S2. Item fit statistics for the PSS-14. Table S3. Item fit statistics for the Perceived Stress subscale. Table S4. Local dependence of the revised PSS-14 items. Table S5. Kelderman’s likelihood ratio tests for the GLLRM of Perceived Stress subscale. Table S6. Item fit statistics for the Perceived Control subscale. Table S7. Item fit statistics for the GLLRM of the Perceived Control subscale. Table S8. Kelderman’s likelihood ratio tests for the GLLRM of the Perceived Control subscale. Table S9. Conversion table for score adjustment. Table S10. Convergent and divergent validity of the PSS-14.

Cales orchamoplati Viggiani & Carver (Figs 1���4) Cales orchamoplati Viggiani & Carver 1988: 44 ���45. Holotype ��, Australia, South Australia, Waite Agricultural Research Institute, Adelaide, 30.xi. 1976, H.M. Brookes and M. Carver, ex Orchamoplatus citri on lemon (ANIC, not examined). Cales orchamoplati Viggiani & Carver: Mottern et al. 2011: 282 (diagnosis). Diagnosis. FEMALE. Colour: yellow, head and mesosoma slightly darker, wings hyaline. Morphology. Stemmaticum with reticulate surface sculpture. Antennal formula 1,1,3,1 (Fig. 2). Scape 2.9��� 3.1 X as long as pedicel and 0.7���0.8 X as long as clava. Pedicel slightly shorter than combined length of F 1 and F 2 (0.8���0.9 X). F 1 1.3 X as long as its maximum width, shorter than F 2 (0.6 X). F 2 subequal in length to its maximum width. Clava 4.3���4.5 X as long as its maximum width, equipped with 10 or 11 hair-like sensilla, apex truncate with 3 terminal peg-like sensilla (Fig. 2). Midlobe of mesoscutum with 2 pairs of setae, arranged symmetrically, side lobes with 2 setae each (Fig. 1). Distance between anterior pair of scutellar setae distinctly greater than distance between posterior pair (Fig. 1). Fore wing 2.8 X as long as width of disc (Fig. 4). Marginal fringe 0.5 X as long as width of disc (Fig. 4). Basal cell without setae. Submarginal vein with 1 seta, marginal vein anteriorly with 5 setae. Apical spur of midtibia distinctly longer than half length of corresponding basitarsus (0.8 X). Ovipositor distinctly shorter than midtibia (0.6���0.7 X) and slightly shorter than clava (0.7���0.8 X). MALE. No males of the species were collected as part of the present study. For a description of C. orchamoplati males from the type locality see Viggiani & Carver (1988: 45). Distribution. Australia: Queensland, South Australia. Material examined. 3 ��, AUSTRALIA: South Australia: Loxton, 34.4512 ��S, 140.5698 ��E, 50 m, December 2009 (J. Altman), ex O. citri (ZSM). Genbank accession. HQ 660516, JF 750733. Comments. Cales orchamoplati has previously been known only from its type locality in Adelaide, South Australia (Viggiani & Carver 1988) and from Mt. Glorious, Queensland (Mottern et al. 2011). It is distinguished from the only other Australian Cales species, C. spenceri (Girault), by its shorter marginal fringe (0.5 X compared to 0.8 X as long as the maximum width of disc in C. spenceri) (Mottern et al. 2011). The 28 S-D 2 sequence data did not show any intraspecific variation. Amplification of the COI barcoding region consistently yielded sequences of endosymbiontic Wolbachia., Published as part of Schmidt, Stefan, Barro, Paul De & Jamieson, Lisa, 2011, Parasitoids of the Australian citrus whitefly, Orchamoplatus citri (Takahashi) (Hemiptera, Aleyrodidae), with description of a new Eretmocerus species (Hymenoptera, Aphelinidae), pp. 27-34 in Zootaxa 2873 on pages 29-30, DOI: 10.5281/zenodo.200545, {"references":["Viggiani, G. & Carver, M. (1988) Cales orchamoplati sp. n. (Hymenoptera: Aphelinidae) from Australia. Australian Journal of Entomology, 27, 43 - 45.","Mottern, J. L., Heraty, J. M. & Hartop, A. E. (2011) Cales (Hymenoptera: Chalcidoidea): morphology of an enigmatic taxon with a review of species. Systematic Entomology, 36, 267 - 284."]}

Eretmocerus orchamoplati Schmidt, sp. nov. (Figs 9���12) Description. FEMALE. Colour: yellow. Morphology [measurements of holotype in square brackets]: Stemmaticum with rugose-reticulate surface structure. Antenna (Fig. 10) with radicle 3.6���3.8 [3.6]X as long as wide. Scape 3.9���4.7 [4.4]X as long as wide, 1.7��� 2.1 [1.8]X length of pedicel, 0.5���0.6 [0.6]X length of clava. Pedicel 2.1���2.7 [2.5]X as long as wide, 0.5���0.6 [0.6]X length of scape, 0.3���0.4 [0.3]X length of clava. First funicular segment transverse, about half as long as its maximum width; second funicular segment slightly broader than long. Clava 3.6 ���5.0 [4.7]X as long as wide. Apex of clava obliquely truncate (Fig. 10). Mesoscutum with 2 pairs of setae arranged symmetrically (Fig. 9), side lobes with 2 setae each. Distance between anterior pair of scutellar setae slightly less than, or subequal to, distance between posterior pair (Fig. 9). Scutellar sensilla lateral to and closer to posterior than to anterior setae. Fore wing 2.2 X as long as width of disc (Fig. 12). Marginal fringe 0.2���0.3 [0.2]X as long as width of disc (Fig. 12). Basal cell without setae. Submarginal vein with 2 setae, marginal vein anteriorly with 4 setae. Marginal vein separated from linea calva by irregular row of 8���10 setae (Fig. 12). Approximately 3���6 tubercles present on ventral surface of wing near posterior end of linea calva. Wing disc posteriorly with an area of less dense setation (Fig. 12). Tergites laterally with the following number of setae: T 1: 1, T 2: 1 or 2, T 3: 2, T 4: 2, T 5: 2 or 3, T 6: 2, T 7: 4. Ovipositor longer than midtibia (1.3���1.4 [1.4]X) and 1.4���1.5 [1.5]X as long as clava. Third valvula 0.2���0.3 X as long as second valvifer. MALE. Colour: yellow with pronotum, propodeum, and apical margins of gastral tergites brownish. Distribution. Australia: New South Wales, Queensland, Victoria. Host. Orchamoplatus citri (Takahashi). Material examined. Holotype female, labelled ��� AUSTRALIA, Queensland, Mundubbera, Durong Rd, 4626, Benhams Orchard (Joey Citrus P/L), 25.6333 ��S, 151.2833 ��E, 140 m, 15.iii. 2010, E. Carlton, D. Papacek & A. Guanilo, DNA-Sample ZSM-HYM-AE 415 -04��� (ANIC). Paratypes. New South Wales: 2 ��, Burringbar, Howards Rd, 28.4220 ��S, 153.4786 ��E, 87 m, 8.ii. 2010 (L. Howie, A. Marcora), ex O. citri on orange (ZSM); 3 ��, 625 Myocum Rd, 28.8180 ��S, 153.4922 ��E, 34 m, 8.ii. 2010 (L. Howie, A. Marcora), ex O. citri on lemon (ZSM); 13, Newybar, 19 Johnston Rd, 28.7244 ��S, 153.5189 ��E, 114 m, 8.ii. 2010 (L. Howie, A. Marcora ex O. citri on Honey Murcart Mandarins (ZSM); 1 ��, Bateman's Bay, 4 Peninsula Drive, 35.7082 ��S, 150.1747 ��E, 5 m, 14.iv. 2010 (A. Chhagan), ex O. citri (ZSM). Queensland: 13, 2��, same data as holotype (ZSM); 3 ��, Coochin Creek Farms, 1755 Roys Rd, Beerwah, 26.892 ��S, 153.086 ��E, 13.v. 2009 (L. Howie, A. Marcora), ex O. citri (NZAC, ZSM); 2 ��, Mundubbera, 25.6 ��S, 151.3 ��E, 12.ii. 2009 (D. Papacek), collected in close association with O. citri. (ZSM); 1 ��, Frank Van Der Meer Cnr Steve Irvin Way & Kings Rd, Glasshouse Mtn 26.891 ��S, 152.962 ��E, 13.v. 2009 (L. Howie, A. Marcora), ex O. citri (NZAC); 2 ��, Biggenden, Cherelley Rd, 4621, Longatong Orchard (Cooranga Citrus P/L), 25.2862 ��S, 151.9570 ��E, 120 m, 1.iv. 2010 (E. Carlton, D. Papacek, A. Guanilo) (ZSM); 2 ��, Indooroopilly, 27.5000��S, 152.9824 ��E, 21 m, September 2009 (P. De Barro) (ZSM). Victoria: 4 ��, Mallacoota, Blue Wren Motel, 37.5587 ��S, 149.7541 ��E, 19 m (A. Chhagan), ex Aleyrodidae (ZSM); 1 ��, Lakes Entrance, 9 Prince Hwy, 33.828 ��S, 144.817 ��E, 25 m (A. Chhagan), ex Aleyrodidae (ZSM). Genbank accession. HQ 660514, HQ 660518, JF 750711 - JF 750715, JF 750729 - JF 750732. Comments. Eretmocerus orchamoplati sp. nov. was collected at coastal locations from central Queensland south to Victoria. The species can be separated from the other Australian Eretmocerus species by a combination of characters, including the transverse first and slightly broader than long second funicular segments, the short marginal fringe of the fore wing, and the few tubercles on the ventral surface of the fore wing near the posterior end of the linea calva. In the key to Australian Eretmocerus species associated with Bemisia tabaci (Gennadius) and Trialeurodes vaporariorum (Westwood) (Hemiptera: Aleyrodidae) (De Barro et al. 2000), E. orchamoplati would key out at the first couplet because of its transverse first funicular segment that is neither cylindrical as in E. mundus Mercet, nor subtriangular as in E. warrae (Naumann & Schmidt) or E. queenslandensis (Naumann & Schmidt). As in the other two parasitoid species examined, the 28 S-D 2 sequence data did not exhibit any intraspecific variation between populations from several locations in Queensland (Beerwah, Brisbane, Mundubbera), New South Wales (Batemans Bay), and Victoria (Mallacoota). The COI sequences exhibited an overall mean distance of 1.0%, with a maximum of 1.7 % between populations from Biggenden (Queensland) and Mallacoota (Victoria)., Published as part of Schmidt, Stefan, Barro, Paul De & Jamieson, Lisa, 2011, Parasitoids of the Australian citrus whitefly, Orchamoplatus citri (Takahashi) (Hemiptera, Aleyrodidae), with description of a new Eretmocerus species (Hymenoptera, Aphelinidae), pp. 27-34 in Zootaxa 2873 on page 32, DOI: 10.5281/zenodo.200545, {"references":["De Barro, P. J., Driver, F., Naumann, I. D., Schmidt, S., Clarke, G. M. & Curran, J. (2000) Descriptions of three species of Eretmocerus Haldeman (Hymenoptera: Aphelinidae) parasitising Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) and Trialeurodes vaporariorum (Westwood) (Hemiptera: Aleyrodidae) in Australia based on morphological and molecular data. Australian Journal of Entomology, 39, 259 - 269."]}

Encarsia iris (Girault) (Figs 5���8) Coccophagus iris Girault 1930: 4. Holotype ��, Australia, Queensland, Brisbane, Indooroopilly, 24 November 1929 (QMBA, type no. 4012, examined). Coccophagus iris Girault: Dahms 1984: 730. Encarsia iris (Girault): Viggiani 1985: 241 ���242. Change of combination. Encarsia iris (Girault): Schmidt & Polaszek, 2007: 2173 ���2174 (redescription). Diagnosis. FEMALE. Colour: head brown. Mesosoma brown except following parts yellow: mesoscutum posteriorly, posteromesal corner of axilla, scutellum, and metanotum. Gaster predominantly brown or basal tergites paler. Antenna yellow. Fore wing with dark band behind marginal vein (Fig. 8). Legs yellow except mid and hind coxae and occasionally hind femur brown. Morphology. Stemmaticum with rugosely strigose surface sculpture (Fig. 7). Antennal formula 1,1,3,3 (Fig. 6). Pedicel longer than (1.1���1.3 X) F 1. F 1 1.3���1.5 X as long as its maximum width, shorter than F 2 (0.7���0.9 X) and F 3 (0.7���0.8 X). F 2 slightly shorter than or subequal in length to F 3 (0.9 ���1.0X). Flagellomeres with the following numbers of sensilla: F 1: 0 or 1, F 2: 2, F 3 ���F 6: 3 or 4. Midlobe of mesoscutum with 8 setae, arranged symmetrically, side lobes with 3 setae each. Scutellar sensilla widely separated (approximately 5��� 6 X maximum width of a sensillum) (Fig. 5). Distance between anterior pair of scutellar setae slightly less than or subequal to distance between posterior pair (Fig. 5). Fore wing 2.3���2.4 X as long as width of disc (Fig. 8). Marginal fringe 0.2 X as long as width of disc (Fig. 8). Basal cell with 3���7 setae. Submarginal vein with 2 setae, marginal vein anteriorly with 6 or 7 setae. Tarsal formula 5,5, 5. Apical spur of midtibia distinctly longer than half length of corresponding basitarsus (0.8��� 0.9 X), the latter distally with 4 or 5 pegs. Tergites laterally with the following number of setae: T 1: 0, T 2: 1, T 3: 1, T 4: 1, T 5: 2, T 6: 2, T 7: 4. Ovipositor longer than midtibia (1.7���2.2 X) and 2.9���3.5 X as long as clava. Third valvula 0.5���0.7 X as long as second valvifer. MALE. Body dark brown except midlobe of mesoscutum posteriorly and scutellum lighter. Legs pale, all coxae and hind femur brown. Antenna light brown (radicle, scape, and pedicel slightly darker brown). Flagellum 6 - segmented with apical two segments partially fused and sensilla overlapping. Species group placement. E. opulenta group. Distribution. Australia: New South Wales, Queensland, Western Australia. Host. Orchamoplatus citri (Takahashi). Material examined. AUSTRALIA: New South Wales: 2 ��, Burringbar, Howards Rd, 28.4220 ��S, 153.4786 ��E, 87 m, 8.ii. 2010 (L. Howie, A. Marcora), ex O. citri on orange (ZSM); 3 ��, 625 Myocum Rd, 28.8180 ��S, 153.4922 ��E, 34 m, 8.ii. 2010 (L. Howie, A. Marcora), ex O. citri on lemon (ZSM); 13, Newybar, 19 Johnston Rd, 28.7244 ��S, 153.5189 ��E, 114 m, 8.ii. 2010 (L. Howie, A. Marcora), ex O. citri on Honey Murcart Mandarins (ZSM). Queensland: 1 ��, Biggenden, Cherelley Rd, 4621, Longatong Orchard (Cooranga Citrus P/L), 25.2862 ��S, 151.9570 ��E, 120 m, 1.iv. 2010 (E. Carlton, D. Papacek, A. Guanilo) (ZSM); 2 ��, Coochin Creek Farms, 1755 Roys Rd Beerwah, 26.892 ��S, 153.086 ��E, 13.v. 2009 (L. Howie, A. Marcora), ex O. citri (ZSM); 1 ��, Frank Van Der Meer Cnr Steve Irvin Way & Kings Rd, Glasshouse Mts, 26.891 ��S, 152.962 ��E, 13.v. 2009 (L. Howie, A. Marcora), ex O. citri (ZSM); 1 ��, Mundubbera, Durong Rd 4626, Benhams Orchard (Joey Citrus P/L), 25.6333 ��S, 151.2833 ��E, 140 m, 15.iii. 2010 (E. Carlton, D. Papacek, A. Guanilo) (ZSM). Genbank accession. HQ 660515, HQ 660517, JF 750716 - JF 750728. Comments. Encarsia iris was the most common parasitoid species reared from O. citri. It was collected at coastal locations from central Queensland south to Victoria, sometimes in large numbers. Orchamoplatus citri is the first host record of this species. The 28 S-D 2 sequence data did not show any intraspecific variation between populations from locations in Queensland (Brisbane, Glasshouse Mts) and New South Wales (Burringbar, Myocum, Newrybar). The COI sequences exhibited an overall mean distance of 0.8 %, with a maximum of 1.4 % between populations from Burringbar (NSW) and Brisbane (QLD)., Published as part of Schmidt, Stefan, Barro, Paul De & Jamieson, Lisa, 2011, Parasitoids of the Australian citrus whitefly, Orchamoplatus citri (Takahashi) (Hemiptera, Aleyrodidae), with description of a new Eretmocerus species (Hymenoptera, Aphelinidae), pp. 27-34 in Zootaxa 2873 on pages 30-31, DOI: 10.5281/zenodo.200545, {"references":["Girault, A. A. (1930) New pests from Australia VIII: 5 pp. Brisbane, private publication.","Dahms, E. C. (1984) A checklist of the types of Australian Hymenoptera described by Alexandre Arsene Girault: III. Chalcidoidea species F - M with advisory notes. Memoirs of the Queensland Museum, 21, 579 - 842.","Viggiani, G. (1985) Additional notes and illustrations on some species of aphelinids described by A. A. Girault and A. P. Dodd in the genera Coccophagus Westwood, Encarsia Forst. and Prospaltella Ashm. (Hym.: Chalcidoidea). Bollettino del Laboratorio di Entomologia Agraria ' Filippo Silvestri', Portici, 42, 233 - 255.","Schmidt, S. & Polaszek, A. (2007) The Australian species of Encarsia Forster (Hymenoptera, Chalcidoidea: Aphelinidae), parasitoids of whiteflies (Hemiptera, Sternorrhyncha, Aleyrodidae) and armoured scale insects (Hemiptera, Coccoidea: Diaspididae). Journal of Natural History, 41, 2099 - 2265."]}

In Australia, the Strengths and Difficulties Questionnaire (SDQ) has been implemented in several national studies, including the Longitudinal Study of Australian Children (LSAC). However, three previous state-level validations indicated problems with instrument dimensionality, warranting further research. To address this gap, the current study employed exploratory graph analysis to investigate dimensionality of the caregiver-completed SDQ version 4 to 10 years in a nationally representative sample of Australian children. Data were from a dual cohort cross-sequential study (LSAC) that included more than 20,000 responses. Gaussian graphical models were estimated in each study wave and exploratory graph analysis applied. Structural consistency, item stability and network loadings were evaluated. The findings provided mixed support for the original SDQ five-factor structure. The Peer Problem scale displayed low structural consistency since items clustered with the Emotional Symptoms and Prosocial behavior, generating four-dimensional structures. Implications for future use of the SDQ version 4 to 10 years in Australia are provided. Refereed/Peer-reviewed

Simple Summary: Black Lives Matter has highlighted the increased social discrepancies that exist not only in the context of social justice but also in public health. Oral cancer screening is not exempt from disparity, with Black Americans less likely to seek screening leading to higher incidence and worse outcomes of oropharyngeal cancers. We investigate interaction analysis and Blinder–Oaxaca decomposition as tools to guide policy to address this disparity. Using National Health and Nutrition Examination Survey (NHANES) data from 2011–2018 we find that being both in poverty and Black results in sub-additive interaction, which is further deconstructed into differences in higher education levels and poverty status. (1) Background: The Black Lives Matter movement has highlighted the discrepancies in public health in regard to race. This study aims to investigate tools that can be used to analyze and investigate this discrepancy, which can be applied to policymaking. (2) Methods: National Health and Nutrition Examination Survey (NHANES) data from 2011–2018 was combined (N = 22,617) to investigate discrepancies of oral cancer screening in Black Americans. We give examples of counterfactual techniques that can be used to guide policy. Inverse probability treatment weighting (IPTW) was used to remove all measured confounding in an interaction analysis to assess the combined effect of socioeconomic status and race. Blinder–Oaxaca decomposition was then used to investigate the intervenable factors associated with differences in race. (3) Results: Sub-additive interaction was found on additive and multiplicative scales when all measured confounding was removed via IPTW (relative excess risk due to interaction (RERI)(OR) = −0.55 (−0.67–−0.42)). Decomposition analysis found that 32% of the discrepancy could be explained by characteristics of higher education and poverty status. (4) Conclusions: Black Americans in poverty are less likely to seek oral cancer screening than the additive likelihood would suggest. Blinder–Oaxaca decomposition is a strong tool to use for guiding policy as it quantifies clear breakdowns of what intervenable factors there are that would improve the discrepancy the most. Refereed/Peer-reviewed

PurposeOur aims are to: (1) estimate prevalence, incidence, clearance and persistence of oral human papillomavirus (HPV) infection among Indigenous Australians; (2) identify risk factors associated with oropharyngeal squamous cell carcinoma (OPSCC)-related HPV types (HPV 16 or 18); (3) develop HPV-related health state valuations and; (4) determine the impact on OPSCC and cervical cancers, and the cost-effectiveness of extending publicly-funded HPV vaccination among Indigenous Australians.ParticipantsParticipants were recruited from February 2018 to January 2019. Twelve-month follow-up occurred from March 2019 to March 2020. Participants provided socio-demographic characteristics, health-related behaviours including tobacco and alcohol use and sexual history. Health state preferences in regard to HPV vaccination, knowledge regarding HPV infection, OPSCC and cervical cancer were collected using a two-stage standard gamble approach. Participants provided saliva samples and DNA for microbial genotyping was extracted.Findings to dateOf the 910 participants who were positive for β-globin at baseline, 35% had any oral HPV infection. The most prevalent HPV types were 13 or 32 (Heck’s disease; 23%). The second most prevalent types were associated with OPSCC (HPV 16 or 18; 3.3%). Of the 645 participants who were positive for β-globin at 12-month follow-up, 43% had any HPV infection. Of these, 33% were HPV types 13 or 32 and 2.5% were HPV 16 or 18. Some 588 participants had β-globin positive oral samples at baseline and 12-month follow-up. The prevalence of any oral HPV infection increased from 34% at baseline to 44% at 12-month follow-up; due to increases in HPV types 13 or 32 (20% at baseline and 34% at 12-month follow-up).Future plansFurther funding will be sought to continue follow-up of this cohort, and to include (after a full medical history) a thorough clinical examination of the external head and neck; a complete oral examination and examination of the oropharynx. Blood tests for early stage OPSCC will also be undertaken.

Objectives To conduct cross-national comparison of education-based inequalities in tooth loss across Australia, Canada, Chile, New Zealand and the United States. Methods We used nationally representative data from Australia's National Survey of Adult Oral Health; Canadian Health Measures Survey; Chile's First National Health Survey Ministry of Health; US National Health and Nutrition Examination Survey; and the New Zealand Oral Health Survey. We examined the prevalence of edentulism, the proportion of individuals having

Aim. The aim of this study was to describe the impact of oral health conditions among a convenience sample of Indigenous Australian adults and compare findings with nationally representative data. Methods. Data were obtained from the Indigenous Oral Health Literacy Project (IOHLP) based in South Australia. Nationally representative data were obtained from the National Survey of Adult Oral Health (NSAOH). The impact of oral disease was measured using the shortened form of the oral health impact profile, OHIP-14. All data were standardised by age group and sex utilising Census data. Results. For each OHIP-14 measure the impact was greater for IOHLP participants. There was considerable variation in the degree of difference between IOHLP and NSAOH participants for individual OHIP-14 items. Conclusion. High levels of effects of oral health conditions were reported by rural-dwelling Indigenous adults. This may exacerbate the health and social disadvantage experienced by this marginalised group. Refereed/Peer-reviewed

AimThe present study aims to develop the Race-related Attitudes and Multiculturalism Scale (RRAMS), as well as to perform an initial psychometric assessment of this instrument in a national sample of Australian adults.MethodsThe sample comprised 2,714 Australian adults who took part in the 2013 National Dental Telephone Interview Survey (NDTIS), which includes a telephone-based interview and a follow-up postal questionnaire. We used Exploratory Factor Analysis (EFA) to evaluate the RRAMS' factorial structure (n = 271) and then proceeded with Confirmatory Factor Analysis (CFA) to confirm the proposed structure in an independent sample (n = 2,443). Measurement invariance was evaluated according to sex, age and educational attainment. Construct validity was assessed through known-groups comparisons. Internal consistency was assessed with McDonald's ΩH and ordinal α. Multiple imputation by chained equations was adopted to handle missing data.ResultsEFA indicated that, after excluding 4 out of the 12 items, a two-factor structure provided a good fit to the data. This configural structure was then confirmed in an independent sample by means of CFA (χ2(19) = 341.070, pConclusionsThe RRAMS appears to be a valid and reliable measure to evaluate multiculturalist attitudes in the Australian context. The instrument may be useful in the assessment and monitoring of interventions aiming to promote multiculturalist inclusive attitudes and to increase social cohesion in Australia.

Background It has been proposed that psychosocial variables are important determinants of oral health outcomes. In addition, the effect of socioeconomic factors in oral health has been argued to work through the shaping of psychosocial stressors and resources. This study therefore aimed to examine the role of psychosocial factors in oral health after controlling for selected socioeconomic and behavioural factors. Methods Logistic and generalised linear regression analyses were conducted on self-rated oral health, untreated decayed teeth and number of decayed, missing and filled teeth (DMFT) from dentate participants in a national survey of adult oral health (n = 5364) conducted in 2004–2006 in Australia. Results After controlling for all other variables, more frequent dental visiting and toothbrushing were associated with poorer self-rated oral health, more untreated decay and higher DMFT. Pervasive socioeconomic inequalities were demonstrated, with higher income, having a tertiary degree, higher self-perceived social standing and not being employed all significantly associated with oral health after controlling for the other variables. The only psychosocial variables related to self-rated oral health were the stressors perceived stress and perceived constraints. Psychosocial resources were not statistically associated with self-rated oral health and no psychosocial variables were significantly associated with either untreated decayed teeth or DMFT after controlling for the other variables. Conclusion Although the role of behavioural and socioeconomic variables as determinants of oral health was supported, the role of psychosocial variables in oral health outcomes received mixed support.

Objective: This paper describes and compares magnitudes of socioeconomic (SES) inequalities in oral health among Indigenous and non-Indigenous children over a 10-year period. Methods: We analysed annual oral health survey data from NSW, NT and SA. Data were extracted for time period 1 (2000–2002, N=215,317) and time period 2 (2007–2010, N=34,495). Oral health outcomes were untreated decayed deciduous teeth (dt) and cumulative dental caries experience (dmft). Postcode-level Socioeconomic Index for Areas was used to assess SES. Age standardisation and complex survey weights were used. Indices of socioeconomic inequality in health (Slope Index of Inequality, Relative Index of Inequality, Absolute and Relative Concentration Index) were used to quantify inequality in dental caries and its changes over time. Results: Oral health outcomes deteriorated in both Indigenous and non-Indigenous populations over time. Indigenous children experienced higher levels of disease at both times. Untreated dt increased in both populations. The cummulative disease (dmft) increased at higher rate among children in low-SES areas in both populations. Over time, there was an increase in socioecononomic inequalities in dmft in all children and in dt in non-Indigenous children. Conclusion: Area-level socioeconomic inequality in child oral health has widened due to deterioration in low-SES children. Refereed/Peer-reviewed

Background: Oropharyngeal cancer is an important, understudied cancer affecting Aboriginal and Torres Strait Islander Australians. The human papillomavirus (HPV) is a significant risk factor for oropharyngeal cancer. Current generation HPV vaccines are effective against the 2 most common types of high-risk HPVs in cancer (hrHPVs 16/18). Objectives: This study aims (1) to yield population estimates of oncogenic genotypes of HPV in the mouth and oropharynx of defined Aboriginal and Torres Strait Islander populations; (2) to estimate the proportion of oropharyngeal cancer attributable to HPV among these Australian citizens; (3) to estimate the impact of HPV vaccination as currently implemented on rates of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians; and (4) taking into account impact on oropharyngeal as well as cervical cancer, to evaluate efficacy and cost-effectiveness of targeted extended HPV vaccination to older ages, among our study population. Methods: Our study design and operation is straightforward, with minimal impost on participants. It involves testing for carriage of hrHPV in the mouth and oropharynx among 1000 Aboriginal South Australians by simple saliva collection and with follow-up at 12 and 24 months, collection of sexual history at baseline, collection of information for estimating health state (quality-of-life) utilities at baseline, genotyping of viruses, predictive outcome and cost-effectiveness modeling, data interpretation and development of vaccination, and follow-up management strategies driven by the Aboriginal community. Results: Participant recruitment for this study commenced in February 2018 and enrollment is ongoing. The first results are expected to be submitted for publication in 2019. Conclusions: The project will have a number of important outcomes. Synthesis of evidence will enable generation of estimates of the burden of oropharyngeal cancer among Aboriginal and Torres Strait Islander Australians and indicate the likely effectiveness and cost-effectiveness of prevention. This will be important for health services planning, and for Aboriginal health worker and patient education. The results will also point to important areas where research efforts should be focused to improve outcomes in Aboriginal and Torres Strait Islander Australians with oropharyngeal cancer. There will be a strong focus on community engagement and accounting for the preferences of individuals and the community in control of HPV-related cancers. The project has international relevance in that it will be the first to systematically evaluate prevention of both cervical and oropharyngeal cancer in a high-risk Indigenous population taking into account all population, testing, and surveillance options. Registered Report Identifier: RR1-10.2196/10503 [JMIR Res Protoc 2018;7(6):e10503]

Observational studies and nonrandomized trials support an association between periodontal disease and atherosclerotic vascular disease. Both diseases occur frequently in Aboriginal Australians. We hypothesized that nonsurgical periodontal therapy would improve measures of arterial function and structure that are subclinical indicators of atherosclerotic vascular disease. This parallel-group, randomized, open label clinical trial enrolled 273 Aboriginal Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling during a single visit, whereas controls received no treatment. Prespecified primary end points measured 12-month change in carotid intima-media thickness, an indicator of arterial structure, and 3- and 12-month change in pulse wave velocity, an indicator of arterial function. ANCOVA used complete case data to evaluate treatment group differences. End points could be calculated for 169 participants with follow-up data at 3 months and 168 participants at 12 months. Intima-media thickness decreased significantly after 12 months in the intervention group (mean reduction=−0.023 [95% confidence interval {CI}, −0.038 to −0.008] mm) but not in the control group (mean increase=0.002 [95% CI, −0.017 to 0.022] mm). The difference in intima-media thickness change between treatment groups was statistically significant (−0.026 [95% CI, −0.048 to −0.003] mm; P =0.03). In contrast, there were no significant differences between treatment groups in pulse wave velocity at 3 months (mean difference, 0.06 [95% CI, −0.17 to 0.29] m/s; P =0.594) or 12 months (mean difference, 0.21 [95% CI, −0.01 to 0.43] m/s; P =0.062). Periodontal therapy reduced subclinical arterial thickness but not function in Aboriginal Australians with periodontal disease, suggesting periodontal disease and atherosclerosis are significantly associated.

riting in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value. 1 As committed Indigenous health researchers in Australia, we reflect Marmot’s ideal — to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live. As a group, we have over 120 collective years’ experience in Indigenous health research. Over this time, particularly in recent years as ethical guidelines have come into play, there have been many examples of research done well. However, as the pool of researchers is constantly replenished, we hold persisting concerns that some emerging researchers may not be well versed in the principles of best practice regarding research among Indigenous Australian populations. Implementing any research methodology among Indigenous Australian groups will work best when the following 10 principles are met. These principles are reflected in the many documents related to working and researching with Indigenous Australians; for example, the National Health and Medical Research Council (NHMRC) ethical guidelines for research among Aboriginal and Torres Strait Islander people. 2 In this article, we set out these principles in one short, accessible document. Essential principles

Background This study seeks to determine if implementing a culturally-appropriate early childhood caries (ECC) intervention reduces dental disease burden and oral health inequalities among Indigenous children living in South Australia, Australia. Methods/Design This paper describes the study protocol for a randomised controlled trial conducted among Indigenous children living in South Australia with an anticipated sample of 400. The ECC intervention consists of four components: (1) provision of dental care; (2) fluoride varnish application to the teeth of children; (3) motivational interviewing and (4) anticipatory guidance. Participants are randomly assigned to two intervention groups, immediate (n = 200) or delayed (n = 200). Provision of dental care (1) occurs during pregnancy in the immediate intervention group or when children are 24-months in the delayed intervention group. Interventions (2), (3) and (4) occur when children are 6-, 12- and 18-months in the immediate intervention group or 24-, 30- and 36-months in the delayed intervention group. Hence, all participants receive the ECC intervention, though it is delayed 24 months for participants who are randomised to the control-delayed arm. In both groups, self-reported data will be collected at baseline (pregnancy) and when children are 24- and 36-months; and child clinical oral health status will be determined during standardised examinations conducted at 24- and 36-months by two calibrated dental professionals. Discussion Expected outcomes will address whether exposure to a culturally-appropriate ECC intervention is effective in reducing dental disease burden and oral health inequalities among Indigenous children living in South Australia.

– Objectives: To determine predictors of untreated dental decay among 15–34-year-olds in Australia. Methods: Data were from Australia’s National Survey of Adult Oral Health, a representative survey that utilized a three-stage, stratified clustered sampling design. Models representing demographic, socioeconomic, dental service utilization and oral health perception variables were tested using multivariable logistic regression to produce odds ratios. Results: An estimated 25.8% (95% CI 22.4–29.5) of 15–34-year-old Australians had untreated dental decay. After controlling for other covariates, those who lived in a location other than a capital city had 2.0 times the odds of having untreated dental decay than their capital city-dwelling counterparts (95% CI 1.29–3.06). Similarly, those whose highest level of education was not a university degree had 2.1 times the odds of experiencing untreated dental decay (95% CI 1.35–3.31). Perceived need of extractions or restorations predicted untreated coronal decay, with 2.9 times the odds for those who perceived a treatment need over those with no such treatment need perception (95% CI 1.84–4.53). Participants who experienced dental fear had 2.2 times the odds of having untreated dental decay (95% CI 1.38–3.41), while those who reported experiencing toothache, orofacial pain or food avoidance in the last 12 months had 1.9 times the odds of having untreated dental decay than their counterparts with no such oral health-related quality-of-life impact (95% CI 1.20–2.92). The multivariate model achieved a ‘useful’ level of accuracy in predicting untreated decay (area under the ROC curve = 0.74; sensitivity = 0.63; specificity = 0.73). Conclusions: In the Australian young adult population, residential location, education level, perceived need for dental care, dental fear, toothache, orofacial pain or food avoidance together were predictors of untreated dental decay. The prediction model had acceptable specificity, indicating that it may be useful as part of a triage system for health departments wishing to screen by means of a questionnaire for apparently-dentally healthy 15–34-year-olds.