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This study aims to describe the natural history of and identify the risk factors associated with oral human papillomavirus (HPV) infections in an Australian Indigenous cohort. A longitudinal cohort study design, with baseline (2018), 12-month, and 24-month data obtained from Indigenous Australians aged 18+ years in South Australia, was performed. Face-to-face interviews were conducted, and saliva samples for HPV testing were collected at each time point. Basic descriptive analyses were conducted to calculate prevalence, incidence, persistence, clearance, and incidence proportions of any HPV infection. Multivariable logistic regression analyses with adjusted prevalence ratios (PRs) were conducted to identify risk factors associated with oral HPV infection. Among 993 participants with valid saliva samples, 44 HPV types were identified. The prevalence of infection with any oral HPV infection was 51.3%, high-risk HPV was 11%, and types implicated in Heck's disease (HPV 13 or 32) was 37.4%. The incidence, persistence, and clearance of any and high-risk HPV infections were 30.7%, 11.8% and 33.3% vs. 9.3%, 2.8%, and 9%, respectively. Our findings indicate that the prevalence, incidence, and persistence of oral HPV infection in a large sample of Indigenous Australians were high, and clearance was low. Oral sex behaviours and recreational drug use were risk factors associated with incident high-risk HPV infection. [ABSTRACT FROM AUTHOR]

Objective: Although the prevalence of poor self-rated oral health and experience of negative life events among Indigenous adults is high, the contribution of modifiable risk factors is unknown. We aimed to estimate the contribution of modifiable risk factors in poor self-rated oral health among Indigenous Australian adults with high and low experience of negative life events using decomposition analysis. Methods: The study utilised a cross-sectional design, with data from a large convenience study of Indigenous adults in South Australia. Participants were stratified based on a median split of negative life events in the last 12 months. The outcome was the proportion of fair/poor self-rated oral health (SROH). Independent variables included experience of racism, sex, age, geographic location, car ownership, and time since last dental visit. Results: Of the 1011 participants, the proportion with fair poor self-rated oral health was 33.5% (95% CI 30.5 to 36.4) and the proportion who had experienced 3+ negative life events in the past 12 months was 47.3% (95% CI 43.7 to 50.9). More than half the contribution in fair/poor self-rated oral health among Indigenous adults with a higher magnitude of negative life events was from experience of racism (55.3%, p<0.001), followed by residential location (19.9%), sex (9.7%) and car ownership (9.8%). Conclusions: The contributions of modifiable risk factors in poor self-rated oral health among Indigenous adults with different exposures to negative life events differed substantially. Targets to reduce racism will decrease oral health inequities for both groups, however Indigenous adults who have experienced substantial negative life events require additional focus on provision of culturally safe dental care. [ABSTRACT FROM AUTHOR]

Objectives: Indigenous Australians experience cumulative forms of oppression. Using intersectionality as the underlying analytical framework, and with oral health as an outcome, we demonstrate how oppressions are interlinked and cannot be treated in isolation. The study aimed to quantify the cumulative effect of two forms of oppression on Indigenous Australian oral health inequities. Methods: This observational study was conducted Feb 2018—Jan 2020. Recruitment occurred through Aboriginal Community Controlled Health Organisations in South Australia, Australia. Eligibility included identifying as Indigenous, residing in South Australia and aged 18+ years. Socio-demographic factors, health-related characteristics, experience of racism, negative life events and self-reported oral health outcomes were collected. The main outcomes were fair/poor self-rated oral health and oral health related quality of life, measured by OHIP-14. Effect-measure modification was used to verify differences on effect sizes per strata of negative life events and racism. The presence of modification was indicated by Relative Excess Risk due to Interactions (RERIs). Results: Data were obtained for 1,011 participants, median age 37 years, 66% female and 63% residing in non-metropolitan locations. Over half (52%) had experienced racism in the past 12 months and 85% had experienced one or more negative life events. Around one-third (34%) rated their oral health as fair/poor and the mean OHIP-14 score was 17. A higher proportion of participants who had experienced both racism and negative life events (46%) were male (52%), aged 37+ years (47%), resided in metropolitan locations (57%), reported difficulty paying a $100 dental bill (47%), had fair/poor self-rated oral health (54%) and higher mean OHIP-14 scores (20). The RERIs observed were 0.31 for fair/poor self-rated oral health and 0.23 for mean OHIP-14. The positive RERIs indicated a super-additive effect between racism, negative life events (effect modifier) and self-reported oral health outcomes. Conclusion: The more oppressions participants experienced, in the form of racism and negative life events, the greater the burden of poor self-reported oral health. The study is one of the first to use intersectionality as a theory to explain oral health inequities as experienced by Indigenous Australians. [ABSTRACT FROM AUTHOR]

In Australia, despite social support increasingly being reported as playing an important role in influencing health outcomes of Aboriginal and Torres Strait Islanders, measures of social support have not yet been validated for Aboriginal people. The current study aimed to evaluate the validity and reliability of the Social Support Scale in an Aboriginal and/or Torres Strait Islander population. The Social Support Scale (SSS) is a 4-item psychological instrument that was designed to evaluate four social support functions, instrumental, informational, emotional and appraisal support. Data included participants from two different samples: (1) Teeth Talk Study (n = 317), an oral-health randomized controlled trial (RCT) conducted with Aboriginal adults; and (2) the South Australian Aboriginal Birth Cohort Study (n = 367), a prospective longitudinal birth cohort study in which pregnant Aboriginal women were interviewed at baseline. The SSS psychometric properties were examined with Graphical Loglinear Rasch Models (GLLRM). The overall fit to a GLLRM was established (χ2(96)sample1 = 52.7, p = 0.06; χ2(25)sample2 = 22.2, p = 0.62) after accounting for local dependence between items 3 and 4. Item 2 displayed differential item functioning by employment status in Sample 1. Regarding dimensionality, the SSS was unidimensional in both samples (γobs1 = 0.80; γexp1 = 0.78, p = 0.65; γobs2 = 0.75, γexp2 = 0.77, p = 0.16). The instrument also displayed good reliability (Rsample1 = 0.82, Rsample2 = 0.84). Despite a few identified limitations (such as poor targeting), the findings indicated that the SSS is a promising instrument to provide culturally-valid and reliable measurement of social support among Aboriginal and/or Torres Strait Islander adults. Future studies should further investigate the instrument psychometric properties in other Aboriginal samples and the development and inclusion of culturally-sensitive items are also recommended. [ABSTRACT FROM AUTHOR]

Objective: The history of oral health research and dental care provision for Aboriginal and Torres Strait Islander Peoples has been framed by oppressive colonial values and wrought with maltreatment and unethical behavior. This commentary aims to collate evidence regarding the healthy history of Aboriginal and Torres Strait Islander oral health, the implications of colonization on oral health, and the current portrayal of oral health. Conclusion: We argue the need to reframe deficit focused discussions of Aboriginal and Torres Strait Islander oral health to strengths‐based narratives by critically engaging with the ways in which the future of Aboriginal and Torres Strait Islander oral health lies in the footprints of the past. [ABSTRACT FROM AUTHOR]

Background: Aboriginal Community Controlled Health Organisations (ACCHOs) play a critical role in supporting Aboriginal and Torres Strait Islander health in Australia. This article aims to identify and describe oral health programming and promotion provided by ACCHOs in South Australia. Methods: All ACCHOs in South Australia were identified through the Aboriginal Health Council of South Australia. A targeted search strategy was designed to include the websites and social media pages (Facebook, Twitter, Instagram) for each organisation. Program characteristics were extracted and summarised, and oral health promotion content was analysed utilising content analysis. Results: Twelve programs were identified across the 12 ACCHOs in South Australia. Of these, seven focused on oral health and five focused on nutrition. Oral health and nutrition information shared online by ACCHOs was extracted and aggregated into oral health and nutrition categories, which included reminders about visiting services, advocacy statements, oral hygiene messaging, appointment availability, education resources, and upcoming community‐based activities. Conclusions: The evidence explored highlights the integral role ACCHOs play in oral health promotion and service delivery. It is critically important that ACCHOs are involved in development and implementation of oral health services to ensure programming reflects community knowledges and is effective in improving oral health equity. [ABSTRACT FROM AUTHOR]

Background: Access to dental services are particularly important among Indigenous populations at a global level. This scoping review aimed to investigate challenges in the provision and utilization of oral health services among Indigenous Australians. Methods: This scoping review was conducted up to June 10, 2020. Five main databases were searched, including PUBMED, SCOPUS, ISI Web of Science, EMBASE and PROQUEST. Thematic analysis was used to analyse the data applying MAX QDA10 software. For a better understanding of the themes and subthemes, a thematic network was presented. Results: Results show that there are six main themes and 14 sub-themes affecting Indigenous Australians' utilization and provision of oral health services. Personal characteristics, socio-economic status and challenges regarding access were the main factors influencing utilization of oral health services. The findings suggest that challenges relating to public health, policymaking and service provision can affect Indigenous Australians' provision to oral health services. Conclusion: Benefits in Indigenous Australian access and utilization of oral health services may improve if policy makers at both national and local levels increase resourcing in this important public health sector. A deeper understanding of the social and cultural nuances driving Indigenous Australians' reluctance to attend for dental care is crucial. [ABSTRACT FROM AUTHOR]

Objectives: Network analysis is an innovative, analytic approach that enables visual representation of variables as nodes and their corresponding statistical associations as edges. It also provides a new way of framing oral health‐related questions as complex systems of variables. We aimed to generate networks of oral health variables using epidemiological data of Indigenous children, and to compare network structures of oral health variables among participants who received immediate or delayed delivery of an oral health intervention. Methods: Epidemiological data from 448 mother‐child dyads enrolled in a randomized controlled trial of dental caries prevention in South Australia, Australia, were obtained. Networks were estimated with nodes representing study variables and edges representing partial correlation coefficients between variables. Data included dental caries, impact on quality of life, self‐rated general health, self‐rated oral health, dental service utilization, knowledge of oral health, fatalism and self‐efficacy in three time points. Communities of nodes, centrality, clustering coefficient and network stability were estimated. Results: The oral health intervention interacted with the network through self‐rated general health and knowledge of oral health. Networks depicting groups shortly after receiving the intervention presented higher clustering coefficients and a similar arrangement of nodes. Networks tended to return to a preintervention state. Conclusion: The intervention resulted in increased connectivity and changes in the structure of communities of variables in both intervention groups. Our findings contribute to elucidating dynamics between variables depicting oral health networks over time. [ABSTRACT FROM AUTHOR]

The article explores human papillomavirus (HPV) vaccination and oropharyngeal cancer among Indigenous Australians. It attempts to explain why health promotion efforts around HPV infection, HPV vaccination and HPV-associated cancers have been unsuccessful among Indigenous Australians. Topics covered include HPV knowledge, the need for culturally specific health education delivery, and health behaviour of Indigenous Australians.

Introduction: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally, reflecting an increase in human papillomavirus (HPV)-related lesions. Indigenous populations are disproportionately affected by OPSCCs. Currently, testing for oral HPV is not recommended as a screening tool to permit early detection of OPSCCs due to the high population prevalence of HPV infection. Periodontitis may be a marker of oral HPV infection, but previous research evaluating this association has been inconclusive. Here we report a large population-based study examining the association between high-risk oral HPV infection and periodontitis among Indigenous South Australians. Methods: We utilised a large convenience sample of Indigenous South Australians aged 18+ years recruited between February 2018 and February 2020. Of the original cohort (n = 1011), 748 (73.9%) participants participated in the 12 month follow-up. Detailed information on sociodemographic characteristics, health-related behaviours, and sexual history were collected at enrolment. Saliva samples were collected at 12 months and tested for the presence of oral HPV DNA using the optimized general primer (GP) + PCR system. The primary outcomes were the prevalence of any high-risk oral HPV DNA, and separately, HPV 16 and/or 18. Periodontitis was assessed at follow-up by using validated self-reported periodontitis screening questions. Logistic regression analyses were undertaken to assess the association between self-reported periodontitis and oral HPV infection with adjustment for potential sociodemographic and behavioural confounders, with estimates presented as odds ratios (OR) and 95% confidence interval (CI). Results: Data on 673 participants (89.9% of the follow-up cohort) were available. Participants ranged in age from 18 to 80 (mean age 42.2, SD 14.7) and 31.5% were male. Overall, 115 (17.1%) participants had self-reported periodontitis, 40 (5.9%) had any high-risk oral HPV and 14 (2.1%) had HPV 16 and/or 18. Any high-risk HPV was detected among seven (17.5%) participants and HPV 16 and/or 18 was detected in three (21.4%) who self-reported periodontitis. In the regression analyses no significant association was found between self-reported periodontitis and high-risk oral HPV (adjusted OR: 1.10; 95% CI: 0.45–2.70) or HPV 16 and/or 18 (adjusted OR: 1.27; 95% CI: 0.32–5.03). Conclusion: This study did not find any association between self-reported periodontitis and high-risk oral HPV among Indigenous South Australians. Further targeted studies with standardized clinical measures of periodontal disease are needed to clarify the link between high-risk oral HPV and periodontal disease. If confirmed this would add further weight to the importance of recommendations about the utility of periodontitis screening to identify individuals at risk of carrying high-risk oral HPV, who may benefit from more intensive screening and ongoing monitoring. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals' preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians.Methods: Development and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test.Results: Data from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91-0.92 in 'screened, cytology normal, HPV vaccination' and 'screened, HPV positive, endoscopy normal', to less than 0.90 (ranging from 0.87-0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75-0.79) in 'early stage throat cancer'. Higher utility scores were observed for 'screened, cytology normal and HPV vaccination' among younger participants (18-40 years), for 'early stage invasive throat cancer' among females, and for 'oral intraepithelial neoplasia' and 'early stage invasive throat cancer' among metropolitan-dwelling participants.Conclusion: Among a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians. [ABSTRACT FROM AUTHOR]

Objective: Working in partnership with Indigenous communities in South Australia, we aimed to develop, pilot test and estimate utility scores for health states relating to cervical cancer screening, precancer, and invasive cervical cancer and precancer/cancer treatment among Indigenous women. Methods: Development and pilot testing of hypothetical cervical cancer health states, specifically through the lens of being an Indigenous Australian woman, was done with an Indigenous Reference Group in conjunction with five female Indigenous community members. Six health states were developed. These included: (1) Screened: cytology normal; (2) human papillomaviruses (HPV) positive with cytology normal; (3) low grade cytology (LSIL);(4) high grade cytology (HSIL); (5) early stage cervical cancer and; (6) later stage cervical cancer. Utility scores were calculated using a two-stage standard gamble approach among a large cohort of Indigenous Australian women taking part in a broader study involving oral HPV infection. The mean and standard deviation (SD) of the rank, percentage of respondents with a utility = 1 (perfect health) and utility score of each health state was summarised. Mean (SD) and medians and inter-quartile range (IQR) over 12 months and lifetime duration were calculated. Potential differences by age and residential location were assessed using the Wilcox Sum Rank test. Results: Data was obtained from 513 Indigenous women aged 19+ years. Mean utility scores were higher for the four non-cancer health states than for invasive cervical cancer states (p-values <0.05). Lower mean utility scores were observed for late stage cervical cancer, with 0.69 at 12 months and 0.70 for lifetime duration (Intra-class correlation coefficients = 0.425). Higher utility scores were observed for the four non-cancer health states among non-metropolitan participants (ranged from 0.93 to 0.98) compared with metropolitan participants (ranged from 0.86 to 0.93) (p-values<0.05). Conclusion: Among a large cohort of Indigenous Australian women, the reduction in quality of life (which utilities reflect) was perceived to be greater with increasing severity of cervical cancer health states. There were differences observed by geographic location, with positive cervical screening and precursor cancer-related quality of life being much higher among non-metropolitan-dwelling participants. These utility values, from one of the largest such studies ever performed in any population will be uniquely able to inform modelled evaluations of the benefits and costs of cervical cancer prevention interventions in Indigenous women. [ABSTRACT FROM AUTHOR]

Introduction: In Australia, health-related quality of life (HRQoL) instruments have been adopted in national population surveys to inform policy decisions that affect the health of Aboriginal and Torres Strait Islanders. However, Western-developed HRQoL instruments should not be assumed to capture Indigenous conceptualization of health and well-being. In our study, following recommendations for cultural adaptation, an Indigenous Reference Group indicated the EQ-5D-5L as a potentially valid instrument to measure aspects of HRQoL and endorsed further psychometric evaluation. Thus, this study aimed to investigate the construct validity and reliability of the EQ-5D-5L in an Aboriginal Australian population.Methods: The EQ-5D-5L was applied in a sample of 1012 Aboriginal adults. Dimensionality was evaluated using Exploratory Graph Analysis. The Partial Credit Model was employed to evaluate item performance and adequacy of response categories. Area under the receiver operating characteristic curve (AUROC) was used to investigate discriminant validity regarding chronic pain, general health and experiences of discrimination.Results: The EQ-5D-5L comprised two dimensions, Physiological and Psychological, and reliability was adequate. Performance at an item level was excellent and the EQ-5D-5L individual items displayed good discriminant validity.Conclusions: The EQ-5D-5L is a suitable instrument to measure five specific aspects (Mobility, Self-Care, Usual activities, Pain/Discomfort, Anxiety/Depression) of Aboriginal and Torres Strait Islander HRQoL. A future research agenda comprises the investigation of other domains of Aboriginal and Torres Strait Islander HRQoL and potential expansions to the instrument. [ABSTRACT FROM AUTHOR]

We tested the effect of an annual caries preventive intervention, delivered by a fly-in/fly-out oral health professional team, with Indigenous children residing in a remote Australian community. Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of who 408 had caregiver consent. One hundred and ninety-six consented to the epidemiological examination and intervention (Intervention group) and 212 consented to the epidemiological examination only (Comparison group). The intervention, which occurred annually, comprised placement of fissure sealants on suitable teeth, and application of povidone-iodine and fluoride varnish to the whole dentition, following completion of any necessary restorative dental treatment. Standard diet and oral hygiene advice were provided. Caries increment (number of tooth surfaces with new dental caries) in both deciduous and permanent dentitions was measured at the 2-year follow-up. Comparison group children had significantly higher number of new surfaces with advanced caries in the permanent dentition than the Intervention group (IRR = 1.61; 95% CI: 1.02–2.54; p = 0.04); with a preventive fraction of 43%. The effect of intervention remained significant with children in the Comparison group developing significantly more advanced caries lesions in the permanent dentition than the Intervention group children in the adjusted multivariable analysis (IRR = 2.21; 95% CI: 1.03–4.71). Indigenous children exposed to the intervention had less increment in advanced dental caries in the permanent dentition than those not exposed to the intervention. [ABSTRACT FROM AUTHOR]

Background: The study of oral health literacy (OHL) is likely to gain new and interesting insights with the use of network analysis, a powerful analytical tool that allows the investigation of complex systems of relationships. Our aim was to investigate the relationships between oral health literacy and oral health-related factors in a sample of Indigenous Australian adults using a network analysis approach. Methods: Data from 400 Indigenous Australian adults was used to estimate four regularised partial correlation networks. Initially, a network with the 14 items of the Health Literacy in Dentistry scale (HeLD-14) was estimated. In a second step, psychosocial, sociodemographic and oral health-related factors were included in the network. Finally, two networks were estimated for participants with high and low oral health literacy. Participants were categorised into 'high' or 'low' OHL networks based on a median split. Centrality measures, clustering coefficients, network stability, and edge accuracy were evaluated. A permutation-based test was used to test differences between networks. Results: Solid connections among HeLD-14 items followed the structure of theoretical domains across all networks. Oral health-related self-efficacy, sporting activities, and self-rated oral health status were the strongest positively associated nodes with items of the HeLD-14 scale. HeLD-14 items were the four most central nodes in both HeLD-14 + covariates network and high OHL network, but not in the low OHL network. Differences between high and low OHL models were observed in terms of overall network structure, edge weight, and clustering coefficient. Conclusion: Network models captured the dynamic relationships between oral health literacy and psychosocial, sociodemographic and oral health-related factors. Discussion on the implications of these findings for informing the development of targeted interventions to improve oral health literacy is presented. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of an oral health literacy intervention on oral health literacy-related outcomes among rural-dwelling Indigenous Australian adults. Methods A total of 400 Indigenous adults (203 intervention and 197 control participants) were recruited into a randomized controlled trial; a functional, context-specific oral health literacy interventions were developed and implemented by Indigenous staff. The intervention comprised five sessions, each lasting 1.5 hours, across a 1-year period. The primary outcome was oral health literacy as assessed by the He LD-14 instrument, with secondary outcomes including the social impact of oral disease, and psychosocial and knowledge-related factors. Three scenarios were used in data analysis: (I) intention to treat; ( II) as treated and; ( III) adherence only. Multiple imputation ( MI) was used to replace missing data. Results The proportion reporting that 'water with fluoride' was good increased in the intervention group within both crude and MI data analyses under the three scenarios. Other crude data analysis yielded no significant differences for either primary or secondary outcomes between intervention and control groups under the three scenarios. After MI, oral health literacy improved when assessed under scenario II (mean change=1.3, 95% CI: 1.1, 1.6). Improvements under three scenarios were also observed for the Oral Health Impact Profile ( OHIP-14; mean change ranged from −0.7 to −3.8), sense of control (mean change ranged from 0.4 to 1.1), oral health-related fatalism (mean change ranged from −0.7 to −0.4) and perceived stress (mean change ranged from −2.1 to −1.1). The proportion reporting that 'cordial was good' decreased in the intervention group from MI analysis under scenarios II and III. Conclusions A context-specific oral health literacy intervention was partially successful in improving oral health literacy and oral health literacy-related outcomes in this vulnerable population, but only after MI. [ABSTRACT FROM AUTHOR]

Objective. To compare general and oral health perceptions between Indigenous and non-Indigenous Australians and to quantify Indigenous Australian health-related frames of reference. Methods. A mixed-methods approach was used. The quantitative component comprised data from four convenience studies of Indigenous oral health and one national oral health survey stratified by Indigenous status. Qualitative data with questions pertaining to frames of reference were collected from 19 Indigenous Australian interviews. Results. Among the Indigenous studies, deficits in perceptions of excellent, very good, or good general health and excellent, very good, or good oral health ranged from 10.5% to 43.8%. Among the non-Indigenous population, the deficit was 5%. Frames of reference appeared to underpin a biomedical conceptual outlook. Conclusion. The deficit in perceived oral health compared with general health was far greater among Indigenous Australians. The frame of reference underpinning Indigenous Australian's perceptions of health reflect those of the general Australian population. [ABSTRACT FROM AUTHOR]

Objectives: Mediation analyses are critical to understanding why behavioral interventions work. Health literacy is a known mediator between socio-economic factors, health behavior and oral health outcomes in various populations, explaining gradients in oral health status and outcomes. We explore whether self-efficacy (SE) mediates the association between oral health literacy (OHL) and self-rated oral health (SROH) in an Indigenous population.Methods: Cross-sectional data collected from 278 rural-dwelling Indigenous Australians evaluated OHL, SE, SROH, socio-demographic and behavioral characteristics. OHL was measured using a validated OHL scale (HeLD-14), SE was measured using a validated SE scale and SROH was measured using a global, one-item statement. Theoretically-driven multivariable models, adjusted for age, sex, income, education, and dental service use estimated the prevalence ratios (PR) and 95 percent confidence intervals for poor SROH.Results: The overall prevalence of poor SROH was 78.8 percent. The prevalence of low OHL was 46.0 percent, while the prevalence of low SE was 56.8 percent. Analysis showed a significant main effect of SE (PR = 2.5, 95 percent CI 1.3-4.6). SE attenuated the effects of OHL on poor SROH (from PR = 2.4 to PR = 2.0), supporting its associated role in the Indigenous population under study. Sobel and bootstrap testing confirmed the significance of the mediating effect (z = 2.2, SE 0.30, P < 0.05) and 95 percent CI (0.11-0.07) (P < 0.05) respectively.Conclusions: Given that SE is a construct amenable to change, our results suggest that interventions that aim to improve SE may have positive impacts on SROH among this vulnerable population. [ABSTRACT FROM AUTHOR]

Objective. Dental diseases have shown to be influenced by area- level socioeconomic status. This study aims to assess the effects of change in area- level SES on the oral health of Australian Indigenous children. Methods. Data were collected from a national surveillance survey for children's dental health at two points of time (2000- 2002/ 2007- 2010). The study examines caries experienced by area- level SES and whether changes in area- level SES (stable- high, upwardly- mobile, downwardly- mobile and stable low) affects caries experience. Results. Dental caries in both the deciduous and permanent dentition increased significantly among Indigenous children during the study period. In stable lowSES areas, the experience of decayed, missing and overall dmft/ DMFT in both dentitions was highest compared with other groups at both Time 1(2.15 vs 1.61, 1.77, 1.87 and 0.86 vs 0.55, 0.67, 0.70 respectively) and Time 2 (3.23 vs 2.08, 2.17, 2.02 and 1.49 vs 1.18, 1.21 respectively). Conclusion. A change in area- level SES was associated with experience of dental disease among Indigenous Australian children. [ABSTRACT FROM AUTHOR]

Discrimination is a very real facet of Australian Aboriginal and Torres Strait Islander (ATSI) life. Paradies has detailed the strong links between racism and chronic stress and the influence this may have on general health, confounding the pre- supposed notion that ATSI populations are more genetically predisposed to chronic diseases. For example a genetic predisposition promoting central adipose storage in populations with recent (in evolutionary terms) changes to hunter- gatherer dietary patterns is thought to contribute to the higher rates of diabetes seen in ATSI and other Native populations. This relationship, however, is far from causal in any straight- forward way. In support of the work by Paradies, research from the U.S. also shows that racism, both explicit and subtle, contributes to chronic disease and suffering among ethnic minorities. While the exploration of the perceived or self- reported racial discrimination is recent, this concept has increasing evidence to support its relationship to poor health outcomes. [ABSTRACT FROM AUTHOR]

Objective. Tooth decay is related to poverty, measured at individual and neighbourhood levels. It is however uncertain if living in an advantaged neighbourhood reduces tooth decay similarly in Australian Indigenous and non- Indigenous children. Methods. This study describes tooth decay by neighbourhood characteristics and Indigenous status, and examines inequalities by Indigenous status. Results. In deciduous dentition the percentage of children with tooth decay and untreated decay decreased on average 26% and 20% respectively in the non- Indigenous sample from poor to affluent neighbourhoods. In Indigenous children tooth decay and untreated decay decreased on average 6% and 8%, respectively, from poor to affluent neighbourhoods. Conclusion. While all children from affluent areas had less tooth decay, the gap between non- Indigenous and Indigenous children remained significant across neighbourhood characteristics. This suggests that both universal and targeted prevention programs should be considered for all Indigenous children irrespective of where they live. [ABSTRACT FROM AUTHOR]

Objectives. This paper assessed the fidelity of an early childhood caries MI intervention among Aboriginal mothers in South Australia. Methods. Four MI- trained staff delivered the intervention and all interviews were recorded. A randomly selected subset (n = 164, 41.2%) were tested for MI fidelity using the Motivational Interviewing Treatment Integrity (MITI) code 3.1.1. A further randomly selected 20 taped sessions were additionally scored by an external expert to assess external reliability. Results. Mean scores for evocation, collaboration, autonomy/ support, direction and empathy ranged from 3.5 (95% CI 3.4- 3.7) to 4.1 (95% CI 4.0- 4.2). The mean global score was 3.8 (95% 3.7- 3.9). The Reflection:Question ratio was 0.9 (95% CI 0.8- 1.0), % Open- ended Questions was 54.9 (95% CI 50.0- 59.8), % Complex Reflections was 54.0 (95% CI 50.5- 57.5) and % MI- adherent statements was 95.0 (95% CI 92.0- 98.0). Inter- assessor reliability was high. Conclusions. Beginner to expert competency in fidelity to the MI model was observed. [ABSTRACT FROM AUTHOR]

Background There are major health disparities between Indigenous and non-Indigenous Australians. To address this, it is vital to understand the landscape of Indigenous trial activity. Methods We extracted data from all Australian trials registered between 2008-2018 on the Australian New Zealand Clinical Trials Registry or ClinicalTrials.gov. Indigenous-focused trials were identified by searching for relevant terms such as 'Indigenous' and 'Aboriginal'. Indigenous versus non-Indigenous trials and Australian trials overall were compared by conditions studied, intervention type, study design and funding. Results Of the 9206 included trials, 139 (1.5%) focused on Indigenous health, and these were mostly in 'Public Health' (n = 69, 50%), 'Mental Health' (n = 35, 25%) and 'Cardiovascular' (n = 25, 18%) (Figure). Compared to other Australian trials, Indigenous trials more frequently studied ear conditions (OR 16.47, 95%CI=8.43-29.99) and public health (OR 4.87, 95%CI=3.65-6.41), and were more likely to focus on screening (OR 3.57, 95%CI=2.10-5.70) and prevention (OR 2.24, 95%CI=1.61-3.08) rather than treatment (OR 0.40, 95%CI =0.30-0.52). They were less likely to be blinded (OR 1.72, 95%CI=1.20-2.49), or have any industry involvement (OR 2.52, 95%CI=1.54-4.43). Conclusions Indigenous trials differed from other Australian trials in health conditions studied, intervention focus, blinding and industry involvement. Relative to population size and burden of disease, the number of trials focusing on Indigenous health is low. Key messages Trial registries can be used to explore whether research appropriately addresses diverse populations such as Indigenous Australians. This can inform future research prioritisation. [ABSTRACT FROM AUTHOR]

Background: Oral health impairment comprises three conceptual domains; pain, appearance and function. This study sought to: (1) estimate the prevalence of severe oral health impairment as assessed by a summary oral health impairment measure, including aspects of dental pain, dissatisfaction with dental appearance and difficulty eating, among a birth cohort of Indigenous Australian young adults (n = 442, age range 16-20 years); (2) compare prevalence according to demographic, socio-economic, behavioural, dental service utilisation and oral health outcome risk indicators; and (3) ascertain the independent contribution of those risk indicators to severe oral health impairment in this population. Methods: Data were from the Aboriginal Birth Cohort (ABC) study, a prospective longitudinal investigation of Aboriginal individuals born 1987-1990 at an Australian regional hospital. Data for this analysis pertained to Wave-3 of the study only. Severe oral health impairment was defined as reported experience of toothache, poor dental appearance and food avoidance in the last 12 months. Logistic regression models were used to evaluate effects of demographic, socio-economic, behavioural, dental service utilisation and clinical oral disease indicators on severe oral health impairment. Effects were quantified as odds ratios (OR). Results: The percent of participants with severe oral health impairment was 16.3 (95% CI 12.9-19.7). In the multivariate model, severe oral health impairment was associated with untreated dental decay (OR 4.0, 95% CI 1.6- 9.6). In addition to that clinical indicator, greater odds of severe oral health impairment were associated with being female (OR 2.0, 95% CI 1.2-3.6), being aged 19-20 years (OR 2.1, 95% CI 1.2-3.6), soft drink consumption every day or a few days a week (OR 2.6, 95% 1.2-5.6) and non-ownership of a toothbrush (OR 1.9, 95% CI 1.1-3.4). Conclusions: Severe oral health impairment was prevalent among this population. The findings suggest that public health strategies that address prevention and treatment of dental disease, self-regulation of soft drink consumption and ownership of oral self-care devices are needed if severe oral health impairment among Indigenous Australian young adults is to be reduced. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Aim Methods Results Conclusion The association between ear problems and traumatic dental injuries (TDIs) has not been examined in longitudinal cohort studies. The study aimed to estimate the effect of ear problems on TDIs in primary and permanent teeth among Australian Indigenous children.The Longitudinal Study of Indigenous Children is a study of two representative cohorts of Indigenous Australian children, aged from 6 months to 2 years (baby cohort) or from 3.5 to 5 years (child cohort) at baseline (2008). The children's mother/primary carer undertook a face‐to‐face interview in 2008, repeated annually for the next 9 years. Ear problems included runny ears, perforated eardrum, total deafness, deaf in one ear, hearing loss/partially deaf, and other ear problems. TDIs were teeth and oral soft and hard tissue injuries. Multivariate survival analysis using Cox proportional regression models estimated hazards ratio (HR) were used in the analysis.A total of 870 from baby cohort and 668 from child cohort Indigenous children, who had no TDIs at baseline were included in the analysis. The prevalence of TDIs was 9.2%, 11.1%, and 6.6% in the total, baby, and child cohorts, respectively. Multivariable models for TDIs indicate children with ear problems had nearly four times (total: HR = 3.72, 95% CI: 1.82–6.77), five times (baby cohort: HR = 4.76, 95% CI: 1.59–11.63), and more than 15 times (child cohort: HR = 16.2, 95% CI: 4.78–49.28) the average hazard over time, than those without ear problems. After adjusting for all covariates, children with ear problems had more than 22 times (HR = 22.03, 95% CI: 4.50–87.07) TDIs than those without ear problems in the child cohort. Mothers/primary carers with lower educational level was positively associated with the incidence of TDIs.Ear problems were a risk indicator for the increased incidence of TDIs in two large cohorts of Indigenous Australian children. Mothers/primary carers' educational level was a significant risk factor for TDIs. [ABSTRACT FROM AUTHOR]

Background: Aboriginal Australians and Torres Strait Islanders (hereafter respectfully referred to as Indigenous Australians) experience disproportionately poor health and low life expectancy compared to non-Indigenous Australians. Poor oral health is a critical, but understudied, contributor to this health gap. A considerable body of evidence links poor oral health to increased risks of other chronic non-communicable conditions, such as diabetes, cardiovascular disease, chronic kidney disease, and poor emotional wellbeing. Main: The oral microbiota is indisputably associated with several oral diseases that disproportionately affect Indigenous Australians. Furthermore, a growing literature suggests direct and indirect links between the oral microbiota and systemic chronic non-communicable diseases that underpin much of the Indigenous health gap in Australia. Recent research indicates that oral microbial communities are shaped by a combination of cultural and lifestyle factors and are inherited from caregivers to children. Systematic differences in oral microbiota diversity and composition have been identified between Indigenous and non-Indigenous individuals in Australia and elsewhere, suggesting that microbiota-related diseases may be distinct in Indigenous Australians. Conclusion: Oral microbiota research involving Indigenous Australians is a promising new area that could benefit Indigenous communities in numerous ways. These potential benefits include: (1) ensuring equity and access for Indigenous Australians in microbiota-related therapies; (2) opportunities for knowledge-sharing and collaborative research between scientists and Indigenous communities; and (3) using knowledge about the oral microbiota and chronic disease to help close the gaps in Indigenous oral and systemic health. [ABSTRACT FROM AUTHOR]