Joanne Hedges

Background: Human papillomavirus (HPV) infects skin and mucous membranes, and high-risk types are associated with oropharyngeal and other cancers. Longitudinal evidence on oral HPV among Aboriginal and Torres Strait Islander peoples remains limited, particularly across geographic settings. Methods: A longitudinal cohort study was conducted among 1011 Indigenous Australian adults in South Australia recruited through Aboriginal Community Controlled Health Organisations. Participants provided saliva samples and completed questionnaires at baseline (2018–2019) and at 12- and 24-month follow-up. Oral HPV was detected using PCR-based assays. Incidence, persistence, and clearance were estimated, and multivariable regression examined associations with behavioural, sexual health, and socioeconomic factors. Results: Oral HPV dynamics differed between metropolitan and non-metropolitan participants. Approximately one-quarter developed an incident infection, with geographic variation in persistence and clearance. Smoking, sexual behaviours, and socioeconomic factors were associated with HPV outcomes. Older age was associated with persistence among non-metropolitan participants, while smoking was associated with higher incidence among metropolitan participants. Conclusions: Oral HPV detection dynamics varied by geographic setting. Culturally appropriate, targeted public health strategies addressing behavioural and social determinants are needed to reduce HPV-related disease burden.

Objectives: To establish the monetary costs of supporting the Indigenous community in Australia to receive culturally safe dental care. Methods: Financial data was analysed from a follow‐up dental intervention study involving 173 Indigenous Australians—164 adults and nine children—who received fully funded dental treatment through private dental clinics. Participants were seen at baseline and 12‐month follow‐up for an oral health assessment, conducted at a location of their preference. Following the initial assessment, participants were referred to a private dental practice near their residence or of their choosing, with preference given to a practice that employed an Indigenous dentist. The study team provided additional support as required, such as transportation vouchers to attend appointments, assistance with bookings, providing reminders, and checking in regarding treatment experiences. Results: Most participants were employed and primarily resided in metropolitan and inner regional locations of South Australia. The total expenditure for private dental treatment was nearly $300 000 AUD, with a median per capita cost of $1332 AUD (IQR: $727–$2311). The largest proportion of funding (42.3%) was spent on restorative treatments, both overall and within each age group. Participants who reported they would have considerable difficulty paying a $100 dental bill had a higher median cost of treatment ($1384, IQR: $1073–$2691) than those who reported they would have less difficulty ($961, IQR: $633–$2001). Following dental treatment, participants reported that both their general and oral health improved. Conclusions: The dental expenditure and volume of care required by participants in this study demonstrate that unmet dental needs persist in the Indigenous community, which can be addressed by reducing cultural, structural, and financial barriers.

Background/Objectives: The HPV vaccine is highly effective and safe in preventing HPV infection. This study explored the relationship between HPV vaccination, HPV knowledge and awareness, and oral HPV infection prevalence among Indigenous Australian adults. Methods: Data were collected from a large convenience sample in South Australia in 2018–19, with annual follow-ups through 2022–23. The primary outcome was oral infection with HPV types 6, 11, 16, 18, 31, 33, 45, 52, or 58. The main exposure was HPV vaccination uptake status, which was categorised as unvaccinated, partially vaccinated (1–2 doses), or fully vaccinated (3 doses). Covariates included sociodemographic factors, general and sexual health behaviours, and HPV knowledge scores (HPV-KT). Risk ratios (RRs) for oral HPV infection were estimated using Poisson regression models. Results: Among the 1006 participants who completed at least one questionnaire and oral HPV test by 24 months, 81% were unvaccinated, 13% partially vaccinated, and 7% fully vaccinated. Fully vaccinated individuals had the highest HPV-KT scores (mean: 3.4) and the lowest oral HPV prevalence (5%). After adjusting for covariates, unvaccinated participants had a 1.08 times higher risk of oral HPV infection (95% CI: 1.00–3.11) compared to those fully vaccinated. Conclusions: Full HPV vaccination (three doses) is associated with lower oral HPV infection and greater HPV knowledge. The protective effect appears stronger than for partial vaccination or no vaccination, underscoring the importance of completing the full vaccine series to reduce oral HPV burden.

Background: Racism arrived in Australia with colonization and its intentionally oppressive policies and actions toward Aboriginal and Torres Strait Islander Peoples. To a large extent, colonial and biomedical agendas are maintained by Australia’s health system that underlies much of the racialized health inequities in the country. Dentistry significantly lags behind medicine and other health care areas in the uptake of antiracism, with the dental accreditation body only acknowledging racism as a determinant of oral health in 2022. Objective: This project will comprehensively co-design strategies for an antiracist dental health system in Australia through the following objectives: (1) development of an antiracist curriculum for dental students; (2) workforce strategies that support the attraction, retention, and well-being of the Aboriginal and Torres Strait Islander dental workforce; and (3) oral health promotion training for Aboriginal Health Workers/Practitioners. Methods: This project is grounded in decolonizing and Indigenous methodologies, which guide our ways of working at the knowledge interface. Co-design Yarning sessions will inform the development and implementation associated with each of the objectives through tabulation and narrative synthesis of sessions. Objectives will be evaluated with both quantitative and qualitative measures and analyzed accordingly with inverse probability of treatment weighting, content analysis, or reflexive thematic analysis. Results: The study received ethical review approval in February 2024 and received funding in June 2024. The co-design phase for each objective will run from July 2024 to February 2025. The dental curriculum will be developed in 2025 and delivered to the 2026 student cohort. Evaluation data will be collected from the comparator student cohort in 2025 and the implementation cohort in 2026. Data collection for the development of workforce strategies will be collected from October 2024 to July 2025; the framework will be developed from August to December 2025 and disseminated in 2026. Oral health promotion training will be developed from August to February 2024, implemented from March to June 2025, and qualitative evaluation data will be collected between July and September 2025. Conclusions: The proposed research will develop an antiracism curriculum for dental students, a tailored Aboriginal and Torres Strait Islander dental workforce framework, and an oral health promotion training program for Aboriginal Health Workers/Practitioners. The processes and final outcomes of this research will be scalable and able to be tailored to different contexts. Together, these strategies will build oral health knowledge at the Community level, in turn supporting Aboriginal and Torres Strait Islander self-determination of oral health. International Registered Report Identifier (IRRID): PRR1-10.2196/69012

Background: Psycho‐oncology is a branch of research related to cancer care that focuses on the psychological, behavioural, spiritual, physical and social aspects of the cancer experience. Whilst psycho‐oncology and its applications are relatively nascent, there is a paucity of research regarding the psycho‐oncological considerations for Indigenous communities. Due to the deleterious impacts of colonisation, the burden of disease experienced amongst Indigenous Peoples is disproportionately higher than in non‐Indigenous populations. Yet, the lack of attention paid towards the development of appropriate models of care fails to reflect this. Therefore, this systematic review aims to build an understanding of psycho‐oncology for Indigenous Peoples, globally. Methods: Two independent reviewers searched PubMed, Embase, Web of Science, PsychInfo and ProQuest using a pre‐established search strategy. The search was not limited by geographic setting, language, age or gender. Qualitative studies with Indigenous participants that focused on the psychological experiences related to cancer were eligible for inclusion. Included articles were critically appraised using the Joanna Briggs Institute appraisal tool for qualitative studies, and thematic findings were meta‐aggregated. Results: The search identified 5632 articles; after screening, a total of 21 studies were included. During the meta‐aggregation phase, 11 synthesised findings were identified: structural racism, biomedical health systems, colonisation, shame, fear, loneliness, spiritual pain, loneliness, gratitude, connection, strength and feeling all consumed. Conclusion: There is a need to prioritise and involve Indigenous healthcare workers in all stages of the cancer experience to preserve traditional, cultural and spiritual ways of healing and to deliver culturally responsive healthcare for Indigenous patients.

Background: Indigenous Australians score worse on both sleep and oral health. This study aimed to evaluate sleep quality and quantity associated with oral health-related quality of life (OHRQoL) among Indigenous Australian adults. Methods: A cross-sectional study involving 728 Indigenous Australian adults aged 18+ years was conducted. Exposure variables were sleep quality and quantity. The primary outcome variable was Oral Health Impact Profile-14 (OHIP14), which has been used to assess OHRQoL. Multivariable log–Poisson regression models were applied to estimate the mean ratios (MRs) for mean OHIP14 scores. Results: The average OHIP14 score was 14.9, and the average amount of sleep was 6.8 h/night. After adjusting for all covariates, self-rated very bad sleep quality was associated with 2.2 times (MR = 2.17, 95% CI: 1.97–2.37) higher OHIP14 scores than those who rated their sleep quality as very good. Participants who self-reported sleeping 7–8 h/night had 0.9 times (MR = 0.89, 95%CI: 0.83–0.95) lower OHIP14 scores than those sleeping more than 8 h. Conclusions: The average number of sleep hours for Indigenous participants were lower than recommended (7–8 h/night). Our findings indicate that poor sleep quality and quantity, and oral health-related behaviours associated with sleep deprivation were positively associated with poor oral health related quality of life among Indigenous Australian adults.