Inequalities between Maori and non-Maori men with prostate cancer in Aotearoa New Zealand.

Maori experience poorer health statistics in terms of cancer incidence and mortality compared to non-Maori. For prostate cancer, Maori men are less likely than non-Maori men to be diagnosed with prostate cancer, but those that are diagnosed are much more likely to die of the disease than non-Maori men resulting in an excess mortality rate in Maori men compared with non-Maori. A review of the literature included a review of the epidemiology of prostate cancer; of screening; of access to healthcare and of treatment modalities. Our conclusion was that there are a number of reasons for the disparity in outcomes for Maori including differences in staging and characteristics at diagnosis; differences in screening and treatment offered to Maori men; and general barriers to healthcare that exist for Maori men in New Zealand. We conclude that there is a need for more culturally appropriate care to be available to Maori men.

Follow-up of an Intervention to Reduce Dental Caries in Indigenous Australian Children: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Testing the long-term usefulness of a childhood intervention and determining the best age of implementation are important for translation and policy change. Objectives: To investigate among children aged 3 years the long-term effectiveness an intervention that aimed to reduce dental caries among South Australian Aboriginal children and to assess if children in the delayed intervention (DI) group had any benefit from the intervention from ages 2 to 3 years and if the intervention usefulness was greater when delivered between pregnancy and age 2 years (immediate intervention [II] vs ages 2 to 3 years [DI]). Design, Setting, and Participants: Secondary analysis of a randomized clinical trial. The study enrolled 448 pregnant women across South Australia, Australia, at baseline (February 1, 2011, to May 30, 2012), with 223 randomly allocated to the II group and 225 to the DI group. Three-year follow-up data were collected November 2014 to February 2016. Interventions: The intervention comprised dental treatment to mothers, fluoride varnish application to children, and motivational interviewing delivered together with anticipatory guidance. This was delivered during pregnancy and at child ages 6, 12, and 18 months for the II group and at child ages 24, 30, and 36 months for the DI group. Main Outcomes and Measures: The mean number of decayed teeth measured at child age 3 years. Results: There were 324 children at age 3 years (52.3% male). The mean number of decayed teeth at age 3 years was 1.44 (95% CI, 1.38-1.50) for the II group and 1.86 (95% CI, 1.89-2.03) for the DI group (mean difference, -0.41; 95% CI, -0.52 to -0.10). The predicted mean number of decayed teeth at age 3 years for the DI group was 2.15. Between ages 2 and 3 years, the caries increment for the II group was 0.82 (95% CI, 0.75-0.89), compared with 0.97 (95% CI, 0.87-1.17) for the DI group (P = .05). Conclusions and Relevance: At the 3-year follow-up, II children had less dental caries than DI children, DI children developed dental caries at a lower trajectory than predicted had the intervention not been received at ages 2 to 3 years, and the caries increment was less between ages 2 to 3 years among II children compared with DI children. This study suggests that the best time to implement the intervention is earlier rather than later infancy. Trial Registration: Australian and New Zealand Clinical Trial Registry Ideintifier: ACTRN12611000111976.

Dental Disease Outcomes Following a 2-Year Oral Health Promotion Program for Australian Aboriginal Children and Their Families: A 2-Arm Parallel, Single-blind, Randomised Controlled Trial.

BACKGROUND: Dental disease has far-reaching impacts on child health and wellbeing. We worked with Aboriginal Australian communities to develop a multifaceted oral health promotion initiative to reduce children's experience of dental disease at age 2 years. METHODS: This was a single-blind, parallel-arm, randomised controlled trial. Participants were recruited from health service providers across South Australia. Women pregnant with an Aboriginal child were eligible. The intervention comprised: (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12 and 18 months; (3) motivational interviewing delivered in conjunction with; (4) anticipatory guidance. The primary outcome was untreated dental decay as assessed by the number of teeth with cavitated and non-cavitated carious lesions (mean dt) at child age 24 months. Analyses followed intention-to-treat principles. The RCT was registered with the Australian and New Zealand Clinical Trial Registry, ACTRN12611000111976. FINDINGS: Women (n = 448) were recruited from February 2011 to May 2012, resulting in 223 children in the treatment group and 225 in the control. Mean dt at age two years was 0.62 (95% CI 0.59 to 0.65) for the intervention group and 0.89 (95% CI 0.85 to 0.92) for the control group (mean difference - 0.27 (95% CI - 0.31, - 0.22)). INTERPRETATION: A culturally-appropriate intervention at four time-points from pregnancy through to 18-months resulted in improvements in the oral health of Aboriginal children. Further consultation with Aboriginal communities is essential for understanding how to best sustain these oral health improvements for young Aboriginal children.

Strategies for Meaningful Engagement between Community-Based Health Researchers and First Nations Participants.

The Baby Teeth Talk Study (BTT) is a partnership-based research project looking at interventions to prevent early childhood caries (ECC) in First Nations populations in Canada. Community-based researchers (CBRs) conducted preventive and behavioral interventions that targeted expectant mothers and their newborns, over a 3-year period. The work of the CBRs requires a great deal of training and skills to administer the interventions. It also requires a broad set of strategies to meaningfully engage participants to make health-promoting changes in their behavior to prevent ECC in their children. After implementing the intervention, BTT CBRs participated in interviews to explore the strategies they employed to engage participants in the prevention of ECC. CBRs perceived two key strategies as essential for meaningful engagement with BTT participants. First, CBRs indicated that their shared experiences through motherhood, First Nations identity, age, and childhood experience provided a positive foundation for dialog with participants that lead to build trust and rapport. Second, supportive interpersonal and culturally based communication skills of the CBR provided further foundation to engage with participants from a strength-based approach. For example, the CBRs knew how to effectively communicate in ways such as being gentle, non-intrusive, and avoiding any perception of judgment when discussing oral health behavior. In First Nations health research, CBRs can provide an essential link in engaging participants and the community for improvements in health. Researchers should carefully consider characteristics such as shared experience and ability to understand cultural communication styles when hiring CBRs in order to build a solid foundation of trust with research participants.

Proposed new industry code on unhealthy food marketing to children and young people: will it make a difference?

Reducing the exposure of children and young people to the marketing of unhealthy foods is a core strategy for reducing the high overweight and obesity prevalence in this population. The Advertising Standards Authority (ASA) has recently reviewed its self-regulatory codes and proposed a revised single code on advertising to children. This article evaluates the proposed code against eight criteria for an effective code, which were included in a submission to the ASA review process from over 70 New Zealand health professors. The evaluation found that the proposed code largely represents no change or uncertain change from the existing codes, and cannot be expected to provide substantial protection for children and young people from the marketing of unhealthy foods. Government regulations will be needed to achieve this important outcome.

Tikanga Maori (Maori Customary Practices) in Oral Health Research.

Early childhood caries is a global health issue for Indigenous populations. The study, "Reducing disease burden and health inequalities arising from chronic dental disease among Indigenous children: an early childhood caries intervention," is being conducted in Australia, Canada, and Aotearoa/New Zealand. OBJECTIVE: To conduct the research in New Zealand using a kaupapa Maori (Maori philosophy) approach. METHODS: This is a mixed-method study incorporating quantitative and qualitative data whilst acknowledging Maori cultural practices by the utilization of Te Whare Tapa Wha, a model for Maori health and well-being. RESULTS: This paper describes the application of the four dimensions of this model, (spiritual, mental, physical and family dimensions) within the research activity. CONCLUSION: Health research projects that are undertaken with Indigenous populations must ensure that the research process embraces Indigenous cultural practices. In Aotearoa/New Zealand Maori leadership over the research process ensures meaningful and beneficial outcomes for the Maori Indigenous population.

Fidelity of Motivational Interviewing in an Early Childhood Caries Intervention Involving Indigenous Australian Mothers.

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.

Racism and Oral Health Outcomes among Pregnant Canadian Aboriginal Women.

This study assessed links between racism and oral health outcomes among pregnant Canadian Aboriginal women. Baseline data were analyzed for 541 First Nations (94.6%) and Métis (5.4%) women in an early childhood caries preventive trial conducted in urban and on-reserve communities in Ontario and Manitoba. One-third of participants experienced racism in the past year determined by the Measure of Indigenous Racism Experience. In logistic regressions, outcomes significantly associated with incidents of racism included: wearing dentures, off-reserve dental care, asked to pay for dental services, perceived need for preventive care, flossing more than once daily, having fewer than 21 natural teeth, fear of going to dentist, never received orthodontic treatment and perceived impact of oral conditions on quality of life. In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services. Programs and policies should address racism's insidious effects on both mothers' and children's oral health outcomes.

Tikanga Maori (Maori Customary Practices) in Oral Health Research.

UNLABELLED: Early childhood caries is a global health issue for Indigenous populations. The study, "Reducing disease burden and health inequalities arising from chronic dental disease among Indigenous children: an early childhood caries intervention," is being conducted in Australia, Canada, and Aotearoa/New Zealand. OBJECTIVE: To conduct the research in New Zealand using a kaupapa Maori (Maori philosophy) approach. METHODS: This is a mixed-method study incorporating quantitative and qualitative data whilst acknowledging Maori cultural practices by the utilization of Te Whare Tapa Wha, a model for Maori health and well-being. RESULTS: This paper describes the application of the four dimensions of this model, (spiritual, mental, physical and family dimensions) within the research activity. CONCLUSION: Health research projects that are undertaken with Indigenous populations must ensure that the research process embraces Indigenous cultural practices. In Aotearoa/New Zealand Maori leadership over the research process ensures meaningful and beneficial outcomes for the Maori Indigenous population.

Fidelity of Motivational Interviewing in an Early Childhood Caries Intervention Involving Indigenous Australian Mothers.

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.

Racism and Oral Health Outcomes among Pregnant Canadian Aboriginal Women.

This study assessed links between racism and oral health outcomes among pregnant Canadian Aboriginal women. Baseline data were analyzed for 541 First Nations (94.6%) and Métis (5.4%) women in an early childhood caries preventive trial conducted in urban and on-reserve communities in Ontario and Manitoba. One-third of participants experienced racism in the past year determined by the Measure of Indigenous Racism Experience. In logistic regressions, outcomes significantly associated with incidents of racism included: wearing dentures, off-reserve dental care, asked to pay for dental services, perceived need for preventive care, flossing more than once daily, having fewer than 21 natural teeth, fear of going to dentist, never received orthodontic treatment and perceived impact of oral conditions on quality of life. In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services. Programs and policies should address racism's insidious effects on both mothers' and children's oral health outcomes.

Health conditions in a cohort of New Zealand Vietnam veterans: hospital admissions between 1988 and 2009.

OBJECTIVES: To inform the provision of support to veterans by analysing hospital discharge data, thereby identifying which conditions show an excess risk, require specific management strategies and deserve further investigation. SETTING: Tertiary level care, including all public and private New Zealand hospitals. PARTICIPANTS: All New Zealand Vietnam veterans with service between 1964 and 1972. PRIMARY OUTCOME MEASURES: Standardised hospitalisation ratios (SHRs) were calculated based on the number of first observed hospital admissions for a condition, those expected being based on New Zealand national hospitalisation rates. RESULTS: The SHR for all causes of hospitalisation was 1.18, 95% CI 1.15 to 1.21, with modest increases for the major common causes, cardio and cerebrovascular disease. Admission rates for chronic renal failure and chronic obstructive pulmonary disease were highest in the 2006-2009 time period. The highest statistically significant hospitalisation risk was for alcohol-related mental disorder, SHR 1.91, 99% CI 1.39 to 2.43. CONCLUSIONS: Chronic renal failure has limited attribution to veteran service but along with chronic obstructive pulmonary disease has the potential to have high costs both to the individual and the health system. We suggest that routine surveillance of veterans by way of a 'flag' in national and primary care databases would facilitate the recognition of service-related conditions and the appropriate provision of healthcare.

Development and evaluation of the Stages of Change in Oral Health instrument.

OBJECTIVES: Oral health personnel are limited in their ability to assess the readiness of patients to make changes to improve oral health. We aimed to develop and test the Stages of Change in Oral Health (SOCOH) model, a scaled index of the stages of change - pre-contemplative, contemplative or active - with particular emphasis on pregnancy. MATERIALS AND METHODS: Items were collected in a self-report questionnaire conducted among a convenience sample of 446 mothers (age range: 14-43 years) pregnant with Aboriginal children in South Australia, Australia. Scales representing openness (four items; Cronbach's alpha = 0.73), value (four items; Cronbach's alpha = 0.71), inconvenience (six items; Cronbach's alpha = 0.79) and permissiveness (four items; Cronbach's alpha = 0.66) were developed. Participants were categorised according to the Stages of Change model and were evaluated against key self-reported oral health outcomes. RESULTS: Some 11.9% of participants were classified as pre-contemplators, 46.4% as contemplators and 41.7% as active. A higher proportion of active participants had a higher education, last visited a dentist less than a year previously, had no dental fear, owned a toothbrush, brushed the previous day, used toothpaste, had no difficulties paying a $100 dental bill, self-reported their dental health as 'excellent' and in the previous 12 months did not experience dental pain, embarrassment related to their dental appearance or difficulties eating food. CONCLUSIONS: The SOCOH model offers an internally consistent and valid instrument for detailed assessment of the readiness for change in regarding oral health behaviours in pregnancy and has potential benefits for clinical decision making and research.

Self-reported racism and experience of toothache among pregnant Aboriginal Australians: the role of perceived stress, sense of control, and social support.

OBJECTIVES: We hypothesized that the psychosocial factors perceived stress and sense of personal control mediated the relationship between self-reported racism and experience of toothache. We hypothesized that social support moderated this relationship. METHODS: Data from 365 pregnant Aboriginal Australian women were used to evaluate experience of toothache, socio-demographic factors, psychosocial factors, general health, risk behaviors, and self-reported racism exposure. Hierarchical logistic regression models estimated odds ratios (ORs) and 95 percent confidence intervals (CIs) for experience of toothache. Perceived stress and sense of personal control were examined as mediators of the association between self-reported racism and experience of toothache. Social support was examined as a moderator. RESULTS: Self-reported racism persisted as a risk indicator for experience of toothache (OR 1.99, 95 percent CI 1.07-3.72) after controlling for age, level of education, and difficulty paying a $100 dental bill. The relationship between self-reported racism and experience of toothache was mediated by sense of control. The direct effect of self-reported racism on experience of toothache became only marginally significant, and the indirect effect was significant (ß coefficient=0.04, bias-corrected 95 percent CI 0.004-0.105, 21.2 percent of effect mediated). Stress was insignificant as a mediator. Social support was insignificant as a moderator. CONCLUSIONS: The findings indicate that high levels of self-reported racism were associated with experience of toothache and that sense of control, but not perceived stress, mediated the association between self-reported racism and experience of toothache among this sample of pregnant Aboriginal Australian women. Social support did not moderate the association between self-reported racism and experience of toothache.

Self-efficacy and self-rated oral health among pregnant aboriginal Australian women.

BACKGROUND: Self-efficacy plays an important role in oral health-related behaviours. There is little known about associations between self-efficacy and subjective oral health among populations at heightened risk of dental disease. This study aimed to determine if low self-efficacy was associated with poor self-rated oral health after adjusting for confounding among a convenience sample of pregnant women. METHODS: We used self-reported data from 446 Australian women pregnant with an Aboriginal child (age range 14-43 years) to evaluate self-rated oral health, self-efficacy and socio-demographic, psychosocial, social cognitive and risk factors. Hierarchical entry of explanatory variables into logistic regression models estimated prevalence odds ratios (POR) and 95% confidence intervals (95% CI) for fair or poor self-rated oral health. RESULTS: In an unadjusted model, those with low self-efficacy had 2.40 times the odds of rating their oral health as 'fair' or 'poor' (95% CI 1.54-3.74). Addition of socio-demographic factors attenuated the effect of low self-efficacy on poor self-rated oral health by 10 percent (POR 2.19, 95% CI 1.37-3.51). Addition of the psychosocial factors attenuated the odds by 17 percent (POR 2.07, 95% CI 1.28-3.36), while addition of the social cognitive variable fatalism increased the odds by 1 percent (POR 2.42, 95% CI 1.55-3.78). Inclusion of the behavioural risk factor 'not brushing previous day' attenuated the odds by 15 percent (POR 2.11, 95%CI 1.32-3.36). In the final model, which included all covariates, the odds were attenuated by 32 percent (POR 1.80, 95% CI 1.05, 3.08). CONCLUSIONS: Low self-efficacy persisted as a risk indicator for poor self-rated oral health after adjusting for confounding among this vulnerable population.

Reducing disease burden and health inequalities arising from chronic disease among indigenous children: an early childhood caries intervention in Aotearoa/New Zealand.

BACKGROUND: Maaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance. METHODS/DESIGN: The participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui.This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm. DISCUSSION: The development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976.

The mortality and cancer experience of New Zealand Vietnam war veterans: a cohort study.

OBJECTIVES: The aim was to observe the patterns of mortality and cancer incidence in New Zealand Vietnam veterans. The objectives were to assess whether the patterns of disease observed were consistent with those associated with military service in Vietnam, and similar to the patterns identified in other groups of Vietnam veterans. DESIGN: A historical cohort study. SETTING: Veterans, identified from service records, with Vietnam service between 1964 and 1972. PARTICIPANTS: Of the 3322 survivors of Vietnam service, we followed up 2783 (84%). OUTCOME MEASURES: Standardised mortality and incidence ratios (SMRs and SIRs, respectively) were calculated based on the number of deaths and cancer registrations observed, those expected being based on New Zealand national rates. RESULTS: All cause mortality was significantly reduced (SMR 0.85, 95% CI 0.77 to 0.94) and cancer incidence non-significantly increased (SIR 1.06, 95% CI 0.97 to 1.16). The risk of mortality from cancers of the head and neck (SMR 2.20, 95% CI 1.09 to 3.93); oral cavity pharynx and larynx (SMR 2.13, 95% CI 1.06 to 3.81) and the incidence of chronic lymphatic leukaemia (CLL) (SIR 1.91, 95% CI 1.04 to 3.20) were, however, significantly increased. Other lymphohaematopoietic disorders, specifically multiple myeloma and Hodgkin disease, showed non-significant mortality excesses, reflected by a similar increase in incidence. CONCLUSIONS: Service in the Vietnam war was associated with defoliant herbicide exposure, including 2,4,5-trichlorophenoxyacetic acid, 2,4-dichlorophenoxyacetic acid, picloram and cacodylic acid. Subsequent reviews of mechanistic, animal and epidemiological evidence led to certain conditions being deemed compensable. The pattern of mortality and cancer incidence is not at odds with the list of compensable conditions and consistent with that found in Australian veterans serving in the same area of Vietnam, but also consistent with smoking and the healthy soldier effect. In common with the Australian experience, this is the only veterans group to show a significant excess of CLL.

Establishment of the New Zealand Drivers Study.

AIM: Despite a significant improvement since graduated licensing was introduced, traffic related injury remains the leading cause of death and hospitalisation among young New Zealanders. The New Zealand Drivers Study (NZDS) was established with a view to providing information that would lead to an improvement in this situation. The NZDS is a prospective cohort study designed to explore the relationship between a comprehensive range of driving and traffic safety related factors and subsequent traffic crashes and convictions among newly licensed drivers. We describe key process objectives in establishing the cohort, and our success in meeting them and the implications arising thereof. METHODS: We compare what occurred with what was proposed in the research protocol. RESULTS: We successfully established a cohort of 3992 newly licensed car drivers with substantial heterogenity in sociodemographic, behavioural, and driving experiences. We have 825 Maori that will allow us to undertake a separate Maori analyses. Response rates to interviews at the restricted and full licence stages have been very high at 87% and 93%, respectively. We have been successful via linkage in following them through the stages of licensure and via linkage obtaining national data on the outcomes of interest. CONCLUSIONS: The NZDS is well placed to make a significant contribution to our knowledge of young driver road safety behaviour. This process has already commenced.

Reducing disease burden and health inequalities arising from chronic disease among Indigenous children: an early childhood caries intervention.

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.