First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study

Conceptualising the relationships between food sovereignty, food security and oral health among global Indigenous Communities: a scoping review

OBJECTIVE

Invasive colonial influences and continuing neoliberal policies have a detrimental impact on Land, health, food and culture for Indigenous Communities. Food security and sovereignty have significant impacts on Indigenous well-being and, specifically, oral health. Aspects relating to food security, such as availability of nutritious foods, are a common risk factor of oral diseases. This scoping review aimed to collate existing evidence regarding the relationship between food sovereignty and/or food security and oral health for Indigenous Communities, globally.

DESIGN

Four databases were searched using keywords related to 'Food security' or 'Food sovereignty,' 'Indigenous Peoples' and 'Oral health.' Duplicates were removed, and two independent reviewers screened the titles and abstracts to identify articles for full-text review. Extracted data were summarised narratively, presenting a conceptual model which illustrates the findings and relationships between food security and/or food sovereignty and oral health.

RESULTS

The search identified 369 articles, with forty-one suitable for full-text review and a final nine that met inclusion criteria. The impact of food security and food sovereignty on oral health was discussed across different populations and sample sizes, ranging from eighteen Kichwa families in Brazil to 533 First Nations and Metis households in Canada. Pathways of influence between food sovereignty and/or food security are explored clinically, quantitatively and qualitatively across oral health outcomes, including early childhood caries, dental caries and oral health-related quality of life for Indigenous Communities.

CONCLUSIONS

Innovative strategies underpinned by concepts of Indigenous food sovereignty are needed to promote oral health equity for Indigenous Communities. The nexus between oral health and Indigenous food sovereignty remains largely unexplored, but has immense potential for empowering Indigenous rights to self-determination of health that honour Indigenous ways of knowing, being and doing.

Barriers and enablers for oral health promotion programs amongst primary healthcare stakeholders in Qatar - a qualitative investigation

BACKGROUND

Oral health of preschool children remains a concern globally. Primary healthcare providers are in a vital position to support preventive oral care programmes. This study explored current practices, perception and barriers of primary health care professionals towards oral health promotion program of children in Qatar.

METHODS

The qualitative research used focus group discussions and interviewed a total of 108 participants that were audio recorded and transcribed verbatim. Four major themes emerged and were analysed to explore contextual patterns within the data.

RESULTS

Participants acknowledged the high prevalence of caries in children and identified the causes in the local context which included parental practices, poor dietary habits, impact of culture lack of oral health knowledge, limitations in the healthcare system, and negative role of the media. However, complex barriers were exposed, including lack of time and ownership, system coordination between organizations, and lack of policy.

CONCLUSION

Health professionals and bureaucrats involved in decision-making held a positive attitude towards oral health prevention programs and were enthusiastic to initiate and support these programs.

Burden of dental caries in individuals experiencing food insecurity: a systematic review and meta-analysis

CONTEXT

Food insecurity affects approximately 2.37 billion people worldwide. Individuals experiencing food insecurity are more likely to exhibit poor health-related endpoints. Dental caries, a highly prevalent noncommunicable disease, is modulated by an interplay between biological, behavioral, and environmental factors.

OBJECTIVE

This systematic review and meta-analysis aimed to assess whether individuals experiencing food insecurity were more likely to exhibit dental caries than individuals facing food security.

DATA SOURCES

The Web of Science, PubMed, Scopus, Embase, Ovid, CINAHL, LILACS, and APA PsycINFO databases were checked from inception to November 2021. Grey literature and Google Scholar were also examined. An updated search was conducted in August 2022. Observational studies were included if they evaluated the association between dental caries and food insecurity status.

DATA EXTRACTION

Data extraction was performed by two reviewers.

DATA ANALYSIS

Random-effects meta-analyses were conducted using R language. In total, 514 references were retrieved from databases, of which 14 articles were included in qualitative synthesis and 7 were merged into meta-analysis. The results of an inverse-variance meta-analysis (OR = 1.62; 95%CI, 1.01-2.60) and a meta-analysis of binary data (OR = 1.66; 95%CI, 1.36-2.02) demonstrated that food-insecure individuals were more likely to exhibit dental caries than food-secure individuals. Inverse-variance meta-analyses appraising multiple strata of food security also showed that individuals experiencing marginal food security (OR = 1.48; 95%CI, 1.28-1.72), individuals experiencing low food security (OR = 1.26; 95%CI, 1.01-1.57), and those experiencing very low food security (OR = 1.33; 95%CI, 1.04-1.71) were more likely to exhibit dental caries than individuals experiencing full food security.

CONCLUSION

Dental caries is associated with food insecurity. Individuals living with food insecurity are more likely to exhibit dental caries than those who have food security.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021268582.

Food insecurity and its consequences in indigenous children and youth in Canada

Food insecurity (FI) is at a crisis level in some Indigenous communities and impacts many of the half million First Nations Inuit and Métis (FNIM) children across Canada, particularly in isolated northern communities. This can lead to malnutrition and can have significant impacts on the physical, intellectual, emotional and social development of a child, often with lasting effects across the life course. This is a narrative review article with extensive search of the medical literature with input from the FNIM National organizations. The primary cause of FI is an imbalance between the high price of food relative to household income, where poverty is a driving factor. The cost and lack of availability to healthy foods has resulted in a transition to unhealthy market foods. Food security programs need to be prioritized, multi-faceted and multi-tiered within a framework of food sovereignty. Translational science, research, to practice is also important. The use of successful Indigenous based models of FI, towards food sovereignty using self-determination, Indigenous Knowledge, strength-based models, and ancestral sustainability are critical. Continued community-based evaluation of FI towards sustainable healthy food programs are important for communities to initiate track, evaluate, and grow robust community-based programs to counter-balance FI. Continued scientific research in the fields of FI, food sovereignty, and their relationship to co-occurring conditions related to healthy eating and beverage consumption are vastly important to the health of Indigenous Peoples. These are all part of many Indigenous connection to the earth, through food source, the maintenance of health through ancestral ways of living, set in the premise of looking forward multiple generations towards the continued resiliency through food, diet, relationship, and sovereignty. Food Security is a human right and needs to be urgently addressed for Indigenous children in Canada.

Building an understanding of Indigenous Health Workers' role in oral health: A qualitative systematic review

OBJECTIVES

Indigenous health workers (IHW) play an integral role in the provision of culturally safe care for Indigenous communities. Despite this, IHW involvement in oral health has been limited. Therefore, this qualitative systematic review aimed to build an understanding of IHW insights on oral health.

METHODS

Two independent reviewers searched PubMed, EMBASE, Web of Science and Scopus using a pre-established search strategy. Qualitative studies that included IHW illustrations about oral health were considered. The search was not limited by geographic setting. Included articles were critically appraised with the Joanna Briggs Institute appraisal tool for qualitative studies.

RESULTS

The search identified 1856 articles eligible for inclusion; a total of 10 articles were included. Four synthesized findings were identified during the meta-aggregation: oral health challenges in community, systemic barriers limiting IHW ability to support oral health, benefits of IHW involvement in oral health and avenues to increase IHW involvement in oral health.

CONCLUSION

The prioritization of Indigenous leadership in oral health has the potential to address many of the current challenges Indigenous communities face. Future works need to determine the capacity of IHW to provide oral health care and explore opportunities to create specific oral health roles for IHW.

Seeking Sweetness: A Systematic Scoping Review of Factors Influencing Sugar-Sweetened Beverage Consumption in Remote Indigenous Communities Worldwide

It is well-established that remote Indigenous communities have higher rates of sugar-sweetened beverage (SSB) consumption than non-Indigenous counterparts, which results in higher rates of chronic diseases such as type 2 diabetes mellitus (T2DM), obesity, and kidney disease. The aetiology leading to this behaviour remains understudied and overlooked. Therefore, the aim of this literature review is to understand the underpinning factors that contribute to SSB consumption in remote Indigenous communities. Studies were identified through five databases (n = 2529) and grey literature searching (n = 54). Following the PRISMA guidelines, each paper was assessed for eligibility, which left 34 studies for inclusion in the review. Within these papers, 37 different factors were found to influence SSB consumption in remote Indigenous communities. These were organised according to the Determinants of Nutrition and Eating (DONE) framework. SSB consumption was found to influence intake through each main level of the framework; individual (n = 9), interpersonal (n = 18), environmental (n = 9), and policy (n = 3). Preference was identified to be the most common factor to influence intake (n = 19), followed by health literacy (n = 15) and community availability (n = 12). Despite this, interventions to reduce SSB intake have never targeted this factor. This paper highlights the importance of a multi-level whole-of-system approach and suggests that an individual’s taste/preference should shape the direction of future research and intervention in this area.

Key Challenges for Indigenous Peoples of Canada in terms of Oral Health Provision and Utilization: A Scoping Review

Background

The oral health of Indigenous peoples in Canada is lacking compared with their non-Indigenous counterparts. This scoping assessment aimed to investigate the obstacles of providing and using oral healthcare among Indigenous peoples in Canada.

Methods

The scoping review took place between December 15, 2021 and January 10, 2022. Five key databases were examined: PubMed, Scopus, ISI Web of Science, Embase, and PROQUEST. The data were analyzed using NVIVO software to facilitate understanding of the major themes, subthemes, and codes provided.

Results

Seven major themes and eighteen subthemes were identified as impacting the oral health provision and utilization of Indigenous peoples in Canada. The major themes are individual characteristics, affordability, availability, accessibility, accommodation, acceptability, and public or government policy. Thus, to improve the oral health of the Indigenous peoples in Canada, an integrated approach is required to address these obstacles.

Conclusions

To address the oral health disparities among Indigenous peoples in Canada, policymakers should adopt an integrated approach.