{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:44:31Z","timestamp":1791888271312,"version":"4.3.4"},"reference-count":52,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["IDP\u2010103988"],"award-info":[{"award-number":["IDP\u2010103988"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001505","name":"Health Research Council of New Zealand","doi-asserted-by":"publisher","award":["09\/644"],"award-info":[{"award-number":["09\/644"]}],"id":[{"id":"10.13039\/501100001505","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n This cross\u2010sectional study examined the cultural and social determinants of health in Canada, New Zealand, and Australia and their relevance to the oral health of Indigenous pregnant women.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n An Indigenous framework was applied to a social determinants of health (SDH) model, Charlotte Loppie's Tree Metaphor, utilising data from the Baby Teeth Talk Study, a multi\u2010national academic\u2010community partnership, to compare SDHs among Indigenous pregnant women in Canada (\n n<\/jats:italic>\n \u2009=\u2009544), New Zealand (\n n<\/jats:italic>\n \u2009=\u2009222), and Australia (\n n<\/jats:italic>\n \u2009=\u2009446). The same survey instrument, with cultural adaptations, was used. Self\u2010rated oral health and the oral health impact on dimensions of quality of life were assessed. \u2018Stem\u2019 SDHs included socio\u2010demographic characteristics, lifestyle practices, oral health literacy, knowledge of children's oral hygiene, value of oral health self\u2010care, psychological stress, sense of mastery, social support, oral health self\u2010efficacy, and fatalism. \u2018Core\u2019 SDHs included dental care access and Indigenous cultural identity. The \u2018Root\u2019 SDH was self\u2010reported interpersonal racism.\n Z<\/jats:italic>\n \u2010tests for the comparison of means and the Normal approximation to the Binomial distribution for proportions were used with statistical adjustment for multiple pairwise comparisons.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The participants' mean age was not statistically different across the countries. Maternal rating of their oral health as \u2018fair\/poor\u2019 was significantly higher in New Zealand (57.7%) and Australia (54.3%) than in Canada (39.0%). First Nations\/M\u00e9tis expectant women in Canada were twice as likely to have visited a dentist in the last year, and least likely to report cost as a barrier to care. They also experienced less racism. Pregnant M\u0101ori women had higher oral health literacy, greater knowledge of children's oral hygiene and greater oral health self\u2010efficacy. Employment income and social support were greatest among M\u0101ori women. Aboriginal women in Australia faced more unfavourable SDHs, particularly those related to socio\u2010economic status. One\u2010in\u2010three First Nations, M\u0101ori and Aboriginal women perceived culture and ethnicity as central to their identity.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Differences in governance, funding, and delivery models for Indigenous oral healthcare can explain disparities in access to dental care for pregnant Indigenous women. Unique historical and cultural trajectories may account for the different SDHs of their oral health experiences, particularly those that are more distal and deeply rooted, such as discrimination and racism. Understanding how socio\u2010cultural determinants differ among diverse Indigenous populations may, in turn, explain the differences in the effectiveness of some interventions (over others) in improving the oral health of Indigenous Peoples.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/cdoe.70128","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:45:32Z","timestamp":1791884732000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cultural and Social Determinants of Indigenous Peoples' Health: Understanding Oral Health Inequities in Canada, New Zealand\/Aotearoa, and Australia"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2340-2307","authenticated-orcid":false,"given":"Herenia P.","family":"Lawrence","sequence":"first","affiliation":[{"name":"Dental Public Health, Indigenous Oral Health Research Group, Faculty of Dentistry University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Broughton","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry University of Otago Dunedin New Zealand (Aotearoa)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Jamieson","sequence":"additional","affiliation":[{"name":"Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School University of Adelaide Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Indigenous Languages Across Canada","year":"2023"},{"key":"e_1_2_10_3_1","volume-title":"Aboriginal and Torres Strait Islander People: Census 2021","year":"2022"},{"key":"e_1_2_10_4_1","volume-title":"2023 Census Population Counts (by Ethnic Group, Age, and M\u0101ori Descent) and Dwelling Counts","year":"2024"},{"key":"e_1_2_10_5_1","volume-title":"Te Reo M\u0101ori Proficiency and Support Continues to Grow","year":"2022"},{"key":"e_1_2_10_6_1","first-page":"222","volume-title":"Atlas of the World's Languages in Danger","author":"Moseley C.","year":"2010"},{"key":"e_1_2_10_7_1","first-page":"72","volume-title":"A Guide to an Act Respecting Indigenous Languages: A Tool for First Nations Language Revitalization 2019\u20132020","author":"Assembly of First Nations","year":"2019"},{"key":"e_1_2_10_8_1","first-page":"535","volume-title":"Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada","author":"Truth and Reconciliation Commission of Canada","year":"2015"},{"key":"e_1_2_10_9_1","first-page":"67","volume-title":"Understanding Indigenous Health Inequalities Through a Social Determinants Model","author":"Loppie C.","year":"2022"},{"key":"e_1_2_10_10_1","first-page":"292","volume-title":"Australia's Dental Generations: The National Survey of Adult Oral Health 2004\u201306","author":"Slade G. D.","year":"2007"},{"key":"e_1_2_10_11_1","first-page":"124","volume-title":"Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey 2007\u20132009","author":"Health Canada","year":"2010"},{"key":"e_1_2_10_12_1","first-page":"355","volume-title":"Our Oral Health: Key Findings of the 2009 New Zealand Oral Health Survey","author":"New Zealand Ministry of Health","year":"2010"},{"issue":"12","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1177\/0022034516658233","article-title":"Inequalities in Indigenous Oral Health: Findings From Australia, New Zealand, and Canada","volume":"95","author":"Jamieson L. M.","year":"2016","journal-title":"Journal of Dental Research"},{"issue":"6","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/j.1600-0528.2009.00497.x","article-title":"Oral Health Inequalities Between Young Aboriginal and Non\u2010Aboriginal Children Living in Ontario, Canada","volume":"37","author":"Lawrence H. P.","year":"2009","journal-title":"Community Dentistry and Oral Epidemiology"},{"issue":"3","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/cdoe.12364","article-title":"Inequalities in Dental Caries Experience Among 4\u2010Year\u2010Old New Zealand Children","volume":"46","author":"Shackleton N.","year":"2018","journal-title":"Community Dentistry and Oral Epidemiology"},{"issue":"2","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/adj.13005","article-title":"Inequalities in Dental Caries Among Indigenous and Non\u2010Indigenous Children in Australia: A Literature Review","volume":"69","author":"Wang X.","year":"2024","journal-title":"Australian Dental Journal"},{"issue":"2","key":"e_1_2_10_17_1","first-page":"156","article-title":"Prioritizing Indigenous Elders' Knowledge for Intergenerational Well\u2010Being","volume":"39","author":"Rowe G.","year":"2020","journal-title":"Canadian Journal on Aging\/La Revue Canadienne du Vieillissement"},{"issue":"4","key":"e_1_2_10_18_1","first-page":"172","article-title":"Effects of a Community\u2010Based Prenatal Nutrition Program on the Oral Health of Aboriginal Children in Northern Ontario","volume":"38","author":"Lawrence H. P.","year":"2004","journal-title":"Probe"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.eclinm.2018.05.001","article-title":"Dental Disease Outcomes Following a 2\u2010Year Oral Health Promotion Program for Australian Aboriginal Children and Their Families: A 2\u2010Arm Parallel, Single\u2010Blind, Randomised Controlled Trial","volume":"1","author":"Jamieson L.","year":"2018","journal-title":"EClinicalMedicine"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012155.pub3"},{"key":"e_1_2_10_21_1","first-page":"129","article-title":"Mokopuna M\u0101ori Me Oranga Niho (M\u0101ori Infants and Oral Health) an Early Childhood Caries Randomised Control Trial Among New Zealand M\u0101ori Children","volume":"117","author":"Broughton J. R.","year":"2021","journal-title":"New Zealand Dental Journal"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2016.0030"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102458\u201012\u2010323"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102458\u201013\u20101177"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2017.00138"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19138112"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/23800844221117143"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1037\/0278\u20106133.19.6.586"},{"key":"e_1_2_10_30_1","first-page":"102","volume-title":"Aboriginal and Torres Strait Islander Health Performance Framework: Summary Report","author":"Australian Institute of Health and Welfare (AIHW)","year":"2025"},{"issue":"1","key":"e_1_2_10_31_1","first-page":"37","article-title":"Development and Psychometric Validation of a Health Literacy in Dentistry Scale (HeLD)","volume":"31","author":"Jones K.","year":"2014","journal-title":"Community Dental Health"},{"issue":"5","key":"e_1_2_10_32_1","first-page":"422","article-title":"Reliability and Validity of Brief Measures of Oral Health\u2010Related Knowledge, Fatalism, and Self\u2010Efficacy in Mothers of African American Children","volume":"27","author":"Finlayson T. L.","year":"2005","journal-title":"Pediatric Dentistry"},{"issue":"5","key":"e_1_2_10_33_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/idj.12119","article-title":"Development and Evaluation of the Stages of Change in Oral Health Instrument","volume":"64","author":"Jamieson L. M.","year":"2014","journal-title":"International Dental Journal"},{"issue":"4","key":"e_1_2_10_34_1","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A Global Measure of Perceived Stress","volume":"24","author":"Cohen S.","year":"1983","journal-title":"Journal of Health and Social Behavior"},{"issue":"1","key":"e_1_2_10_35_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.2307\/2136319","article-title":"The Structure of Coping","volume":"19","author":"Pearlin L. I.","year":"1978","journal-title":"Journal of Health and Social Behavior"},{"key":"e_1_2_10_36_1","first-page":"156","volume-title":"Work Stress and Social Support (Volume 4 of Addison\u2010Wesley Series on Occupational Stress)","author":"House J. S.","year":"1981"},{"issue":"2","key":"e_1_2_10_37_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1922\/CDH_00201Parker07","article-title":"Oral Health\u2010Related Self\u2010Efficacy and Fatalism in a Regional South Australian Aboriginal Population","volume":"39","author":"Parker E. J.","year":"2022","journal-title":"Community Dental Health"},{"key":"e_1_2_10_38_1","first-page":"322","volume-title":"First Nations Regional Longitudinal Health Survey (RHS) 2002\/03: Results for Adults, Youth and Children Living in First Nations Communities","author":"First Nations Information Governance Centre (FNIGC)","year":"2003"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475\u20109276\u20107\u20109"},{"issue":"2","key":"e_1_2_10_40_1","first-page":"129","article-title":"The Reliability and Validity of the RAPIDD Scale: Readiness Assessment of Parents Concerning Infant Dental Decay","volume":"68","author":"Weinstein P.","year":"2001","journal-title":"ASDC Journal of Dentistry for Children"},{"key":"e_1_2_10_41_1","first-page":"35","volume-title":"Health Inequalities and Social Determinants of Aboriginal Peoples' Health","author":"Reading C. L.","year":"2009"},{"issue":"1","key":"e_1_2_10_42_1","article-title":"Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics","volume":"1989","author":"Crenshaw K.","year":"1989","journal-title":"University of Chicago Legal Forum"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0279614"},{"key":"e_1_2_10_44_1","volume-title":"IRCC Anti\u2010Racism Strategy 2.0 (2021\u20102024) \u2013 Change Management","author":"Duckworth S.","year":"2022"},{"key":"e_1_2_10_45_1","first-page":"96","volume-title":"National Report of the First Nations Regional Health Survey Phase 3","author":"First Nations Information Governance Centre","year":"2018"},{"key":"e_1_2_10_46_1","first-page":"17","volume-title":"First Peoples, Second Class Treatment: The Role of Racism in the Health and Well\u2010Being of Indigenous Peoples in Canada","author":"Allan B.","year":"2015"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102023\u2010073320"},{"issue":"4","key":"e_1_2_10_48_1","article-title":"Traditional and Cultural Approaches to Childrearing: Preventing Early Childhood Caries in Norway House Cree Nation, Manitoba","volume":"14","author":"Cidro J.","year":"2014","journal-title":"Rural and Remote Health"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.15353\/cfs\u2010rcea.v5i2.249"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010015\u20100027\u20105"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.22605\/RRH7910"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1155\/ijod\/7094004"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.17269\/s41997\u2010023\u201000800\u20106"}],"container-title":["Community Dentistry and Oral Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cdoe.70128","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cdoe.70128","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cdoe.70128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:45:37Z","timestamp":1791884737000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cdoe.70128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":52,"alternative-id":["10.1111\/cdoe.70128"],"URL":"https:\/\/doi.org\/10.1111\/cdoe.70128","archive":["Portico"],"relation":{},"ISSN":["0301-5661","1600-0528"],"issn-type":[{"value":"0301-5661","type":"print"},{"value":"1600-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"2026-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cdoe.70128"}}