Australian Adult Population Research Articles

Energy poverty and health: Panel data evidence from Australia

Australia's diverse climate makes it vulnerable to cold winters and extremely warm summers, characterised by severe bushfires and heat waves. Thus, unlike most European countries, energy poverty in Australia is linked with difficulty both maintaining adequate warmth during winter and ensuring adequate cooling during summer. Energy poverty in Australia is, therefore, associated with cold-and-heat-related health issues. We draw on 13 waves of representative panel data for the Australian adult population to examine the relationship between energy poverty and self-assessed health. We use both objective and subjective indicators of energy poverty. We instrument for energy poverty using energy prices. When we instrument for energy poverty, we find that a standard deviation increase in energy poverty is associated with a decline in general health between 0.099 and 0.296 standard deviations. The finding that energy poverty lowers health is robust to different ways of measuring health and alternative methods to addressing endogeneity of energy poverty, including using internal instruments, dynamic panel methods and propensity score matching.

Ultra-processed food consumption and obesity in the Australian adult population

BackgroundRapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level.MethodsA cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ≥20 years from the National Nutrition and Physical Activity Survey 2011–2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking.ResultsSignificant (P-trend ≤ 0.001) direct dose–response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97 kg/m2; 95% CI 0.42, 1.51) and WC (1.92 cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR = 1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR = 1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level.ConclusionThe findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.

Estimated health benefits, costs, and cost-effectiveness of eliminating industrial trans-fatty acids in Australia: A modelling study.

trans-fatty acids (TFAs) are a well-known risk factor of ischemic heart disease (IHD). In Australia, the highest TFA intake is concentrated to the most socioeconomically disadvantaged groups. Elimination of industrial TFA (iTFA) from the Australian food supply could result in reduced IHD mortality and morbidity while improving health equity. However, such legislation could lead to additional costs for both government and food industry. Thus, we assessed the potential cost-effectiveness, health gains, and effects on health equality of an iTFA ban from the Australian food supply. Markov cohort models were used to estimate the impact on IHD burden and health equity, as well as the cost-effectiveness of a national ban of iTFA in Australia. Intake of TFA was assessed using the 2011-2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution with a mean of 0.5% energy per day (corresponding to TFA intake only from nonindustrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and changes in IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICERs) using net policy cost and HALYs gained. Health benefits and healthcare cost changes were also assessed in subgroups based on socioeconomic status, defined by Socio-Economic Indexes for Areas (SEIFA) quintile, and remoteness. Compared to a base case of no ban and current TFA intakes, elimination of iTFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost saving (net cost <0 AUD) or cost-effective (i.e., ICER < AUD 169,361/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and lifetime, respectively. Findings were robust across several sensitivity analyses. Key limitations of the study include the lack of recent data of TFA intake and the small sample sizes used to estimate intakes in subgroups. As with all simulation models, our study does not prove that a ban of iTFA will prevent IHD, rather, it provides the best quantitative estimates and corresponding uncertainty of a potential effect in the absence of stronger direct evidence. Our model estimates that a ban of iTFAs could avert substantial numbers of IHD events and deaths in Australia and would likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health. These findings suggest that elimination of iTFA can cost-effectively improve health and health equality even in countries with low iTFA intake.

Psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic.

Objective This study assessed the psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic. Methods An anonymous online cross-sectional survey was conducted in a large metropolitan tertiary health service located in Melbourne, Australia. The survey was completed by nurses, midwives, doctors and allied health (AH) staff between 15 May and 10 June 2020. The Depression, Anxiety and Stress Scale - 21 items (DASS-21) assessed the psychological well-being of respondents in the previous week. Results In all, 668 people responded to the survey (nurses/midwives, n=391; doctors, n=138; AH staff, n=139). Of these, 108 (16.2%) had direct contact with people with a COVID-19 diagnosis. Approximately one-quarter of respondents reported symptoms of psychological distress. Between 11% (AH staff) and 29% (nurses/midwives) had anxiety scores in the mild to extremely severe ranges. Nurses and midwives had significantly higher anxiety scores than doctors (P<0.001) and AH staff (P<0.001). Direct contact with people with a COVID-19 diagnosis (P<0.001) and being a nurse or midwife (P<0.001) were associated with higher anxiety scores. Higher ratings of the health service's pandemic response and staff support strategies were protective against depression (P<0.001), anxiety (P<0.05) and stress (P<0.001). Conclusions The COVID-19 pandemic had a significant effect on the psychological well-being of hospital clinical staff, particularly nurses and midwives. Staff would benefit from (additional) targeted supportive interventions during the current and future outbreaks of infectious diseases. What is known about the topic? The outbreak of COVID-19 is having, and will have, a considerable effect on health services. No Australian data about the effect of COVID-19 on the psychological well-being of hospital clinical staff are available. What does this paper add? Australia healthcare providers have experienced considerable emotional distress during the COVID-19 pandemic, particularly nurses and midwives and clinical staff who have had direct contact with people with a COVID-19 diagnosis. In this study, nurses and midwives had significantly higher levels of anxiety, depression and stress during the pandemic than general Australian adult population norms, and significantly more severe anxiety symptoms than medical and AH staff. Despite a lower number of COVID-19 cases and a lower death rate than in other countries, the proportion of Australian hospital clinical staff experiencing distress is similar to that found in other countries. What are the implications for practitioners? Targeted well-being interventions are required to support hospital clinical staff during the current and future outbreaks of infectious diseases and other 'crises' or adverse events.

Drunkorexia: An investigation of symptomatology and early maladaptive schemas within a female, young adult Australian population

ObjectiveDrunkorexia is a trend on the rise within the young adult population with significant physical, psychological, and social health implications. Many studies have investigated the link between Early Maladaptive Schemas (EMS) and both eating disorders and substance misuse. To date, no studies have specifically focused on EMS amongst those with Drunkorexia behaviours. The main objectives of this study were to further investigate the prevalence of Drunkorexia behaviour amongst Australian young adult females, and to elucidate the pattern of EMS and behaviours associated with Drunkorexia amongst young adult female Australian students.MethodsThis study used a cross‐sectional, between groups, correlational design. Participants were Australian university students, aged 18–24-years old.ResultsIn excess of 28% participants reported engaging in characteristic Drunkorexic behaviours to specifically offset ingested alcohol calories while not engaging in such behaviours routinely for any other reason or with any other type of food or drink. The EMS most predictive of Drunkorexia‐type behaviour were Insufficient Self‐Control, Emotional Deprivation, and Social Isolation. EMS significantly contributed to the variance in Drunkorexia‐type behaviours, over and above that explained by eating disorder and binge drinking symptomatology.ConclusionsIncreasing numbers of individuals are endorsing symptoms of Drunkorexia‐type behaviour, increasing the risk of potential physical, psychological, and social health‐related problems. Addressing key EMS that may be associated with Drunkorexia‐type behaviours may strengthen future preventative and intervention programs. Given the exploratory nature of this research, further studies are required to clarify the relationship between EMS and Drunkorexia.

Patient chosen gap payments in primary care: Predictions of patient acceptability, uptake and willingness to pay from a discrete choice experiment.

Compulsory co-payments limit access and may compromise quality in primary care. Patient Chosen Gap Payments (PCGPs) allow patients to specify a (voluntary) out-of-pocket contribution, creating an incentive for patient-centred care without the need for complex outcomes-based funding formulae. It is not yet known if widespread use of PCGP services is consistent with consumer preferences. We conducted a discrete choice experiment (DCE) in a sample of the adult Australian general population (n=1457) during April 2019 to simulate patient choice between alternative primary care services and describe preferences for PCGP services. Participants also completed a supplementary valuation task in which participants reported their intended PCGP contribution for PCGP services. Finally, we conducted policy-simulations to predict market shares when PCGP clinics operate alongside the two existing models of primary care funding in Australia. Results suggest that patients prefer shorter wait time, longer consults, lower compulsory copayments, services with higher patient satisfaction ratings, choice of doctor and $0 suggested voluntary contribution for PCGP services. Policy-simulations suggest that high-quality PCGP services could obtain market share of up to 39% and voluntary contributions of up to $25.36 per service (95%CI: $10.24, $40.47), potentially adding $1.48 billion AUD in revenues and funding for primary care at no cost to government. Low-quality PCGP services are unlikely to capture significant market share and PCGP contributions were lowest for low-quality PCGP services ($12.12, 95%CI: $2.09, $26.34). Further field testing is recommended where (i) patients make consequential choices (e.g. real payments for simulated services), and (ii) dynamic effects on quality of care and utilisation can be observed; particularly in vulnerable populations. We conclude that PCGP services aligned with patient preferences could capture significant market share and substantially increase revenue to general practice.

Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees.

This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one's private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel.

Limitations In Knowledge And Practice Of Healthy Lifestyle Guidelines In A Sample Of Australian Adults.

PURPOSE: Cardiovascular disease (CVD) is the leading cause of death in Australia. Physical activity (PA), optimal sleep, ample fruit/vegetable consumption, reduced screen time, limited alcohol consumption and not smoking are all protective against CVD, however, evidence shows that knowledge of Australian health guidelines and engagement in healthy behaviors is less than sufficient. We aimed to identify knowledge and engagement in 6 lifestyle behaviors in a convenience sample of Australian adults. METHODS: Australian adults (>18 years) were invited through social media to complete an online anonymous survey via Survey Monkey assessing healthy lifestyle behavior choices and knowledge of Australian health guidelines. Data were reported as means and standard deviation or percentages. Simple linear regressions were performed to identify any significant associations between knowledge and practice. RESULTS: Australian adults (n=219; 69% female; M=30±14; range 18-73) completed the survey. Only 26% of the sample knew and self-reported BMI (M=23.00±5.7) and only 32% of the sample reported their health as very good or excellent. Correct knowledge of individual health guidelines was 67% PA, 61% sleep, 42% fruit and 41% vegetable consumption, 30% screen time, and 29% alcohol, of which 30%, 84%, 23%, 16%, 21%, 53% met the guidelines respectively. Eighty percent of the sample reported smoking as harmful; however, only 28% of the sample had not smoked in the prior 6 months. Alarmingly, on average participants reported spending 8.6±4.2 hours/day watching a screen and sat for 8.4±3.6 hours/day. Knowledge of the guidelines was associated with adherence to the guidelines for moderate PA (r=0.22; p<0.01), sleep (r=0.15; p=0.04) and fruit (r=0.41; p<0.01) and vegetable (r=0.38; p<0.01) intake. CONCLUSIONS: On average, less than 50% of this sample of the Australian adult population are aware of the national guidelines for 4 out of 6 healthy lifestyle behaviors and less than 30% meet the national health guidelines for PA, screen time and fruit/vegetable consumption. Moreover, greater than 70% of the sample have smoked or tried smoking in the past 6 months. More research is needed to identify ways to not only help Australians become more aware of the individual health behavior guidelines but also to improve healthy lifestyle choices.

National Study of Adult Oral Health 2017-18: root caries.

The prevalence of root caries in Australia is expected to increase due to an ageing population and increase in tooth retention. This report presents findings from the Australian National Study of Adult Oral Health 2017-18. A stratified random sample of 15731 Australians aged ≥15years participated in a telephone or online survey. Of those, 5022 dentate people underwent an oral assessment. Carious root surfaces were defined as ≥1mm of affected dentine/cementum. Prevalence was defined as the percentage with ≥one natural tooth with untreated caries on root surfaces. Severity was measured as the mean number of root surfaces with caries. Prevalence of untreated root caries in the Australian adult dentate population was 8.2% and increased with increasing age (range 2%-17.8%). Men (9.3%) compared to women (7.2%), people living in remote (18.0%) versus regional (9.3%) and major cities (7.6%), and those with the lowest household income (15.4%) compared to middle (7.6%) and highest tertile (3.2%) had untreated root caries. The average number of decayed or filled root surfaces in the Australian adult population was 1.1 (95% CI 0.9, 1.2). Root caries was associated with older age, living outside a major city and lower income.

Periodontal diseases in the Australian adult population.

The study aimed to present the population patterns of periodontal diseases and trends of periodontitis in the Australian adult population. Data collected in the recent National Study of Adult Oral Health (NSAOH) 2017-18 were used to present the current population patterns of periodontal diseases. Periodontal assessment was carried out at three sites per tooth for all present teeth, excluding third molars. Prevalence of gingivitis, periodontal pocket depth of 4+mm, gingival recession of 2+mm, and clinical attachment loss of 4+mm were calculated and reported. The US CDC/AAP case definition was used to define cases of moderate to severe periodontitis. NSAOH 2017-18 data were combined with data collected in NSAOH 2004-06 using similar methods to describe age- and cohort-related trends of periodontitis. The prevalence of periodontal diseases and conditions were relatively high in the Australian adult population. Some three in every ten Australian adults had moderate to severe periodontitis. There was a tendency of higher prevalence of periodontitis in NSAOH 2017-18 than in NSAOH 2004-06 among people of the same age. Periodontal diseases and conditions remain a significant problem in the Australian adult population.

Dental fluorosis in the Australian adult population.

The use of fluoride involves a balance between protection against caries and risk of dental fluorosis. Prevalence and trend of dental fluorosis in the adult population are not frequently reported. To describe the prevalence of dental fluorosis in the Australian adult population. Data from the National Study of Adult Oral Health (NSAOH) 2004-06 and 2017-18 were used. Prevalence of fluorosis was reported using data from the NSAOH 2017-18. Case definitions of fluorosis were as follows: having a TF score of 2+ (TF2+) or a TF score of 3+ (TF3+) on one or more maxillary central incisors. Synthetic cohorts were constructed by year of birth allowing for time trend analysis. One in ten Australian adults were found to have dental fluorosis at TF2+. The prevalence of TF3+was low. Time trend analysis revealed an increase in the prevalence and severity of fluorosis among those born during 1970s to 1980s decade. Such prevalence declined among those who were born after measures were introduced in early 1990s to reduce exposure to discretionary fluorides. The prevalence of dental fluorosis in the Australian adult population was found to be related to population-level changes in fluoride exposure.

Trend and distribution of coronal dental caries in Australians adults.

To report the experience of coronal dental caries in the Australian adult population. Dentate people aged 15years and over were online or telephone interviewed, and dental examined (n=5022). The number of decay, missing and filled surfaces (DMFS) were recorded. Independent variables were demographic, socioeconomic conditions and dental care characteristics. Proportions of DMFS >0, average DMFS and its components were calculated. Overall, 32.1% had decayed surfaces, with a higher proportion found in males (34.7%) and 40% higher in those living in remote areas than in those living in major city and regional areas. The prevalence of decayed surfaces varied from 37.4% (lowest income group) to 25.0% (highest income group). The mean number of decayed surfaces was three times higher in the lowest income group compared to the highest one. Uninsured people had a higher prevalence of decayed surfaces and lower mean of filling surfaces than insured group. Participants with an unfavourable pattern of dental visiting had two times higher prevalence of decay than their counterparts. Overall, three quarters (77.4%) had at least one filling in their permanent dentition. This percentage increased from 61.6% among 15-34 year olds, to 88.0% among those aged 55-74years. Socioeconomic inequalities in caries experience persist in Australia.

Prevalence and correlates of normal body mass index central obesity among people with cardiovascular diseases in Australia

ObjectiveObesity is one of the most common risk factors for cardiometabolic diseases in Australia and worldwide. Recent studies show that people with normal body mass index (BMI) but with central obesity are at increased risk of morbidity and mortality from cardiometabolic diseases. This risk has not been explained well. The aim of this study was to examine the magnitude, correlates and effects of normal BMI central obesity in the Australian adult population. Study designLongitudinal study with data linkage. MethodsWe used the Baker Biobank, which contains sociodemographic, behavioural, clinical and mortality data. Data were collected between 2000 and 2011 from 6530 adults who were between 18 and 69 years of age. Biobank data were linked to the National Death Index. A matrix of BMI and waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) were used to create adiposity categories. For analysis, we used descriptive statistics, logistic regression and cox regression models. ResultsThe overall prevalence of normal BMI central obesity was 13.4% by WHtR and 14.4% by WHR. Gender, age, BMI and physical activity were associated with normal BMI central obesity. Higher odds of multimorbidity and increased hazards of all-cause and cardiovascular mortality were associated with WHR. ConclusionWHtR and WHR, when each used with BMI, provided similar estimates of prevalence of normal BMI central obesity. However, WHR is a better predictor of all-cause and cardiovascular mortality.

Oral health impacts among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

This paper examines oral health impacts of toothache experience, self-rated oral health (SROH), being uncomfortable with dental appearance, and avoiding foods in the Australian adult population. The explanatory variables include age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data were collected in the interview in NSAOH 2017-18. There were lower percentages with: toothache in the highest (14.8%) than middle (21.2%) and lower income tertiles (25.2%); fair/poor SROH in the highest (15.8%) than middle (24.1%) and lower tertiles (34.8%); uncomfortable with appearance in the highest (29.1%) than middle (35.3%) and lower tertiles (42.2%); and food avoidance in the higher (15.3%) than middle (22.9%) and lower tertiles (34.4%). There were higher percentages with: toothache in the unfavourable (32.2%) than intermediate (23.1%) and favourable (11.7%) visiting groups; fair/poor SROH in the unfavourable (44.0%) than intermediate (27.4%) or favourable (10.2%) groups; being uncomfortable about appearance in the unfavourable (47.6%) than intermediate (39.5%) or favourable (25.8%) groups; and avoiding foods in the unfavourable (34.8%) than intermediate (26.0%) or favourable (14.5%) groups. Socioeconomic status and dental visiting were associated with oral health impacts. Oral health impacts were worse for those with lower income and unfavourable visiting patterns.

Xerostomia: its prevalence and associations in the adult Australian population.

Little is known of the occurrence of dry mouth among Australians. To describe the prevalence and associations of xerostomia in a nationally representative sample of Australian adults. Dentate persons aged 15+years were asked 'How often does your mouth feel dry?' (response options 'never', 'occasionally', 'frequently' or 'always'). Those responding 'frequently' or 'always' were classified as xerostomic. The prevalence of xerostomia was 13.2% (95% CI 12.4, 14.0). It ranged from 9.3% (95% CI 7.9, 10.8) among 15-to-34-year-old to 26.5% (95% CI 23.3, 30.0) among those aged 75+years. Prevalence was higher in the lowest income tertiles (24.5%, 95% CI 22.6, 26.5), lowest SEIFA tertiles (15.7%, 95% CI 14.2, 17.3), those who were dentally uninsured (16.6%, 95% CI 15.4, 17.8) and those with unfavourable dental visiting patterns (18.1%, 95% CI 16.2, 20.1). More than one in ten Australians experience dry mouth. Among older Australians, this estimate is one in four. With an ageing, medicated population that is increasing in size, xerostomia is a condition that needs to be better understood, recognized and managed by both dental and general health practitioners.

Guest Editorial.

This Special Issue of the Australian Dental Journal coincides with an unprecedented health event in the 21st century: the COVID-19 pandemic. Given the social and economic consequences of the disease, the vivid debate about the most effective public health measures to tackle the epidemic and the global spread of the epidemic,1 people worldwide are becoming familiar with words such as ‘epidemiology’, ‘epidemic curve’, ‘fatality rate’, ‘surveillance systems’ ‘prediction’, ‘modelling’, among other. However, what is epidemiology? Epidemiology has been conceptualised as ‘the study of the occurrence and distribution of health-related events, states, and processes in specified populations, including the study of the determinants influencing such processes, and the application of this knowledge to control relevant health problems’. Two central assumptions support this definition and, therefore, Epidemiology itself: (i) the diseases, health conditions, and their determinants are not randomly distributed in a population; (ii) the knowledge of these factors has practical implications for the control and prevention of diseases and health problems.2 This Special Issue of the Australian Dental Journal is about epidemiology, more precisely about oral epidemiology, the branch of epidemiology dedicated to oral diseases and disorders its socioeconomic, behavioural and health services related factors. It describes the state of oral health and use of dental services of the Australian adult population using information from the National Study of Adult Oral Health (NSAOH) 2017–18.3 The NSAOH 2017–18 was conducted by the Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide in partnership with the Australian Government Department of Health and State/Territory health departments and dental services with support from the National Health and Medical Research Council (NHMRC). This national study involved collection of interviews from over 15,000 adults across Australia, with clinical oral epidemiological examinations performed on over 5,000 people. NSAOH 2017–18 is only the third national oral examination survey of adults in Australia. It follows from the second National Survey of Adult Oral Health conducted in 2004–06,4 and the initial National Oral Health Survey of Australia 1987–88.5 The purpose of this Special Issue is to provide a descriptive ‘snapshot’ of oral health in the adult population of Australia and to describe their use of dental services. The findings provide up-to-date evidence that can contribute to the development of oral health policies and programs in Australia. Such evidence continues to be essential because oral diseases represent a considerable burden on the health of the public. This calls for information about the distribution of oral disease and provision of dental care among relevant subgroups of the Australian population. This report also includes some comparisons of results with the first two surveys, evaluating trends in oral disease and dental care that have occurred over the past 30 years. These trends provide insights into historical influences on dental care and likely trends in oral health status. The first set of papers deal with the methods involved in relation to sampling, data collection, weighting of the data and representativeness. Following these methods papers are a set of papers that describe oral health status for outcomes such as tooth loss, caries and periodontal disease. Other important oral conditions such as fluorosis and xerostomia are also presented. The final set of papers includes impacts of oral conditions, use of dental services and dental behaviours. Together the information in these papers reflects a valuable national resource that demonstrates the widespread nature of oral diseases in the Australian population, the impacts of these oral diseases, the groups within our society that suffer the greatest burden from oral diseases and the importance of access to dental services for Australians.

Oral epidemiological examination - protocol: the National Study of Adult Oral Health 2017-18.

The National Study of Adult Oral Health (NSAOH) 2017-18 aimed to collect data on population oral health status of the Australian adult population. This complex nation-wide project required reliable data collection procedures. The NSAOH 2017-18 Oral Epidemiological Examination Protocol has been developed based on internationally accepted examination procedures. Examiners have been trained and calibrated in using the protocol. Details of the clinical examination components are provided. Examiner reliability has been tested and presented.

Estimated Health Benefits, Costs, and Cost-Effectiveness of Eliminating Industrial Trans-Fatty acids in Australia

Abstract Objectives To assess the potential cost-effectiveness, health gains, and effects on health equality of eliminating industrial trans-fatty acids (TFAs) from the Australian food supply. Methods Markov cohort models were used to estimate the cost-effectiveness and policy impact on (ischemic heart disease) IHD burden and health equity of a national ban of industrial TFAs in Australia. Intake of TFA was assessed using the 2011–2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting (0.5% energy per day from TFA; corresponding to TFA intake only from non-industrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICER) using net policy cost and HALYs gained. Health benefits and health care cost changes were also assessed in subgroups based on socioeconomic status and remoteness. Results Elimination of industrial TFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost-saving or cost-effective (i.e., ICER &amp;lt; 169,361 AUD/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and life time, respectively. The TFA ban was estimated to be cost-saving or highly cost-effective in sensitivity analyses altering assumptions of post-intervention TFA intake, abundance of TFA-containing products, or discount rate. Conclusions A ban of industrial TFAs could avert substantial numbers of IHD events and deaths in Australia and will likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health. Funding Sources National Health and Medical Research Council; and UNSW.

Nutrient patterns and depressive symptoms among Australian adults.

Much of the current literature on the associations between diet and depression focus on single nutrients rather than nutrient patterns (NPs). We investigated the association between NPs and depressive symptoms (DepS) in an Australian adult population. DepS were examined at two different time points, in 2010 (Stage 3, n = 1743, 49.0% males) and 2015 [North West 2015 (NW15), n = 1,024, 46.6% males] of the North West Adelaide Health Study (NWAHS). Dietary habits were evaluated using a food frequency questionnaire (FFQ) at Stage 3. DepS were assessed using the Center for Epidemiological Studies Depression (CES-D) scale at Stage 3 and NW15. Principal component analysis was used to identify NPs as well as the factor structure of the CES-D. Log- and negative binomial regression analyses were used to assess the association between NPs and DepS scores. Ordinal logistic regression analysis was undertaken between the NPs and identified factors of the CES-D score. Three NPs (from theFFQ) and two-factors (from theCES-D score) were obtained. After adjusting for known confounding variables, a 'plant-sourced' NP (β-carotene, fibre, vitamin C, potassium and α-carotene) was inversely associated with DepS at Stage 3 [prevalence ratio (PR)Q4VsQ1, 0.78; 95% CI 0.66-0.92; p = 0.003], whereas an 'animal-sourced' (ω-3 fatty acid, monounsaturated fat, vitamin E and cholesterol) or 'mixed-source' (phosphorous, protein, vitamin B2, iodine and zinc) NP was not associated with DepS. There was an inverse relationship between the'plant-sourced' NP and the'(absence of) positive-affect' factor from the CES-D in both stages. The 'plant-sourced' NP is consistently and inversely associated with DepS; however, longitudinal studies are recommended to confirm these results.

Investigating the relationships between social capital, chronic health conditions and health status among Australian adults: findings from an Australian national cohort survey

BackgroundSocial capital is a collective attribute of communities that determines health and well-being of populations. The collective resources in a high social capital community have been reported to result in better health outcomes. While evidence supports the links between social capital and various health outcomes, it is not clear about underlying mechanisms connecting multiple dimensions of social capital to health.MethodsUsing the two-wave data from a nationally representative cohort study of Australian adults (N = 16,637), this study examined the effects of two dimensions of social capital (i.e., structural and cognitive social capital) on physical and mental health in the Australian adult population. Based on prior literature and theoretical reasoning, it was anticipated that the structural and cognitive social capital would influence self-assessed health status (physical and mental health). Additionally, these two dimensions of social capital were hypothesized to moderate the relationships between chronic health conditions and these two aspects of health status.ResultsAnalyses showed that the effects of chronic health conditions on mental health status were moderated by the structural social capital (β = .652, SE = .249, p = .009). Additionally, it was found that perceived community cohesion was predictive of mental health (β = .295, SE = .103, p = .004). Our analysis also indicated that perceptions of disadvantaged neighbourhood environment contributed to poorer mental health status (β = −.461, SE = .144, p = .001). However, none of the social capital variables significantly predicted physical health status.ConclusionsFindings suggest that the structural dimension of social capital would function as a buffer against the malicious effects of chronic health conditions, impairments and disabilities. Specifically, community participation (structural social capital) is indispensable to develop an effective community-based program to improve health and well-being of those with chronic health conditions or disabilities, as increasing active participation may generate beneficial effects in this vulnerable population. Subjective perceptions about communities can also play an important role in improving better health outcomes. Further research is needed to examine underlying mechanisms linking the multiple dimensions of social capital to health outcomes among individuals who are vulnerable to external stressors.