Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake

Background. Tooth decay is the most common paediatric disease and there is a serious paediatric tooth decay epidemic in Alaska Native communities. When untreated, tooth decay can lead to pain, infection, systemic health problems, hospitalisations and in rare cases death, as well as school absenteeism, poor grades and low quality-of-life. The extent to which population-based oral health interventions have been conducted in Alaska Native paediatric populations is unknown. Objective. To conduct a systematic review of oral health interventions aimed at Alaska Native children below age 18 and to present a case study and conceptual model on multilevel intervention strategies aimed at reducing sugar-sweetened beverage (SSB) intake among Alaska Native children. Design. Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement, the terms “Alaska Native”, “children” and “oral health” were used to search Medline, Embase, Web of Science, GoogleScholar and health foundation websites (1970–2012) for relevant clinical trials and evaluation studies. Results. Eighty-five studies were found in Medline, Embase and Web of Science databases and there were 663 hits in GoogleScholar. A total of 9 publications were included in the qualitative review. These publications describe 3 interventions that focused on: reducing paediatric tooth decay by educating families and communities; providing dental chemotherapeutics to pregnant women; and training mid-level dental care providers. While these approaches have the potential to improve the oral health of Alaska Native children, there are unique challenges regarding intervention acceptability, reach and sustainability. A case study and conceptual model are presented on multilevel strategies to reduce SSB intake among Alaska Native children. Conclusions. Few oral health interventions have been tested within Alaska Native communities. Community-centred multilevel interventions are promising approaches to improve the oral and systemic health of Alaska Native children. Future investigators should evaluate the feasibility of implementing multilevel interventions and policies within Alaska Native communities as a way to reduce children's health disparities

Grudge spending:The interplay between markets and culture in the purchase of security

In the paper, we use data from an English study of security consumption, and recent work in the cultural sociology of markets, to illustrate the way in which moral and social commitments shape and often constrain decisions about how, or indeed whether, individuals and organizations enter markets for protection. Three main claims are proffered. We suggest, firstly, that the purchase of security commodities is a mundane, non-conspicuous mode of consumption that typically exists outside of the paraphernalia of consumer culture - a form of grudge spending. Secondly, we demonstrate that security consumption is weighed against other commitments that individuals and organizations have and is often kept in check by these competing considerations. We find, thirdly, that the prospect of consuming security prompts people to consider the relations that obtain between security objects and other things that they morally or aesthetically value, and to reflect on what the buying and selling of security signals about the condition and likely futures of their society. These points are illustrated using the examples of organizational consumption and gated communities. In respect of each case, we tease out the evaluative judgements that condition and constrain the purchase of security among organizations and individuals and argue that they open up some important but neglected questions to do with the moral economy of security