Communicating Environmental Health Risks with Indigenous Populations: A Systematic Literature Review of Current Research and Recommendations for Future Studies

Updated review on contaminant communication experiences in the circumpolar Arctic

Arctic populations are amongst the highest exposed populations to long-range transported contaminants globally, with the main exposure pathway being through the diet. Dietary advice is an important immediate means to address potential exposure and help minimize adverse health effects. The objective of this work is to enable easier access to dietary advice and communication guidance on contaminants with a focus on the Arctic. This manuscript is part of a special issue summarizing the Arctic Monitoring and Assessment Programme's Assessment 2021: Human Health in the Arctic. The information was derived with internet searches, and by contacting relevant experts directly. Results include risk communication efforts in European Arctic countries, effectiveness evaluation studies for several Arctic countries, experience of social media use, and the advantages and challenges of using social media in risk communication. We found that current risk communication activities in most Arctic countries emphasize the importance of a nutritious diet. Contaminant-related restrictions are mostly based on mercury; a limited amount of dietary advice is based on other contaminants. While more information on effectiveness evaluation was available, specific information, particularly from Arctic countries other than Canada, is still very limited.

Awareness and perceptions of contaminants in the Dehcho and sahtú regions of the Northwest Territories

The development and dissemination of health messaging is a critical component of reducing health disparities. Participants (n = 87) from a human biomonitoring study in six Dene communities responded to a survey about health communication regarding contaminants. The survey included questions on awareness of health messages and risk perceptions related to country foods and contaminants. The vast majority of participants reported eating country foods (99%) and heard that country foods had beneficial nutrients (90%). Seventy per cent of respondents had heard or seen messages about fish with high levels of mercury, and 60% had concerns about the safety or quality of country foods they consumed. Respondents who reported decreasing the number of fish they ate since hearing the messages about fish and mercury had lower (p = 0.04) mercury concentration in hair, compared to those who had not heard the messages. However, no differences in hair mercury were observed for respondents who reported to have changed their fishing location, chosen smaller fish or eaten less predatory fish since hearing the messages. Results indicate the need to examine reasons for self-reported behaviour changes, in addition to awareness. The conclusions of this study can inform the development of messaging and risk management decisions about contaminants within Indigenous populations.

Using the National Land Cover Database as an indicator of shrub-steppe habitat: comparing two large United States federal lands with surrounding regions

There is a need to assess whether ecological resources are being protected on large, federal lands. The aim of this study was to present a methodology which consistently and transparently determines whether two large Department of Energy (U.S. DOE) facilities have protected valuable ecological lands on their sites compared to the surrounding region. The National Land Cover Database (2019) was used to examine the % shrub-scrub (shrub-steppe) and other habitats on the DOE's Hanford Site (HS, Washington) and on the Idaho National Laboratory (INL), compared to a 10-km and 30-km diameter band of land surrounding each site. On both sites, over 95% is in shrub-scrub or grassland, compared to the surrounding region. Approximately 70% of 10 km and 30-km bands around INL, and less than 50% of land surrounding HS is located in these two habitat types. INL has preserved a significantly higher % shrub/scrub habitat than HS, but INL allows grazing on 60% of its land. HS has preserved a significantly higher % grassland than INL but no grazing on site is present. The methodology presented may be used to compare key ecological habitat types such as grasslands, forest, and desert among sites in different parts of the country. This methodology enables managers, resource trustees, and the public to (1) make remediation decisions that protect resources, (2) assess whether landowners and managers have adequately characterized and protected environmental resources on their sites, and (3) whether landowners and managers have protected the integrity of that land as well as its climax vegetation.

Exploring practices, challenges, and priorities for human health and ecological risk assessments in Indigenous communities in Canada

Indigenous peoples in Canada are disproportionately exposed to environmental contaminants and may face elevated health risks related to their unique cultural, spiritual, and economic relationships with the land, including the use of traditional food systems. However, to date, institutionalized approaches to assess risks to human and ecological health from contaminants have not been well developed or implemented with Indigenous community contexts in mind. There is regulatory interest in developing new approach methods for risk assessment, and thus an opportunity to increase their relevance to Indigenous communities in which they will be ultimately applied. Therefore, we conducted an anonymous mixed-methods survey of those involved with risk assessment in Indigenous communities in Canada to: (1) understand risk assessment practice in Indigenous communities, (2) explore challenges with conventional assessment methods and compare these across sectors, and (3) gather perspectives on the development of new approaches. In all, 38 completed survey responses were received (14% response rate). Respondents were from Indigenous community environment and health offices (21% of respondents), Indigenous governments (8%), federal and provincial governments (21%), and academia (45%). Risk communication was seen as the most challenging part of risk assessment (71% responded "difficult"), and nearly all respondents agreed that time (86%), cost (76%), and resource availability (86%) were "moderate" to "serious" problems. Few respondents (16%) had heard of "new approach methods" for risk assessment, and 76% of respondents (and 100% of community-based respondents) agreed on the need to develop improved risk assessment approaches. To modernize risk assessment, respondents recommended advancing cumulative risk assessment methods, improving risk communication, and promoting Indigenous leadership and Traditional Knowledge in assessment activities. Integr Environ Assess Manag 2024;20:1677-1692. © 2024 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Risk communication and perceptions about lead ammunition and Inuit health in Nunavik, Canada

Lead ammunition is commonly used to hunt waterfowl and other wildlife in the Arctic. Hunting with lead is problematic because the toxicant can be transferred to the consumer. Therefore, it is critical to evaluate perceptions and awareness of the risks associated with using lead ammunition among Arctic populations. Results of the Nunavik Child Development Study (a longitudinal health study gathering information on health and well-being among Inuit in Nunavik, Canada) included advice to eliminate the use of lead ammunition in hunting practices. We surveyed 112 Nunavik residents (93 women; 18 men) about their awareness of lead related messages, use of lead ammunition and risk perceptions about contaminants. Sixty-seven participants (59.8%) reported there was an active hunter in their household. We found that only 27% of participants had heard or seen the messages about reducing lead ammunition. After participants viewed the Nunavik Child Development Study messages about lead, 44% stated they would stop using lead ammunition. However, 28% indicated that they would continue using lead ammunition. We conclude that, while messages had an overall positive effect, further study is required to understand why people continue to use lead ammunition.

Communication and Perspectives About COVID-19 and Vaccinations Among Native Americans

The COVID-19 pandemic disproportionately affected Native American people and communities across the United States. Despite unequal losses during the pandemic, Native Americans have high vaccination rates. We provide insight into perspectives of COVID-19 and vaccinations through in-depth interviews with Native Americans. Through this research, we provide a holistic view of how Native Americans perceive vaccines by pairing Indigenous perspectives of risk and the Health Belief Model. We discuss the importance of tribal sovereignty in developing health communication strategies, and the need for messaging that is trusted and culturally appropriate.

"When people see me, they know me; they trust what I say": characterizing the role of trusted sources for smoke risk communication in the Okanogan River Airshed Emphasis Area

INTRODUCTION

As wildfire smoke events increase in intensity and frequency in the Pacific Northwest, there is a growing need for effective communication on the health risks of smoke exposure. Delivery through a trusted source or intermediary has been shown to improve reception of risk communication messages. This is especially salient in rural and tribal communities who may be hesitant to trust information from state and federal agency sources. This study aims to identify and characterize trusted sources for smoke risk information in the Okanogan River Airshed Emphasis Area (ORAEA), a rural region of North Central Washington state that is heavily impacted by smoke from wildfires and prescribed fire.

METHODS

The research team conducted a qualitative study using data collected through key informant interviews and focus groups to assess the role of various sources and intermediaries in disseminating smoke risk information. We used a consensual coding approach in NVivo Qualitative Analysis Software to sort data into preliminary categories, which were grouped into themes using a thematic analysis approach. We used member checking and iterative feedback processes with local project partners throughout the project to ensure credibility of results.

RESULTS

Through the analysis, we identified three themes characterizing trusted sources for smoke risk communication in the ORAEA. These themes were: (1) local and tribal sources of information are perceived as more trustworthy than state and federal government sources, (2) trustworthiness is determined by an evaluation of multiple factors, in particular, perceived credibility, quality of information, and relationship with the source, and (3) conservative political ideology and perceived parallels with COVID-19 communication influence perception of trust. Within each theme, we identified several sub-themes, which contributed additional nuance to our analysis.

CONCLUSION

This study provides insights into which sources of information are trusted by rural and tribal community members in the ORAEA and why. Results from our study emphasize the importance of relationships and collaboration with local and tribal partners in smoke risk communication. In this paper, we discuss implications for state and federal agency practitioners and present recommendations for how to work with local and tribal partners on smoke risk communication.

Communication about Alzheimer's disease and research among American Indians and Alaska Natives

Introduction

American Indian and Alaska Native (AI/AN) people infrequently participate in Alzheimer's disease (AD) research, despite the rapidly increasing population of AI/AN people aged 65 and older.

Methods

We surveyed 320 adults who identified as AI/AN at two Native-focused events and used ordinary least squares regression and logistic regression models to test associations between demographic factors and perceived risk of AD, knowledge about AD, and willingness to participate in research, along with preferred source of AD information.

Results

Willingness to participate in research was highest among those living in a city versus reservation and associated with perceived personal risk for AD. Health professionals and the internet were preferred sources of information about AD.

Discussion

These hypothesis-generating results provide insight into perceptions of AD and willingness to participate in research. Conclusions could inform development of AD recruitment strategies for AI/ANs and influence participation in AD research.

Informing the Co-Development of Culture-Centered Dietary Messaging in the Inuvialuit Settlement Region, Northwest Territories

Northern Indigenous communities require collaborative approaches to health communication about food that are grounded in Indigenous knowledges and cultures; however, preferences and best methods for this process remain understudied. This participatory study discusses how Inuvialuit (Inuit from the Western Arctic) knowledge and the perspectives of territorial, regional, and local dietary message stakeholders can inform the co-development of culture-centered dietary messaging to support healthy, safe, and culturally appropriate diets in Tuktoyaktuk, NWT. A community researcher in Tuktoyaktuk conducted storytelling interviews with country food knowledge holders (n = 7) and community members (n = 3), and a talking circle with local public health dietary message disseminators (n = 2) in June-July 2021. The lead author conducted key informant telephone and videoconference interviews with territorial and regional dietary message disseminators (n = 5) in June 2021. Interviews were coded and analyzed thematically. Our findings indicate that participants at all levels support increased inclusion of cultural and community perspectives about food to develop regionally and locally tailored dietary messaging. While most dietary message stakeholders wish to be involved in co-development processes, some country food knowledge holders in Tuktoyaktuk expressed a desire to lead local communications about country foods. Informed by participants' experiences and needs, we provide recommendations for future community-led approaches to further (co-)develop and communicate effective, culturally meaningful dietary messaging that promotes Inuvialuit food sovereignty.

Factors That Influence Risk Perceptions and Successful COVID-19 Vaccination Communication Campaigns With American Indians

COVID-19 vaccinations are the primary tool to end the pandemic. However, vaccine hesitancy continues to be a barrier to herd-immunity in the United States. American Indians (AI) often have higher levels of distrust in western medicine and lower levels of satisfaction with health care when compared to non-Hispanic Whites. Yet AIs have high COVID-19 vaccination rates. We discuss factors that influence AI risk perceptions of COVID-19 vaccinations including the impact of COVID-19 on AI Elders, community, and culture. We conclude with future research needs on vaccination communication and how culturally congruent communication campaigns may have contributed to high COVID-19 vaccination rates.

Communication With American Indians and Alaska Natives About Cardiovascular Disease

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives. Reducing CVD risk requires effective communication about risk factors and preventive behaviors. Messages should be designed with an understanding of where people seek health information, their perceptions of a hazard, and their perception of information sufficiency. We examined these components of message design to inform strategies to effectively communicate information about CVD to American Indians and Alaska Natives.

METHODS

We surveyed 220 adults who self-identified as American Indians or Alaska Natives at 2 Native-focused events in urban areas. Our survey included items on demographic characteristics, place of residence, sources of information used to learn about CVD, perceived information sufficiency, and perceptions about the importance of CVD as a health problem.

RESULTS

Respondents used the internet (67%), their doctors (66%), friends and relatives (63%), brochures (62%), and television (61%) to learn about CVD. Participants aged 60 or older and those living on a reservation were more likely to use their doctor to learn about CVD than their younger (≤30 y) or urban peers. CVD was viewed as a major problem for American Indians and Alaska Natives (84%) and for Americans in general (86%). Most respondents felt moderately (54%) or well informed (37%) about CVD.

CONCLUSION

Various information sources should be used to increase awareness about CVD. Special attention may be needed to optimize communication to American Indians and Alaska Natives aged 60 or older and people living on reservations. Further study is needed to determine how our findings can best inform effective interventions to reduce CVD morbidity and mortality among these populations.

Drivers and health implications of the dietary transition among Inuit in the Canadian Arctic: a scoping review

OBJECTIVE

The current study undertook a systematic scoping review on the drivers and implications of dietary changes among Inuit in the Canadian Arctic.

DESIGN

A keyword search of peer-reviewed articles was performed using PubMed, Web of Science, CINAHL, Academic Search Premier, Circumpolar Health Bibliographic Database and High North Research Documents. Eligibility criteria included all full-text articles of any design reporting on research on food consumption, nutrient intake, dietary adequacy, dietary change, food security, nutrition-related chronic diseases or traditional food harvesting and consumption among Inuit populations residing in Canada. Articles reporting on in vivo and in vitro experiments or on health impacts of environmental contaminants were excluded.

RESULTS

A total of 162 studies were included. Studies indicated declining country food (CF) consumption in favour of market food (MF). Drivers of this transition include colonial processes, poverty and socio-economic factors, changing food preferences and knowledge, and climate change. Health implications of the dietary transition are complex. Micro-nutrient deficiencies and dietary inadequacy are serious concerns and likely exacerbated by increased consumption of non-nutrient dense MF. Food insecurity, overweight, obesity and related cardiometabolic health outcomes are growing public health concerns. Meanwhile, declining CF consumption is entangled with shifting culture and traditional knowledge, with potential implications for psychological, spiritual, social and cultural health and well-being.

CONCLUSIONS

By exploring and synthesising published literature, this review provides insight into the complex factors influencing Inuit diet and health. Findings may be informative for future research, decision-making and intersectoral actions around risk assessment, food policy and innovative community programmes.

Culturally Adapted Mobile Technology Improves Environmental Health Literacy in Laurentian, Great Lakes Native Americans (Anishinaabeg)

The presence of persistent bioaccumulative toxics (PBT) in aquatic food chains complicates decision processes of people with a strong culture of fish consumption. This environmental contamination is especially problematic for Native American populations in the Laurentian Great Lakes region (Anishinaabeg). Pursuing the growing discipline of environmental health literacy (EHL) may help reduce toxic exposures, support healthy decision-making, and combat health deficits. Our goals for this research were first to improve environmental health literacy using novel technologies and second to help define environmental health literacy metrics that can be tracked over time, especially regarding culturally-contextualized health interests. We recently reported that a mobile app (Gigiigoo'inaan App) presenting personalized, culturally-contextualized fish consumption advice may improve EHL for the Anishinaabeg. Gigiigoo'inaan App safely supports desired fish consumption rates by putting local data into the hands of the Anishinaabeg. We conducted a pre-test post-test evaluation with 103 Aninishinaabe adults. Participants estimated their current fish meal consumption over a hypothetical month before exposure to the software and then planned their future consumption of fish meals in a month after using the mobile app. Significantly more monthly traditional fish meals on average (Median: 4 vs 2, p=0.0005) were selected when using the app versus pre-exposure to the app. Significantly more traditional grams of fish were also selected during use of the app relative to the pretest (Median: 680.39g vs 453.59g, p=0.0007). These increases were accompanied by widespread (97%) adherence to conventional advice that minimizes PBT exposure health effects (ATSDR minimum risk levels).