The health of Canada's Aboriginal children: results from the First Nations and Inuit Regional Health Survey

The Mental Health of First Nations Children in Manitoba: A Population-Based Retrospective Cohort Study Using Linked Administrative Data: La santé mentale des enfants des Premières Nations au Manitoba : une étude de cohorte rétrospective dans la population, à l'aide de données administratives liées

OBJECTIVE

First Nations children face a greater risk of experiencing mental disorders than other children from the general population because of family and societal factors, yet there is little research examining their mental health. This study compares diagnosed mental disorders and suicidal behaviours of First Nations children living on-reserve and off-reserve to all other children living in Manitoba.

METHOD

The research team, which included First Nations and non-First Nations researchers, utilized population-based administrative data that linked de-identified individual-level records from the 2016 First Nations Research File to health and social information for children living in Manitoba. Adjusted rates and rate ratios of mental disorders and suicide behaviours were calculated using a generalized linear modelling approach to compare First Nations children (n = 40,574) and all other children (n = 197,109) and comparing First Nations children living on- and off-reserve.

RESULTS

Compared with all other children, First Nations children had a higher prevalence of schizophrenia (adjusted rate ratio (aRR): 4.42, 95% confidence interval (CI), 3.36 to 5.82), attention-deficit hyperactivity disorder (ADHD; aRR: 1.21, 95% CI, 1.09 to 1.33), substance use disorders (aRR: 5.19; 95% CI, 4.25 to 6.33), hospitalizations for suicide attempts (aRR: 6.96; 95% CI, 4.36 to 11.13) and suicide deaths (aRR: 10.63; 95% CI, 7.08 to 15.95). The prevalence of ADHD and mood/anxiety disorders was significantly higher for First Nations children living off-reserve compared with on-reserve; in contrast, hospitalization rates for suicide attempts were twice as high on-reserve than off-reserve. When the comparison cohort was restricted to only other children in low-income areas, a higher prevalence of almost all disorders remained for First Nations children.

CONCLUSION

Large disparities were found in mental health indicators between First Nations children and other children in Manitoba, demonstrating that considerable work is required to improve the mental well-being of First Nations children. Equitable access to culturally safe services is urgently needed and these services should be self-determined, planned, and implemented by First Nations people.

Systematic Review and Meta-analysis: First Nations, Inuit, and Métis Youth Mental Health

OBJECTIVE

The ongoing effects of colonialism disproportionately place Indigenous youth at risk for mental health challenges. This meta-analysis examined lifetime and past-year prevalence estimates of mental health challenges among First Nations, Inuit, and Métis youth in Canada.

METHOD

Five electronic databases were searched from their inceptions until June 17, 2021. Studies were included if they assessed mental health challenges among First Nations, Inuit, and/or Métis youth (≤18 years old). Risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 28 articles were eligible. Sixteen studies contained data on First Nations, 2 on Inuit, one on Métis, and 10 aggregated Indigenous participants. Among First Nations participants, pooled prevalence estimates for past-year suicidality (8.9%), mood and/or anxiety (<2.9%), attention-deficit/hyperactivity (2.9%), oppositional defiant (8.8%), and conduct (12.8%) disorder diagnoses were identified. Limited studies containing Inuit, Métis, and aggregated Indigenous participants also found high levels of disruptive disorder symptoms. Data were very limited for lifetime prevalence estimates. Studies assessed to have a moderate or high methodological risk of bias (k = 19) or using measures that are not yet culturally validated (k = 25) may contribute to inaccuracies in prevalence estimates.

CONCLUSION

Existing data suggest that Indigenous youth have a low prevalence of mental health challenges, with the exception of disruptive behaviors. Future studies should use culturally validated tools and partner with Indigenous communities to ensure optimal identification of mental health challenges.

Domestic Risk Factors for Atopic and non-Atopic Asthma in First Nations Children Living in Saskatchewan, Canada

Both allergic and non-allergic asthma phenotypes are thought to vary by specific housing and other indoor environmental conditions. This study evaluated risk factors for allergic asthma phenotypes in First Nation children, an understudied Canadian population with recognized increased respiratory morbidity. We conducted a cross-sectional survey with a clinical component to assess the respiratory health of 351 school-age children living on two rural reserve communities. Asthma was defined as parental report of physician diagnosed asthma or a report of wheeze in the past 12 months. Atopy was determined by a ≥ 3-mm wheal response to any of six respiratory allergens upon skin prick testing (SPT). Important domestic and personal characteristics evaluated included damp housing conditions, household heating, respiratory infections and passive smoking exposure. Asthma and atopy prevalence were 17.4% and 17.1%, respectively. Of those with asthma, 21.1% were atopic. We performed multivariate multinomial logistic regression modelling with three outcomes: non-atopic asthma, atopic asthma and no asthma for 280 children who underwent SPT. After adjusting for potential confounders, children with atopic asthma were more likely to be obese and to live in homes with either damage due to dampness (p < 0.05) or signs of mildew/mold (p = 0.06). Both natural gas home heating and a history of respiratory related infections were associated with non-atopic asthma (p < 0.01). Domestic risk factors for asthma appear to vary by atopic status in First Nations children. Determining asthma phenotypes could be useful in environmental management of asthma in this population.

Health, Social, Education, and Justice Outcomes of Manitoba First Nations Children Diagnosed with Fetal Alcohol Spectrum Disorder: A Population-Based Cohort Study of Linked Administrative Data

OBJECTIVE

To examine health services, social services, education, and justice system outcomes among First Nations children and youth with fetal alcohol spectrum disorder (FASD).

METHODS

In this retrospective cohort study, health and social services, education, and justice data were linked with clinical records on First Nations (FN) individuals aged 1 to 25 and diagnosed with FASD between 1999 and 2010 (n = 743). We compared the FN FASD group to non-FN individuals with FASD (non-FN FASD; n = 315) and to First Nations individuals (matched on age, sex, and income) not diagnosed with FASD (FN non-FASD; n = 2229). Rates and relative risks (RRs) were calculated using generalized linear models.

RESULTS

FN FASD individuals had similar health services use to non-FN FASD individuals but had greater involvement with child welfare (RR, 1.20; 95% confidence interval [CI], 1.02 to 1.41) and the justice system (RR, 1.37; 95% CI, 1.07 to 1.74) and were more likely to be charged with a crime (RR, 1.40; 95% CI, 1.05 to 1.86). There were no suicides/suicide attempts among the non-FN FASD individuals during the study, but the crude rate/100 person-years of suicides among FN FASD individuals (0.22 for females; 1.06 for males) was substantially higher than for FN non-FASD individuals (0.08 for females; 0.32 for males). There were no significant differences between groups in the education outcomes we measured.

CONCLUSIONS

Young people with FASD are at risk for poor health, education, and social outcomes, but First Nations young people with FASD face comparably higher risks, particularly with child welfare and justice system involvement. The study emphasizes a critical need for appropriate resources for First Nations children with FASD.

Evaluation of eczema, asthma, allergic rhinitis and allergies among the grade-7 children of Iqaluit

Background

Little is known about the prevalence of asthma, allergic rhinitis, eczema and allergies among Canadian Inuit children, especially those living in the arctic and subarctic areas.

Methods

A cross-sectional study among grade seven students attending schools in Iqaluit, the capital city of Nunavut, was conducted during the 2016/2017 school year. We used the International Study of Allergy and Asthma in Children (ISAAC) questionnaire with added questions relevant to the population. In addition, skin prick tests (SPT) were conducted to test for sensitization to common food and environmental allergens.

Results

The prevalence of current asthma is 5.2%, all of them were males and 2/3 of them were Inuit and all had a previous respiratory hospitalization. Past asthma prevalence is 8.6%, 60% males and 60% Inuit. There was an inverse relationship to crowdedness possibly as a confounding factor because of getting a higher prevalence among the non-Inuit who usually live in less crowded houses. Current allergic rhinitis prevalence is 8.6%, 60% of the cases were among the mixed Inuit/Caucasian ethnicity while no cases among the non-Inuit, there was a female predominance 3:2. Past history of allergic rhinitis prevalence is 10.3%, half of the cases were among the mixed ethnicity (5.2% of that ethnicity) followed by Inuit (3.4%) and non-Inuit (1.7%), female: Male ratio 1:1. Current eczema prevalence was 27.6%, with half of the cases among the mixed ethnicity (13.8% of that group), followed by Inuit (8.6%). There was a female predominance with protective effect of exclusive breastfeeding. Past eczema prevalence 34.5%, with half of the cases were among the mixed ethnicity (17.2% of that group), followed by Inuit (10.3%). There was a female predominance. We noted a high rate of sensitization to Cat at 29.2%, most of the cases were among the mixed ethnicity, while absent sensitization to other common inhalant allergens.

Conclusion

While being cautious about firm conclusions due to the small sample size and power, the noticed variations in the prevalence and risk factors of asthma, allergic rhinitis and eczema among different ethnicities living at the same subarctic environment might be related to several possible explanations like genetic, gene-environment interaction and/or lifestyle factors, it was out of the scope of this study to determine the causality of such variation in prevalence, which emphasizes the need for further investigation.

Health profiles of First Nations children living on-reserve in Northern Ontario: a pooled analysis of survey data

BACKGROUND

The Aboriginal Children's Health and Well-Being Measure (ACHWM) was developed to enable Aboriginal health leaders to gather information on the health of children at a local community level. This paper aims to describe the typical health profiles of First Nation children living on traditional territory as a reference to assist in the interpretation of ACHWM scores.

METHODS

Three First Nations in Ontario, Canada, gathered health data from children using the ACHWM administered on Android tablets between 2013 and 2015. The survey data were previously analyzed to inform local health planning. These survey data were pooled to describe the distribution of ACHWM summary and quadrant scores from a larger sample and inform interpretation of ACHWM scores.

RESULTS

ACHWM data from 196 participants (aged 7.6 to 21.7 yr) across 3 communities were included in the pooled sample. ACHWM summary scores ranged from 39.8 to 98.7 with a mean of 74.1 (95% confidence interval [CI] 72.5-75.7) and a maximum of 100. Strengths were reported in the spiritual (mean 78.7, 95% CI 76.7-80.8), physical (mean 77.1, 95% CI 75.1-79.0) and emotional (mean 74.4, 95% CI 72.5-76.3) quadrants. The greatest opportunity for improvement was in the mental (cognition) quadrant (mean 61.6, 95% CI 56.9-63.4).

INTERPRETATION

This paper presents initial estimates for child health scores based on self-report from a large sample of First Nations children living on reserve. These results establish benchmarks to aid interpretation of the ACHWM scores in these and other communities and contexts in the future.

Mental health-related emergency department presentations and hospital admissions in a cohort of urban Aboriginal children and adolescents in New South Wales, Australia: findings from SEARCH

OBJECTIVES

The aim of the current study is to quantify mental health-related emergency department (ED) presentations and hospitalisations, and associated child and family characteristics, in children recruited through four Aboriginal Community Controlled Health Organisations.

SETTING

Four Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban or large regional centres in New South Wales, Australia.

PARTICIPANTS

1476 Aboriginal children aged 0-17 years at recruitment to the Study of Environment on Aboriginal Resilience and Child Health.

PRIMARY OUTCOME MEASURES

ED presentations and hospital admissions with a primary mental health diagnosis obtained via linkage to population health datasets.

RESULTS

Over a median of 6-year follow-up, there were 96 ED presentations affecting 62 children (10.7/1000 person-years) and 49 hospitalisations affecting 34 children (5.5/1000 person-years) for mental health conditions. Presentations/admissions increased with age. ED presentation was increased with: living in foster versus parental care (adjusted rate ratio (RR)=3.97, 95% CrI 1.26 to 11.80); high versus low baseline child emotional/behavioural problems (adjusted RR=2.93, 95% CrI 1.50 to 6.10); and caregiver chronic health conditions versus none (adjusted RR=2.81, 95% CrI 1.31 to 6.63). Hospitalisations were significantly increased with caregiver unemployment versus home duties (adjusted RR=4.48, 95% CrI 1.26 to 17.94) and caregiver chronic health problems versus none (adjusted RR=3.83, 95% CrI 1.33 to 12.12).

CONCLUSIONS

Tertiary care for mental health issues was relatively common among participating Aboriginal children, with risk elevated for those living in foster care, with prior mental health and behavioural problems and with carers with chronic illness and/or unemployment. While this study suggests high rates of serious mental health events among children from participating communities, the optimum means for reducing these rates, and the need for tertiary care, has not yet been determined. Such information is urgently required to inform policy and programmes to support Aboriginal child and adolescent mental health.

Innovating for Transformation in First Nations Health Using Community-Based Participatory Research

Community-based participatory research (CBPR) provides the opportunity to engage communities for sustainable change. We share a journey to transformation in our work with eight Manitoba First Nations seeking to improve the health of their communities and discuss lessons learned. The study used community-based participatory research approach for the conceptualization of the study, data collection, analysis, and knowledge translation. It was accomplished through a variety of methods, including qualitative interviews, administrative health data analyses, surveys, and case studies. Research relationships built on strong ethics and protocols to enhance mutual commitment to support community-driven transformation. Collaborative and respectful relationships are platforms for defining and strengthening community health care priorities. We further discuss how partnerships were forged to own and sustain innovations. This article contributes a blueprint for respectful CBPR. The outcome is a community-owned, widely recognized process that is sustainable while fulfilling researcher and funding obligations.

Evaluation of eczema, asthma, allergic rhinitis and allergies among the Grade-1 children of Iqaluit

Background

Little is known about the prevalence of asthma, allergic rhinitis, eczema and allergies among Canadian Inuit children, especially those living in the arctic and subarctic areas.

Methods

A cross-sectional study among Grade 1 students attending schools in Iqaluit, the capital of Nunavut, was conducted during the 2015/2016 school year. We used the International Study of Allergy and Asthma in Children questionnaire with added questions relevant to the population. In addition, skin prick tests were conducted to test for sensitization to common food and environmental allergens.

Results

The prevalence of current asthma was 15.9% (> 2:1 males) with the highest prevalence among those with any non-Inuit heritage at 38.5%. The prevalence of current and past allergic rhinitis was 6.8%, also predominant among males, with the lowest prevalence among the mixed ethnicity. Home crowdedness was inversely related to past asthma. Being ever outside Nunavut was associated with higher prevalence of current and past asthma. No statistically significant relationship was found with passive smoking or exclusive breast feeding during the first 4 months of life. The current eczema prevalence was 20.5%, with the highest prevalence recorded among the Inuit at 25% compared to 15.4% among the mixed ethnicity and 14.3% among the non-Inuit. We noted a high rate of sensitization to cat at 26.7% while absent sensitization to other common inhalant allergens.

Conclusion

Variations in the prevalence and risk factors of asthma, allergic rhinitis and eczema among different ethnicities living at the same subarctic environment may be related to genetic, gene-environment interaction and/or lifestyle factors that require further investigation.

Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

BACKGROUND

Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences.

METHODS

On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries.

RESULTS

Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture.

CONCLUSIONS

The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

A screening mechanism to recognize and support at-risk Aboriginal children

OBJECTIVES

The Aboriginal Children's Health and Well-Being Measure© (ACHWM) was developed to assess health from the perspectives of Aboriginal children. The purpose of this paper is to document the screening process, embedded within the ACHWM, and assess its effectiveness.

METHODS

The ACHWM was implemented in 2014/2015 with children 8 to 18 years of age living on the Wiikwemkoong Unceded Territory. Survey responses were screened to identify potential risk, using an automated algorithm run on computer tablets. Local mental health workers conducted brief mental health assessments to identify and support children at-risk. Data were analyzed to estimate effectiveness of this screening process.

RESULTS

A total of 293 children completed the ACHWM. The screening tool identified 35% with potential risk. Mental health workers confirmed 18% of all participants as being at-risk, and all were referred for support. The sensitivity of the tool was 75% while specificity was 79%. Improvements to the screening algorithm resulted in a specificity of 97% and negative predictive value of 95%, with no loss of sensitivity.

CONCLUSION

Responsible population health surveys require a process to recognize and respond to answers indicative of health risks. This paper provides an example of a screening and triage process that enabled our survey team to screen responses in real time, respond to potential risk immediately, and connect participants to local support services. This process proved essential to conducting an ethical survey. The high specificity and negative predictive value make it an effective triage tool that is particularly valuable in Aboriginal communities and with higher-risk populations.

Creating exclusive breastfeeding knowledge translation tools with First Nations mothers in Northwest Territories, Canada

Background

Breastfeeding is an ideal method of infant feeding affecting lifelong health, and yet the uptake of breastfeeding in some Indigenous communities in Canada's north is low.

Objective

The aims of this project were to determine the rate and determinants of exclusive breastfeeding in a remote community in the Northwest Territories and to create knowledge translation tools to enhance breastfeeding locally.

Methods

The study methodology followed three steps. Firstly, a series of retrospective chart audits were conducted from hospital birth records of Tłı̨chǫ women (n=198) who gave birth during the period of 1 January 2010 to 31 December 2012. A second follow-up chart audit determined the rate of exclusive breastfeeding and was conducted in the local Community Health Centre. Chart audit data included the following factors related to breastfeeding: age of mother, parity, birthweight and Apgar scores. Secondly, semi-structured interviews with a purposive sample of Tłı̨chǫ mothers (n=8) and one Elder were conducted to identify breastfeeding practices, beliefs and the most appropriate medium to use to deliver health messages in Tłı̨chǫ. Third, based on the information obtained in Step 2, two knowledge translation tools were developed in collaboration with a local community Advisory Committee.

Results

The rate of exclusive breastfeeding initiation in the Tłı̨chǫ region is less than 30%. Physiological and demographic factors related to breastfeeding were identified. Thematic analysis revealed two overarching themes from the data, namely, “the pull to formula” (lifestyle preferences, drug and alcohol use, supplementation practices and limited role models) and “the pull to breast feeding” (traditional feeding method, spiritual practice and increased bonding with infant).

Conclusion

There are a myriad of influences on breastfeeding for women living in remote locations. Ultimately, society informs the choice of infant feeding for the new mother, since mothers’ feeding choices are based on contextual realities and circumstances in their lives that are out of their control. As health care providers, it is imperative that we recognize the realities of women's lives and the overlapping social determinants of health that may limit a mother's ability or choice to breastfeed. Further health promotion efforts, grounded in community-based research and a social determinants framework, are needed to improve prenatal and postnatal care of Indigenous women and children in Canada.

Cancer incidence, mortality, and stage at diagnosis in First Nations living in Manitoba

BACKGROUND

In the present study, we examined breast (bca) and colorectal cancer (crc) incidence and mortality and stage at diagnosis for First Nations (fn) individuals and all other Manitobans (aoms).

METHODS

Several population-based databases were linked to determine ethnicity and to calculate age-standardized incidence and mortality rates. Logistic regression was used to compare bca and crc stage at diagnosis.

RESULTS

From 1984-1988 to 2004-2008, the incidence of bca increased for fn and aom women. Breast cancer mortality increased for fn women and decreased for aom women. First Nations women were significantly more likely than aom women to be diagnosed at stages iii-iv than at stage i [odds ratio (or) for women ≤50 years of age: 3.11; 95% confidence limits (cl): 1.20, 8.06; or for women 50-69 years of age: 1.72; 95% cl: 1.03, 2.88). The incidence and mortality of crc increased for fn individuals, but decreased for aoms. First Nations status was not significantly associated with crc stage at diagnosis (or for stages i-ii compared with stages iii-iv: 0.98; 95% cl: 0.68, 1.41; or for stages i-iii compared with stage iv: 0.91; 95% cl: 0.59, 1.40).

CONCLUSIONS

Our results underscore the need for improved cancer screening participation and targeted initiatives that emphasis collaboration with fn communities to reduce barriers to screening and to promote healthy lifestyles.

Racial Discrimination, Cultural Resilience, and Stress

OBJECTIVE

Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome).

METHODS

Data were collected from October 2012 to February 2013 (N = 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression.

RESULTS

The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R(2) = 0.21 and adjusted R(2) = 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively.

CONCLUSIONS

In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.

Ear Infection and Its Associated Risk Factors in First Nations and Rural School-Aged Canadian Children

Background. Ear infections in children are a major health problem and may be associated with hearing impairment and delayed language development. Objective. To determine the prevalence and the associated risk factors of ear infections in children 6–17 years old residing on two reserves and rural areas in the province of Saskatchewan. Methodology. Data were provided from two rural cross-sectional children studies. Outcome variable of interest was presence/absence of an ear infection. Logistic regression analysis was conducted to examine the relationship between ear infection and the other covariates. Results. The prevalence of ear infection was 57.8% for rural Caucasian children and 43.6% for First Nations children living on-reserve. First Nations children had a lower risk of ear infection. Ear infection prevalence was positively associated with younger age; first born in the family; self-reported physician-diagnosed tonsillitis; self-reported physician-diagnosed asthma; and any respiratory related allergy. Protective effect of breastfeeding longer than three months was observed on the prevalence of ear infection. Conclusions. While ear infection is a prevalent condition of childhood, First Nations children were less likely to have a history of ear infections when compared to their rural Caucasian counterparts.

Cancer incidence, morbidity, and survival in Canadian first nation children: a Manitoba population-based study from the cancer in young people in Canada (CYP-C) registry

BACKGROUND

Health disparities between Canadian First Nation (FN) people and the rest of the national population exist. No studies have specifically documented cancer-related health outcomes in Canadian FN children. The purpose of this study was to describe the incidence of pediatric malignancies in Manitoba FN children, and to compare morbidity patterns and survival between FN and non-FN children with cancer in the Canadian province of Manitoba.

PROCEDURE

A retrospective, population-based review of all children (0-14.99 years) diagnosed with malignancy (2001-2008) in Manitoba, Canada was undertaken using the Cancer in Young People in Canada registry. FN children were compared to the non-FN population for markers of morbidity and survival.

RESULTS

The average annual age-standardized incidence rate for all childhood cancers in FN children was 132 per 1,000,000 per year. 240 children were included in the morbidity and survival analyses (38 FN; 202 non-FN). No differences were found between FN and non-FN children in time from first presentation of symptoms to consultation with an oncology specialist or diagnosis, or number of hospital admissions / total days of admission for treatment complications. Overall survival was inferior for FN children in univariable analysis (P = 0.048) but not when risk group was included in a multivariable analysis (P = 0.15). No difference in event free survival or cumulative incidence of relapse was identified.

CONCLUSION

The estimated incidence of childhood cancers in the Manitoba FN population is similar to provincial incidence rates. No differences in morbidity patterns or survival were found between Manitoba FN and non-FN children with cancer.

Healthy Weights Interventions in Aboriginal Children and Youth: A Review of the Literature

There is evidence that Aboriginal children and youth in Canada and elsewhere are at higher risk of obesity and overweight than other children. However, there has been no review of healthy weights interventions specifically aimed at Aboriginal children. A structured search for peer-reviewed articles presenting and evaluating healthy weights interventions for Aboriginal children and youth was conducted. Seventeen articles, representing seven interventions, were reviewed to identify their main characteristics, evaluation design, and evaluation outcomes. Interventions included several large community-based programs as well as several more focused programs that all targeted First Nations or American Indians, rather than Métis or Inuit. Only 1 program served an urban Aboriginal population. None of the published evaluations reported significant reductions in obesity or overweight or sustained increases in physical activity, although some evaluations presented evidence of positive effects on children's diets or on nutrition knowledge or intentions. We conclude that broader structural factors affecting the health of Aboriginal children may limit the effectiveness of these interventions, and that more evidence is required regarding interventions for Aboriginal children in various geographic and cultural contexts in Canada including Inuit and Métis communities.

Prevalence and predictors of food allergy in Canada: a focus on vulnerable populations

BACKGROUND

Studies suggest that individuals of low education and/or income, new Canadians (immigrated <10 years ago), and individuals of Aboriginal identity may have fewer food allergies than the general population. However, given the difficulty in recruiting such populations (hereafter referred to as vulnerable populations), by using conventional survey methodologies, the prevalence of food allergy among these populations in Canada has not been estimated.

OBJECTIVES

To estimate the prevalence of food allergy among vulnerable populations in Canada, to compare with the nonvulnerable populations and to identify demographic characteristics predictive of food allergy.

METHODS

By using 2006 Canadian Census data, postal codes with high proportions of vulnerable populations were identified and households were randomly selected to participate in a telephone survey. Information on food allergies and demographics was collected. Prevalence estimates were weighted by using Census data to account for the targeted sampling. Multivariable logistic regression was used to identify predictors of food allergy.

RESULTS

Of 12,762 eligible households contacted, 5734 households completed the questionnaire (45% response rate). Food allergy was less common among adults without postsecondary education versus those with postsecondary education (6.4% [95% CI, 5.5%-7.3%] vs 8.9% [95% CI, 7.7%-10%]) and new Canadians versus those born in Canada (3.2% [95% CI, 2.2%-4.3%] vs 8.2% [95% CI, 7.4%-9.1%]). There was no difference in prevalence between those of low and of high income or those with and without Aboriginal identity.

CONCLUSION

Analysis of our data suggests that individuals of low education and new Canadians self-report fewer allergies, which may be due to genetics, environment, lack of appropriate health care, or lack of awareness of allergies, which reduces self-report.

Health research involving First Nations, Inuit and Métis children and their communities

Canadian and international guidelines address the ethical conduct of health research in general and the issues affecting Indigenous populations in particular. This statement summarizes, for clinicians and researchers, relevant ethical and practical considerations for health research involving Aboriginal children and youth. While not intended to duplicate findings arising from lengthy collaborative processes, it does highlight 'wise practices' that have successfully generated knowledge relevant to, respectful of and useful for Aboriginal children, youth and their communities. Further research on current health issues and inequities should lead to practical, effective and culturally relevant applications. Expanding our knowledge of ways to address the health disparities facing Canada's Aboriginal children and youth can inform health policy and the provision of services. Community-based participatory research is proposed as a means to achieve this goal.

Asthma education program for First Nations children: an exemplar of the knowledge-to-action framework

BACKGROUND

The prevalence of asthma in Aboriginal children is 6% to 14%. Gaps in knowledge regarding asthma and its management exist in First Nations (FN) communities, and culturally relevant education and resources are required. Studies have recommended that the children's asthma education program, the 'Roaring Adventures of Puff', be modified through partnership with FN communities to be culturally appropriate.

OBJECTIVE

To adapt this knowledge tool and design an effective implementation process for FN knowledge users (children with asthma and care providers), guided by the Canadian Institutes of Health Research knowledge translation framework.

METHODS

The problem was identified, knowledge was identified⁄reviewed⁄selected (literature review); knowledge was adapted to the local context (FN working and advisory groups); barriers to knowledge use were assessed (by knowledge users); and interventions were selected, tailored and implemented (modified curricula and the creation of a new activity book and web-based resources, and regional coordinators, asthma educator mentors and community teams were recruited).

RESULTS

Major outcomes were the adapted tools and blueprints for tailoring implementation. Additional outcomes were preliminary observations and outputs from the iterative processes, including information about local context and barriers. Specific additions were roles for community members supported by asthma educators (applying FN teaching models and addressing health care demands); relevant triggers (addressing knowledge gaps); and FN images and stories, themes of circle, sacred teachings, nature and family⁄elders (culture and addressing low reading levels).

CONCLUSION

The framework model provides a logical, valuable tool for adapting a knowledge tool and implementation process to new knowledge users. Future research should measure uptake, effect on health outcomes of FN asthma sufferers and sustainability.

Anthropometric measurements in Canadian children: a scoping review

OBJECTIVE

The objective of the current study was to identify what forms of anthropometric measurement are currently being utilized with Canadian children and youth and what are the gaps in the literature on this topic.

METHODS

The current study utilized a scoping review methodology in order to achieve the study objectives. Online databases Medline and PubMed and CINAHL were used to search articles from the last decade (2002-2012) that addressed Canadian children aged 2-18 years.

SYNTHESIS

50 studies were included in this review. A variety of anthropometric measurements were identified, including body mass index, waist circumference, hip-to-waist ratio, among others. Six of the included studies (12%) utilized nationally representative data from large-scale studies. BMI was the most reported form of measurement with 88% of studies collecting it. Waist circumference was a distant second with 20% of studies reporting it. Several gaps in the literature exist with regards to First Nations (FN) research; many of the measurement methods were not used. Additionally, FN accounted for only 2.5% of the study's sample. The majority of studies took place in Quebec (29%) and Ontario (27%).

CONCLUSION

Body mass index is the most reported method of anthropometric measurement used for children. Efforts should be taken by health care practitioners and researchers to collect other forms of measurement in order to assist in understanding the validity of other measures and their value when used with children. Furthermore, attention needs to be focused on utilizing and studying various forms of anthropometric measurement across all Canadian regions and populations.

Association of breastfeeding with asthma in young Aboriginal children in Canada

BACKGROUND

Few studies have investigated the factors associated with asthma in young Aboriginal children.

OBJECTIVE

To characterize the association of demographic, environmental and early life factors with asthma in young Aboriginal children in Canada.

METHODS

The 2006 Aboriginal Children's Survey was conducted among off-reserve Aboriginal children zero to six years of age to obtain information on Aboriginal children's development and well-being. The prevalence of asthma in Aboriginal children was obtained from the parental report of asthma as diagnosed by a health care professional.

RESULTS

The prevalence of reported asthma among off-reserve Aboriginal children zero to six years of age (n=14,170) was 9.4%. Asthma prevalence in both exclusively breastfed children (6.8%) and ever but not exclusively breastfed children (9.0%) was significantly lower than that in nonbreastfed children (11.0%). In the multiple logistic regression analysis, exclusive breastfeeding was protective of asthma compared with nonbreastfeeding (OR 0.59 [95% CI 0.44 to 0.78]). Older age groups, male sex, having two or more older siblings, low birth weight, day care attendance and ear infection were significant risk factors for asthma.

CONCLUSIONS

The prevalence of asthma among young Aboriginal children zero to six years of age living off reserve was slightly lower than that reported for all other Canadian children. Breastfeeding, especially exclusively breastfeeding, was protective of asthma in Aboriginal children, which is consistent with what has been observed in non-Aboriginal children in Canada. Public health interventions intended for reducing asthma incidence in young Aboriginal children should include breastfeeding promotion programs.

The health of Inuit children under age 6 in Canada

OBJECTIVES

Previous research has suggested that Inuit children experience poor health as compared to their non-Aboriginal counterparts, although social determinants such as family and social conditions, lifestyle or behaviour, and cultural factors may be at play. The purpose of the current study was to examine the parent-reported health of Inuit children under 6 years of age living in Canada.

STUDY DESIGN AND METHODS

Data from the 2006 Aboriginal Children's Survey were used to examine measures of Inuit child health as rated by parents including child health, limitations to physical activity, chronic conditions, ear infections, and dental problems. Associations between social determinants of health and parent-rated Inuit child health were also explored.

RESULTS

Most Inuit children under age 6 were reported by their parents or guardians to be in excellent or very good health. The most common chronic conditions identified were asthma, speech and language difficulties, allergies, lactose intolerance, and hearing impairment. Several social determinants of health were associated with child health, including parental education, household income, breastfeeding, and perceived housing conditions.

CONCLUSIONS

The findings show that social determinants of health, including both socio-economic and household characteristics, are associated with Inuit child health.

Being useful: achieving indigenous youth involvement in a community-based participatory research project in Alaska

Objectives

To report on a participatory research process in southwest Alaska focusing on youth involvement as a means to facilitate health promotion. We propose youth-guided community-based participatory research (CBPR) as way to involve young people in health promotion and prevention strategizing as part of translational science practice at the community-level.

Study design

We utilized a CBPR approach that allowed youth to contribute at all stages.

Methods

Implementation of the CBPR approach involved the advancement of three key strategies including: (a) the local steering committee made up of youth, tribal leaders, and elders, (b) youth-researcher partnerships, and (c) youth action-groups to translate findings.

Results

The addition of a local youth-action and translation group to the CBPR process in the southwest Alaska site represents an innovative strategy for disseminating findings to youth from a research project that focuses on youth resilience and wellbeing. This strategy drew from two community-based action activities: (a) being useful by helping elders and (b) being proud of our village.

Conclusions

In our study, youth informed the research process at every stage, but most significantly youth guided the translation and application of the research findings at the community level. Findings from the research project were translated by youth into serviceable action in the community where they live. The research created an experience for youth to spend time engaged in activities that, from their perspectives, are important and contribute to their wellbeing and healthy living. Youth-guided CBPR meant involving youth in the process of not only understanding the research process but living through it as well.

Overweight and obesity among North American Indian infants, children, and youth

The frequency of overweight and obesity among North American Indian children and youth exceeds that of other ethnic groups in the United States. This observation is based on studies using body mass index as the primary measure of overweight and obesity. In the mid-20th century, there were regional differences among North American Indian groups in sub-adults' size and shape and only a few Southwestern groups were characterized by high rates of overweight and obesity. In most populations, the high prevalence of overweight and obesity developed in the last decades of the 20th century. Childhood obesity may begin early in life as many studies report higher birth weights and greater weight-for-height in the preschool years. Contributing factors include higher maternal weights, a nutritional transition from locally caught or raised foods to store bought items, psychosocial stress associated with threats to cultural identity and national sovereignty, and exposure to obesogenic pollutants, all associated to some degree with poverty. Obesity is part of the profile of poor health among Native Americans in the US and Canada, and contributes to woefully high rates of diabetes, cardiovascular disease, and early mortality. Interventions that are culturally appropriate are needed to reduce weights at all points in the lifespan.