First Nations and Inuit mental health and the Non-Insured Health Benefits program: Urgent priorities for evaluation

The mental health needs and disparities facing First Nations and Inuit in Canada far exceed those of the general population and yet accessing culturally safe care remains a serious challenge. One means for accessing mental health care is through the Non-Insured Health Benefits (NIHB) mental health counselling program run by Indigenous Services Canada. However, evaluations of the efficacy of the NIHB's mental health counselling program remain entirely absent in the academic literature and this is startling given that this program receives significant federal funding to care for a population that experiences extreme marginalization. The following commentary will present three challenges observed with the present state of the program in the areas of service accessibility, the need for an Indigenous mental health workforce, and culturally safe care. For each challenge presented, we make recommendations on how to improve the program in its current state. The conclusion of this article advocates for a broader evaluation of the NIHB mental health counselling program from the perspective of its service users and its registered mental health professionals. This type of evaluation is commensurate with the Calls to Action outlined by the Truth and Reconciliation Commission of Canada.

Sociocultural factors in relation to mental health within the Inuit population of Nunavik

OBJECTIVE

Built on the Inuit determinants approach of health, this study aimed to identify sociocultural factors associated with mental health among Inuit of Nunavik to guide programs and services.

METHODS

The data were collected through the Qanuilirpitaa? 2017, a survey characterized by the involvement of several Inuit representatives. Depressive symptoms (10-item Center for Epidemiologic Studies-Depression scale, CES-D), lifetime suicide ideation and attempts, and past-year ideation were self-reported mental health indicators. Sociocultural factors represented four thematic domains: social support, community activities, traditional practices, and cultural identity. Analyses tested whether the sociocultural factors were associated with indicators of mental health using weighted multivariate regressions.

RESULTS

Among the sociocultural factors considered, family cohesion and weekly hunting/fishing activities were associated with lower depression scores. Community cohesion and lower cultural identity (centrality scale) were associated with a lower likelihood of past-year and lifetime ideation while family cohesion was related to a lower likelihood of lifetime attempts. People with psychological distress (higher CES-D, suicidal ideation or attempts) were more likely to participate in healing and wellness activities.

CONCLUSION

Although limited by their cross-sectional character, these analyses, based on the community component of the Qanuilirpitaa?, suggest that strengthening of family and community cohesion, and support of regular hunting and fishing deserve further attention as potential cumulative preventive avenues for Inuit mental health.

No time to grieve: Inuit loss experiences and grief practices in Nunavik, Quebec

This article presents an overview of past and current grief rituals and practices and existing grassroots and institutional initiatives seeking to address the complex, prolonged, and traumatic grief experienced by many Inuit living in Quebec. While conducting a study seeking to identify the strengths, resources, and challenges for Nunavik's Inuit communities related to end-of-life care, results emerged concerning how family caregivers' grief related to the dying process was compounded by the sequelae of historic loss experiences (e.g., losses related to Canada's federal policies, including residential schools, forced relocations, and dog slaughters) and by present loss experiences (e.g., tragic and sudden deaths in local communities). To better support caregivers, an understanding of these grief experiences and a vision of bereavement care inclusive of community mobilization efforts to develop bereavement training and support is needed. We conclude with a discussion of a community capacity approach to bereavement care.

How is Etuaptmumk/Two-Eyed Seeing characterized in Indigenous health research? A scoping review

Our scoping review sought to consider how Etuaptmumk or Two-Eyed Seeing is described in Indigenous health research and to compare descriptions of Two-Eyed Seeing between original authors (Elders Albert and Murdena Marshall, and Dr. Cheryl Bartlett) and new authors. Using the JBI scoping review methodology and qualitative thematic coding, we identified seven categories describing the meaning of Two-Eyed Seeing from 80 articles: guide for life, responsibility for the greater good and future generations, co-learning journey, multiple or diverse perspectives, spirit, decolonization and self-determination, and humans being part of ecosystems. We discuss inconsistencies between the original and new authors, important observations across the thematic categories, and our reflections from the review process. We intend to contribute to a wider dialogue about how Two-Eyed Seeing is understood in Indigenous health research and to encourage thoughtful and rich descriptions of the guiding principle.

Altered functional activations of prefrontal brain areas during emotional processing of fear in Inuit adolescents exposed to environmental contaminants

Exposure to mercury, lead and polychlorinated biphenyls (PCBs) have been associated with emotional dysregulation, but their neuronal correlates have yet to be examined. Inuit from Nunavik (Northern Quebec, Canada) face internalizing problems and are among the most exposed individuals to these environmental contaminants in the world. The aim of this study was to examine the link between pre- and postnatal exposure to these contaminants and brain fear-circuitry in Inuit adolescents. Facial expression stimuli were presented to participants (mean age = 18.3 years) in a magnetic resonance imaging (MRI) scanner. Fear conditioning and extinction tasks included neutral faces as the conditioned threat and safety cues and a fearful face paired with a shrieking scream as the unconditioned stimulus. Functional MRI data were gathered at the conditioning phase (n = 71) and at the extinction phase (n = 62). Mercury, lead and PCB 153 concentrations were measured in blood samples at birth (cord blood) and at the time of the adolescent testing to estimate pre- and postnatal exposure, respectively. For each time point, exposures were categorized in tertiles (low, moderate and high exposed groups). Mixed analyses of variance were conducted for each contaminant of interest controlling for sex, age, socioeconomic status, drug/alcohol use, food insecurity and contaminant co-exposure. Results revealed greater differential activation during the conditioning phase in the right orbitofrontal cortex in participants with moderate and high concentrations of cord blood PCB 153 compared to those in the low exposure group. During the extinction phase, the high prenatal mercury exposed group showed a lower differential activation in the right and left anterior cingulate cortex compared to those in the low-exposed group; whereas there was a higher differential activation in right dorsolateral prefrontal cortex in the high postnatal lead exposed group compared to the moderate- and low-exposed groups. Our study is the first to show alterations in the prefrontal brain areas in fear conditioning and extinction tasks in relation to environmental contaminant exposures. The observed brain correlates may advance our understanding of the emotional problems associated with environmental chemical toxicity.

Reproductive health interventions for Inuit youth in the north: a scoping review

BACKGROUND

Inuit have thrived in the northern regions of Canada and Alaska for thousands of years. Recent evidence suggests that Inuit in this region have experienced systemic barriers to reproductive health with resulting disparities in reproductive health-related outcomes including those among youth. Northern youth-focused reproductive health intervention research or evaluations have not to date been well summarized. The objective of this scoping review was to summarize the literature over the past twenty years focusing on reproductive health interventions for adolescents in northern Inuit communities.

METHODS

English-language articles from 2000 to 2020 were identified from seven scientific databases, a general internet search and a review of relevant websites. Two reviewers screened titles, abstracts and full texts and included articles if they mentioned a reproductive health intervention and pertained, directly or indirectly, to reproductive health for Inuit aged 10-19 in northern communities.

RESULTS

Seventeen articles met the inclusion criteria, across six themes: (1) Barriers to reproductive health interventions in the north; (2) Northern midwifery; (3) Northern birthing centres; (4) Fetal fibronectin tests for identifying high-risk pregnancies; (5) Prenatal education classes; and (6) Interventions to improve access to and quality of reproductive health supports.

CONCLUSION

Overall there is relatively limited evidence base specific to reproductive health interventions and northern Inuit youth. What does exist largely focuses on maternal health interventions and is inclusive of but not specific to youth. There is some evidence that youth specific educational programs, participatory action research approaches and the promotion of northern birthing centres and midwifery can improve reproductive health for adolescents and young mothers in northern Inuit communities. Future initiatives should focus on the creation and evaluation of culturally relevant and youth specific interventions and increasing community and youth participation in intervention research for better reproductive health.

Inuit knowledge of Arctic Terns (Sterna paradisaea) and perspectives on declining abundance in southeastern Hudson Bay, Canada

The Arctic Tern (Sterna paradisaea; takatakiaq in Inuttitut) breeds in the circumpolar Arctic and undertakes the longest known annual migration. In recent decades, Arctic Tern populations have been declining in some parts of their range, and this has been a cause of concern for both wildlife managers and Indigenous harvesters. However, limited scientific information is available on Arctic Tern abundance and distribution, especially within its breeding range in remote areas of the circumpolar Arctic. Knowledge held by Inuit harvesters engaged in Arctic Tern egg picking can shed light on the ecology, regional abundance and distribution of this marine bird. We conducted individual interviews and a workshop involving 12 Inuit harvesters and elders from Kuujjuaraapik, Nunavik (northern Québec), Canada, to gather their knowledge of Arctic Tern cultural importance, ecology, and stewardship. Interview contributors reported a regional decline in Arctic Tern numbers which appeared in the early 2000s on nesting islands near Kuujjuaraapik. Six possible factors were identified: (1) local harvest through egg picking; (2) nest disturbance and predation; (3) abandonment of tern nesting areas (i.e., islands that have become connected to the mainland due to isostatic rebound); (4) climate change; (5) natural abundance cycles within the Arctic Tern population; and (6) decline of the capelin (Mallotus villosus) in the region. Recommendations from Inuit contributors related to Arctic Tern stewardship and protection included: (1) conduct more research; (2) let nature take its course; (3) conduct an awareness campaign; (4) implement an egg picking ban; (5) coordinate local egg harvest; (6) start ‘tern farming’; (7) protect Arctic Terns across their migration route; and (8) harvest foxes predating on terns. Our study highlighted complementarities between Inuit knowledge and ecological science, and showed that Inuit harvesters can make substantial contributions to ongoing and future Arctic tern research and management initiatives.

Aging, Health and Place from the Perspective of Elders in an Inuit Community

This paper explores perspectives of Inuit elders on the relationships between aging, health and place. Their views are important to consider in the context of a growing proportion and number of older people in Arctic communities, a new sociological condition. Developing policies and programs to promote healthy aging in Inuit communities is challenging as there is little known about the social and living conditions that promote healthy aging in the Arctic. In this study twenty Inuit aged between 50 to 86, from one community in Nunavut, participated to in-depth qualitative interviews. Themes discussed included aging and health, housing conditions, community conditions, land-based activities, medical and leisure travel outside of the community, and mobility and accessibility. Preliminary analyses of the qualitative data were validated in the community through a focus group with four participants and an interpreter. Interviews and the focus group transcripts were analysed using thematic content analyses and NVivo 12 qualitative data analysis program (QSR International Pty Ltd. 2017). Participants reported that spending time with children, having social support, living in houses adapted to aging health conditions, having access to community activities and services, and time spent on the land were the main resources supporting their health. Several factors limited the availability of these resources. These include: lack of accessibility to resources; structural factors impacting their availability; and natural and social changes in interpersonal relationships. Participants also stressed the importance of being able to grow old in their own community. Knowledge generated in this project contributes to policies and programs targeting housing and community conditions to support healthy aging, and aging in place, in Inuit Nunangat.

The social determinants of healthy ageing in the Canadian Arctic

A better knowledge of the social determinants of health (SDH) promoting healthy ageing in Inuit communities is needed to adapt health and social policies and programs. This study aims to identify SDH associated with healthy ageing. Using the 2006 Aboriginal Peoples Survey (n = 850 Inuit aged ≥50 years), we created a holistic indicator including multiple dimensions of health and identified three groups of participants: those in 1) good 2) intermediate and 3) poor health. Sex and age-adjusted multinomial regression models were applied to assess the associations between this indicator and SDH measured at the individual, household and community scales. In comparison to APS respondents in the "Poor health" profile, those in the "Good health" profile were more likely to have a higher individual income, to participate in social activities, and to have stronger family ties in the community ; those in the "Intermediate health" profile were less likely be in a relationship, more likely to live in better housing conditions, and in better-off communities. Results indicate that SDH associated with the "Good health" profile related more to social relationships and participation, those associated with the "Intermediate health" profile related more to economic and material conditions.

Exploring Community Mobilization in Northern Quebec: Motivators, Challenges, and Resilience in Action

Nunavimmiut (people of the land) are the Indigenous peoples of the northern peninsula of the province of Quebec. Communities of Nunavik and its regional organizations have been making concerted efforts in implementing community-based strategies to support family wellbeing. These community strategies are grounded in many of the values underpinning community psychology: favoring empowerment-oriented approaches, fostering community capacity, and transforming organizational cultures to allow for new modes of interaction, as well as new policies and practices that are grounded in community and culture. Despite the growing support and expectation for community mobilization, there is still very little research on the processes and challenges to such mobilization. In this study, we explored the unique challenges and facilitators to community endeavors in northern Quebec in order to better understand the complex dynamics and the strengths that Inuit build upon. We first used a focused ethnographic approach in the context of a 5-year community mobilization project in Nunavik. We then conducted 12 individual interviews and two small group interviews with Inuit working on community-based wellbeing-oriented mobilization projects in four additional communities. Results expose how sociogeographical realities and colonialism influence the process of community mobilization. They also highlight the values and motivational factors that lead community members to move beyond these influences.

Environmental and Motivational Determinants of Physical Activity among Canadian Inuit in the Arctic

Background: Canadian Inuit have transited from a physically active hunter-gatherer subsistence lifestyle into sedentary ways of life. The purpose of the current study was to measure physical activity levels among Nunavut Inuit adults, and explore the socio-cognitive and environmental factors influencing the number of steps taken per day. Method: Inuit and non-Inuit adults (N = 272) in Nunavut participated in a seven-day pedometer study during summer and winter seasons. Participants were asked to complete the Neighbourhood Environmental Walkability Scale (NEWS) and Behavioral Regulation in Exercise Questionnaire (BREQ-3). Data analyses included descriptive statistics, hierarchical linear regression, and tests of mediation effects. Results: Participants had limited to low activity at a rate of 5027 ± 1799 and 4186 ± 1446 steps per day, during summer and winter, respectively. There were no seasonal and age effects on the number of steps. Gender effects and community differences were observed. Perceived infrastructure and safety as well as land use mix diversity were found to be positive environmental correlates of steps taken, which were partially mediated by identified motivational regulation. Conclusion: Physical activity levels among Nunavut adults are generally low, but can be promoted by improving the external physical environment and internal motivational regulation.

Provision of comprehensive, culturally competent palliative care in the Qikiqtaaluk region of Nunavut: Health care providers' perspectives

OBJECTIVE

To explore health care providers' perceptions of the provision of palliative care in the Qikiqtaaluk (formerly known as Baffin) region of Nunavut.

DESIGN

An exploratory, qualitative, cross-sectional design using in-depth, semistructured interviews.

SETTING

Qikiqtaaluk region of Nunavut.

PARTICIPANTS

Seven physicians and 6 registered nurses who worked in Iqaluit or other northern Inuit communities in the Qikiqtaaluk region of Nunavut.

METHODS

Thirteen health care providers participated in in-person or telephone semistructured interviews, which were audiorecorded and transcribed verbatim.

MAIN FINDINGS

Interviews with the participating health care providers in the Qikiqtaaluk region of Nunavut revealed 5 complex and interwoven themes that influence the provision of comprehensive, culturally competent palliative care services to Indigenous patients: respecting Inuit culture, end-of-life care planning, and the role of family; recognizing the importance of the northern community (sense of home); being aware of the limited health care resources; recognizing the critical role of medical interpreters; and improving the quality of palliative care programs and resources, as well as health care provider training in palliative care and Inuit end-of-life care.

CONCLUSION

Health care providers in the Qikiqtaaluk region of Nunavut have identified several important themes that influence the provision of culturally sensitive and comprehensive palliative care, most notably the need to develop palliative care resources and programs. It is hoped that the results of this study can be used to help guide palliative care strategies including program development and educational initiatives for health care providers. These initiatives can help build community capacity within a currently underserviced population and improve end-of-life care services available to Nunavut patients and their families. Further studies are required to determine the perspectives of medical interpreters, as well as palliative care patients and their families.

Understanding the Connections Between Dogs, Health and Inuit Through a Mixed-Methods Study

Dogs have been an integral part of the Inuit social and cultural environment for generations, but their presence also generates public health risks such as bites and exposure to zoonotic diseases such as rabies. In Nunavik, Canada, some prevention and control interventions targeting dogs have been implemented but have not demonstrated their effectiveness in a long-term sustainable perspective. This study was conducted in one Inuit community of Nunavik and used mixed methods to get a better understanding of factors that affect human and dog health, dog-related risks for humans and perceptions of dogs in Inuit communities using an interdisciplinary perspective in line with the Ecohealth approach. Results unveiled different perceptions and practices between Inuit and non-Inuit members of the community with regard to dogs and highlighted the positive role of dogs and their importance for Inuit health and well-being. This study provides new knowledge that is crucial for the development of integrated, sustainable and culturally adapted solutions to both the mitigation of dog-related health risks and the reinforcement of health and wellness benefits of dogs for Inuit.

Psychometric validation of the household food insecurity access scale among Inuit pregnant women from Northern Quebec

Background

Globally, food insecurity is a major public health concern. In North America, it is particularly prevalent in certain sub-groups, including Indigenous communities. Although many Indigenous and remote communities harvest and share food, most food security assessment tools focus on economic access. This study describes the psychometric evaluation of a modified Household Food Insecurity Access Scale (HFIAS), developed for mixed economies, to assess food insecurity among pregnant Inuit women.

Methods

The HFIAS was administered to 130 pregnant women in Nunavik (Arctic region of Quebec), Canada. Data were fit to a Rasch Rating Scale Model (RSM) to determine the discrimination ability of the HFIAS. Person parameter (Theta) estimates were calculated based on the RSM to provide a more accurate scoring system of the modified HFIAS for this population. Theta values were compared to known correlates of food insecurity.

Results

Comparative fit indices showed preference for a modified version of the HFIAS over the original. Theta values displayed a continuum of severity estimates and those values indicating greater food insecurity were consistently linked to known correlates of food insecurity. Participants living in households with more than 1 hunter (Theta = -.45) or more than 1 fisher (Theta = -.43) experienced less food insecurity than those with no hunters (Theta = .48) or fishers (Theta = .49) in their household. The RSM indicated the scale showed good discriminatory ability. Subsequent analyses indicated that most scale items pertain to the classification of a household as moderately food insecure.

Conclusions

The modified HFIAS shows potential for measuring food insecurity among pregnant women in Nunavik. This is an efficient instrument that can inform interventions targeting health conditions impacting groups that obtain food through both monetary and non-monetary means.

From respect to rights to entitlement, blocked aspirations and suicidal behavior

Dr. Bill Richards was a noted psychiatrist who worked with Alaska Native people for many years. This paper was taken from notes he used for a slide presentation at a conference. In it, he discussed the possible relationship between rapid social change and the increasing rates of suicide among northern people. He summarized the limitations in the existing suicide data, including its essentially descriptive nature, the short time periods of study, small numbers of observations and lack of complete health service use information which could help anticipate a suicidal event. Richards noted the importance of suicide as an indicator condition that could be used to link social survey and health information data bases. He closed his paper with a discussion of the transition from an era of "rights" to one of "entitlements," and described his observations of growing overt anger and hostile dependency upon government programs. Last, Richards related his concerns over the collection of health service use and epidemiological data associated with a suicidal event.

Arctic Peoples and Beyond: research opportunities in neuroscience and behaviour

OBJECTIVES

Arctic and northern peoples are spread across Alaska, Canada, Russia and the Scandinavian countries. Inhabiting a variety of ecosystems, these 4 million residents include Indigenous populations who total about 10% of the population. Although Arctic peoples have very diverse cultural and social systems, they have health issues related to environmental impacts and knowledge/treatment disparities that are common to other minority and Indigenous peoples around the world. Research that explores the neuroscience and behavioural aspects of these health disparities offers challenges and significant opportunities. As the next generation of neuroscientists enter the field, it is imperative that they view their contributions in terms of translational medicine to address health disparities.

STUDY DESIGN

A workshop was designed to bring neuroscientists together to report on the current directions of neuroscience research and how it could impact health disparities in the North. This workshop produced research recommendations for the growth of neuroscience in the North.

METHODS

On May 31, 2006 the National Institute of Neurological Disorders and Stroke, the Burroughs Wellcome Foundation, the Arctic Division of AAAS and the University of Alaska co-sponsored a workshop entitled "Arctic Peoples and Beyond: Decreasing Health Disparities through Basic and Clinical Research." Also, the role and goals of the International Union for Circumpolar Health (IUCH) were presented at the meeting.

RESULTS

A set of recommendations related to research opportunities in neuroscience and behaviour research and ways to facilitate national and international partnerships were developed.

CONCLUSIONS

These recommendations should help guide the development of future health research in circumpolar neuroscience and behaviour. They provide ideas about research support and informational exchange that will address health challenges.

Youth and adult community member beliefs about Inupiat youth suicide and its prevention

OBJECTIVES

To better understand youth and adult community members' perceived causes and possible preventative steps to address the high Inupiat youth suicide rates in Northwest Alaska.

STUDY DESIGN

A five-item, open-ended survey focusing on community members' perceptions of suicide causes, warning signs, and protective factors was administered in the twelve Native villages served by the Maniilaq Association, a native non-profit organization.

METHODS

A total of 382 surveys were completed. Qualitative answers were assigned to categories by two reviewers. Main categories are described reflecting the percentages of all response categories and those of youth and adult respondents. To discern whether the difference in proportion between adult and youth respondents was significant, a two-tailed z test was used to compare the two category proportions with their respective sample sizes.

RESULTS

The results showed that villagers believe that a community-based approach is most beneficial. Many risk factors for suicide were associated with alienation, and prevention strategies were linked to increased communication and connection with others, their culture and spirituality. The results also show that different perspectives are held by adults and youth. Adult respondents identified boredom as the primary reason for suicide. This--according to adult survey responses--can be addressed through programs offering young people activities, education, and a sense of culture. In contrast, the majority of young people attribute suicide to stress. The young respondents answers highlight the need for adults to talk to them about their everyday lives and their futures so that they receive the guidance and support they need to navigate difficulties that arise.

CONCLUSIONS

These differing adult and youth conceptions of youth suicide prevention need to be aligned in order to create effective youth suicide prevention strategies for Inupiat and other Native populations.

Stress, coping, and well-being among the Yup`ik of the Yukon-Kuskokwim Delta: the role of enculturation and acculturation

OBJECTIVES

To report on the relationships between cultural identity and stress, coping, and psychological well-being in Yup'ik communities.

STUDY DESIGN

A quantitative self-administered questionnaire.

METHODS

A health and wellness survey was completed by a total of 488 Yup'ik participants (284 women and 204 men) from 6 rural villages in the Yukon-Kuskokwim Delta region. Respondents were fairly equally distributed across an age range of 14 to 94 (mean +/- SD = 38.50 +/- 17.18).

RESULTS

Participants who reported living more of a Kass'aq way of life (greater acculturation) reported experiencing greater psychosocial stress, less happiness, and greater use of drugs and alcohol to cope with stress. Participants who reported identifying more with a traditional Yup'ik way of life reported greater happiness, more frequent use of religion and spirituality to cope with stress, and less frequent use of drugs and alcohol to cope with stress.

CONCLUSIONS

In conjunction with previous research, the data strongly indicates that in general, Yup'ik people in the Y-K Delta tend to associate stress and negative health outcomes with the process of acculturation, and health and healing with the process of enculturation. Research that focuses on documenting the intrinsic strengths of indigenous worldviews may contribute to positive transformations in community health.

Youth perspectives on sexually transmitted infections and sexual health in Northern Canada and implications for public health practice

OBJECTIVE

High rates of sexually transmitted infections in the Arctic have been a focus of recent research, and youth are believed to be at greatest risk of infection. Little research has focused on understanding youth perspectives on sexual health. The goal of this study was to collect the perspectives of youth in Nunavut on sexual health and relationships with the intent of informing public health practice.

METHOD

This qualitative research study was conducted within an Indigenous knowledge framework with a focus on Inuit ways of knowing. Data were collected through face-to-face interviews in three Nunavut communities with 17 youth between the ages of 14 and 19 years. Participants were asked open-ended questions about their experiences talking about sexual health and relationships with their family, peers, teachers or others in the community.

RESULTS

There are four key findings, which are important for public health: (a) Parents/caregivers are the preferred source of knowledge about sexual health and relationships among youth respondents; (b) youth did not report using the Internet for sexual health information; (c) youth related sexual decision-making to the broader community context and determinants of health, such as poverty; and (d) youth discussed sexual health in terms of desire and love, which is an aspect of sexual health often omitted from the discourse.

IMPLICATIONS AND CONTRIBUTION

The youth in this study articulated perspectives on sexual health, which are largely neglected in current public health practice in the North. The findings from this study underscore the important role of community-led participatory research in contributing to our understanding of the public health challenges in our communities today, and provide direction for future interventions and research.

"Symptoms of something all around us": Mental health, Inuit culture, and criminal justice in Arctic communities in Nunavut, Canada

RATIONALE

Rehabilitation-oriented criminal court mental health initiatives to reduce the number of people with mental illness caught in the criminal justice system exist in many North American cities and elsewhere but not in the mainly Inuit Canadian Arctic territory of Nunavut.

OBJECTIVE

This study explores whether the therapeutic aims of these resource-intensive, mainly urban initiatives can be achieved in criminal courts in Nunavut's resource constrained, culturally distinct and geographically remote communities.

METHOD

A qualitative multiple-case study in the communities of Iqaluit, Arviat and Qikiqtarjuaq involved 55 semi-structured interviews and three focus groups with participants representing four sectors essential to these initiatives: justice, health, community organizations and community members. These interviews explored whether the therapeutic jurisprudence (TJ) principles that guide criminal court mental health initiatives and the component objectives of these principles could be used to improve the criminal court response to people with mental illness in Nunavut.

RESULTS

Interviews revealed 13 themes reflecting perceptions of Inuit culture's influence on the identification of people with mental illness, treatment, and collaboration between the court and others. These themes include cultural differences in defining mental illness, differences in traditional and contemporary treatment models, and the importance of mutual cultural respect.

CONCLUSION

The findings suggest Inuit culture, including its recent history of cultural disruption and change, affects the vulnerability of Nunavut communities to the potential moral and legal pitfalls associated with TJ and criminal court mental health initiatives. These pitfalls include the dominance of biomedical approaches when identifying a target population, the medicalization of behaviour and culture, the risk of "paternalism" in therapeutic interventions, and shortcomings in interdisciplinary collaboration that limit considerations of Inuit culture. The pitfalls are not fatal to efforts to bring the rehabilitative benefits of these initiatives to Nunavut, but they require careful vigilance when employing TJ principles in an Indigenous circumpolar context.

Developing and Field Testing a Community Based Youth Initiative to Increase Tuberculosis Awareness in Remote Arctic Inuit Communities

BACKGROUND

Inuit in Canada have the highest reported tuberculosis (TB) incidence rate in Canada, even higher than other Canadian Indigenous groups. The aim of this study was to increase TB awareness among Inuit youth and their communities by equipping those who can best reach this population with a community based, youth focused, education initiative built on interventions adapted from a previous TB awareness study.

METHODS

The Taima TB Youth Education Initiative was a field test case study of a knowledge translation (KT) strategy aimed at community members who provide health education in these communities. In the first stage of this study, interventions from a larger TB awareness campaign were adapted to focus on youth living in remote Inuit communities. During the second stage of the study, investigators field tested the initiative in two isolated Inuit communities. It was then applied by local implementation teams in two other communities. Evaluation criteria included feasibility, acceptability, knowledge uptake and health behavior change.

RESULTS

Implementation of the adapted KT interventions resulted in participation of a total of 41 youth (19 females, 22 males) with an average age of 16 years (range 12-21 years) in four different communities in Nunavut. Community celebration events were attended by 271 community members where TB messaging were presented and discussed. All of the health care workers and community members surveyed reported that the adapted interventions were acceptable and a useful way of learning to some extent. Knowledge uptake measures indicated an average TB knowledge score of 64 out of 100. Local partners in all four communities indicated that they would use the Taima TB Youth Education Initiative again to raise awareness about TB among youth in their communities.

CONCLUSIONS

The TB awareness interventions adapted for the Taima TB Youth Education Initiative were acceptable to the Inuit communities involved in the study. They resulted in uptake of knowledge among participants. Implementation by local implementation teams was feasible as evidenced by the participation and attendance of youth and community members in all communities. The ability to implement the interventions by local implementation teams indicates there is potential to scale up in other remote communities in the arctic setting.

Female Sterilization and Poor Mental Health: Rates and Relatedness among American Indian and Alaska Native Women

OBJECTIVE

To describe the reproductive and mental health of American Indian and Alaska Native (AI/AN) women, an understudied population.

METHODS

Data from the 2004 Behavioral Risk Factor Surveillance System survey were analyzed to determine the 1) prevalence of female sterilization among a nationally representative sample of reproductive age AI/AN women and 2) the association of female sterilization and poor mental health among AI/AN women compared with non-Hispanic White, non-Hispanic Black, and Hispanic women.

RESULTS

Nearly 25% of AI/AN women reported female sterilization, a prevalence higher than the comparison racial/ethnic groups (p < .005). Adjusting for sociodemographic characteristics, AI/AN women reporting female sterilization had nearly 2.5 times the odds of poor mental health compared with AI/AN women not reporting female sterilization (p = .001). The same magnitude of relationship between female sterilization and poor mental health was not found for non-Hispanic White, non-Hispanic Black, and Hispanic women.

CONCLUSIONS

The prevalence of female sterilization is greater among AI/AN women compared with non-Hispanic White, non-Hispanic Black, and Hispanic women, and AI/AN women reporting female sterilization have higher odds of reporting poor mental health. Common cultural experiences, such as a shared ancestral history of forced sterilizations, may be relevant, and could be considered when providing reproductive and mental health services to AI/AN women.

Couples Counseling for Aboriginal Clients Following Intimate Partner Violence: Service Providers' Perceptions of Risk

Interventions for family violence in Aboriginal communities should take a culture-based approach and focus on healing for the whole family. The purpose of this research was to identify risk issues from the perspective of service providers for couples counseling with Aboriginal clients following intimate partner violence. A total of 25 service providers participated in over the phone interviews concerning risk with Aboriginal men in couple counseling. Five concepts emerged including (a) collaterals, (b) commitment to change, (c) violence, (d) mind-set, and (e) mental health. It was concluded that culturally competent interventions should involve the entire community and have a restorative approach. The concepts were compared and contrasted with the available literature.

Validation of the 10-item Kessler Psychological Distress Scale (K10) in the 2012 Aboriginal Peoples Survey

BACKGROUND

The 10-item Kessler Psychological Distress Scale (K10) is a short measure of non-specific psychological distress, which has been shown to be a sensitive screen for the Diagnostic and Statistical Manual of Mental Disorders criteria for anxiety and mood disorders. The scale has yet to be validated as a measure of psychological distress for Aboriginal peoples in Canada.

DATA AND METHODS

Using the 2012 Aboriginal Peoples Survey (APS), this study examined the psychometric properties of the K10 for First Nations people living off reserve, Métis, and Inuit aged 15 or older. The factor structure and internal consistency of the K10 were examined via confirmatory factor analysis and Cronbach's alpha, respectively. Descriptive statistics by sex, education, household income, and age group were provided for the scale. K10 construct validity was further assessed by examining associations with mental health variables in the 2012 APS: self-rated mental health, self-reported diagnosed mood and anxiety disorders, and self-reported suicidal ideation in the past 12 months.

RESULTS

A unidimensional "Distress" model with correlated errors was a good fit to the data. Cronbach's alpha values were satisfactory. K10 mean scores were positively skewed, with most respondents reporting few or no distress symptoms. Females and respondents with lower education and household income levels had significantly higher distress. Respondents aged 55 or older had significantly lower distress than their younger counterparts. K10 mean scores were significantly higher for respondents who reported poor mental health, a diagnosed mood disorder, a diagnosed anxiety disorder, or suicidal ideation in the past 12 months. Results were consistent across all three Aboriginal groups.

INTERPRETATION

Based on the 2012 APS, the total score of the K10 appears to be psychometrically sound for use as a broad measure of non-specific psychological distress for First Nations people living off reserve, Métis, and Inuit.

What all students in healthcare training programs should learn to increase health equity: perspectives on postcolonialism and the health of Aboriginal Peoples in Canada

BACKGROUND

The ongoing role of colonialism in producing health inequities is well-known. Postcolonialism is a theoretical approach that enables healthcare providers to better understand and address health inequities in society. While the importance of postcolonialism and health (PCH) in the education of clinicians has been recognized, the literature lacks guidance on how to incorporate PCH into healthcare training programs. This study explores the perspectives of key informants regarding content related to PCH that should be included in Canadian healthcare training programs, and how this content should be delivered.

METHODS

This qualitative study involved in-depth, semi-structured interviews with nineteen individuals with insight into PCH in Canada. Data were analyzed collaboratively to identify, code and translate key emergent themes according to the six phases of the DEPICT method.

RESULTS

Three themes emerged related to incorporating PCH into Canadian healthcare training programs: (1) content related to PCH that should be taught; (2) how this content should be delivered, including teaching strategies, who should teach this content and when content should be taught, and; (3) why this content should be taught. For the Canadian context, participants advised that PCH content should include a foundational history of colonization of Aboriginal Peoples in Canada, how structures rooted in colonialism continue to produce health inequities, and how Canadian clinicians' own experiences of privilege and oppression affect their practice. Participants also advised that this content should be integrated longitudinally through a variety of interactive teaching strategies and developed in collaboration with Aboriginal partners to address health inequities.

CONCLUSIONS

These findings reinforce that clinicians and educators must understand health and healthcare as situated in social, political and historical contexts rooted in colonialism. Postcolonialism enables learners to understand and respond to how colonialism creates and sustains health inequities. This empirical study provides educators with guidance regarding PCH content and delivery strategies for healthcare training programs. More broadly, this study joins the chorus of voices calling for critical reflection on the limits and harms of an exclusively Western worldview, and the need for action to name and correct past wrongs in the spirit of reconciliation and justice for all.

Impact of Inuit customary adoption on behavioral problems in school-age Inuit children

A large proportion of Inuit children in Arctic Quebec are adopted in accordance with traditional Inuit customs. In contrast to adoptions in Southern Canada and the United States, the child is adopted at birth and by a close family member; he or she knows who his or her biological parents are, and will typically have contact with them. Studies of other populations have reported an increased incidence of behavior problems in adopted compared with nonadopted children. This study examined the actual extent of the increase in the number of behavior problems seen in Inuit children adopted in accordance with traditional customs. In a prospective longitudinal study conducted in the Canadian Arctic (n = 46 adopted and 231 nonadopted children), prenatal and familial variables were documented at birth and at school age (M = 11.3 years). Behavior problems were assessed on the Teacher Report Form of the Child Behavior Checklist. Adopted children lived in more economically disadvantaged families, but their caregivers were less prone to depression, domestic violence, or alcohol abuse compared with those of the nonadopted children. The adoption status was not related to the teacher's report of attention problems, externalizing or internalizing behaviors, after controlling for confounders. Despite less favorable socioeconomic circumstances, a higher extent of behavioral problems was not seen at school age in Inuit children adopted at birth by a family member. Psychosocial stressors associated with adoption are more likely to be responsible for an association with higher levels of childhood behavior problems rather than adoption per se.

Yup'ik culture and context in Southwest Alaska: community member perspectives of tradition, social change, and prevention

This paper provides an introduction to key aspects of Yup'ik Inuit culture and context from both historical and contemporary community member perspectives. Its purpose is to provide a framework for understanding the development and implementation of a prevention initiative centered on youth in two communities in Southwest Alaska as part of collaboration with the University of Alaska Fairbanks and the National Institutes of Health. This paper is written from the perspective of elders and local prevention workers from each of the two prevention communities. The co-authors discuss their culture and their community from their own perspectives, drawing from direct experience and from ancestral knowledge gained through learning and living the Yuuyaraq or the Yup'ik way of life. The authors of this paper identity key aspects of traditional Yup'ik culture that once contributed to the adaptability and survivability of their ancestors, particularly through times of hardship and social disruption. These key processes and practices represent dimensions of culture in a Yup'ik context that contribute to personal and collective growth, protection and wellbeing. Intervention development in Yup'ik communities requires bridging historical cultural frames with contemporary contexts and shifting focus from reviving cultural activities to repairing and revitalizing cultural systems that structure community.

A protective factors model for alcohol abuse and suicide prevention among Alaska Native youth

This study provides an empirical test of a culturally grounded theoretical model for prevention of alcohol abuse and suicide risk with Alaska Native youth, using a promising set of culturally appropriate measures for the study of the process of change and outcome. This model is derived from qualitative work that generated an heuristic model of protective factors from alcohol (Allen et al. in J Prev Interv Commun 32:41-59, 2006; Mohatt et al. in Am J Commun Psychol 33:263-273, 2004a; Harm Reduct 1, 2004b). Participants included 413 rural Alaska Native youth ages 12-18 who assisted in testing a predictive model of Reasons for Life and Reflective Processes about alcohol abuse consequences as co-occurring outcomes. Specific individual, family, peer, and community level protective factor variables predicted these outcomes. Results suggest prominent roles for these predictor variables as intermediate prevention strategy target variables in a theoretical model for a multilevel intervention. The model guides understanding of underlying change processes in an intervention to increase the ultimate outcome variables of Reasons for Life and Reflective Processes regarding the consequences of alcohol abuse.

Promoting resilience and wellbeing through an outdoor intervention designed for Aboriginal adolescents

INTRODUCTION

Aboriginal people in Canada (First Nations, Inuit and Métis) have a lower health status compared to the Canadian population. There is a particular concern about the mental health and wellbeing of First Nations adolescents living on reserves. Interventions following principles of outdoor education and adventure therapy appear to be an appropriate fit for this population. These approaches have proven effective in non-Aboriginal populations, yet there is very little evidence on the efficacy of these types of program for Aboriginal adolescents. The primary purpose of this study was to evaluate the impact of an outdoor adventure leadership experience (OALE) on the resilience and wellbeing of First Nations adolescents from one reserve community. The secondary purposes were to explore whether this impact was sustainable, and whether there were any intervening factors that may have influenced the impact.

METHODS

The collaborative research team used a mixed-method design to evaluate the 10-day OALE for adolescents from Wikwemikong Unceded Indian Reserve in northern Ontario, Canada. The main outcome assessed was resilience, measured by self-report, using the 14-Item Resilience Scale (RS-14). Several other exploratory measures assessed other aspects of health and well-being. The questionnaire package was administered at three different time periods: (T1) one day before the OALE; (T2) one month after the OALE; and (T3) one year after the OALE. The Mental Component Score (MCS) of the SF-12v2 was used to confirm any changes in resilience. Open-ended questions were appended to the questionnaire at the 1-year point to identify any intervening factors that may have impacted any changes in resilience and wellbeing. The primary analysis compared mean RS-14 scores at T1 with those at T2. Responses to the open-ended questions were analyzed using content analysis.

RESULTS

Over two summers (2009 and 2010), 73 youth 12-18 years of age from Wikwemikong participated in a standardized 10-day OALE program. This represented 15% of the on-reserve population of adolescents in this age range. Survey responses from 59 (80.8%) participants were available for analysis at T1, compared to 47 (64.4%) at T2 and 33 (45.2%) at T3. The mean RS-14 score was 73.65 at baseline, and this improved 3.40 points (p=0.011) between T1 and T2. However, the resilience scores at T3 (1 year post-OALE) had a mean of 74.19, indicating a return back to pre-OALE levels. The mean MCS score at T1 was 48.23 and it improved over the subsequent two time periods. Several intervening factors reported at T3 may have influenced the decrease in resilience scores from T2 to T3. These included changes in family living situation, death in the family, and other life stressors that occurred over the course of the year.

CONCLUSIONS

Outcome scores from this study provide a unique glimpse into the self-reported health and wellbeing for adolescents within one First Nations community in Canada. The OALE program was beneficial in promoting resilience for adolescents in Wikwemikong over the short-term. Future studies are necessary to assess whether the OALE (or similar outdoor type interventions) are effective within other communities.

A review of protective factors and causal mechanisms that enhance the mental health of Indigenous Circumpolar youth

OBJECTIVES

To review the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North.

STUDY DESIGN

A systematic literature review of peer-reviewed English-language research was conducted to systematically examine the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with elements of a realist review. From 160 records identified in the initial search of 3 databases, 15 met the inclusion criteria and were retained for full review. Data were extracted using a codebook to organize and synthesize relevant information from the articles.

RESULTS

More than 40 protective factors at the individual, family, and community levels were identified as enhancing Indigenous youth mental health. These included practicing and holding traditional knowledge and skills, the desire to be useful and to contribute meaningfully to one's community, having positive role models, and believing in one's self. Broadly, protective factors at the family and community levels were identified as positively creating and impacting one's social environment, which interacts with factors at the individual level to enhance resilience. An emphasis on the roles of cultural and land-based activities, history, and language, as well as on the importance of social and family supports, also emerged throughout the literature. More than 40 protective factors at the individual, family, and community levels were identified as enhancing Indigenous youth mental health. These included practicing and holding traditional knowledge and skills, the desire to be useful and to contribute meaningfully to one's community, having positive role models, and believing in one's self. Broadly, protective factors at the family and community levels were identified as positively creating and impacting one's social environment, which interacts with factors at the individual level to enhance resilience. An emphasis on the roles of cultural and land-based activities, history, and language, as well as on the importance of social and family supports, also emerged throughout the literature.

CONCLUSIONS

Healthy communities and families foster and support youth who are resilient to mental health challenges and able to adapt and cope with multiple stressors, be they social, economic, or environmental. Creating opportunities and environments where youth can successfully navigate challenges and enhance their resilience can in turn contribute to fostering healthy Circumpolar communities. Looking at the role of new social media in the way youth communicate and interact is one way of understanding how to create such opportunities. Youth perspectives of mental health programmes are crucial to developing appropriate mental health support and meaningful engagement of youth can inform locally appropriate and culturally relevant mental health resources, programmes and community resilience strategies.

Central role of relatedness in Alaska native youth resilience: Preliminary themes from one site of the Circumpolar Indigenous Pathways to Adulthood (CIPA) study

This qualitative study of youth resilience takes place in an Alaska Native community, which has undergone rapid, imposed social change over the last three generations. Elders, and successive generations have grown up in strikingly different social, economic and political contexts. Youth narratives of relationships in the context of adolescent growth and development offer insights to better understand culturally-patterned experience, continuity and change. Local youth and adults shaped the design, implementation and analysis phases of this participatory study. Multiple interviews, totaling 20 older (ages 15-18) and younger (11-14) boys and girls provide accounts of everyday lives and life histories. Although losing close relationships was the most common stressor, many of the participants' resilience strategies centered on their connections to others. Participants cultivated 'relatedness', nurturing relationships that took on kinship qualities. Within these relationships, youth participants acted more responsibly and/or developed a sense of competency and self-worth because of others' reliance on them.

The experience of HIV diagnosis among Aboriginal people living with HIV/AIDS and depression

In this article, we consider how the broad context of Aboriginal people's lives can shape their experience and understanding of their HIV diagnosis. We conducted interviews across Canada with 72 Aboriginal people living with HIV who also reported feelings of depression. Consistent with what has been found in previous studies, participants responded to their HIV diagnosis with shock, disbelief, and often anger. Prior depression, drug and alcohol use, multiple losses, stigma, and social isolation also shaped how participants experienced their diagnosis. We consider how the history of colonization of Aboriginal communities in Canada relates to the experience of HIV diagnosis, and end with a discussion of the service implications of our findings.

Challenges to recruit and retain American Indian and Alaskan Natives into social work programs: the impact on the child welfare workforce

There is a shortage of professionally trained American Indian/Alaskan Native (AI/AN) social workers available to provide services including child welfare services to tribal communities. This study used a mixed-model survey design to examine the perceptions of 47 AI/AN BSW and MSW students enrolled in social work programs across the to determine the challenges associated with recruitment and retention. The findings are supported in the literature. Findings indicate that social work academic programs have not made substantial gains in the recruitment and retention of AI/AN students over several decades. Students identified the following seven major barriers to successful recruitment and retention: (1) a lack of AI/AN professors; (2) a shortage of field placement agencies that serve AI/AN clients; (3) conflicts between students' academic obligations and responsibilities to their families and tribal communities; (4) students' feelings of cultural isolation; (5) the need for AI/AN role models and mentors; (6) a lack of understanding by universities of cultural customs and traditional values; and (7) racism. Implications for policy and practice are offered.

The power of protection: a population-based comparison of Native and non-Native youth suicide attempters

This study provides actionable information about intervening with American Indian/Alaska Native (AI/AN) youth to prevent suicide. Statewide school survey data were used to model the impact of risk and protective factors on self-reported suicide attempts (both AI/AN and non-AI/AN). The cumulative risk and protective model worked similarly for both groups. AI/AN youth had a higher threshold of risk before making a suicide attempt. Protective factors buffered the impact of risk, particularly for the higher risk youth.

More than half a million California adults seriously thought about suicide in the past year

In 2009, nearly 2.4 million adults in California reported having seriously thought about suicide during their lifetimes. Among these adults, more than half a million had thought seriously about suicide sometime during the past year. Members of sexual minorities were almost three times as likely as all adults in California to have had suicidal thoughts during the past year. This policy brief, based on data from the 2009 California Health Interview Survey (CHIS), presents a comprehensive overview of risk factors associated with suicidal thoughts among adults ages 18 and older and highlights differences in suicidal ideation among demographic groups and geographic regions in California.

Ethnic Differences in Symptoms of Post-traumatic Stress after the Exxon Valdez Oil Spill

Introduction:

Previous studies have reported ethnic differences in the prevalence of post-traumatic stress disorder (PTSD), but the reasons for these differences remain unclear.

Hypothesis:

Ethnic differences in the prevalence of PTSD may reflect ethnic differences in (1) exposure to traumatic events; (2) appraisal of such event as traumatic; and (3) culturally-determined responses to standardized diagnostic instruments, reflecting differences in cultural meanings associated with physical symptoms and idioms of distress.

Methods:

Ethnic differences in risk factors and factor structures of PTSD symptoms were examined in 188 Alaskan Natives and 371 Euro-Americans exposed to the Exxon-Valdez oil spill in 1989.

Results:

High levels of social disruption were associated with PTSD one year after the oil spill in both ethnic groups. However, low family support, participation in spill clean-up activities, and a decline in subsistence activities were significantly associated with PTSD in Alaskan Natives, but not in Euro-Americans. Factor analysis of the Diagnostic Interview Schedule PTSD subscale revealed five factors for both ethnic groups. However, the items comprising these factors were dissimilar.

Conclusions:

These results suggest that social disruption is sufficiently traumatic to be associated with symptoms of post-traumatic stress, but that a diagnosis of PTSD must take into consideration local interpretations of these symptoms.

Personalized medicine: challenge and promise

The new health care buzz words include "personalized or individualized medicine." Populations such as American Indians and Alaska Natives potentially have much to gain from this new science to overcome the known health disparities in these populations. This will require participation and acceptance of diverse populations. This article reviews the promise and challenges of individualizing cancer care using principles of community-based participatory research.

Breast cancer and screening in American Indian and Alaska Native women

Data relative to breast cancer among American Indian and Alaska native (AI/AN) women are limited and vary by regions. Despite national decreases in breast cancer incidence and mortality rates, declines in these measures have not yet appeared among AI/AN women. Health disparities in breast cancer persist, manifest by higher stage at diagnosis, and lower screening rates compared to other racial and ethnic groups. Disproportionately more AI/AN are younger at diagnosis. Screening beginning at age 40, improving access, annual rescreening, community education and outreach, and mobile mammography for rural areas are ways to improve these disparities in breast cancer.

Use of cognitive question testing methodologies in participant action research: implementing the Three-Step Test-Interview Method in Indian county

This study describes the use of cognitive question testing methods to pretest a Web-based questionnaire designed to gather information from American Indian and Alaska Native (AI/AN) youth between the ages of 18 and 25. The questionnaire included items related to risk and resiliency factors as well as potentially sensitive topics of victimization and delinquency. Question testing was completed with a sample of 15 youth living in three different regions of the United States. The Three Step Test Interview Method was modified to collect information related to interface usability, cognitive response, and cultural interpretation of survey items. Data collected from the question testing process resulted in questionnaire changes that included query wording, the inclusion and exclusion of survey items based on cultural input, the reordering and rendering of survey items, and improvements in interface usability. Implications for survey research with the AI/AN youth population are discussed.

Alpha brain-wave neurofeedback training reduces psychopathology in a cohort of male and female Canadian aboriginals

OBJECTIVE

The study was conducted to determine if alpha brain-wave neurofeedback training can have positive psychological results by reducing anxiety and other psychopathology.

METHOD

The cohort participated in alpha brain-wave neurofeedback training for 76 minutes (day 1) to 120 or more minutes (days 5-7) daily for 7 days. Electroencephalogram (EEG) electrodes were attached to the head with conductive gel according to the 10-20 International Electrode Placement System. During training, participants were seated in a comfortable armchair within a soundproof and lightproof room. Brain-wave signals were amplified for processing by analog-to-digital converters and polygraphs, then filtered to the pure delta, theta, alpha, beta, and gamma bands as well as subbands of these bands of the EEG. For 2-minute epochs, trainees sat with their eyes closed in the dark listening to their feedback tones as the filtered alpha brain-wave EEG signals controlled the loudness of the tones. Then a "ding" sounded and the tones stopped. For 8 seconds, a monitor lit up with dimly illuminated, static numbers, indicating the strength of their alpha brain waves, after which the feedback tones resumed and the process was repeated.

PARTICIPANTS

40 adult volunteers were recruited from the aboriginal population (First Nations, Métis, and Inuit) of Canada. The cohort ranged in age from 25 to 60 years and included males and females.

SETTING

The study was conducted at Biocybernaut Institute of Canada in Victoria, British Columbia.

PRIMARY OUTCOME MEASURES

Data was obtained to determine the effectiveness of this training by giving four psychological tests (Minnesota Multi-Phasic Personality Inventory, and the trait forms of the Multiple Affect Adjective Check List, Clyde Mood Scale, and Profile of Mood States) on the first day prior to commencing training and on the seventh day upon completion of the training. EEG data was also compiled throughout the training and analyzed as a factor of the training process.

RESULTS

Postintervention data showed positive results with reduction of psychopathology when compared to the data from testing prior to the training. Analysis of this data showed improvement in several areas of psychopathology.

CONCLUSION

Alpha brain-wave neurofeedback training daily for 7 days does have positive psychological results in adult male and female Canadian aboriginals as measured by data from four psychological tests on the participants.

Achieving balance: healing in native art

It has been my great fortune to have spent this past summer traveling across North America with my husband. We left our home state of New Hampshire in June and, in late July, arrived in the 49th state, Alaska, where we have settled in for the winter. From Manitoulin Island and the shores of Lake Huron to the Black Hills of South Dakota and on through the Canadian Rockies, we traveled through a number of North American Native communities. It is this experience and my recent introduction to Alaskan Native culture and peoples that are the impetus for this feature, where I will explore the historical and re-emerging use of art to promote health and healing in Native communities.

Unikkaartuit: meanings of well-being, unhappiness, health, and community change among Inuit in Nunavut, Canada

Suicide among young Inuit in the Canadian Arctic is at an epidemic level. In order to understand the distress and well-being experienced in Inuit communities, a first step in understanding collective suicide, this qualitative study was designed. Fifty Inuit were interviewed in two Inuit communities in Nunavut, Canada, and questionnaires asking the same questions were given to 66 high school and college students. The areas of life investigated here were happiness and wellbeing, unhappiness, healing, and community and personal change. Three themes emerged as central to well-being: the family, talking/communication, and traditional Inuit cultural values and practices. The absence of these factors were most closely associated with unhappiness. Narratives about community and personal change were primarily about family, intergenerational segregation, an increasing population, more trouble in romantic relationships among youth, drug use, and poverty. Change over time was viewed primarily as negative. Discontinuity of kinship structure and function appears to be the most harmful effect of the internal colonialism imposed by the Canadian government in the 1950s and 1960s. Directions toward community control and action are encouraging, and are highlighted. Inuit community action toward suicide prevention and community wellness is part of a larger movement of Indigenous self-determination.

Alcohol/drug exposure, HIV-related sexual risk among urban American Indian and Alaska Native Youth: evidence from a national survey

BACKGROUND

Migration of the native populations from reservations to the urban areas has resulted in mixed ethnicities of American Indian/Alaskan Native (AIAN) children. Minority youth require special attention and services in urban schools as they disproportionately experience poverty, low educational attainment, unemployment, and single-parent status.

METHODS

We used 2005 and 2007 Youth Risk Behavior Survey data to examine alcohol/drug use patterns and their association with sexual risk taking among AIAN only (single-racial) and biracial youth in combination with White, African American, or Hispanic ethnicities (N = 1178).

RESULTS

Overall, one half of the students were sexually active, with significantly higher rates among males; AIAN-Black students initiated sex earlier than the other groups. Condom nonuse is higher among AIAN-Whites (>50%) compared to one third of AIAN-Hispanics and one fourth of AIAN-Blacks. Nearly 10% of all students, except AIAN-Blacks, reported lifetime use of heroin/meth. Sexual behavior was significantly associated with episodic drinking. Students with Hispanic background have twice the odds of being sexually active compared to AIANs.

CONCLUSIONS

Our findings underscore growing health care needs and targeted prevention initiatives for mixed racial underserved native youth. Urban school settings have potential to deliver services and offer alcohol/drug prevention programs to address the needs of mixed racial native urban youth. Using the School Based Health Clinic model has been successful; we need to reform prevention approaches to accommodate needs of multiracial urban native youth.

The use of Photovoice to document and characterize the food security of users of community food programs in Iqaluit, Nunavut

INTRODUCTION

Food insecurity is a chronic problem affecting Inuit communities. The most comprehensive assessment of Inuit food security to-date, the Inuit Health Survey, reported that 70% of Inuit pre-school children lived in 'food insecure' households. Food banks and soup kitchens are relatively new in the Arctic but the number of users is increasing. Little is known about the experience and determinants of food insecurity among food program users who are often among the most marginalized (socially and economically) in communities. The use of participatory research methods when working in the north of Canada can promote meaningful knowledge exchange with community members and this approach was used in the present 'Photovoice' research. Photovoice uses photography to develop a baseline understanding of an issue, in this case the experience and determinants of food insecurity among users of community food programs in Iqaluit, Nunavut. The target population includes those who face significant social and economic marginalization, an often neglected group in Arctic food systems research.

METHODS

Eight regular users of food programs were recruited and engaged in a Photovoice research project to document factors determining their daily food consumption. The research method was introduced in workshops and discussion included the ethical concerns related to photography and how to take pictures. Participants were supplied with digital cameras, and asked to answer the following question using photography: 'What aspects of your everyday life affect what you eat and how much you have to eat?'. In the final workshop, photographs were discussed among the group and participants identified key themes in the photographs, offering an understanding of food insecurity from their perspectives. The group then discussed what should be done with the knowledge gained.

RESULTS

Factors improving food security were the customary systems for sharing 'country food', and the presence of social support networks in the community, such as the Food Bank, the Soup Kitchen and the Tukisigiarvik Center. Factors identified as negatively affecting food security were the high cost of food in the Arctic, and substance abuse. The participants decided by consensus whether and how the knowledge from this project would be disseminated. They decided that a museum exhibit of the photographs in the summer of 2010 and promotion of the results among policy-makers in Nunavut were of high priority.

CONCLUSION

The use of participatory research approaches such as Photovoice offers promise for exploring food security issues among similarly disadvantaged and vulnerable populations elsewhere in the Arctic. This approach was found to be a useful method for gathering and sharing research data because the data was generated and analysed by the participants. The clear and concise messages developed by the participants can be used to inform policy. This research method can assist in making a valuable contribution to health research, both in the Arctic and worldwide, because it promotes an understanding of the experiences of individuals from their own perspective.

Awareness and knowledge about human papillomavirus among Inuit women in Nunavik, Quebec

Accurate knowledge about human Papillomavirus (HPV) and its link to cervical cancer is essential for women to understand and make use of cervical cancer prevention and detection opportunities. This study was the first to survey awareness and knowledge of HPV in a population of Canadian Inuit. The objectives of this study were to assess the level of awareness and knowledge of Inuit women in Nunavik, Quebec, Canada, about HPV infection and its relation to cervical cancer and to study correlates of this awareness. A cross-sectional survey design was used. Women were recruited through convenience sampling at two recruitment sites in Ungava Bay from March 2008 to June 2009. Questionnaires were completed by 175 women aged 18-63. Thirty one percentage reported that they had heard of HPV. Of the women who had heard of HPV, 53% knew that HPV causes cervical cancer. The level of HPV awareness was not found to vary with participants' age. Awareness of HPV was found to be associated with greater or equal to 13 years of education (OR = 4.4, 95%: 1.3-15.1) and knowing someone with cervical cancer (OR = 3.6, 95%: 1.4-8.9). Despite the high prevalence of HPV and incidence of cervical cancer in Inuit populations, there is a low level of knowledge in this population. The lack of awareness and knowledge and misconceptions found in this study has been consistently found in other non-Indigenous populations.