Experience and representations of health and social services in a community of Nunavik.

OBJECTIVES: The study aims to explore representations and experiences with health and social services in an Inuit community of Nunavik. METHODS: A total of 15 semi-structured interviews were conducted with Inuit adults from a community of Northern Quebec. Informal interviews and participatory observation was conducted on six visits over two years. A thematic inductive analysis of data was conducted. RESULTS: Participants' experiences with care were largely related to the nature of interactions with service providers, and feelings about whether perceived needs were being met. Often these needs were socio-economic. Perceptions of services were based on concepts of trust, privacy and fear of consequences of divulging information, three intrinsically related themes. CONCLUSIONS: Reflections must be made on how to address the socio-economic needs of patients and how to go beyond the immediate requests to hear the psychosocial needs that patients might not feel safe to talk about.

"It reflects the society in which we live, except now everything is accentuated": youth, social inequities, and the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has been an extraordinary moment of uncertainty and rapid transformation. The effects lockdowns had on youths' mental and physical health, as well as the challenges they posed for young peoples' learning, were of great concern. It quickly became clear that government responses to COVID-19, in particular regarding the social determinants of health, were not equally experienced across all social groups. This paper adopts an interdisciplinary lens at the intersection of health and education and uses Max Weber's lifestyle theory to analyze the inequitable experience of the COVID-19 pandemic. We examine most directly social inequities in education during the first wave of COVID-19 and explore long-term effects on youths' educational opportunities, health, and well-being. METHODS: We use focus group materials collected from our Spring 2020 study. This study explored how youth were differentially experiencing the pandemic. Participants included 18 youth between the ages of 13 and 18 (11 girls, 7 boys). Participants were stratified by private and public secondary schools and we ran focus groups in which experiences of the pandemic were discussed. RESULTS: Our results show (1) clear differences in early access to education for youth who attended public and private institutions in Quebec during the COVID-19 pandemic; (2) access to the internet and computers offset learning opportunities for students across Quebec throughout the COVID-19 pandemic; and (3) few of the differences experienced during the pandemic were based on youth's behaviours, or life choices, but rather stemmed from differences in material and structural opportunities, based largely, but not solely, on what type of school the youth attended (public or private). CONCLUSION: The way in which the COVID-19 pandemic was handled by the Quebec education system deepened existing social inequities in education between private and public school attendees. Given the importance of education as one of the main determinants of health, particularly during transition periods such as adolescence, we must ensure that future policies do not repeat past mistakes.

RéSUMé: OBJECTIFS: La pandémie de la COVID-19 a été un moment d'incertitude et de transformation rapide hors du commun, soulevant des questions inédites sur les effets du confinement sur la santé mentale et physique des jeunes ainsi que sur les défis engendrés en termes d'apprentissage chez les jeunes. Il s'est rapidement avéré que les réponses du gouvernement à la COVID-19, en particulier en ce qui concerne les déterminants sociaux de la santé, n'étaient pas vécues de la même manière dans tous les groupes sociaux. Cet article adopte une optique interdisciplinaire à l'intersection de la santé et de l'éducation et utilise la théorie du mode de vie de Max Weber pour analyser l'expérience inéquitable de la pandémie de COVID-19. Nous examinons plus directement les inégalités sociales dans l'éducation pendant la première vague de COVID-19 et explorons les effets à long terme sur la santé et le bien-être des jeunes. MéTHODES: Nous utilisons les données recueillies lors de notre étude du printemps 2020 qui a exploré comment les jeunes vivaient différemment la pandémie. Les participants sont 18 jeunes âgés de 13 à 18 ans (11 filles, 7 garçons). Les participants ont été stratifiés par écoles secondaires privées et publiques et nous avons organisé des groupes de discussion dans lesquels les expériences de la pandémie ont été discutées. RéSULTATS: Nos résultats montrent 1) de nouvelles et profondes inégalités sociales dans le système d'éducation qui ont été créées par les mesures de confinement gouvernementales au Québec et 2) un accès inéquitable aux ressources mobilisées pour s'adapter aux mesures gouvernementales. CONCLUSION: L'étude du cas des inégalités sociales en contexte d'éducation pendant la pandémie offre d'importants apprentissages sur les inégalités sociales en général. Nous concluons cette étude en réfléchissant à l'espace intersectoriel important entre l'éducation et la santé pour les jeunes.

Families navigating community resources: understanding and supporting Nunavimmiut families.

In a project aiming to develop community-led resources for families in northern Quebec, Canada, members (Inuit and non-Inuit) of the project decided to meet with Inuit parents to hear their experiences and needs, and to better understand how family dynamics might be related to ways of using resources within communities. In this article, we present secondary analyses of interviews conducted in 2015 with 14 parents living in a community of Nunavik, northern Quebec, accompanied by participatory analysis sessions. A dual data analysis strategy was adopted. Non-Inuit researchers and research assistants with significant lived experience in Nunavik explored what they learned from the stories that Inuit parents shared with them through the interviews and through informal exchanges. Inuit partners then discussed the large themes identified by the research team to guide non-Inuit researchers in their analysis. The aim was to better inform non-Inuit service providers and people whose mandate it is to support community mobilisation in relation to the heterogeneous realities of Inuit families, and the ways in which they can be of support to families based on their specific realities and needs.

Communities being well for family well-being: Exploring the socio-ecological determinants of well-being in an Inuit community of Northern Quebec.

Inuit communities of Canada experience many disparities in health and psychosocial context. Research in community psychology has shown associations between such socio-ecological factors and individual well-being. The objective of the study was to explore how community-level determinants of well-being influence family well-being in a northern community of Nunavik, Quebec. A total of 14 participants were interviewed. A thematic inductive analysis was conducted to extract community determinants of family well-being from the data. A system science approach was used to explore the associations between determinants and larger psychosocial dynamics. A community workshop was held to discuss the results and their meaning. A total of 25 determinants were coded, 16 of which were community-level. Community-level stressors were highly interrelated, whereas community supports were generally disconnected and superimposed on narratives of stressors. Participants spoke of desired supports. In their narratives, these supports were connected to a variety of determinants of well-being, suggesting the need to connect, redefine and support existing resources rather than simply add on new ones. We discuss intricate links between family and community well-being in small and geographically isolated communities.

Changing rates of suicide ideation and attempts among Inuit youth: a gender-based analysis of risk and protective factors.

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15-24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross-sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

Effects of binge drinking on infant growth and development in an Inuit sample.

Prenatal exposure to an average of 0.5 oz absolute alcohol per day (the equivalent of 7 standard drinks per week) during pregnancy has been found to be associated with numerous adverse effects on pre- and postnatal development. In the animal model, concentrated alcohol exposure has been found to lead to more adverse effects than exposure to the same total quantity of alcohol ingested in smaller doses over a longer period of time. The primary aim of this study is to determine whether, in a population where binge drinking is common but total alcohol consumption across pregnancy is low, prenatal exposure to alcohol is associated with effects on prenatal growth, visual acuity and cognitive development during infancy. The second aim is to determine which of several indicators of alcohol consumption best predicts pre- and postnatal outcomes. Data were collected from 216 Inuit women and their infants living in Nunavik, the northern region of Québec. Maternal interviews were conducted during mid-pregnancy and at 1 and 6 months postpartum. Birth weight, length, and head circumference were assessed at delivery. Visual acuity and cognitive development were assessed at 6 months of age. In this population in which infrequent heavy episodic drinking is common, even occasional binge exposure was associated with reduced prenatal growth and poorer visual acuity at 6 months of age. A simple dichotomous measure of binge drinking during pregnancy provided the best predictor of fetal growth and 6-month acuity. The population studied here is unusual in terms of its pattern of binge alcohol consumption. To our knowledge, this is the first study to observe effects of binge drinking during pregnancy on infant growth and development in a sample where the average daily alcohol intake is low (<0.5 ounces).