Exploring ambivalence toward pregnancy among young Inuit women.

Ambivalence toward pregnancy is an important predictor of early pregnancy as documented in diverse Western societies. Inuit women from Nunavik, a northern region of Quebec, Canada, experience a high rate of early pregnancy, yet no study has explored their attitudes toward pregnancy. Grounded in a participatory approach, this study aimed to explore ambivalence toward pregnancy, among other pregnancy-related attitudes, and identify themes underlying ambivalence among young Inuit women from Nunavik. We conducted semi-structured interviews with 15 women aged 16 to 20 years, who became pregnant during the year preceding the interview. We used an inductive approach to analyse the data. Eleven participants were identified as ambivalent toward pregnancy while three were characterised as having a favourable attitude, and one as unfavourable. Four themes related to ambivalence were identified: the value of childbearing/motherhood; the use of contraceptives; the likelihood of becoming pregnant; and the ideal age to become pregnant. A better understanding of young women's attitudes toward pregnancy could contribute to the development of culturally relevant programmes to more effectively support adolescents, pregnant adolescents and young mothers, and to lead to better care.

Sociocultural determinants of alcohol and cannabis use and misuse among Nunavimmiut.

OBJECTIVE: Stemming from historical traumas and changes in the Inuit way of life, substance use and its intertwined problems are a major cause of concern for Nunavimmiut. This study's objective is to investigate sociocultural determinants of substance use and misuse to inform culturally appropriate public health programs. METHODS: The 2017 Qanuilirpitaa? survey was conducted among a sample intended to be representative of Nunavimmiut aged 16 and over (total n = 1326). Sociocultural factors included cultural identity, land-based activities, involvement in community activities, social support, and family and community cohesion. The frequency of binge drinking (5 or more drinks on one occasion), cannabis use, and problematic substance use (CAGE and DAST-10) were documented. Data were analyzed using weighted multivariate logistic regressions. Inuit partners were involved from the planning of analyses to the co-interpretation of results. RESULTS: Nearly a third of Nunavimmiut aged 16 and over reported binge drinking at least once a week (29.3%), and 68.6% of drinkers were at risk of potential drinking problems. Forty-five percent (45%) reported using cannabis at least once a week, and 30% of drug users were at risk of potential drug abuse problems. Volunteering and participation in community activities were associated with lower odds of cannabis use, as was frequently going on the land with weekly binge drinking, potential drinking problems, and weekly cannabis use. Social support and community cohesion were associated with higher odds of weekly binge drinking, as was cultural identity (centrality scale) with potential drinking problems. CONCLUSION: Key determinants of substance use relevant to Inuit culture were identified. Results are in line with our Inuit partners' experience in their communities and are coherent with current land-based interventions implemented in Nunavik. A thorough understanding of substance use contexts and related stressors should guide the content and implementation of substance use programs in Nunavik.

RéSUMé: OBJECTIF: Suite aux traumas historiques et changements au mode de vie, l'usage de substance et les problèmes associés sont une source d'inquiétude majeure pour les Nunavimmiut. L'objectif de cette étude est d'investiguer les déterminants socioculturels de l'usage de substances pour adapter les programmes de santé publique à la culture Inuit. MéTHODES: L'enquête Qanuilirpitaa? 2017 repose sur un échantillon sélectionné pour être représentatif des Nunavimmiut (16 ans et plus; n = 1 326). Les déterminants socioculturels incluent : identité culturelle, activités sur le territoire, activités communautaires, support social, cohésion familiale et communautaire. La fréquence de consommation excessive d'alcool (5 consommations ou plus), l'usage du cannabis et l'usage problématique (CAGE et DAST-10) ont été documentés. Données analysées par régression multiple pondérée. Nos partenaires Inuit ont été impliqués de la planification des analyses à la co-interprétation des résultats. RéSULTATS: Près du tiers des Nunavimmiut de 16 ans et plus ont rapporté une consommation hebdomadaire excessive d'alcool (29,3 %) et 68,6 % de ceux consommant de l'alcool étaient potentiellement à risque de consommation problématique. Quarante-cinq pourcent (45 %) ont rapporté consommer du cannabis au moins une fois par semaine et 30 % des consommateurs de drogue étaient à risque de consommation potentiellement problématique. Le bénévolat et la participation aux activités communautaires étaient associés à une cote plus faible d'usage de cannabis, tout comme la pratique fréquente d'activités sur le territoire avec la consommation hebdomadaire excessive d'alcool, d'usage potentiellement problématique d'alcool et d'usage hebdomadaire de cannabis. Le support social et la cohésion communautaire étaient associés à une cote plus élevée de consommation excessive hebdomadaire d'alcool, tout comme l'identité culturelle (centralité) avec l'usage potentiellement problématique d'alcool. CONCLUSION: Des déterminants clés de l'usage de substance spécifiques aux Inuit ont été identifiés. Les résultats concordent avec le vécu de nos partenaires dans leurs communautés et le cadre théorique d'interventions déjà implémentées impliquant des activités sur le territoire et de guérison. Les contextes de consommation et les stresseurs associés devraient guider l'élaboration des programmes au Nunavik.

Profiles of childhood adversities in Inuit from Nunavik: description and associations with indicators of socioeconomic characteristics, support, and community involvement.

OBJECTIVES: Distress and associated health problems reported by Nunavik Inuit emanate from heterogeneous roots, including adverse childhood experiences. This study aims to (1) identify distinct childhood adversity profiles and (2) examine associations between these profiles and sex, socioeconomic characteristics, social support, and community involvement among Nunavimmiut. METHODS: In a sample of 1109 adult Nunavimmiut, sex, socioeconomic characteristics, support, community involvement, residential school attendance, and 10 forms of adverse childhood experiences (ACEs) were documented using questionnaires. Latent class analyses and weighted comparisons were performed for three subgroups: 18-49 years; 50 years and above with experience of residential school; and 50 years and above without experience of residential school. The analysis design, the manuscript drafts, and the key findings were discussed and co-interpreted with the collaboration of community representatives, taking into consideration Inuit culture and needs. RESULTS: A total of 77.6% of Nunavimmiut reported having experienced at least one form of childhood adversity. Three ACE profiles were identified among the 18-49-year-olds: low ACEs (43.0%), household stressors (30.7%), and multiple ACEs (26.3%). Two profiles characterized ACEs experienced among the 50-year-olds and over with and without history of residential schooling: low ACEs (80.1% and 77.2%, respectively) and multiple ACEs (19.9% and 22.8%, respectively). Among the group of 18-49-year-olds, as compared to the low ACE profile, the profile with household stressors included proportionally more women (odds ratio [OR] = 1.5) and was associated with lower involvement in volunteering and community activities (mean score reduced by 0.29 standard deviation [SD]) and lower family cohesion (SD = - 0.11), while the multiple ACE profile was related to a lower rate of employment (OR = 0.62), lower family cohesion (SD = - 0.28), and lower satisfaction with ability to practice traditional activities (SD = - 0.26). CONCLUSION: Childhood adversities among Nunavimmiut do not occur in isolation and experiencing multiple forms of childhood adversities predicts lower socioeconomic status, support, and community involvement in adulthood. Implications for the planning of health and community services in Nunavik are discussed.

RéSUMé: OBJECTIFS: La détresse et les problèmes de santé associés rapportés par les Inuits du Nunavik émanent de racines hétérogènes, notamment des expériences négatives durant l'enfance. Cette étude vise à : 1) identifier des profils distincts d'adversités vécues durant l'enfance; et 2) examiner les associations entre ces profils et le sexe, les caractéristiques socioéconomiques, le soutien social et l'engagement communautaire des Nunavimmiut. MéTHODES: Dans un échantillon de 1 109 adultes Nunavimmiut, le sexe, les caractéristiques socioéconomiques, le soutien, l'engagement communautaire, la fréquentation des pensionnats et 10 formes d'expériences négatives durant l'enfance (ENE) ont été documentés à l'aide de questionnaires. Des analyses de classes latentes et des comparaisons pondérées ont été réalisées pour trois sous-groupes : 18­49 ans; 50 ans et plus avec et sans expérience de pensionnat. Le plan d'analyses, les ébauches de manuscrit et les principaux résultats ont été discutés et co-interprétés avec la collaboration de représentants des communautés, en tenant compte de la culture et des besoins inuits. RéSULTATS: Un total de 77,6 % des Nunavimmiut ont déclaré avoir vécu au moins une forme d'adversité durant l'enfance. Trois profils d'ENE ont été identifiés chez les 18­49 ans : ENE faibles (43,0 %), facteurs de stress domestiques (30,7 %) et ENE multiples (26,3 %). Deux profils caractérisaient les ENE vécus chez les 50 ans et plus avec et sans antécédents de pensionnat : faibles ENE (80,1 % et 77,2 %, respectivement) et ENE multiples (19,9 % et 22,8 %, respectivement). Parmi le groupe des 18­49 ans, par rapport au profil des ENE faibles, le profil avec facteurs de stress domestiques incluait proportionnellement plus de femmes (rapport de cotes [RC] = 1,5) et était associé à une plus faible implication dans le bénévolat et les activités communautaires (score moyen réduit de 0,29 écart-type [ET]) et une cohésion familiale plus faible (ET = -0,11), tandis que le profil d'ENE multiples était lié à un taux d'emploi plus faible (RC = 0,62), à une cohésion familiale plus faible (ET = -0,28) et à une plus faible satisfaction à l'égard de la capacité à pratiquer des activités traditionnelles (ET = -0,26). CONCLUSION: Les adversités vécues en enfance par les Nunavimmiut ne surviennent pas de manière isolée et le fait de vivre de multiples formes d'ENE prédit un statut socio-économique, un soutien et une implication communautaire inférieurs à l'âge adulte. Les implications pour la planification des services de santé et communautaires au Nunavik sont discutées.

Shedding light on attitudes towards pregnancy among Inuit adolescents from Nunavik.

Better understanding attitudes toward pregnancy - a potent predictor of adolescent pregnancy - could help explain the high adolescent pregnancy rate in Nunavik, Canada. The objective of this study was to assess the distribution of different attitudes toward pregnancy and the factors associated with high pregnancy likelihood attitudes (HPLA; favourable, indifferent, and ambivalent), focusing on the perceived benefits of childbearing (BOC). T-tests, chi-square tests, and logistics regressions were performed based the answers of 159 Inuit women aged 16 to 20 years from the Qanuilirpitaa? survey. About 43% were ambivalent, 16% favourable, 5% indifferent, and 35% unfavourable toward pregnancy. Bivariate analysis indicate that the HPLA group was more likely to work, to report less frequent positive interactions, and to show a higher BOC score compared to others. Multivariate analysis show that an increased BOC score was associated with HPLA (OR = 1.09, 95% CI = 1.01 - 1.18). Perceiving that a baby would strengthen the relationship with the other parent (OR = 1.65, 95% CI = 1.15 - 2.37) and that it would help to access housing were individually associated with HPLA (OR = 1.45, 95% CI = 1.02 - 2.10). Findings provide evidence to support Inuit adolescents' reproductive choices.

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.

RéSUMé: OBJECTIF: Basée sur la conception Inuit des déterminants de la santé, cette étude identifie des facteurs socioculturels associés à la santé mentale chez les Inuit du Nunavik afin de guider les programmes et les services de santé. MéTHODE: Les données proviennent de Qanuilirpitaa? 2017, une enquête ayant impliqué plusieurs représentants Inuit. Les symptômes dépressifs (échelle Center for Epidemiologic Studies-Depression, 10 items, CES-D), les idéations suicidaires et les tentatives de suicide à vie, et les idéations au cours des derniers mois furent les indicateurs de santé mentale analysés. Des facteurs socioculturels investigués représentaient, eux, quatre domaines : support social, activités communautaires, pratiques traditionnelles et identité culturelle. Des régressions multivariées pondérées ont testé les associations entre les facteurs socioculturels et la santé mentale. RéSULTATS: Parmi les facteurs socioculturels investigués, la cohésion familiale et une pratique hebdomadaire de chasse/pêche étaient associées au score dépressif inférieur. La cohésion communautaire et une identité culturelle (centralité) plus faible s'associaient à une probabilité moindre d'idéations suicidaires à vie et au cours des 12 derniers mois; la cohésion familiale était associée à une probabilité moindre des tentatives suicidaires à vie. Les personnes rapportant une détresse supérieure (CES-D élevé, idéations ou tentatives) participaient davantage à des activités de guérison/de bien-être. CONCLUSION: Limitées par leur caractère transversal, ces analyses, inspirées du volet communautaire de Qanuilirpitaa?, suggèrent qu'un renforcement de la cohésion familiale et communautaire, ainsi qu'un soutien d'activités de chasse et de pêche régulières méritent davantage d'attention en tant qu'avenues préventives cumulatives potentielles pour la santé mentale des Inuit.

The psychosocial dimension of housing in Nunavik: does social support vary with household crowding?

OBJECTIVES: Studies show that living in overcrowded households can contribute to the erosion of social support, which is an important factor in health and well-being. In this study, we examine the relationship between household crowding and social support for Inuit living in Nunavik (hereafter referred to as Nunavimmiut), a region where housing shortages are considered a serious public health problem. We assess whether overcrowding is associated with lower levels of perceived social support and whether this association varies by gender and age group. METHODS: Cross-sectional data are from Qanuilirpitaa? the 2017 Nunavik Health Survey (N = 1306; aged 16 years and older). A perceived social support index was derived from answers to questions related to three different components of social support: positive interaction, emotional support, and love and affection. Associations between overcrowding (more than one person per room) and perceived social support were assessed using weighted linear and logistic regressions, adjusted for several factors. Sex- and age-stratified analyses were also conducted. RESULTS: Nunavimmiut report significantly lower levels of social support when living in overcrowded households, independently of other covariates. Analyses stratified by sex and age further show that the detrimental association between overcrowding and perceived social support is higher and stronger for men and older adults (both men and women 55 years and older). CONCLUSION: Overcrowding is associated with lower levels of perceived social support, which is a key component of health for the general population and for Nunavimmiut. Future research should examine the factors creating stronger associations between overcrowding and lower social support for men and older adults.

RéSUMé: OBJECTIFS: Des études montrent que le fait de vivre dans un ménage surpeuplé peut contribuer à l'érosion du soutien social, qui est un facteur important de santé et de bien-être. Dans cette étude, nous examinons la relation entre le surpeuplement des ménages et le soutien social chez les Inuits du Nunavik, une région où la pénurie de logements est considérée comme un grave problème de santé publique. Nous évaluons si le surpeuplement est associé à des niveaux plus faibles de soutien social perçu chez les Inuits vivant au Nunavik (ci-après appelés Nunavimmiut), et si cette association varie selon le sexe et le groupe d'âge. MéTHODES: Les données transversales proviennent de Qanuilirpitaa? l'enquête sur la santé au Nunavik de 2017 (N = 1 306; âgés de 16 ans et plus). Un indice de soutien social perçu a été dérivé des réponses aux questions relatives à trois composantes différentes du soutien social : interaction positive, soutien émotionnel, et amour et affection. Les associations entre le surpeuplement résidentiel (plus d'une personne par pièce) et le soutien social perçu ont été évaluées à l'aide de régressions linéaires et logistiques pondérées, ajustées pour plusieurs facteurs. Des analyses stratifiées par sexe et par âge ont également été réalisées. RéSULTATS: Les Nunavimmiut déclarent des niveaux de soutien social significativement plus faibles lorsqu'ils vivent dans des ménages surpeuplés, indépendamment d'autres covariables. Les analyses stratifiées par sexe et par âge montrent en outre que l'association néfaste entre le surpeuplement et le soutien social perçu est plus élevée et plus forte chez les hommes et les adultes plus âgés (hommes et femmes de 55 ans et plus). CONCLUSION: Le surpeuplement résidentiel est associé à des niveaux inférieurs de soutien social perçu, lequel est une composante clé de la santé pour la population générale et pour les Nunavimmiut. Les recherches futures devraient examiner les facteurs en cause derrière l'association entre le surpeuplement résidentiel et l'affaiblissement du soutien social chez les hommes et les adultes plus âgés.

Drinking motives supporting binge drinking of Inuit adolescents.

OBJECTIVES: Binge drinking has been identified as a public health concern among several Indigenous communities in Canada. Drinking motives have been shown to significantly influence drinking patterns among youth, but no research has been conducted among Inuit populations. This article assesses whether specific drinking motives are related to the number of binge drinking episodes among Inuit adolescents from Nunavik. METHODS: The data are drawn from the Nunavik Child Development Study, a longitudinal study conducted in the Canadian Arctic. Questions on alcohol use, binge drinking and drinking motives were asked to 174 adolescents (mean age of 18.5 years). Analyses of variance were used to test the relation between drinking motives and number of binge drinking episodes over the last year. RESULTS: Most Inuit participants mentioned drinking for enhancement reasons. A higher number of binge drinking episodes were reported among both adolescent males and adolescent females who frequently endorse enhancement motives, while social and coping motives have been exclusively related to binge drinking episodes among males. CONCLUSION: Findings highlight that motivational aspects supporting binge drinking among Inuit adolescents vary across sex and slightly contrast with studies conducted in non-Indigenous populations. Culturally relevant preventive interventions that target motivational aspects and take into account sex differences are needed.

Household overcrowding and psychological distress among Nunavik Inuit adolescents: a longitudinal study.

About half of Nunavik Inuit live in overcrowded households compared to very few Canadians from the general population. Living in overcrowded households is associated with greater risks of suffering from mental health problems for Canadian adolescents. The present work aims at studying prospectively the hypothesised relationship between household overcrowding at childhood and psychological distress during adolescence among Nunavik Inuit, as well as the hypothesised relationship between these phenomena when they are both measure at adolescence. Recruited as part of the Nunavik Child Development Study, 220 participants were met at 11 years old in average and then when they were 18 years old in average. Household overcrowding was assessed using the people per room ratio. Psychological distress symptoms were operationalised at adolescence using depressive symptoms and suicidal thoughts. The results did not show that childhood household crowding had a long-term effect on psychological distress. An absence of moderation by sex of the association was also found in the present study. Despite those results, household crowding could be a risk factor only when in interaction with other elements related with poverty or housing or could be experienced as a difficulty for adolescents on other aspects than depressive symptoms and suicidal thoughts.

Teen pregnancy in Inuit communities - gaps still needed to be filled.

Teen pregnancy is depicted around the world as an important cause of health disparities both for the child and the mother. Accordingly, much effort has been invested in its prevention and led to its decline in the northern hemisphere since the mid-1990s. Despite that, high rates are still observed in the circumpolar regions. As Inuit communities have granted better understanding of teenage pregnancy a priority for the coming years, this article comprehensively reviews this multidimensional issue. By depicting current prevalence, likely determinants and possible impacts documented among Inuit of Canada, Alaska and Greenland, and contrasting them to common knowledge that has emerged from other populations over the years, great gaps surface. In some regions, the number of pregnancies per number of Inuit women aged between 15 and 19 years has increased since the turn of the millennium, while statistics from others are either absent or difficult to compare. Only few likely determinants of teenage pregnancy such as low education and some household factors have actually been recognized among Inuit populations. Documented impacts of early pregnancy on Inuit women and their children are also limited compared to those from other populations. As a way to better address early pregnancy in the circumpolar context, the defence for additional scientific efforts and the provision of culturally adapted sexual health prevention programmes appear critical.