Factors associated with booster seat use among Indigenous peoples in Canada.

OBJECTIVE: Booster seat use among the general population remains relatively low, despite their effectiveness in preventing injury among children when involved in motor vehicle collisions. Given the prevention of injuries that booster seats provide, understanding the factors that hinder or facilitate the use of these seats is critical, particularly in communities that are often overlooked when conducting general population studies. To date, no studies have examined the prevalence and predictors of booster seat use among Indigenous peoples in Canada. The purpose of this study was to examine the use of booster seat use among Indigenous peoples across Canada and the factors that impact their use. METHODS: Data were collected from a survey of participants from First Nations communities and organizations serving Indigenous peoples nationwide. Hypotheses arising from known predictors of booster seat use across the general population were tested using logistic regression models. RESULTS: The strongest predictor of booster seat use, even when all other study factors were accounted for, was the reduction of barriers related to the use of booster seats, such as a child's resistance to being placed or staying in the passive safety restraint or a parent, guardian, or other caregiver being unwilling to use or unsure of how to install/setup the booster seat. CONCLUSION: Most Indigenous participants consistently used booster seats to safely secure children being transported in vehicles. However, this compliance rate is well below that of the general population. Accessibility and affordability of child safety restraints and/or children's refusal to use booster seats, as well as having more than 1 child to secure, were identified as mitigating factors. Access to and the affordability of booster seats, coupled with clear and understandable information on how to use them, are critical components to compliance. Raising awareness among Indigenous peoples communities regarding the importance of using booster seats is imperative. To achieve this, Indigenous peoples must lead discussions to ensure that child safety strategies not only are based on research and best practices but are culturally connected and community driven. Through meaningful collaboration, vehicle-related injuries and mortality among Indigenous children can be significantly reduced.

Motor vehicle collision-related injuries and deaths among Indigenous Peoples in Canada: Meta-analysis of geo-structural factors.

Introduction: Indigenous Peoples are much more likely than non-Indigenous Peoples to be seriously injured or die in motor vehicle collisions (MVCs). This study updates and extends a previous systematic review, suggesting that future research ought to incorporate social-environmental factors. Methods: We conducted a systematic review and meta-analysis of the published and grey literature on MVCs involving Indigenous Peoples in Canada between 2010 and 2020. We focussed on personal (e.g. driving an old vehicle) and community social-environmental-economic factors (e.g. prevalent low socioeconomic status). Results: Eleven comparative cohorts that resulted in 23 at minimum, age-standardised, mortality or morbidity rate outcomes were included in our meta-analysis. Indigenous Peoples were twice as likely as non-Indigenous Peoples to be seriously injured (rate ratio [RRpooled] = 2.18) and more than 3 times as likely to die (RRpooled = 3.40) in MVCs. Such great risks to Indigenous Peoples do not seem to have diminished over the past generation. Furthermore, such risks were greater on-reserves and in smaller, rural and remote, places. Conclusion: Such places may lack community resources, including fewer transportation and healthcare infrastructural investments, resulting in poorer road conditions in Indigenous communities and longer delays to trauma care. This seems to add further evidence of geo-structural violence (geographical and institutional violence) perpetrated against Indigenous Peoples in yet more structures (i.e. institutions) of Canadian society. Canada's system of highways and roadways and its remote health-care system represent legitimate policy targets in aiming to solve this public health problem.

Résumé Introduction: Les Autochtones ont beaucoup plus tendance que les non-Autochtones à subir des blessures graves ou à perdre la vie dans une collision de véhicules motorisés. La présente étude actualise et élargit une revue systématique antérieure qui avait conclu que la recherche future devait incorporer les facteurs socio-environnementaux. Méthode: Nous avons réalisé une revue systématique et méta-analyse de la littérature publiée et parallèle sur les collisions de véhicules motorisés entre 2010 et 2020 chez les Autochtones du Canada. Nous nous sommes concentrés sur les facteurs socio-environnementaux personnels (p. ex. vieux véhicules) et communautaires (p. ex. prévalence de faible statut socio-économique). Résultats: Onze cohortes comparatives ayant donné au minimum 23 paramètres d'évaluation du taux de mortalité ou de morbidité standardisés en fonction de l'âge ont été incluses dans notre méta-analyse. Les Autochtones avaient deux fois plus tendance que les non-Autochtones à subir des blessures graves (rapport des taux [RTgroupé] = 2,18) et présentaient un risque plus de 3 fois plus élevé de perdre la vie (RTgroupé = 3,40) dans une collision de véhicules motorisés. La dernière génération d'Autochtones n'a pas vu cet énorme risque diminuer. En outre, le risque était supérieur dans les réserves et dans les agglomérations plus petites, plus rurales et plus éloignées. Conclusion: Ces agglomérations sont parfois dépourvues de ressources communautaires, y compris d'un investissement important dans les infrastructures de transport et de santé, ce qui explique les routes en mauvaise condition et les délais prolongés pour recevoir des soins de traumatologie dans les communautés autochtones. Cela semble ajouter d'autres preuves de violence géostructurelle [violence géographique et institutionnelle] perpétrée contre les Autochtones dans encore plus de structures (les institutions) de la société canadienne. Le réseau canadien de routes et d'autoroutes, et son système de santé en région éloignée représentent des cibles légitimes pour les politiques qui visent à résoudre ces problèmes de santé publique. Mots-clés: Canada, hospitalisation, Autochtone, Premières Nations, Inuit, Métis, morbidité, mortalité, collision de véhicules motorisés, réserve, rural.

Consoling the Bereaved: Exploring How Sympathy Cards Influence What People Say.

In a sequential mixed methods study, interview data showed that bereaved parents consistently reported "stupid" or "insensitive" things people said that were not helpful when their child died. Subsequently, a discourse analysis of 170 sympathy cards was conducted to assess societal messaging that may influence people's insensitive words. The findings reflected two distinct time periods in the bereavement process: a time of sadness followed by a time of peace. Possible links to insensitive things people said included: suggestions that the sad time should only last a few days, suggestions of "healing," religious statements such as the deceased being with God or advice to pray to God, and notions of celebration in some contexts. Very few excerpts were similar to the advice-giving quotes that interviewees considered to be insensitive. Many cards reflected the love and memories inherent in creating a continuing bond with the deceased and achieving peace.

Profound barriers to basic cancer care most notably experienced by uninsured women: Historical note on the present policy considerations.

America is considering the replacement of Obamacare with Trumpcare. This historical cohort revisited pre-Obamacare colon cancer care among people living in poverty in California (N = 5,776). It affirmed a gender by health insurance hypothesis on nonreceipt of surgery such that uninsured women were at greater risk than uninsured men. Uninsured women were three times as likely as insured women to be denied access to such basic care. Similar men were two times as likely. America is bound to repeat such profound health care inequities if Obamacare is repealed. Instead, Obamacare ought to be retained and strengthened in all states, red and blue.