Prevalence of cannabis use and the frequency, types, and sources of cannabis products used in northern remote territories of the Canadian legal cannabis market.

OBJECTIVE: The Cannabis Policy Study in the Territories (CPST) is an annual repeat cross-sectional study aiming to evaluate the impacts of cannabis legalization in the Canadian territories (Yukon, Northwest Territories, and Nunavut), where there is a paucity of data on cannabis use. This current study's objective was to describe the 2022 CPST, including methods, population prevalence estimates of cannabis use, and legal cannabis sources and perceptions in the territories. METHODS: The 2022 CPST includes 2462 respondents (aged 16 +) residing in the territories who either use or do not use cannabis. Respondents were recruited through mail-push-to-web invitations sent via licensed mailing lists, sampling from a near census of households in the territories. Population-weighted indicators of cannabis use are described. RESULTS: Past 12-month cannabis use was self-reported by 46.1%, and 21.8% self-reported daily/almost daily use. The most commonly used product types among past 12-month consumers were dried flower (73.4%), edibles (59.0%), and vape oils (35.7%). On average, 74.8% of cannabis products used in the past 12 months were from legal sources, though legal sourcing varied by product type (54.4‒92.2%). Cannabis consumers reported favourable perceptions of legal compared to illegal cannabis products regarding quality, convenience, and safety, but a lesser extent for price. CONCLUSION: Cannabis use is highly prevalent in the territories, particularly daily/almost daily use, and legal market penetration is high despite region remoteness. Following cannabis legalization, monitoring cannabis use prevalence and patterns in remote regions is important for informing the development of harm reduction and prevention initiatives that consider the unique needs of these regions.

RéSUMé: OBJECTIF: L'Étude sur les politiques relatives au cannabis dans les territoires (Cannabis Policy Study in the Territories ‒ CPST) est une étude transversale annuelle qui a pour but d'évaluer les répercussions de la légalisation du cannabis dans les territoires canadiens (Yukon, Territoires du Nord-Ouest et Nunavut), où il existe peu de données sur la consommation de cannabis. L'objectif de la présente étude était de décrire l'étude CPST de 2022, y compris la méthodologie, les estimations de la prévalence de la consommation de cannabis au sein de la population, ainsi que les sources et les perceptions du cannabis vendu légalement dans les territoires. MéTHODES: L'étude CPST menée en 2022 a consisté à interroger 2 462 personnes âgées de 16 ans et plus qui résident dans les territoires. Les répondants incluent des personnes qui consomment du cannabis et d'autres qui n'en consomment pas. Les répondants ont été recrutés au moyen d'invitations envoyées par la poste à partir de listes d'envoi autorisées. Les échantillons ont été effectués à partir d'un quasi-recensement des ménages qui résident dans les territoires. Les indicateurs pondérés en population de la consommation de cannabis sont décrits. RéSULTATS: Au cours des 12 derniers mois, le pourcentage d'autodéclarations de consommation de cannabis était de 46,1 %, et 21,8 % des répondants ont déclaré consommer quotidiennement ou presque. Les produits les plus couramment utilisés par les consommateurs au cours des 12 derniers mois étaient les fleurs séchées (73,4 %), les produits comestibles (59,0 %) et les huiles de vapotage (35,7 %). En moyenne, 74,8 % des produits de cannabis consommés au cours des 12 derniers mois provenaient de sources légales, bien que l'approvisionnement légal varie selon le type de produit (de 54,4 % à 92,2 %). Les consommateurs de cannabis ont déclaré percevoir favorablement les produits de cannabis vendus légalement comparativement aux produits vendus illégalement en ce qui a trait à la qualité, à la commodité et à la sécurité, mais dans une moindre mesure en matière de prix. CONCLUSION: La consommation de cannabis est très répandue dans les territoires, en particulier la consommation quotidienne ou presque quotidienne. De plus, la pénétration du marché des produits vendus légalement est élevée malgré l'éloignement des régions. À la suite de la légalisation du cannabis, la surveillance de la prévalence et des tendances de consommation du cannabis dans les régions éloignées fournit des renseignements importants pour l'élaboration d'initiatives de réduction des méfaits et de prévention qui tiennent compte des besoins uniques de ces régions.

Game bird consumption in Dene communities of the Northwest Territories, Canada.

OBJECTIVE: Game bird consumption is an important part of the diet of Indigenous populations in Canada and, as part of country food consumption, is associated with improved nutritional status. The objective of this project was to document the consumption of game birds for Dene First Nations in the Northwest Territories (NWT), Canada. DESIGN: Participants were invited to complete a FFQ using an iPad to document the types of country foods consumed, as well as consumption frequency and preparation methods, including thirteen types of game birds. SETTING: The project was implemented in nine communities in the Dehcho and Sahtú regions of the NWT, Canada. PARTICIPANTS: A total of 237 children and adult participants from Dene First Nations in the Mackenzie Valley region of the NWT took part in the current study. RESULTS: FFQ findings indicated that game birds were frequently consumed in both Dehcho and Sahtú communities. Canada goose and mallard were found to be consumed by the largest number of participants. Five different species (including Canada goose and mallard) were found to be consumed by at least 25 % of participants over the last year. When consuming game birds, most participants reported consuming the meat as well as most, if not all, other parts of the bird. CONCLUSIONS: Differences were observed since the last country food assessment in the 1990s in the same regions. These findings increase knowledge of the current Dene diet patterns and support the understanding of diet transition.

Skeletal pathology and bone mineral density changes in wild muskrats (Ondatra zibethicus) and red squirrels (Tamiasciurus hudsonicus) inhabiting arsenic polluted areas of Yellowknife, Northwest Territories (Canada): A radiographic densitometry study.

The City of Yellowknife is a known hotspot of arsenic contamination and there is a growing body of evidence suggesting that local wildlife in the vicinity of the abandoned Giant Mine site may be at risk of decreased bone mineralization and various bone disorders. The purpose of this study was to preliminarily measure bone mineral density (BMD) changes and investigate the incidence, pattern, and severity of bone lesions in wild muskrats and red squirrels breeding in three (3) catchment areas at different distances from the Giant Mine Site in Yellowknife, Northwest Territories (Canada): ~2 km (location 1), ~18 km (location 2), and ~40-100 km (location 3). Full femoral bones of 15 muskrats and 15 red squirrels were collected from the three sampling locations (5 from each location) and subjected to radiographic analysis and densitometric measurements. The patterns and severities of bone lesions, including changes in bone mineral density, were evaluated and compared between groups. As levels were significantly higher in the bones of muskrats caught from location 1 and 2, relative to location 3. Further, As and Cd levels were significantly higher in the bones of squirrels caught from locations 1 and 2 relative to squirrels caught from location 3. The preliminary results from bones revealed that radiographic abnormalities such as bone rarefaction, osteopenia, and thinning of the femoral shafts with significant ossific cystic lesions and bowing were the most common skeletal pathologies found in bones of red squirrels from the three locations. Radiographic appearances of massive sclerosis and dysplasia, including severe osteocondensation and osteopathia striata-like abnormalities, were found in the bones of muskrats from all the sampling locations. Densitometric evaluation showed no significant differences between the three locations in the bone parameters measured. However, there was a statistically significant correlation between As content in the bones of muskrats and percent fat content in the femur samples, which suggests that accumulation of As could have been a causal factor for a change in percent fat in femurs of muskrats.

Health risk assessment of arsenic exposure among the residents in Ndilǫ, Dettah, and Yellowknife, Northwest Territories, Canada.

There are concerns in Yellowknife, Northwest Territories, Canada, about arsenic exposure due to past mining operations, particularly the former Giant Mine. The objective of this study was to characterize the risk of arsenic exposure and associated risk factors among the local residents. Arsenic (As) and its species were quantified in urine (n = 1966) using inductively coupled mass spectrometry. Children in the study were found to have significantly higher (p < 0.05) urinary inorganic-related As (uiAs) concentrations than children in the general Canadian population, as well as adults in the study. Additionally, uiAs concentrations in children, particularly those above the 95th percentile, are above the Biomonitoring Equivalents (BE) levels that are associated with dermal effects, vascular problems and cancer risks. Multiple linear regression results showed that market seafood (fish and shellfish) and rice consumption frequency were significantly positively associated with uiAs. Specific to children, drinking lake water was positively associated with uiAs. Specific to adults, consumption of local mushrooms and berries were significantly positively associated with uiAs while there was a significant negative association with age, smoking and recreational water activities. The risk factors identified in this research can be used for public health education to lower arsenic intake. Overall, these results support the need for an ongoing monitoring program.

Baseline Assessment of Alcohol-Related Knowledge of and Support for Alcohol Warning Labels Among Alcohol Consumers in Northern Canada and Associations With Key Sociodemographic Characteristics.

OBJECTIVE: Evidence-informed alcohol warning labels (AWLs) are a promising, well-targeted strategy to increase consumer awareness of health risks. We assessed consumers' baseline knowledge of alcohol-related cancer risk, standard drinks, and low-risk drinking guidelines as well as levels of support for AWLs. We further assessed associations with sociodemographic factors. METHOD: Forming part of a larger study testing new evidence-informed AWLs in a northern Canadian territory compared with a neighboring territory, baseline surveys were completed among liquor store patrons systematically selected in both sites. Chi-square and multivariable logistic regression analyses were performed to assess outcomes. RESULTS: In total, 836 liquor store patrons (47.8% female) completed baseline surveys across both sites. Overall, there was low knowledge of alcohol-related cancer risk (24.5%), limited ability to calculate a standard drink (29.5%), and low knowledge of daily (49.5%) and weekly (48.2%) low-risk drinking guideline limits. There was moderate support for AWLs with a health warning (55.9%) and standard drink information (51.4%), and lower support for low-risk drinking guideline labels (38.7%). No sociodemographic characteristics were associated with cancer knowledge. Identifying as female and having adequate health literacy were associated with support for all three AWLs; high alcohol use was associated with not supporting standard drink (adjusted odds ratio = 0.60, 95% CI [0.40, 0.88]) and low-risk drinking guideline (adjusted odds ratio = 0.57, 95% CI [0.38, 0.87]) labels. CONCLUSIONS: Few consumers in this study had key alcohol-related health knowledge; however, there was moderate support for AWLs as a tool to raise awareness. Implementation of information-based interventions such as evidence-informed AWLs with health messages including alcohol-related cancer risk, standard drink information, and national drinking guidelines is warranted.

Testing Alcohol Labels as a Tool to Communicate Cancer Risk to Drinkers: A Real-World Quasi-Experimental Study.

OBJECTIVE: This study tested the initial and continued effects of cancer warning labels on drinkers' recall and knowledge that alcohol can cause cancer. METHOD: A quasi-experiment was conducted to examine changes in the intervention versus comparison site for three outcomes: unprompted and prompted recall of the cancer warning, and knowledge that alcohol can cause cancer. The intervention site applied cancer warning labels to alcohol containers in its liquor store for 1 month, and the two liquor stores in the comparison site did not apply cancer labels. In total, 2,049 unique cohort participants (1,056 male) were recruited at liquor stores in the intervention and comparison sites to participate in surveys 4 months before labels were applied and 2 and 6 months after the cancer label was halted because of alcohol industry interference. Generalized estimating equations tested differences in outcomes between sites over time adjusting for socio-demographics and other covariates. RESULTS: Two months after the cancer label, unprompted (+24.2% vs. +0.6%; adjusted odds ratio [AOR] = 32.7, 95% CI [5.4, 197.7]) and prompted (+35.7% vs. +4.1%; AOR = 6.2, 95% CI [3.6, 10.9]) recall increased to a greater extent in the intervention versus comparison site. There was a 10% greater increase in knowledge (+12.1% vs. +11.6%; AOR = 1.1, 95% CI [0.7, 1.5]) 2 months after the cancer label in the intervention versus comparison site. Similar results were found 6 months after the cancer label for all three outcomes. CONCLUSIONS: In a real-world setting, cancer warning labels get noticed and increase knowledge that alcohol can cause cancer. Additional cancer label intervention studies are required that are not compromised by industry interference.

Arsenic bioaccumulation in subarctic fishes of a mine-impacted bay on Great Slave Lake, Northwest Territories, Canada.

A subarctic fish community in mine-impacted Yellowknife Bay (Great Slave Lake, Northwest Territories, Canada) was investigated for biological and ecological processes controlling arsenic bioaccumulation. Total concentrations of arsenic, antimony, and metals were measured in over 400 fishes representing 13 species, and primary producers and consumers were included to characterize food web transfer. Yellowknife Bay had slightly more arsenic in surface waters (~3 µg/L) relative to the main body of Great Slave Lake (<1 µg/L), resulting in two-fold higher total arsenic concentrations in muscle of burbot (Lota lota), lake whitefish (Coregonus clupeaformis), and northern pike (Esox lucius). Other mining-associated contaminants, specifically antimony, lead, and silver, were typically below analytical detection in those fish species. No evidence was found for enhanced bioaccumulation of arsenic in long-lived, slow-growing subarctic fishes. Food web biodilution of total arsenic occurred between primary producers, aquatic invertebrates, and fish, although trophic position did not explain arsenic concentrations among fishes. Pelagic-feeding species had higher total arsenic concentrations compared to littoral fishes. Arsenic accumulated in subarctic fishes to comparable levels as fishes from lakes around the world with similar water arsenic concentrations. This first comprehensive study for a subarctic freshwater food web identified the importance of water exposure, biodilution, and habitat-specific feeding on arsenic bioaccumulation.

The Australian Aboriginal Birth Cohort study: socio-economic status at birth and cardiovascular risk factors to 25 years of age.

OBJECTIVES: To determine whether socio-economic status at birth is associated with differences in risk factors for cardiovascular disease - body mass index (BMI), blood pressure, blood lipid levels - during the first 25 years of life. DESIGN: Analysis of prospectively collected data. SETTING, PARTICIPANTS: 570 of 686 children born to Aboriginal mothers at the Royal Darwin Hospital during 1987-1990 and recruited for the Aboriginal Birth Cohort Study in the Northern Territory. Participants resided in 46 urban and remote communities across the NT. The analysed data were collected at three follow-ups: Wave 2 in 1998-2001 (570 participants; mean age, 11 years), Wave 3 in 2006-2008 (442 participants; mean age, 18 years), and Wave 4 in 2014-2016 (423 participants; mean age, 25 years). MAIN OUTCOME MEASURES: Cardiovascular disease risk factors by study wave and three socio-economic measures at the time of birth: area-level Indigenous Relative Socioeconomic Outcomes (IRSEO) index score and location (urban, remote) of residence, and parity of mother. RESULTS: Area-level IRSEO of residence at birth influenced BMI (P < 0.001), systolic blood pressure (P = 0.024), LDL-cholesterol (P = 0.010), and HDL-cholesterol levels (P < 0.001). Remoteness of residence at birth influenced BMI (P < 0.001), HDL-cholesterol (P < 0.001), and triglyceride levels (P = 0.043). Mother's parity at birth influenced BMI (P = 0.039). CONCLUSIONS: Our longitudinal life course analyses indicate that area-level socio-economic factors at birth influence the prevalence of major cardiovascular disease risk factors among Indigenous Australians during childhood and early adulthood.

Syndemic Factors Associated with Safer Sex Efficacy Among Northern and Indigenous Adolescents in Arctic Canada.

BACKGROUND: Syndemic approaches explore the synergistic relationships between social and health inequities. Such approaches are particularly salient for the Northwest Territories, Canada, that experiences national social (food insecurity, intimate partner violence [IPV]) and health (sexually transmitted infections [STI]) disparities. Safer sex efficacy (SSE) includes knowledge, intention, and relationship dynamics that facilitate safer sex negotiation. We examined factors associated with SSE among NWT adolescents. METHODS: We conducted a cross-sectional survey with a venue-based sample of adolescents aged 13-17 in 17 NWT communities from 2016 to 2017. Summary statistics and statistical comparisons were conducted, followed by crude and adjusted multivariable regression models to assess factors associated with SSE. RESULTS: Among participants (n = 610; mean age 14.2 years [SD 1.5]; 49.5% cisgender women, 48.9% cisgender men, 1.6% transgender persons; 73.3% Indigenous), one-quarter (n = 144; 23.6%) reported food insecurity and nearly one-fifth (n = 111; 18.2%) IPV. In adjusted analyses, among young women, food insecurity (ß - 1.89[CI - 2.98, - 0.80], p = 0.001) and IPV (ß - 1.31[CI - 2.53, - 0.09], p = 0.036) were associated with lower SSE, and currently dating was associated with increased SSE (ß 1.17[CI 0.15, 2.19], p = 0.024). Among young men, food insecurity (ß - 2.27[CI - 3.39, - 1.15], p = 0.014) was associated with reduced SSE. Among sexually active participants (n = 115), increased SSE was associated with consistent condom use among young women (ß 1.40[0.19, 2.61], p = 0.024) and men (ß 2.14[0.14, 4.14], p = 0.036). CONCLUSIONS: Food insecurity and IPV were associated with lower SSE-a protective factor associated with consistent condom use-underscoring the need to address poverty and violence to advance adolescent sexual health in the NWT.

Design of a human biomonitoring community-based project in the Northwest Territories Mackenzie Valley, Canada, to investigate the links between nutrition, contaminants and country foods.

Community-based projects place emphasis on a collaborative approach and facilitate research among Indigenous populations regarding local issues and challenges, such as traditional foods consumption, climate change and health safety. Country foods (locally harvested fish, game birds, land animals and plants), which contribute to improved food security, can also be a primary route of contaminant exposure among populations in remote regions. A community-based project was launched in the Dehcho and Sahtù regions of the Northwest Territories (Canada) to: 1) assess contaminants exposure and nutrition status; 2) investigate the role of country food on nutrient and contaminant levels and 3) understand the determinants of message perception on this issue. Consultation with community members, leadership, local partners and researchers was essential to refine the design of the project and implement it in a culturally relevant way. This article details the design of a community-based biomonitoring study that investigates country food use, contaminant exposure and nutritional status in Canadian subarctic First Nations in the Dehcho and Sahtù regions. Results will support environmental health policies in the future for these communities. The project was designed to explore the risks and benefits of country foods and to inform the development of public health strategies.

Pathways between depression, substance use and multiple sex partners among Northern and Indigenous young women in the Northwest Territories, Canada: results from a cross-sectional survey.

OBJECTIVES: Sexual and mental health disparities exist in the Northwest Territories (NWT) compared with other Canadian regions. STI rates are 10-fold higher, and youth suicide rates double the Canadian average. Scant research has examined associations between mental and sexual health among youth in the NWT. The study objective was to explore pathways from depression to multiple sex partners (MSP) among young women in the NWT, Canada. METHODS: We implemented a cross-sectional survey in 2015-2016 with a venue-based recruitment sample of young women aged 13-17 attending secondary schools in 17 NWT communities. We conducted path analysis to test a conceptual model examining associations between depression and a history of MSP, examining substance use and peer support as mediators. RESULTS: Participants (n=199; mean age: 13.8, SD: 1.27) mostly identified were Indigenous (n=154; 77.4%) and one-fifth (n=39; 20.5%) were sexually diverse/non-heterosexual. Almost two-thirds (n=119; 63.3%) reported depression symptoms. One-quarter (n=53; 26.6%) were currently dating, and 16.1% (n=32) reported a lifetime history of >1 sex partner (classified as having MSP). There was no direct effect between depression and MSP (ß=0.189, p=0.087, 95% CI 0.046 to 0.260). Depression had a direct effect on substance use (ß=0.023, p<0.050, 95% CI 0.118 to 0.500), and an indirect effect on MSP through substance use (ß=0.498, SE=0.10, p<0.001, 95% CI 0.141 to 0.280). Depression was associated with lower peer support (ß=-0.168, p<0.010, 95% CI -0.126 to 0.280); peer support was not associated with MSP (ß=-0.158, p=0.130, 95% CI -0.126 to 0.001). CONCLUSION: This research is among the first to identify mental health factors associated with STI vulnerability among young women in the NWT. Findings demonstrate the importance of addressing depression and substance use in sexual health interventions in Northern contexts.

ANTHRAX IN THE MACKENZIE WOOD BISON (BISON BISON ATHABASCAE) POPULATION: 2012 ANTHRAX OUTBREAK AND HISTORICAL EXPOSURE IN NONOUTBREAK YEARS.

Anthrax, caused by the spore-forming bacterium Bacillus anthracis, poses a threat to wood bison (Bison bison athabascae) conservation. We used descriptive epidemiology to characterize a large outbreak of anthrax in the Mackenzie bison population in the Northwest Territories, Canada, in 2012 and investigated historical serologic exposure of the bison to the bacterium in nonoutbreak years. Between late June and early August 2012, 451 bison carcasses were detected; mortality peaked from 13-19 July. A substantial number of calves, yearlings, and adult females died in the 2012 outbreak, unlike in two previous anthrax outbreaks in this population that killed mostly mature males. On the basis of the difference in estimates of population size prior to the outbreak (2012) and after the outbreak (2013), it is possible that not all dead bison were found during the outbreak. We assessed serologic history of exposure to B. anthracis by using samples from the Mackenzie wood bison population collected between 1986 and 2009. Overall, 87 of 278 samples were positive (31%). Seroprevalence was lower in females (18%, 10/55) than males (36%, 72/203). The highest proportion of positive submissions (90%) was from 1994, the year following the only anthrax outbreak within the historical data set. Both adult males and females had a higher likelihood of being seropositive than the younger age categories. There was a trend toward declining antibody levels between the 1993 and 2012 outbreak years.

Inferring infection hazard in wildlife populations by linking data across individual and population scales.

Our ability to infer unobservable disease-dynamic processes such as force of infection (infection hazard for susceptible hosts) has transformed our understanding of disease transmission mechanisms and capacity to predict disease dynamics. Conventional methods for inferring FOI estimate a time-averaged value and are based on population-level processes. Because many pathogens exhibit epidemic cycling and FOI is the result of processes acting across the scales of individuals and populations, a flexible framework that extends to epidemic dynamics and links within-host processes to FOI is needed. Specifically, within-host antibody kinetics in wildlife hosts can be short-lived and produce patterns that are repeatable across individuals, suggesting individual-level antibody concentrations could be used to infer time since infection and hence FOI. Using simulations and case studies (influenza A in lesser snow geese and Yersinia pestis in coyotes), we argue that with careful experimental and surveillance design, the population-level FOI signal can be recovered from individual-level antibody kinetics, despite substantial individual-level variation. In addition to improving inference, the cross-scale quantitative antibody approach we describe can reveal insights into drivers of individual-based variation in disease response, and the role of poorly understood processes such as secondary infections, in population-level dynamics of disease.

Backcountry Travel Emergencies in Arctic Canada: A Pilot Study in Public Health Surveillance.

Residents in the Canadian Arctic regularly travel in remote, backcountry areas. This can pose risks for injuries and death, and create challenges for emergency responders and health systems. We aimed to describe the extent and characteristics of media-reported backcountry travel emergencies in two Northern Canadian territories (Nunavut and Northwest Territories). A case-series of all known incidents between 2004 and 2013 was established by identifying events in an online search of two media outlets, Nunatsiaq News and Northern News Services. We identified 121 incidents; these most commonly involved young men, and death occurred in just over 25% of cases. The territories differed in the seasonal patterns. News media provides a partial source of data to estimate the extent and characteristics of backcountry emergencies. This information is needed to improve emergency preparedness and health system responsiveness in the Arctic.

Patterns of youth injury: a comparison across the northern territories and other parts of Canada.

BACKGROUND: Injury is the leading cause of death for young people in Canada. For those living in the northern territories (Yukon, Nunavut, and the Northwest Territories), injury represents an even greater problem, with higher rates of injury for people of all ages in northern areas compared with the rest of Canada; however, no such comparative studies have focussed specifically on non-fatal injury in youth. OBJECTIVES: To profile and examine injuries and their potential causes among youth in the northern territories as compared with other parts of Canada. DESIGN: Cross-sectional data from the 2009/2010 Health Behaviour in School-aged Children survey (youth aged 11-15 years) were examined for the Canadian northern territories and the provinces (n=26,078). Individual survey records were linked to community-level data to profile injuries and then study possible determinants via multilevel regression modelling. RESULTS: The prevalence of injury reported by youth was similar in northern populations and other parts of Canada. There were some minimal differences by injury type: northern youth experienced a greater percentage of neighbourhood (p<0.001) and fighting (p=0.02) injuries; youth in the Canadian provinces had a greater proportion of sport-related injuries (p=0.01). Among northern youth, female sex (RR=0.87, 95% CI 0.81-0.94), average (RR=0.88, 95% CI 0.80-0.97) or above-average affluence (RR=0.84, 95% CI 0.76-0.91), not being drunk in the past 12 months (RR=0.77, 95% CI 0.69-0.85), not riding an all-terrain vehicle (RR=0.81, 95% CI 0.68-0.97) and not having permanent road access (RR=0.89, 95% CI 0.80-0.98) were protective against injury; sport participation increased risk (RR=1.45, 95% CI 1.33-1.59). CONCLUSIONS: Patterns of injury were similar across youth from the North and other parts of Canada. Given previous research, this was unexpected. When implementing injury prevention initiatives, individual and community-level risk factors are essential to understand; however, specific positive safety assets that might exist in different community contexts must also be considered.

Echinococcus multilocularis and Echinococcus canadensis in wolves from western Canada.

Echinococcus species are important parasites of wildlife, domestic animals and people worldwide; however, little is known about the prevalence, intensity and genetic diversity of Echinococcus tapeworms in Canadian wildlife. Echinococcus tapeworms were harvested from the intestines of 42% of 93 wolves (Canis lupus) from five sampling regions in the Northwest Territories, Manitoba and Saskatchewan, and visually identified to genus level by microscopic examination. Genetic characterization was successful for tapeworms from 30 wolves, and identified both Echinococcus canadensis and Echinococcus multilocularis in all sampling locations. Mixed infections of E. canadensis/E. multilocularis, as well as the G8/G10 genotypes of E. canadensis were observed. These findings suggest that wolves may be an important definitive host for both parasite species in western Canada. This represents the first report of wolves naturally infected with E. multilocularis in North America, and of wolves harbouring mixed infections with multiple species and genotypes of Echinococcus. These observations provide important information regarding the distribution and diversity of zoonotic species of Echinococcus in western North America, and may be of interest from public health and wildlife conservation perspectives.

Helicobacter pylori incidence and re-infection in the Aklavik H. pylori Project.

BACKGROUND: The Aklavik H. pylori Project (AHPP) (www.canhelpworkinggroup.ca) is a community-driven project examining Helicobacter pylori infection and its influence on health in a diverse Aboriginal community in the Northwest Territories. Initial research revealed that 58% of 333 participants who underwent a urea breath test (UBT) between 2007 and 2010 were H. pylori-positive. From 2008 to 2010, we offered treatment to H. pylori-positive participants and 113 consented to this treatment. OBJECTIVE: We estimated H. pylori incidence in AHPP participants who initially tested negative and the re-infection frequency in initially positive participants who were successfully treated to clear the infection. METHODS: Participants who were initially H. pylori-negative or negative after treatment during 2008-2010 were eligible for inclusion. From November 2011 to June 2012, participants were offered a UBT and the samples were analyzed using infrared spectroscopy (IRIS). Participants with a positive test result were classified as new cases for estimating incidence among participants testing negative at baseline and re-infection among those successfully treated for H. pylori infection. RESULTS: Among 38 initially negative participants, follow-up UBT showed that 33 remained negative, 3 were positive, and 2 had uncertain status. The estimated incidence proportion during the follow-up period was 8.3% (95% CI: 1.8-22.0%). Among 43 participants with a negative post-treatment UBT, 41 remained negative and 2 were positive. The estimated re-infection proportion during the follow-up period was 4.7% (95% CI: 0.6-16.0%). The frequency of new cases was similar in males and females. Aboriginal participants had a combined re-infection/incidence rate of 2.4% per year (95% CI: 0.8-5.9% per year). All 9 non-Aboriginal participants remained free from infection throughout the study period, as did all 23 participants aged 55 years and above. CONCLUSIONS: The AHPP has substantially reduced the burden of infection in Aklavik since 2008. Continued monitoring, treatment, community engagement and knowledge translation activities are needed to ensure a lasting benefit of the project.

Examining DNA fingerprinting as an epidemiology tool in the tuberculosis program in the Northwest Territories, Canada.

BACKGROUND: Tuberculosis (TB) is an important public health problem in the Northwest Territories (NWT), particularly among Canadian Aboriginal people. OBJECTIVE: To analyse the transmission patterns of tuberculosis among the population living in the NWT, a territorial jurisdiction located within Northern Canada. METHODS: This population-based retrospective study examined the DNA fingerprints of all laboratory confirmed cases of TB in the NWT, Canada, between 1990 and 2009. An isolate of each lab-confirmed case had genotyping done using IS6110 Restriction Fragment Length Polymorphism. DNA patterns were assigned to each DNA fingerprint, and indistinguishable fingerprints patterns were assigned a cluster. Social network analysis (SNA) was used to examine direct linkages among cases determined through conventional contact tracing (CCT), their DNA fingerprint and home community. RESULTS: Of the 225 lab-confirmed cases identified, the study was limited to 195 subjects due to DNA fingerprinting data availability. The mean age of the cases was 43.8 years (±22.6) and 120 (61.5%) males. The Dene (First Nations) encompassed 120 of the cases (87.7%), 8 cases (4.1%) were Inuit, 2 cases (1.0%) were Metis, 7 cases (3.6%) were Immigrants and 1 case had unknown ethnicity. One hundred and eighty six (95.4%) subjects were clustered, resulting in 8 clusters. Trend analysis showed significant relationships between with risk factors for unemployment (p=0.020), geographic location (p≤0.001) and homelessness (p≤0.001). Other significant risk factors included excessive alcohol consumption, prior infection with Mycobacterium tuberculosis and prior contact with a case of TB. CONCLUSIONS: This study demonstrates how DNA fingerprinting and SNA can be additional epidemiological tools, along with CCT method, to determine transmission patterns of TB.

Dietary adequacy and alcohol consumption of Inuvialuit women of child-bearing age in the Northwest Territories, Canada.

BACKGROUND: Previous studies highlight a possible association between alcohol-drinking patterns and dietary inadequacies, which may have negative implications, particularly for women of child-bearing age. The present study aimed to compare dietary adequacy among alcohol drinkers versus nondrinkers in Inuvialuit women of child-bearing age. METHODS: A cross-sectional survey of 92 randomly selected women of childbearing age (19-44 years) was conducted in three communities in the Northwest Territories of Arctic Canada, using a validated quantitative food frequency questionnaire. Data were analysed to compare mean daily energy and nutrient intakes, dietary adequacy and nutrient densities (per 4184 kJ) between alcohol drinkers and nondrinkers, as well as heavy drinkers and nonheavy drinkers, using the nonparametric Wilcoxen rank sum test. RESULTS: The response rate was between 65% and 85% depending on the community sampled. Of the study participants, 54% (n = 49) were drinkers and 46% (n = 42) were nondrinkers. Of the drinkers, 45% (n = 22) were heavy drinkers. Mean energy intakes were high among all women, although they were significantly higher among drinkers [17,179 kJ (4106 kcal)] compared to nondrinkers [13,317 kJ (3183 kcal)]. There were no significant differences in nutrient intake between the two groups; however, drinkers had a lower nutrient density for most nutrients. Heavy drinkers had a significantly lower nutrient density for all nutrients, except protein, iron, and vitamins B6 , C and D, compared to nonheavy drinkers. CONCLUSIONS: The findings of the present study provide evidence of inadequate dietary intake among Inuvialuit of child-bearing age, regardless of alcohol-drinking behaviour.