"All the problems in the community are multifaceted and related to each other": Inuit concerns in an era of climate change.

OBJECTIVE: Human dimensions of climate change research in the Arctic often proposes ways for local communities to adapt to changes to their environment, foregrounding problems posed by climate change while treating social, political, and economic factors as background conditions. We explore the relevance of this research paradigm for Inuit by examining how Inuit from Kangiqsujuaq present and discuss the major issues facing their community. METHODS: We thematically code and analyze the responses of 107 Inuit to three free-response questions about the problems facing their community and the best things about their community. The data were collected as part of a questionnaire for a project focused on food security and food sharing conducted in Kangiqsujuaq, Nunavik, in 2013 to 2014. RESULTS: Few respondents mentioned issues relating to climate change among the most pressing problems faced by their community. Rather, a suite of interconnected social and economic issues, particularly substance abuse and the cost of living, emerged as the main concerns of Kangiqsujuarmiut. However, the environment was a central theme in respondents' favorite thing about their community. CONCLUSIONS: In light of the concerns identified by Inuit, we argue that much research on climate change makes incorrect a priori assumptions and consequently fails to capture aspects of Arctic socioecological systems that are essential for how Inuit are responding to climate change. An inductive, open-ended approach can help produce research more relevant to communities.

Trauma in northern Quebec, 2005-2014: epidemiologic features, transfers and patient outcomes.

BACKGROUND: The Inuit people residing in Nunavik, Quebec, are vulnerable to major trauma owing to environmental and social factors; however, there is no systematic data collection for trauma in Nunavik, and, apart from data regarding patients who are transferred to tertiary care centres, no data enter the Quebec trauma registry directly from Nunavik. We performed a study to characterize the epidemiologic features of trauma in Nunavik, and describe indications for transfer and outcomes of patients referred to the tertiary trauma centre. METHODS: We collected data retrospectively for all patients with trauma admitted to the Centre de santé Tulattavik de l'Ungava in Kuujjuaq from 2005 to 2014. Sociodemographic, injury and health services data were extracted. The data were analyzed in conjunction with coroners' reports on death from trauma in Nunavik. RESULTS: A total of 797 trauma cases were identified. The most common causes of injury were motor vehicle collisions (258 cases [32.4%]), falls (137 [17.2%]) and blunt assault (95 [11.9%]). One-third of patients (262 [32.9%]) were transferred to the tertiary care centre in Montréal. The incidence rate of major trauma (Injury Severity Score > 12) was 18.1 and 21.7 per 10 000 person-years in the Kuujjuaq region and the Puvirnituq region, respectively, which translates to a relative risk (RR) of 4 compared to the Quebec population. The disparity observed in trauma mortality rate was even greater, with an RR of 47.6 compared to the Quebec population. CONCLUSION: The study showed major disparity in trauma incidence and mortality rate between Nunavik and the province of Quebec. Our findings allow for a better understanding of the burden of injury and regional trauma mortality in Nunavik, and recommendations for optimization of the trauma system in this unique setting.

Tackling the question of micronutrients intake as one of the main levers in terms of Inuit food security.

PURPOSE OF REVIEW: The Inuit population living in North Canada is facing a drastic change in lifestyle, which has brought about a dramatic nutrition transition characterized by a decrease in the traditional foods consumption and an increasing reliance on processed, store-bought foods. This rapid dietary shift leads to a significant public health concern, as wild-harvested country foods are rich in many micronutrients including vitamins, trace elements and minerals while the most frequently eaten Western foods mainly provide energy, fat, carbohydrates and sodium. This review addresses the emerging strategies to tackle food insecurity in this population. RECENT FINDINGS: Recent studies indicate that diets with a higher fraction of traditional foods (and a lower fraction of ultra-processed foods) exhibit a better Healthy Eating Index. This provides a basis to develop new dietary policies anchored in contemporary food realities. SUMMARY: In Northern remote communities, improving food security requires holistic approaches. A mixed strategy that targets the revitalization of traditional foods systems and local food production initiatives seems the most promising strategy, to meet the dietary needs in terms of micronutrients, with respect to the cultural identity of local populations.

Fuzzy cognitive mapping with Inuit women: what needs to change to improve cervical cancer screening in Nunavik, northern Quebec?

BACKGROUND: Among Canadian Inuit, cervical cancer incidence and mortality rates are up to three times higher than the Canadian average. Cervical cancer is preventable through regular screening which, in Quebec, is opportunistic and requires physical examination and Papanicolaou ("Pap") smears. Since Human Papillomavirus (HPV) is the necessary cause of cervical cancer, HPV testing is a plausible screening alternative. HPV testing by self-sampling also addresses several barriers associated with physical examination and access to healthcare. In a participatory research paradigm, we worked with two communities of Nunavik to explore the possible implementation of HPV self-sampling. METHOD: Key community stakeholders formed an Advisory Committee to guide direct discussions with Inuit women. We presented available facts around cervical cancer, HPV and the female anatomy, and used Fuzzy Cognitive Mapping to collate women's views. A thematic analysis summarized data, adding links and weights to represent the relationship of each factor on the outcome: screening for cervical cancer. RESULTS: According to the 27 Inuit women who participated, the most influential factor in using health services was the cultural awareness of the healthcare provider. A significant barrier to screening was patient lack of information. The principal vector of change - the factor most likely to influence other factors - was the means of communication between the healthcare provider and the patient: visual communication was told to be the most effective. CONCLUSION: Fuzzy Cognitive Mapping is a practical tool for discussing possible health actions with stakeholders and to inform future research. The tool offers a visual aid for discussion across cultural and educational differences. It can help to build the partnerships that incorporate community voices into co-design of interventions that are relevant to and aligned with the needs of those who use them.

Socioeconomic inequalities in psychological distress and suicidal behaviours among Indigenous peoples living off-reserve in Canada.

BACKGROUND: Indigenous peoples in Canada have high rates of psychological distress and suicide. We sought to assess the socioeconomic inequalities in psychological distress and suicidal behaviours, and the factors that explain them within Indigenous peoples living off-reserve. METHODS: Using the nationally representative 2012 Aboriginal Peoples Survey collected from Indigenous adults living off-reserve in Canada, we measured income-related inequalities in psychological distress (measured on the 10-item Kessler Psychological Distress Scale) and suicidal behaviours (suicidal ideation and suicide attempt) and identified factors contributing to these inequalities using the concentration index (C) approach. RESULTS: Among 14 410 individuals representing 600 750 Indigenous adults (aged ≥ 18 yr) living off-reserve in Canada, the mean score of psychological distress was 16.1; 19.4% reported lifetime suicidal ideation and 2.2% reported a lifetime suicide attempt. Women had higher psychological distress scores (mean score 16.7 v. 15.2, p < 0.001), and prevalence of suicidal ideation (21.9% v. 16.1%, p < 0.001) and suicide attempts (2.3% v. 2.0%, p = 0.002) than men. Poorer individuals disproportionately experienced higher psychological distress (C = -0.054, 95% confidence interval [CI] -0.057 to -0.050), suicidal ideation (C n = -0.218, 95% CI -0.242 to -0.194) and suicide attempts (C n = -0.327, 95% CI -0.391 to -0.263). Food insecurity and income, respectively, accounted for 40.2% and 13.7% of the psychological distress, 26.7% and 18.2% of the suicidal ideation and 13.4% and 7.8% of the suicide attempts concentrated among low-income Indigenous peoples. INTERPRETATION: Substantial income-related inequalities in psychological distress and suicidal behaviours exist among Indigenous peoples living off-reserve in Canada. Policies designed to address major contributing factors such as food insecurity and income may help reduce these inequalities.

A systematic review and meta-analysis of cardiorespiratory fitness among Indigenous populations in North America and circumpolar Inuit populations.

Indigenous populations experience health disparities including increased obesity, diabetes and cardiovascular disease rates. Cardiorespiratory fitness is beneficial for maintaining positive health outcomes. The objective of this systematic review is to evaluate cardiorespiratory fitness among Indigenous populations including comparisons across genders, Indigenous identities, age groups, decades, socio-demographic variables and in comparison to non-Indigenous groups. Included articles reported various cardiorespiratory fitness measures using maximal treadmill or cycle ergometer tests, 20 m shuttle run, 1 mile run/walk test and 6 min walk test. From 14 databases searched in March 2017, including MEDLINE, EMBASE and Scopus, 1069 citations were evaluated and 39 articles included, representing 32 investigations and 10,579 individuals. First Nations/American Indian (FN/AI) adults have greater cardiorespiratory fitness than Inuit. Inuit and FN/AI men and boys have higher cardiorespiratory fitness than women and girls. Lower cardiorespiratory fitness is associated with obesity, metabolic syndrome and a western lifestyle. Cardiorespiratory fitness has declined among Inuit adults, averaging 51.7 ±â€¯7.9 mL·kg-1·min-1 in 1970 to 37.7 ±â€¯6.9 mL·kg-1·min-1 in 2000. Among men, FN/AI have greater cardiorespiratory fitness compared to European-descents, and European-descents have greater cardiorespiratory fitness compared to Inuit. The 1 mile run/walk time showed that FN/AI boys, girls, and youth had faster times compared to European-descendants, but 20 m shuttle run showed that European-descent boys and youth advanced to further stages compared to FN/AI populations. Cardiorespiratory fitness is declining, and among some Indigenous populations to lower levels than European-descent populations. Improving cardiorespiratory fitness for Indigenous populations should be considered a primary health strategy.

Association of blood polychlorinated biphenyls and cholesterol levels among Canadian Inuit.

BACKGROUND: It has generally been thought that Inuit populations have low risk of cardiovascular disease due to high consumption of omega-3 fatty acids found in traditional marine-based diets. However, results of recent surveys showed that Inuit populations are experiencing increasing rates of cardiovascular disease and related risk factors. OBJECTIVE: The purpose of this study was to investigate if blood polychlorinated biphenyls (PCBs) are associated with high cholesterol and related parameters in Canadian Inuit, known risk factors for cardiovascular disease. METHODS: The Adult Inuit Health Survey (IHS, 2007-2008) included 2595 Inuit participants from three regions of the Canadian Arctic, of which 2191 could be classified as with or without high cholesterol. The high cholesterol outcome was defined by LDL-C > 3.36mmol/L or taking medication(s) that reduce cholesterol, and was examined in adjusted logistic regression models with individual blood levels of PCB congeners, sum of dioxin-like PCBs (∑DL-PCBs), or sum of non-dioxin-like PCBs (∑NDL-PCBs). Statistically significant covariates for high cholesterol were ranked in importance according to the proportion of the model log likelihood explained. Continuous clinical parameters of total cholesterol, triglycerides, LDL-C, and HDL-C were examined in multiple linear regression models with ∑DL-PCBs or ∑NDL-PCBs. RESULTS: A total of 719 participants had high cholesterol (32.8%). PCBs were associated with increased risk of high cholesterol, and higher levels of serum triglycerides, total cholesterol, and LDL-C. No association was observed between PCBs and serum HDL-C. With respect to other statistically significant covariates for high cholesterol, the log likelihood ranking of PCBs generally fell between body mass index (BMI) and age. CONCLUSION: Further work is needed to corroborate the associations observed with PCBs and lipids in Canadian Inuit and to examine if they are causal in the direction anticipated.

Dietary sources of energy and nutrients in the contemporary diet of Inuit adults: results from the 2007-08 Inuit Health Survey.

OBJECTIVE: To characterize the major components of the contemporary Inuit diet and identify the primary sources of energy and essential nutrients. DESIGN: Dietary data were derived from the 24 h recall collected by the Inuit Health Survey (IHS) from 2007 to 2008. The population proportion method was used to determine the percentage contribution of each group. Unique food items/preparations (ninety-three country foods and 1591 market foods) were classified into eight country food groups and forty-one market food groups. Nutrient composition of each food item was obtained from the Canadian Nutrient File. SETTING: Thirty-six communities across three Inuit regions of northern Canada. SUBJECTS: A representative sample (n 2095) of non-pregnant Inuit adults (≥18 years), selected through stratified random sampling. RESULTS: Despite their modest contribution to total energy intake (6·4-19·6 %, by region) country foods represented a major source of protein (23-52 %), Fe (28-54 %), niacin (24-52 %) and vitamins D (up to 73 %), B6 (18-55 %) and B12 (50-82 %). By contrast, the three most popular energy-yielding market foods (i.e. sweetened beverages, added sugar and bread) collectively contributed approximately 20 % of total energy, while contributing minimally to most micronutrients. A notable exception was the contribution of these foods to Ca (13-21 %) and vitamins E (17-35 %) and C (as much as 50 %). Solid fruits were consumed by less than 25 % of participants while vegetables were reported by 38-59 % of respondents. CONCLUSIONS: Country foods remain a critical dimension of the contemporary Inuit diet.

Vitamin D status and intake of lactating Inuit women living in the Canadian Arctic.

OBJECTIVE: To determine the prevalence and correlates of healthy vitamin D status in lactating Inuit women living in remote regions of the Arctic. DESIGN: Cross-sectional. SETTING: Households were selected randomly in thirty-six communities of Nunavut, Nunatsiavut and Inuvialuit Settlement Region. Dietary intake was assessed using a 24 h recall and an FFQ. Anthropometric measurements, household living conditions, supplement use and health status were assessed. In fasting samples, serum 25-hydroxyvitaimn D (25(OH)D) was measured using a chemiluminescent assay (LIAISON; Diasorin Inc.). SUBJECTS: Lactating Inuit women participating in the 2007-2008 International Polar Year Inuit Health Survey conducted in the months of August to October. RESULTS: Among participants (n 34), 8·8, 26·5 and 50·0 % had 25(OH)D concentrations at or above 75, 50 and 40 nmol/l, respectively. More than one-third of participants did not consume traditional foods during the previous day and only 11·3 % of total energy intake was derived from traditional foods. Only 14·7 % of the sample consumed the daily number of milk servings recommended by Canada's Food Guide (two servings) for First Nations, Inuit and Métis. Using multivariable logistic regression to examine 25(OH)D≥40 nmol/l, only higher body fat was inversely correlated with 25(OH)D concentration. CONCLUSIONS: The present study is the first to assess simultaneously vitamin D status and other known factors that affect it among lactating Inuit women living in remote communities in the Arctic. Healthy maternal vitamin D status was observed in 25 % of participants during the late summer and early autumn. This requires further assessment in a larger sample spanning more seasons.

Assessing Disparities in the Rates of HCV Diagnoses Within American Indian or Alaska Native Populations Served by the U.S. Indian Health Service, 2005-2015.

Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The Indian Health Service (IHS), via federal and tribal health facilities provides medical services to an estimated 2.2 million AI/AN people in the United States. HCV diagnoses, defined by International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) codes, were analyzed from 2005 to 2015. Results showed 29,803 patients with an HCV diagnosis; 53.4% were among persons born 1945-1965 and overall HCV burden was higher among males than females. These data will help inform local, regional, and national efforts to address, plan for and carry out a national strategy to provide treatment for HCV infected patients and programs to prevent new HCV infections.

Acute care hospitalizations for mental and behavioural disorders among First Nations people.

BACKGROUND: National information about acute care hospitalizations for mental/behavioural disorders among Aboriginal people in Canada is limited. DATA AND METHODS: This study describes acute care hospitalizations for mental /behavioural disorders among First Nations people living on and off reserve. The 2006 Census was linked to the Discharge Abstract Database from 2006/2007 through 2008/2009 for all provinces (except Ontario and Quebec) and the three territories. Hospitalizations for seven types of disorders were identified. "Most responsible" diagnosis and secondary diagnoses were examined separately. Age-standardized hospitalization rates (ASHRs) per 100,000 population and rate ratios were calculated. RESULTS: ASHRs for most responsible and secondary diagnoses of mental/behavioural disorders were significantly higher for First Nations people living on and off reserve than for non-Aboriginal people. The leading diagnoses were the same for each group, but the rank order differed. Among First Nations people, the most common diagnoses were substance-related disorders, mood disorders, and schizophrenic/psychotic disorders. Among non-Aboriginal people, mood disorders were the leading most responsible diagnosis, followed by schizophrenic/psychotic disorders and substance-related disorders. The greatest rate differences between First Nations and non-Aboriginal people for both most responsible and secondary diagnoses were for substance-related disorders. DISCUSSION: The higher burden of hospitalizations due to mental/behavioural disorders among First Nations people provides benchmarks and points to the need of considering every hospital admission as an important opportunity for intervention and prevention. The Truth and Reconciliation Commission of Canada (2015) has recognized that the poorer health outcomes of Aboriginal people in Canada were rooted in the legacies of colonization. Further research is required to better understand the direct impacts on mental health.

Ethnic disparities in children's oral health: findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada.

BACKGROUND: Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. METHODS: A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. RESULTS: We observed significant ethnic disparities in children's oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. CONCLUSIONS: Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for demographic, socioeconomic and caries-related behavioral factors, with Filipino, Arab, and Indigenous children being the most affected.

Food insecurity and food consumption by season in households with children in an Arctic city: a cross-sectional study.

BACKGROUND: High rates of food insecurity are documented among Inuit households in Canada; however, data on food insecurity prevalence and seasonality for Inuit households with children are lacking, especially in city centres. This project: (1) compared food consumption patterns for households with and without children, (2) compared the prevalence of food insecurity for households with and without children, (3) compared food consumption patterns and food insecurity prevalence between seasons, and (4) identified factors associated with food insecurity in households with children in Iqaluit, Nunavut, Canada. METHODS: Randomly selected households were surveyed in Iqaluit in September 2012 and May 2013. Household food security status was determined using an adapted United States Department of Agriculture Household Food Security Survey Module. Univariable logistic regressions were used to examine unconditional associations between food security status and demographics, socioeconomics, frequency of food consumption, and method of food preparation in households with children by season. RESULTS: Households with children (n = 431) and without children (n = 468) participated in the survey. Food insecurity was identified in 32.9% (95% CI: 28.5-37.4%) of households with children; this was significantly higher than in households without children (23.2%, 95% CI: 19.4-27.1%). The prevalence of household food insecurity did not significantly differ by season. Demographic and socioeconomic characteristics of the person responsible for food preparation, including low formal education attainment (ORSept = 4.3, 95% CI: 2.3-8.0; ORMay = 3.2, 95% CI: 1.8-5.8), unemployment (ORSept = 1.1, 95% CI: 1.1-1.3; ORMay = 1.3, 95% CI: 1.1-1.5), and Inuit identity (ORSept = 8.9, 95% CI: 3.4-23.5; ORMay = 21.8, 95% CI: 6.6-72.4), were associated with increased odds of food insecurity in households with children. Fruit and vegetable consumption (ORSept = 0.4, 95% CI: 0.2-0.8; ORMay = 0.5, 95% CI: 0.2-0.9), as well as eating cooked (ORSept = 0.5, 95% CI: 0.3-1.0; ORMay = 0.5, 95% CI: 0.3-0.9) and raw (ORSept = 1.7, 95% CI: 0.9-3.0; ORMay = 1.8, 95% CI: 1.0-3.1) fish were associated with decreased odds of food insecurity among households with children, while eating frozen meat and/or fish (ORSept = 2.6, 95% CI: 1.4-5.0; ORMay = 2.0, 95% CI: 1.1-3.7) was associated with increased odds of food insecurity. CONCLUSIONS: Food insecurity is high among households with children in Iqaluit. Despite the partial subsistence livelihoods of many Inuit in the city, we found no seasonal differences in food security and food consumption for households with children. Interventions aiming to decrease food insecurity in these households should consider food consumption habits, and the reported demographic and socioeconomic determinants of food insecurity.

Smoking prevalence among Inuit in Canada.

Using data from the 1991, 2001 and 2012 Aboriginal Peoples Survey, this study examines the prevalence of smoking among Inuit aged 15 or older, by location of residence, sex and age group. Overall, the prevalence of daily smoking was significantly lower in 2012 than in 1991; this was true for Inuit living inside and outside Inuit Nunangat, for men and women, for most age groups, and for those in all Inuit regions except Nunavik. The average number of cigarettes smoked per day by daily smokers decreased steadily and significantly over time, except among those living outside Inuit Nunangat or in Nunavik, and those aged 55 or older. The average age of daily smoking initiation remained stable at 15.

Birth outcomes among First Nations, Inuit and Métis populations.

BACKGROUND: First Nations, Inuit, and Métis are at higher risk of adverse birth outcomes than are non-Indigenous people. However, relatively little perinatal information is available at the national level for Indigenous people overall or for specific identity groups. DATA AND METHODS: This analysis describes and compares rates of preterm birth, small-for-gestational-age birth, large-for-gestational-age birth, stillbirth, and infant mortality (neonatal, postneonatal, and cause-specific) in a nationally representative sample of First Nations, Inuit, Métis, and non-Indigenous births. The study cohort consisted of 17,547 births to Indigenous mothers and 112,112 births to non-Indigenous mothers from 2004 through 2006. The cohort was created by linking the Canadian Live Birth, Infant Death and Stillbirth Database to the long form of the 2006 Census, which contains a self-reported Indigenous identifier. RESULTS: With the exception of small-for-gestational-age birth, adverse birth outcomes occurred more frequently among First Nations, Inuit, and Métis women than among non-Indigenous women. Inuit had the highest preterm birth rate (11.4 per 100 births; 95% CI: 9.7 to 13.1) among the three Indigenous groups. The large-for-gestational-age rate was highest for First Nations births (20.9 per 100 births; 95% CI: 19.9 to 21.8). Infant mortality rates were more than twice as high for each Indigenous group compared with the non-Indigenous population, and rates of sudden infant death syndrome were more than seven times higher among First Nations and Inuit. DISCUSSION: The results confirm disparities in birth outcomes between Indigenous and non-Indigenous populations, and demonstrate differences among First Nations, Métis and Inuit.

Suicide Rates in Aboriginal Communities in Labrador, Canada.

OBJECTIVES: To compare suicide rates in Aboriginal communities in Labrador, including Innu, Inuit, and Southern Inuit, with the general population of Newfoundland, Canada. METHODS: In partnership with Aboriginal governments, we conducted a population-based study to understand patterns of suicide mortality in Labrador. We analyzed suicide mortality data from 1993 to 2009 from the Vital Statistics Death Database. We combined this with community-based methods, including consultations with Elders, youths, mental health and community workers, primary care clinicians, and government decision-makers. RESULTS: The suicide rate was higher in Labrador than in Newfoundland. This trend persisted across all age groups; however, the disparity was greatest among those aged 10 to 19 years. Males accounted for the majority of deaths, although suicide rates were elevated among females in the Inuit communities. When comparing Aboriginal subregions, the Innu and Inuit communities had the highest age-standardized mortality rates of, respectively, 165.6 and 114.0 suicides per 100 000 person-years. CONCLUSIONS: Suicide disproportionately affects Innu and Inuit populations in Labrador. Suicide rates were high among male youths and Inuit females.

Causes and Disparities in Death Rates Among Urban American Indian and Alaska Native Populations, 1999-2009.

OBJECTIVES: To characterize the leading causes of death for the urban American Indian/Alaska Native (AI/AN) population and compare with urban White and rural AI/AN populations. METHODS: We linked Indian Health Service patient registration records with the National Death Index to reduce racial misclassification in death certificate data. We calculated age-adjusted urban AI/AN death rates for the period 1999-2009 and compared those with corresponding urban White and rural AI/AN death rates. RESULTS: The top-5 leading causes of death among urban AI/AN persons were heart disease, cancer, unintentional injury, diabetes, and chronic liver disease and cirrhosis. Compared with urban White persons, urban AI/AN persons experienced significantly higher death rates for all top-5 leading causes. The largest disparities were for diabetes and chronic liver disease and cirrhosis. In general, urban and rural AI/AN persons had the same leading causes of death, although urban AI/AN persons had lower death rates for most conditions. CONCLUSIONS: Urban AI/AN persons experience significant disparities in death rates compared with their White counterparts. Public health and clinical interventions should target urban AI/AN persons to address behaviors and conditions contributing to health disparities.

Trajectories of Alcohol Use and Binge Drinking Among Pregnant Inuit Women.

BACKGROUND: This study investigated trajectories of alcohol use and binge drinking among Inuit women starting from a year before pregnancy until a year after delivery, examined transition rates between time periods, and established whether specific factors could be identified as predictors of changes in alcohol behaviors. METHODS: Drinking trajectories and movement among alcohol users and binge drinkers (i.e. non-binging and binging) were explored by Markov modeling across time periods. Two hundred and forty-eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to obtain descriptive data on alcohol use during the year before pregnancy, the conception period, the pregnancy and the year after delivery. RESULTS: The proportions of drinkers and bingers were 73 and 54% during the year prior to pregnancy and 62 and 33% after delivery. Both alcohol use and binge drinking trajectories demonstrated a significant drop in prevalence between the year before conception to the conception period. We also noted high probabilities of becoming an abstainer or not binging at this time. However, up to 60% of women continued to drink alcohol during pregnancy. Women in couples and not consuming marijuana were more likely to decrease their binge drinking at conception. CONCLUSIONS: This study emphasizes the importance of including the period around conception in the definition of drinking patterns during pregnancy. The importance of considering alcohol consumption in a multidimensional way (personal, familial and social determinants) is also addressed while trying to minimize problems both for the fetus and the mother.

Claims for disease-modifying therapy by Alberta non-insured health benefits clients.

BACKGROUND: Uncontrolled disease activity in inflammatory diseases of the joints, skin and bowel leads to morbidity and disability. Disease-modifying therapies are widely used to suppress this disease activity, but cost-coverage is variable. For Treaty First Nations and Inuit people in Canada without alternative private or public health insurance, cost-coverage for disease-modifying therapy is provided through Non-Insured Health Benefits (NIHB). Our objective was to describe the prevalence and patterns of treatment with disease-modifying therapy for the NIHB claimant population, and also examine adjuvant therapy (analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids) use. METHODS: Cases (n = 2512) were defined by ≥1 claim for a disease-modifying anti-rheumatic drug (DMARD) or biologic between 1999 and 2012 in the NIHB pharmacy claim database. The proportion of the population with claims for individual agents and drug classes annually was calculated to estimate annual incidence and prevalence rates for use of disease-modifying therapy, and the prevalence of use of individual DMARDs, biologics and adjuvants. Differences in the proportion accessing adjuvant therapies and median doses in the 6 months following initiation of disease-modifying therapies was estimated. RESULTS: The incidence rate of treatment was calculated at an average of 127.5 cases per 100,000 population between 2001 and 2012, and the cumulative prevalence, accounting for patients lost to the database, increased and then stabilized at 1.3 % in the last three years of the study. Annual dispensation of methotrexate, combination DMARD therapy and biologic therapy approached 35 %, 19 %, and 10 % of the cohort respectively. A declining prevalence of claims for acetaminophen (28 % to 15 %) and anti-inflammatories (73 % to 63 %) occurred from 2000 to 2012, however corticosteroid (32 %) and opioid (65 %) dispensation remained stable. The proportion of patients with claims for NSAIDs (69.9 % to 61.1 %, p = 0.002), oral corticosteroids (45.4 % to 33.6 %, p < 0.001) and parenteral corticosteroids (16.2 % to 8.3 %, p = 0.002) decreased in the 6 months following biologic initiation. CONCLUSIONS: The proportion of NIHB clients with active claims for disease-modifying therapy is lower than expected based on existing epidemiologic knowledge of the prevalence of inflammatory conditions in the First Nations and Inuit populations. These findings should be further explored in order to optimize treatment outcomes for NIHB claimants with inflammatory disease.

Reproductive history and dietary habits and breast cancer risk in Greenlandic Inuit: a case control study.

BACKGROUND: The incidence of breast cancer in Greenland has increased considerably since 1970. It has been suggested that the previous low incidence is associated with the traditional lifestyle and marine food diet, and that the increase in breast cancer risk may be due to changes to a more westernized diet and lifestyle. OBJECTIVE: To investigate the relation between food intake, reproductive factors and the risk of breast cancer in Greenlandic Inuit women. DESIGN: A case control study with participants from all regions of Greenland. The sampling was carried out at Dronning Ingrids Hospital in Nuuk, Greenland where all breast cancer cases are treated. The reproductive factors and dietary intake were assessed using a questionnaire completed at enrolment. Student t-test was used to compare group differences for continuous data. Fisher's exact test and Pearson's Chi-square were used to compare distribution frequency of data between groups. Odd ratios (ORs) were obtained using logistic regression. Estimates with a P-value ≤0.05 were considered significant. RESULTS: Information on reproductive factors and dietary intake was available for 116 participants, 60 breast cancer cases and 56 controls. We found that the risk of having breast cancer was significantly reduced (OR: 0.24 [95% CI 0.09; 0.66]) for the group with ≥3 full-term pregnancies and breastfeeding duration of ≥6 months compared to the group with ≤2 full-term pregnancies and breastfeeding duration of <6 months. We found that intake of fruit and vegetables when analyzed together, significantly reduced breast cancer risk (OR: 0.22 [95% CI 0.05; 0.98]). CONCLUSIONS: Higher parity, longer breastfeeding duration and intake of fruit and vegetables were protective factors for breast cancer risk. No clear associations between breast cancer and traditional or other imported food were seen.