Predictors of household food insecurity and relationship with obesity in First Nations communities in British Columbia, Manitoba, Alberta and Ontario.

OBJECTIVE: To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity. DESIGN: Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics. SETTING: Western and Central Canada. PARTICIPANTS: First Nations peoples aged ≥19 years. RESULTS: Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19-30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56). CONCLUSIONS: The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.

Seafood consumption patterns, their nutritional benefits and associated sociodemographic and lifestyle factors among First Nations in British Columbia, Canada.

OBJECTIVE: To describe seafood consumption patterns in First Nations (FN) in British Columbia (BC) and examine lifestyle characteristics associated with seafood consumption; to identify the top ten most consumed seafood species and their contributions to EPA and DHA intake; and to estimate dietary exposure to methylmercury, polychlorinated biphenyls and dichlorodiphenyldichloroethylene. DESIGN: Dietary and lifestyle data from the First Nations Food Nutrition and Environment Study, a cross-sectional study of 1103 FN living in twenty-one communities across eight ecozones in BC, Canada, were analysed. Seafood consumption was estimated using a traditional FFQ. Seafood samples were analysed for contaminant contents. RESULTS: Seafood consumption patterns varied significantly across BC ecozones reflecting geographical diversity of seafood species. The top ten most consumed species represented 64 % of total seafood consumption by weight and contributed 69 % to the total EPA+DHA intake. Mean EPA+DHA intake was 660·5 mg/d in males, 404·3 mg/d in females; and 28 % of FN met the Recommended Intake (RI) of 500 mg/d. Salmon was the most preferred species. Seafood consumption was associated with higher fruit and vegetable consumption, lower smoking rate and increased physical activity. Dietary exposure to selected contaminants from seafood was negligible. CONCLUSIONS: In FN in BC, seafood continues to be an essential part of the contemporary diet. Seafood contributed significantly to reaching the RI for EPA+DHA and was associated with a healthier lifestyle. Given numerous health benefits, seafood should be promoted in FN. Efforts towards sustainability of fishing should be directed to maintain and improve access to fisheries for FN.

A total diet study and probabilistic assessment risk assessment of dietary mercury exposure among First Nations living on-reserve in Ontario, Canada.

Methyl Mercury (MeHg) exposure is a global environmental health concern. Indigenous peoples around the world are susceptible to MeHg exposure from often higher fish consumption compared to general populations. The objective of this study was to estimate dietary exposure to methylmercury (MeHg) among First Nations living on-reserve in the province of Ontario, Canada. A total diet study was constructed based on a 24-h recall from the First Nations Food, Nutrition, and Environment Study (FNFNES), and measured contaminant concentrations from Health Canada for market foods, and FNFNES for traditional foods. A probabilistic assessment of annual and seasonal traditional food consumptions was conducted for 1429 adult participants. Results were compared to exposures in the general Canadian population and reference values from Health Canada for adults and women of childbearing age (ages 19-50). Results indicated traditional foods to be the primary contributor to the dietary total MeHg intake (72%). The average dietary total MeHg exposure in the First Nations population in Ontario (0.039µg/kg/d) was 1.6 times higher than the general Canadian population; however, the majority (97.8%) of the population was below the reference values. Mercury concentrations in participants' hair samples (n = 744) ranged from 0.03 to 13.54µg/g, with an average of 0.64µg/g (geometric average of 0.27µg/g). Less than 1% of the population had a hair mercury value above the 6µg/g level, and 1.3% of women of child bearing age had values greater than 2µg/g. Fish species contributing to the MeHg intake included pickerel-walleye, pike, perch and trout. Only 7.9% of the population met the recommended fish consumption rate of two, 3.5oz servings per week from the American Heart Association. Therefore, consumption of lower trophic level fish can be promoted to provide the maximum nutritional benefit with minimal risk of MeHg exposure.

Association between fish consumption, dietary omega-3 fatty acids and persistent organic pollutants intake, and type 2 diabetes in 18 First Nations in Ontario, Canada.

BACKGROUND: First Nations (FNs) populations in Canada experience a disproportionally higher rate of obesity and type 2 diabetes (T2D) compared to the general population. Recent data suggest that a high consumption of fish may help prevent T2D. On the other hand, fish might also be a potential source of environmental contaminants which could potentially be a risk factor for T2D. OBJECTIVE: To investigate the potential associations between self-reported T2D and consumption of locally-harvested fish, dietary long-chain omega-3 fatty acids (n-3FAs) and persistent organic pollutants intake among adult FNs living on reserve in Ontario. DESIGN: Data from the First Nations Food Nutrition and Environment Study, which included a cross-sectional study of 1429 Ontario FNs adults living in 18 communities across 4 ecozones in 2012 were analyzed. Social and lifestyle data were collected using household interviews. The consumption of locally-harvested fish was estimated using a traditional food frequency questionnaire along with portion size information obtained from 24hr recalls. Fish samples were analyzed for the presence of contaminants including dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs). Dietary intakes of DDE and PCBs were estimated using community-specific levels of DDE/PCBs in fish species. Multiple logistic regression models adjusted for potential covariates including age, gender, body mass index, physical activity, total energy intake, smoking, and education were developed. RESULTS: The prevalence of T2D in Ontario FNs was 24.4%. A significant positive association between fish consumption of one portion per week and more and T2D compared to no fish consumption was found (OR=2.5 (95% CI: 1.38-4.58). Dietary DDE and PCBs intake was positively associated with T2D (OR=1.09 (95%CI: 1.05-1.75) for DDE and OR=1.07 (95%CI: 1.004-1.27) for PCBs) per unit increase in DDE/PCBs while n-3-FAs intake, adjusted for DDE/PCBs intake, showed an inverse effect against T2D among older individuals (OR=0.86 (95% CI: 0.46-0.99). CONCLUSION: Our results support previous findings that exposure to DDE and PCBs may increase the risk of T2D. Elevated levels of contaminants in fish may counteract with potentially beneficial effects of n-3FAs from fish consumption. However, the overall health benefits of high consumption of fish with a high n-3 FAs content may outweigh the adverse effect of contaminants.

Reduction of Seclusion and Restraint in an Inpatient Psychiatric Setting: A Pilot Study.

The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010-September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008-September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.

Influence of colonoscopy quality measures on patients' colonoscopist selection.

OBJECTIVES: The Affordable Care Act emphasizes the use of quality metrics and greater patient understanding of health-care options and access to physician performance data. The objectives of this study were to determine patients' familiarity with colonoscopy quality measures (CQMs) and their influence on patient selection of a colonoscopist. METHODS: A prospective survey of patients before screening or surveillance colonoscopy at university hospital, community hospital, and ambulatory procedure center endoscopy units was performed from 2011 to 2012. RESULTS: Among the 417 participants, 20% (85/417) researched their physician's rating. The rates of familiarity with CQM were 88 % (353/402) for adequate bowel preparation, 30% (118/398) for adenoma detection rate (ADR), 26% (102/397) for cecal intubation rate, and 21% (82/394) for greater-than-6-min withdrawal time. Ninety-six percent (366/386) believed that colonoscopists' reporting of ADR to other physicians was important or very important. In selecting a colonoscopist, primary care provider referral was ranked as the first or second-most important of four factors in 87% (339/391). Even among patients who responded "it is very important" to report CQM to other doctors and patients, none ranked CQM as the most important factor in selecting a colonoscopist. CONCLUSIONS: Patient awareness of CQM, other than adequate bowel preparation, was low. Quality measure reporting is important to patients, but primary care provider referral was the most important factor in colonoscopist selection. This suggests that primary care providers, as well as patients, are important to include in educational strategies regarding quality metrics.

The association of prescription opioid use with suicide attempts: An analysis of statewide medical claims data.

BACKGROUND: Suicides and opioid overdose deaths are among the most pressing public health concerns in the US. However direct evidence for the association between opioid use and suicidal behavior is limited. The objective of this article is to examine the association between frequency and dose of prescription opioid use and subsequent suicide attempts. METHODS AND FINDINGS: This retrospective cohort study analyzed 4 years of statewide medical claims data from the Connecticut All-Payer Claims Database. Commercially insured adult patients in Connecticut (n = 842,773) who had any medical claims beginning in January 2012 were followed through December 2015. The primary outcome was suicide attempt identified using International Classification of Diseases (ICD 9) diagnosis codes. Primary predictor variables included frequency of opioid use, which was defined as the number of months with claims for prescription opioids per year, and strength of opioid dose, which was standardized using morphine milligram equivalent (MME) units. We also controlled for psychiatric and medical comorbidities using ICD 9 codes. We used Cox proportional hazards regression to examine the association between frequency, dose, and suicide attempts, adjusting for medical and psychiatric comorbid conditions. Interactions among measures of opioid use and comorbid conditions were analyzed. In this cohort study with follow-up time up to 4 years (range = 2-48 months, median = 46 months), the hazard ratios (HR) from the time-to-event analysis indicated that patients prescribed opioid medications for at least 6 months during the past year and at 20-50 MME levels or higher had 4.44 (95% CI: [3.71, 5.32]) to 7.23 (95% CI: [6.22, 8.41]) times the risk of attempted suicide compared to those not prescribed opioids. Risk of suicide attempt was sharply elevated among patients with psychiatric conditions other than anxiety who were prescribed more frequent and higher opioid doses. In contrast, more frequent and higher doses of prescription opioids were associated with lower risk of suicide attempts among patients with medical conditions necessitating pain management. This study is limited by its exclusive focus on commercially insured patients and does not include patients covered by public insurance. It is also limited to patients' receipt of prescription opioids and does not take into account opioids obtained through other means, nor does it include measures of actual patient opioid use. CONCLUSIONS: This analysis provides evidence of a complex relationship among prescription opioids, mental health, pain and other medical comorbidities, and suicide risk. Findings indicate the need for proactive suicide surveillance among individuals diagnosed with affective or psychotic disorders who are receiving frequent and high doses of opioids. However, appropriate opioid treatment may have significant value in reducing suicide risk for those without psychiatric comorbidities.

Importance of fish for food and nutrition security among First Nations in Canada.

OBJECTIVE: To investigate the relationships between fish/seafood consumption patterns and food security status among First Nations (FN) communities in Canada. We estimated the contribution of fish/seafood to daily nutrient requirements. Barriers to traditional food (TF) access including fish were summarized. METHODS: Data were collected by the First Nations Food, Nutrition and Environment Study (2008-2018). The sample of this participatory study comprised 6258 randomly selected FN adults. Fish/seafood consumption was estimated with a food frequency questionnaire. Food security status was assessed with the Household Food Security Survey Module. The contribution of fish/seafood to protein, n-3 fatty acid, vitamin (A, B12, D, niacin) and mineral (selenium, zinc) requirements was assessed by comparison to Dietary Reference Intakes. RESULTS: Regional differences were observed in fish/seafood consumption patterns and their relationship with food security status. In the eastern regions (Ontario, Quebec/Labrador and the Atlantic region), consumption of fish/seafood and other TF was significantly higher among food insecure compared with food secure FN participants. Severely food insecure men (particularly in British Columbia, Alberta, Quebec/Labrador and the Atlantic region) tended to eat a higher amount of TF, including fish/seafood, compared with food secure and moderately food insecure men, while no difference was observed in women. Fish/seafood provided good sources of selected nutrients. However, the high cost of harvesting equipment, industry-related activities and climate change reduce access to fish/seafood and other wildlife. CONCLUSION: Fish/seafood continues to be vital to the diet of FN communities. Focusing on policies that support FN increased access to fish/seafood has the potential to decrease food insecurity and support sustainable livelihoods. Future policies should focus on socio-economic determinants of food insecurity and support traditional harvesting and sustainable fisheries among FN communities.

RéSUMé: OBJECTIF: Étudier les relations entre les modèles de consommation de poissons/fruits de mer et l'état de la sécurité alimentaire chez les Premières Nations (PN) au Canada. Nous avons estimé la contribution des poissons/fruits de mer aux besoins quotidiens en nutriments. Les obstacles à l'accès aux aliments traditionnels (AT), y compris le poisson, ont été résumés. MéTHODES: Les données ont été recueillies dans le cadre de l'Étude sur l'alimentation, la nutrition et l'environnement chez les Premières Nations (2008­2018). L'échantillon de cette étude participative comprenait 6 258 adultes PN sélectionnés au hasard. La consommation de poissons/fruits de mer a été estimée à l'aide d'un questionnaire de fréquence alimentaire. Le niveau de sécurité alimentaire a été évalué à l'aide du Module d'enquête sur la sécurité alimentaire des ménages. La contribution des poissons/fruits de mer aux besoins en protéines, en acides gras n-3, en vitamines (A, B12, D, niacine) et en minéraux (sélénium, zinc) a été évaluée par rapport aux apports nutritionnels de référence. RéSULTATS: Des différences régionales ont été observées dans les modes de consommation de poissons/fruits de mer et leur relation avec le niveau de sécurité alimentaire. Dans les régions de l'Est (Ontario, Québec/Labrador et région atlantique), la consommation de poissons/fruits de mer et d'autres AT était significativement plus élevée chez les personnes vivant dans les ménages en situation d'insécurité alimentaire que chez celles en sécurité alimentaire. Les hommes en situation d'insécurité alimentaire sévère (en particulier en Colombie-Britannique, en Alberta, au Québec/Labrador et en région atlantique) avaient tendance à manger une plus grande quantité d'AT, y compris du poisson/fruits de mer, par rapport aux hommes en sécurité alimentaire et en insécurité alimentaire modérée, alors qu'aucune différence n'a été observée chez les femmes. Les poissons/fruits de mer ont fourni de bonnes sources de nutriments sélectionnés. Cependant, le coût élevé du matériel de chasse, les activités liées à l'industrie et le changement climatique réduisent l'accès aux poissons/fruits de mer et à d'autres espèces sauvages. CONCLUSION: Les poissons/fruits de mer continuent d'être essentiels à l'alimentation des PN. L'amélioration de l'accès aux poissons/fruits de mer a le potentiel de promouvoir la sécurité alimentaire et des moyens de subsistance durables. Les politiques futures devraient se concentrer sur les déterminants socio-économiques de l'insécurité alimentaire et soutenir la récolte traditionnelle et la pêche durable chez les PN.

Levels of metals and persistent organic pollutants in traditional foods consumed by First Nations living on-reserve in Canada.

OBJECTIVES: First Nations may have a higher risk of contaminant exposure from the consumption of traditional foods. The objective of this study was to measure concentrations of metals and organochlorines in traditional foods commonly consumed by First Nations in Canada and estimate the risk from dietary exposure. METHODS: Data were collected from the participatory First Nations Food, Nutrition and Environment Study (2008-2018). Traditional food samples were collected by community members and concentrations of metals and organochlorines were measured. The population-weighted mean daily contaminant intake from traditional food items was estimated. Hazard quotients (HQs) were calculated by dividing contaminant intake with the toxicological reference values (TRVs). RESULTS: A total of 2061 food samples (different parts and organs) from 221 species were collected. The highest concentrations of cadmium were found in the kidneys of land mammals: moose kidney was the most significant contributor to intake. The meat of land mammals and birds had the highest lead concentrations and were the most significant contributors to intake. Arsenic was highest in seaweed, and prawn was the most significant contributor. Mercury and methyl mercury were highest in harp seal meat, with walleye/pickerel contributing most to intake. Harp seal meat also had the highest p,p'-DDE and PCB concentrations, and ooligan grease and salmon were the most significant contributors to intake. The percentage of adults eating traditional food who exceeded the TRVs was 1.9% for cadmium, 3.7% for lead, 13.6% for arsenic, 0.7% for mercury, and 0% for p,p'-DDE and PCBs. All median HQs, and most 95th percentile HQs, were less than 1. CONCLUSION: These results can be used as a baseline of contaminant levels and exposure in traditional foods for future monitoring programs and to support risk assessment programs.

RéSUMé: OBJECTIFS: Les Premières Nations peuvent avoir un risque plus élevé d'exposition aux contaminants en raison de la consommation d'aliments traditionnels. L'objectif de cette étude était de mesurer les concentrations de métaux et d'organochlorés dans les aliments traditionnels couramment consommés par les Premières Nations au Canada et estimer le risque d'exposition alimentaire. MéTHODES : Les données ont été recueillies dans le cadre de l'Étude sur l'alimentation, la nutrition et l'environnement des Premières Nations (2008­2018), une étude participative. Des échantillons d'aliments traditionnels ont été prélevés par les membres de la communauté et les concentrations de métaux et d'organochlorés ont été mesurées. L'apport quotidien moyen pondéré pour la population de contaminants provenant du système alimentaire traditionnel a été estimé. Les quotients de risque (QR) ont été calculés en divisant l'apport par les valeurs toxicologiques de référence (VTR). RéSULTATS: Un total de 2 061 échantillons d'aliments (différentes parties et organes) de 221 espèces ont été collectés. Les concentrations les plus élevées de cadmium ont été trouvées dans les reins des mammifères terrestres : le rein d'orignal était le principal contributeur aux apports en cadmium. La viande de mammifères terrestres et d'oiseaux présentait les concentrations de plomb les plus élevées et était le principal contributeur aux apports en plomb. La concentration en arsenic était la plus élevée dans les algues tandis que la crevette était le contributeur le plus important pour ce contaminant. Les concentrations de mercure et de méthylmercure étaient les plus élevées dans la viande de phoque du Groenland, le doré jaune et le brochet contribuant le plus aux apports de ces contaminants. La viande de phoque du Groenland présentait également les concentrations les plus élevées de p,p'-DDE et de BPC, et la graisse d'eulikan et le saumon en étaient les principaux contributeurs. Le pourcentage d'adultes consommant des aliments traditionnels qui dépassaient les VTR était de 1,9 % pour le cadmium, 3,7 % pour le plomb, 13,6 % pour l'arsenic, 0,7 % pour le mercure et 0 % pour le p,p'-DDE et les PCB. Tous les QR médians et la plupart des QR du 95e centile étaient inférieurs à 1. CONCLUSION: Ces résultats peuvent être utilisés comme référence pour les futurs programmes de surveillance et pour soutenir les programmes d'évaluation des risques.

Regionally representative hair mercury levels in Canadian First Nations adults living on reserves.

OBJECTIVE: The primary objective of this participatory study was to assess the current body burden of mercury among First Nations adults. METHODS: The First Nations Food, Nutrition and Environment Study (2008-2018) collected regionally representative data from First Nations adults living on reserves south of the 60th parallel. Mercury was analyzed in hair as a preferred biomarker for prolonged exposure. Hair samples, a 5 mm bundle cut from the occipital region, were collected from the participants who gave consent and measured for total mercury concentrations using cold vapor atomic fluorescence spectrophotometry. RESULTS: In total, 3404 First Nations adults living in 92 communities provided hair samples. This represents 52.5% of the respondents to the household surveys. The mean hair mercury concentrations were 0.56 µg/g among all participants and 0.34 µg/g among women of childbearing age (WCBA). There were 64 exceedances of Health Canada's mercury biomonitoring guidelines (44 WCBA, 8 women aged 51+ years, 3 men aged 19-50 years, and 9 men aged 51+ years). CONCLUSION: Current mercury exposure no longer presents a significant clinical health risk in most of the First Nations population south of the 60th parallel across Canada. However, mercury exposure continues to be an ongoing environmental public health concern that requires continued monitoring and assessment. Women of childbearing age (19-50 years) and older individuals living in northern ecozones and Quebec have higher mercury exposures, often exceeding Health Canada's guidelines. Careful risk communication and risk management programs need to focus on northern ecozones and Quebec.

RéSUMé: OBJECTIF: L'objectif principal de cette étude participative était d'évaluer la charge corporelle actuelle de mercure chez les adultes des Premières Nations. MéTHODES: L'Étude sur l'alimentation, la nutrition et l'environnement chez les Premières Nations (2008­2018) a permis de recueillir des données régionales représentatives auprès d'adultes des Premières Nations vivant dans des réserves au sud du 60e parallèle. Le mercure a été analysé dans les cheveux; il s'agit d'un biomarqueur de choix en cas d'exposition prolongée. Des échantillons de cheveux, soit une mèche de 5 mm coupée de la région occipitale, ont été recueillis auprès des participants qui ont donné leur consentement, et les concentrations totales de mercure ont été mesurées par spectrophotométrie de fluorescence atomique à vapeur froide. RéSULTATS: Au total, 3 404 adultes des Premières Nations vivant dans 92 communautés ont fourni des échantillons de cheveux, ce qui représente 52,5 % des répondants aux enquêtes auprès des ménages. Les concentrations moyennes de mercure dans les cheveux étaient de 0,56 µg/g pour l'ensemble des participants et de 0,34 µg/g pour les femmes en âge de procréer. Il y a eu 64 dépassements des valeurs de biosurveillance du mercure recommandées par Santé Canada (44 femmes en âge de procréer, 8 femmes de 51 ans et plus, 3 hommes de 19 à 50 ans et 9 hommes de 51 ans et plus). CONCLUSION: L'exposition actuelle au mercure ne présente plus un risque important pour la santé clinique de la plupart des populations des Premières Nations au sud du 60e parallèle au Canada. Toutefois, l'exposition au mercure demeure une préoccupation de santé publique environnementale qui doit faire l'objet d'une surveillance et d'une évaluation continues. Les femmes en âge de procréer (de 19 à 50 ans) et les personnes âgées vivant dans les écozones nordiques ou au Québec sont plus exposées au mercure, exposition qui dépasse souvent les valeurs recommandées par Santé Canada. Des programmes de communication et de gestion des risques rigoureux doivent être axés sur les écozones nordiques et le Québec.

Metals in the drinking water of First Nations across Canada.

OBJECTIVES: The First Nations Food, Nutrition and Environment Study (FNFNES), a community-based participatory research project, measured the levels of metals of health concern and the levels of metals that have operational guidance (OG) and aesthetic objectives (AO) in drinking water of First Nations (FN) south of the 60th parallel. METHODS: Both stagnant (first draw) and flushed tap water samples were collected from participating households in 91 FN representing 11 ecozones. The concentrations of metals were quantified and compared to Health Canada's Guidelines for Canadian Drinking Water Quality (GCDWQ). RESULTS: In total, 1516 FN households participated in this study component. Exceedances of the 2019 GCDWQ for the health-based maximum acceptable concentration (MAC) were found for five metals: lead 8.4% of households (first draw), manganese 4.0%, uranium 1.6%, aluminum 1.3%, and copper 0.2% (flushed). Flushing taps resulted in a decrease to 0.7% of households exceeding the lead MAC. Exceedances of the current OG for aluminum were found in 14.2% and the exceedances of the proposed OG were found in 18.1% of households (flushed). Exceedances of the AO (flushed) were as follows: manganese 12.8%, sodium 5.1%, iron 3.5%, and copper 0.4%. Results of the study were compared to provincial surveys where the data were available. Taste and colour were reported to be the main reasons for limiting the use of tap water. CONCLUSION: Overall, the quality of drinking water with respect to trace metals of human health concern is satisfactory. However, elevated lead levels were found in some FN communities. Until appropriate action can take place, it was recommended to flush the water before use to reduce the lead levels.

RéSUMé: OBJECTIFS: L'Étude sur l'alimentation, la nutrition et l'environnement chez les Premières Nations (EANEPN), un projet de recherche participative communautaire, a mesuré la concentration de métaux préoccupants pour la santé et ceux ayant une directive opérationnelle et des objectifs esthétiques dans l'eau potable des Premières Nations (PN) au sud du 60e parallèle. MéTHODES: Des échantillons d'eau stagnante (premier écoulement) ainsi que ceux d'eau après rinçage des robinets ont été prélevés auprès de ménages participants, dans 91 PN, représentant 11 écozones. Les concentrations en métaux ont été quantifiées et comparées à celles des recommandations pour la qualité de l'eau potable au Canada (RQEPC) de Santé Canada. RéSULTATS: Au total, 1 516 ménages des PN ont participé à ce volet de l'étude. La concentration maximale acceptable (CMA) pour la santé selon les RQEPC de 2019 a été dépassée pour cinq métaux: le plomb, dans 8,4 % des ménages (premier écoulement); le manganèse dans 4,0 % des ménages; l'uranium dans 1,6 % des ménages; l'aluminium, dans 1,3 % des ménages; et le cuivre, dans 0,2 % des ménages (après le rinçage des robinets). Le rinçage des robinets a abouti à une baisse de la concentration en plomb de 0,7% au niveau des ménages dépassant la CMA. La concentration en aluminium a dépassé la valeur de la directive opérationnelle actuelle dans 14,2 % des ménages. Elle a été dépassée et la valeur opérationnelle recommandée dans 18,1 % des ménages (après le rinçage des robinets). Pour les objectifs esthétiques (après le rinçage des robinets), les dépassements des valeurs de concentration des métaux étaient les suivants : le manganèse, dans 12,8 % des ménages; le sodium, dans 5,1 % des ménages; le fer, dans 3,5 % des ménages; et le cuivre, dans 0,4 % des ménages. Les résultats de l'étude ont été comparés aux sondages provinciaux où les données provinciales étaient disponibles. Le goût et la couleur seraient les principales raisons invoquées pour la réduction de l'utilisation de l'eau du robinet. CONCLUSION: Dans l'ensemble, la qualité de l'eau potable est satisfaisante en ce qui concerne les niveaux de traces de métaux présentant un risque pour la santé humaine. Toutefois, des niveaux de plomb élevés ont été constatés dans certaines collectivités des PN. En attendant que des mesures appropriées soient prises, il a été recommandé de rincer le robinet (faire couler l'eau) avant d'utiliser l'eau pour réduire les niveaux de plomb.

Pharmaceuticals in source waters of 95 First Nations in Canada.

OBJECTIVES: Pharmaceuticals are emerging contaminants in the environment. Little has been published about the presence of pharmaceuticals in waterbodies nearby or on reserve land of First Nations in Canada. The objectives of this study were to (1) quantify the level of pharmaceuticals in First Nations' surface waters, (2) calculate the human health risks of the mixtures found, and (3) measure the exposure to pharmaceuticals in First Nations' drinking water where source water was highly contaminated. METHODS: This participatory study measured the levels of 43 pharmaceuticals from surface water samples taken at three water sampling sites chosen by the 95 participating First Nations. The sites were in proximity to recreational areas, fishing areas, drinking water sources, and/or wastewater outflows. When elevated levels of pharmaceutical mixtures were found in samples, drinking water samples were obtained and analyzed for potential pharmaceuticals. Human health risks were calculated by an established protocol. RESULTS: In total, 432 samples were collected at 302 water sampling sites (285 surface water, 11 drinking water, and 6 wastewater sites). Quantifiable levels of 35 pharmaceuticals were found in 79 of the 95 (83%) participating First Nations at 193 of the 285 surface water sites (68%). Overall, the levels found were comparable to or lower than those found in other studies in Canada and worldwide. CONCLUSION: In almost all participating First Nations, there is no human health risk from consuming surface water for drinking. However, surface water in the vicinity of major urban centres should not be used as secondary untreated water sources due to the elevated human health risk associated with exposure to the mixtures of multiple pharmaceuticals detected.

RéSUMé: OBJECTIFS: Les produits pharmaceutiques sont des contaminants émergents dans l'environnement. Peu d'articles ont été publiés sur la présence de produits pharmaceutiques dans les plans d'eau à proximité ou sur les terres des réserves des Premières Nations au Canada. Les objectifs de cette étude étaient de 1) quantifier le niveau de produits pharmaceutiques dans les eaux de surface des Premières Nations, 2) calculer les risques pour la santé humaine des mélanges trouvés, et 3) mesurer l'exposition aux produits pharmaceutiques dans l'eau potable des Premières Nations où la source d'eau était fortement contaminée. MéTHODES: Cette étude participative a mesuré les niveaux de 43 produits pharmaceutiques à partir d'échantillons d'eau de surface prélevés dans trois sites d'échantillonnage d'eau choisis par les 95 Premières Nations participantes. Les sites se trouvaient à proximité d'aires récréatives, de pêche, d'eau potable et/ou d'eaux usées. Lorsque des niveaux élevés de mélanges pharmaceutiques ont été trouvés dans les échantillons, des échantillons d'eau potable ont été prélevés et analysés pour la présence possible de produits pharmaceutiques. Les risques pour la santé humaine ont été calculés selon un protocole établi. RéSULTATS: Au total, 432 échantillons ont été prélevés sur 302 sites d'échantillonnage d'eau (285 eaux de surface, 11 sites d'eau potable et 6 sites d'eaux usées). Des niveaux quantifiables de 35 produits pharmaceutiques ont été trouvés dans 79 des 95 (83 %) Premières Nations participantes, soit sans 193 des 285 sites d'eau de surface (68 %). Dans l'ensemble, les niveaux trouvés étaient comparables ou inférieurs à ceux trouvés dans d'autres études au Canada, aux États-Unis et dans le monde. CONCLUSION: Dans presque toutes les Premières Nations participantes, il n'y a aucun risque pour la santé humaine lié à la consommation d'eau de surface pour la boisson. Cependant, les eaux de surface à proximité des grands centres urbains ne devraient pas être utilisées comme sources d'eau secondaires non traitées en raison du risque élevé pour la santé humaine associé à l'exposition aux mélanges de plusieurs produits pharmaceutiques détectés.

The relationship between dietary exposure to persistent organic pollutants from fish consumption and type 2 diabetes among First Nations in Canada.

OBJECTIVE: We previously examined the associations between dietary dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs) intake from fish consumption and type 2 diabetes (T2D) prevalence in Ontario and Manitoba. This study aims to further explore the relationship in a regionally representative sample of First Nations adults living on-reserve across Canada. METHODS: Dietary, health and lifestyle data collected by the cross-sectional First Nations Food, Nutrition and Environment Study (2008-2018) were analyzed. This participatory study included 6091 First Nations adult participants who answered questions on T2D. The consumption of locally caught fish was estimated with a food frequency questionnaire. A total of 551 samples from 96 fish species were collected and analyzed for the presence of DDE and PCBs. The associations between fish and dietary DDE/PCBs intake with self-reported T2D were investigated using multiple logistic regression models adjusted for confounders. RESULTS: Dietary exposure to DDE (>2.11 ng/kg/bw) and PCBs (>1.47 ng/kg/bw) vs no exposure was positively associated with T2D with ORs of 2.33 (95% CI: 1.24-4.35) for DDE and 1.43 (95% CI: 1.01-3.59) for PCBs. The associations were stronger among females (DDE OR = 3.11 (1.41-6.88); PCBs OR = 1.76 (1.10-3.65)) and older individuals (DDE OR = 2.64 (1.12-6.20); PCBs OR = 1.44 (1.01-3.91)) as compared with males and younger participants. Also, significant dose-response relationships were found for fish consumption in females only. CONCLUSION: This study confirms our previous findings that dietary DDE/PCBs exposure may increase the risk of T2D. The effect of DDE/PCBs from fish consumption is driven by geographical differences in DDE/PCBs concentrations in fish and by the amount of fish consumed, and is more prominent in females than in males.

RéSUMé: OBJECTIF: Nous avons précédemment examiné les associations entre l'apport alimentaire de dichlorodiphényldichloroéthylène (DDE) et de polychlorobiphényles (PCB) provenant de la consommation de poisson et la prévalence du diabète de type 2 (DT2) en Ontario et au Manitoba. Cette étude vise à explorer davantage la relation dans un échantillon régionalement représentatif d'adultes des Premières Nations vivant dans des réserves partout au Canada. MéTHODE: Les données sur l'alimentation, la santé et le mode de vie recueillies par l'Étude transversale sur l'alimentation, la nutrition et l'environnement chez les Premières Nations (2008­2018) ont été analysées. Cette étude participative comprenait 6 091 participants adultes des Premières Nations qui ont répondu à des questions sur le DT2. La consommation de poisson pêché localement a été estimée à l'aide d'un questionnaire de fréquence alimentaire. Au total, 551 échantillons de 96 espèces de poissons ont été prélevés et analysés pour la présence de DDE et de PCB. Les associations entre la consommation de poisson et l'exposition aux DDE/PCB avec le DT2 auto-déclaré ont été étudiées à l'aide de modèles de régression logistique multiples ajustés pour les facteurs de confusion. RéSULTATS: L'exposition alimentaire au DDE (>2,11 ng/kg/pc) et aux PCB (>1,47 ng/kg/pc) par rapport à l'absence d'exposition était positivement associée au DT2 avec des OR de 2,33 (IC à 95% : 1,24­4,35) pour le DDE et 1,43 (IC à 95% : 1,01­3,59) pour les PCB. Les associations étaient plus fortes chez les femmes (DDE OR = 3,11 (1,41­6,88); PCB OR = 1,76 (1,10­3,65)) et les individus plus âgés (DDE OR = 2,64 (1,12­6,20); PCB OR = 1,44 (1,01­3,91)) par rapport aux hommes et aux participants plus jeunes. De plus, des relations dose-réponse significatives ont été trouvées pour la consommation de poisson chez les femmes seulement. CONCLUSION: Cette étude confirme nos conclusions précédentes selon lesquelles l'exposition à travers l'alimentation aux DDE/PCB peut augmenter le risque de DT2. L'effet du DDE/PCB sur la consommation de poisson est lié aux différences géographiques dans les concentrations de DDE/PCB dans le poisson et à la quantité de poisson consommée, et est plus important chez les femmes que chez les hommes.

Identifying risk factors for mortality among patients previously hospitalized for a suicide attempt.

Age-adjusted suicide rates in the US have increased over the past two decades across all age groups. The ability to identify risk factors for suicidal behavior is critical to selected and indicated prevention efforts among those at elevated risk of suicide. We used widely available statewide hospitalization data to identify and test the joint predictive power of clinical risk factors associated with death by suicide for patients previously hospitalized for a suicide attempt (N = 19,057). Twenty-eight clinical factors from the prior suicide attempt were found to be significantly associated with the hazard of subsequent suicide mortality. These risk factors and their two-way interactions were used to build a joint predictive model via stepwise regression, in which the predicted individual survival probability was found to be a valid measure of risk for later suicide death. A high-risk group with a four-fold increase in suicide mortality risk was identified based on the out-of-sample predicted survival probabilities. This study demonstrates that the combination of state-level hospital discharge and mortality data can be used to identify suicide attempters who are at high risk of subsequent suicide death.