The correlates of physical activity among adult Métis.

OBJECTIVES: Métis, with a population of close to 390,000 people, are a culturally distinct and constitutionally recognized Aboriginal group in Canada that suffers from poorer overall health than non-Aboriginal Canadians. One important predictor of good health is physical activity. Guided by frameworks based on social and Aboriginal-specific determinants, we investigated the correlates of leisure-time physical activity (LTPA) and active transportation (walking) among adult Métis, with a particular focus on how culturally specific variables were associated with these two types of activity. We also examined how demographic, geographic, socioeconomic and health-related factors were associated with physical activity. DESIGN: We used data from Statistics Canada's 2006 Aboriginal Peoples Survey and Métis Supplement to analyze the correlates of physical activity among Métis aged 20-64, using a series of logistic regression models. RESULTS: Having attended a Métis cultural event in the past year was positively associated with LTPA, as was a high level of spirituality. Similarly, those who had attended a cultural event in the last year were more likely to report a high level of active transportation. Speaking an Aboriginal language and being a member of a Métis organization were not independently associated with the two types of physical activity. Self-perceived health, being male and household income were other correlates positively associated with LTPA, whereas age, body mass index and smoking were negatively associated with this type of activity. Active transportation was positively associated with self-perceived health and being female, while negatively associated with age and body mass index. CONCLUSIONS: The results of this study suggest that interventions aimed at increasing physical activity among adult Métis might be more successful if they are connected to cultural activities and spirituality. This research also suggests that demographic, socioeconomic and health-related factors are important considerations when designing initiatives to increase physical activity among adult Métis.

How shortcomings in the mental health system affect the use of involuntary community treatment orders.

Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n=5), carers (n=6), clinicians (n=15) and members of the Mental Health Review Tribunal of NSW (n=12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.

Factors associated with heavy drinking among off-reserve First Nations and Métis youth and adults: Evidence from the 2012 Canadian Aboriginal Peoples Survey.

Objective . Aboriginal people in Canada are at higher risk to heavy alcohol consumption than are other Canadians. The objective of this study was to examine a set of culturally specific correlates of heavy drinking among First Nations and Métis youth and adults. Methods . Demographic, geographic, socioeconomic and health-related variables were also considered. Data were used from Statistics Canada's 2012 Aboriginal Peoples Survey to predict heavy drinking among 14,410 First Nations and Métis 15years of age and older. Separate sets of binary sequential logistic regression models were estimated for youth and adults. Results . Among youth, those who had hunted, fished or trapped within the last year were more likely to be heavy drinkers. In addition, current smokers and those who most frequently participated in sports were at higher odds of heavy alcohol consumption. Among adults, respondents who had hunted, fished or trapped within the last year were more likely to drink heavily. On the other hand, those who had made traditional arts or crafts within the last year were less likely to drink heavily. Conclusions . Men, younger adults, smokers, those who were unmarried, those who had higher household incomes, and those who had higher ratings of self-perceived health were more likely to be heavy drinkers. Efforts aimed at reducing the prevalence of heavy drinking among this population may benefit from considering culturally specific factors, in addition to demographic variables and co-occurring health-risk behaviors.

A cross-sectional examination of the correlates of current smoking among off-reserve First Nations and Métis adults: Evidence from the 2012 Aboriginal Peoples Survey.

INTRODUCTION: The purpose of this study was to examine the correlates of current smoking among off-reserve First Nations and Métis adults, two Aboriginal Canadian groups that are at higher risk to smoke and more likely to suffer from chronic health conditions relative to their non-Aboriginal counterparts. A particular focus was on culturally specific factors and their associations with current smoking. METHODS: We used data from Statistics Canada's, 2012 Aboriginal Peoples Survey to investigate the correlates of smoking among 12,720 First Nations and Métis adults. Sequential binary logistic regression models were estimated to examine associations between smoking and culturally specific, demographic, geographic, socioeconomic and health-related variables. RESULTS: Overall, 39.4% were current smokers. Multivariate results found that those who had hunted, fished or trapped within the last year were more likely to be smokers. In addition, respondents who were exposed to an Aboriginal language at home or outside the home were more likely to be smokers. Current smoking was significantly associated with being aged 35 to 49 years, living in a small population center, low income, low education, unemployment, being unmarried, low ratings of self-perceived health, heavy drinking and low body mass index. Respondents aged 65 years and older and those living in British Columbia were less likely to smoke. DISCUSSION: The results of this study suggest that it may be useful to consider cultural characteristics, particularly language in efforts to reduce the prevalence of manufactured tobacco use among First Nations and Métis adults. Interventions should also consider demographic, geographic and socioeconomic variables, in addition to co-occurring health-risk behaviors.

The correlates of current smoking among adult Métis: Evidence from the Aboriginal Peoples Survey and Métis Supplement.

OBJECTIVE: To examine the correlates of current smoking among Métis aged 18 years and older, with a particular focus on culturally-specific factors. Cultural factors included spirituality, knowledge of an Aboriginal language, membership in a Métis organization and attendance at Métis cultural events. Demographic, geographic, socio-economic and health-related variables were also considered. METHODS: Data from 6,610 adult Métis aged 18 years and older who responded to the 2006 Aboriginal Peoples Survey and Métis supplement were used to examine the correlates of current smoking using sequential binary logistic regression modelling. RESULTS: Overall, 39.9% of adult Métis respondents in the sample were current smokers. Adult Métis who reported a high level of spirituality were less likely to be current smokers. Those who spoke an Aboriginal language, or lived in a house where an Aboriginal language was spoken, were more likely to be current smokers. Being a member of a Métis organization and attending cultural events were not independently associated with current smoking. Métis with higher household income, greater education, higher self-perceived health, and greater physical activity participation were less likely to be current smokers, whereas those who reported heavy alcohol consumption were more likely to be current smokers. CONCLUSIONS: The results of this study suggest that interventions aimed at reducing smoking among adult Métis might be more successful if they include some connection to spirituality. It is also evident that co-occurring risk behaviours, in addition to demographic and socio-economic factors, are important considerations when developing interventions to reduce smoking among this population.

Out of sight, out of mind: making involuntary community treatment visible in the mental health system.

Most specialised mental health services in Australia are delivered in community settings and one in six services comprise involuntary treatment. Despite a growing demand for community treatment orders (CTOs) worldwide - and comparatively high rates of use in Australia - the clinical, legal and ethical aspects of CTOs remain contentious. This article examines federal, state and territory mental health policy documents and discovers little reference to CTOs. The "invisibility" of CTOs in mental health policy raises questions about the transparency and accountability of the mental health system, and about whether this policy silence ultimately entrenches the marginalisation of, and discrimination against, people living with mental illness.