Burden of disease from Helicobacter pylori infection in western Canadian Arctic communities.

BACKGROUND: Indigenous communities across the circumpolar north have elevated H. pylori (Hp) prevalence and stomach cancer incidence. We aimed to describe the Hp-associated disease burden among western Canadian Arctic participants in community-driven projects that address concerns about health risks from Hp infection. METHODS: During 2008-2013, participants underwent Hp screening by urea breath test and gastroscopy with gastric biopsies. We estimated Hp prevalence and prevalence by Hp status of endoscopic and histopathologic diagnoses. RESULTS: Among 878 participants with Hp status data, Hp prevalence was: 62% overall; 66% in 740 Indigenous participants; 22% in 77 non-Indigenous participants (61 participants did not disclose ethnicity); 45% at 0-14 years old, 69% at 15-34 years old, and 61% at 35-96 years old. Among 309 participants examined endoscopically, visible mucosal lesions were more frequent in the stomach than the duodenum: the gastric to duodenal ratio was 2 for inflammation, 8 for erosions, and 3 for ulcers. Pathological examination in 308 participants with gastric biopsies revealed normal gastric mucosa in 1 of 224 Hp-positive participants and 77% (65/84) of Hp-negative participants with sharp contrasts in the prevalence of abnormalities between Hp-positive and Hp-negative participants, respectively: moderate-severe active gastritis in 50 and 0%; moderate-severe chronic gastritis in 91 and 1%; atrophic gastritis in 43 and 0%; intestinal metaplasia in 17 and 5%. CONCLUSIONS: The observed pattern of disease is consistent with increased risk of stomach cancer and reflects substantial inequity in the Hp-associated disease burden in western Arctic Canadian hamlets relative to most North American settings. This research adds to evidence that demonstrates the need for interventions aimed at reducing health risks from Hp infection in Indigenous Arctic communities.

Prevalence of overweight and obesity among indigenous populations in Canada: A systematic review and meta-analysis.

Previous studies on overweight and obesity among indigenous peoples in Canada have been inconclusive. A systematic review was conducted on the prevalence of overweight and obesity among Canadian indigenous populations. Major bibliographic databases were searched for relevant studies published between January 1990 and June 2013. We reviewed 594 abstracts and included 41 studies in the meta-analyses. Using the heterogeneity test (Cochrane Q) results, the overall prevalence was estimated using fixed- or random-effects model. Nonadults (<18 years) had a pooled prevalence of overweight and obesity at 29.8% (95% CI: 25.2-34.4) and 26.5% (95% CI: 21.8-31.3), respectively. The pooled prevalence of overweight and obesity among adults were 29.7% (95% CI: 28.2-31.2) and 36.6% (95% CI: 32.9-40.2), respectively. Adult males had higher overweight prevalence than females (34.6% vs. 26.6%), but lower obesity prevalence (31.6% vs. 40.6%). Nonadult girls had higher prevalence than boys [overweight: 27.6%; 95% CI: 22.6-32.7 vs. 24.7%; 95% CI: 19.0-30.5; obesity: 28.6%; 95% CI: 20.3-36.9 vs. 25.1%; 95% CI: 13.8-36.4]. Nonadult Inuit had the highest overweight and lowest obesity prevalence. Although Inuit adult had the lowest prevalence of overweight (28.7%; 95% CI: 27.3-30.2) and obesity (32.3%; 95% CI: 25.5-39.1), it was relatively high. This study highlights the need for nutritional intervention programs for obesity prevention among indigenous populations in Canada.

Knowledge, attitudes, and behaviours towards cancer screening in indigenous populations: a systematic review.

Cancer mortality among indigenous peoples is increasing, but these populations commonly under use cancer-screening services. This systematic review explores knowledge, attitudes, and behaviours towards cancer screening among indigenous peoples worldwide. Searches of major bibliographic databases identified primary studies published in English up to March, 2014; of 33 eligible studies, three were cohort studies, 27 cross-sectional, and three case-control. Knowledge of and participation in screening was greater for breast cancer than for other cancers. Indigenous peoples tended to have less knowledge, less favourable attitudes, and a higher propensity to refuse screening than non-indigenous populations. The most common factors affecting knowledge, attitudes, and behaviours towards cancer screening included access to screening, knowledge about cancer and screening, educational attainment, perceived necessity of screening, and age. Greater understanding of knowledge, attitudes, and behaviours towards cancer screening in diverse indigenous cultures is needed so that culturally appropriate cancer prevention programmes can be provided.

Assessment of dietary intake among Inuvialuit in Arctic Canada using a locally developed quantitative food frequency questionnaire.

OBJECTIVE: Inuvialuit in Arctic Canada are experiencing a nutritional and lifestyle transition, characterized by a declining consumption of traditional foods, increased consumption of non-nutrient-dense store-bought foods (NNDF), and reduced levels of physical activity with a concurrent rise in chronic diseases. The aim of the present study was to determine dietary intake of Inuvialuit adults in the Northwest Territories, Canada, using a culturally specific, validated quantitative food frequency questionnaire (QFFQ). METHODS: A cross-sectional dietary survey of 213 randomly selected adults (≥19 years) was conducted in 3 remote communities in the Northwest Territories. Nonparametric analysis was used to compare mean nutrient intake, dietary inadequacy, and differences in nutrient density among men and women. Data were also analyzed to determine the top food groups contributing to energy and selected nutrients. RESULTS: With response rates of 65% to 85%, 43 men (mean age 43.2 ± 12.8) and 170 women (mean age 44.7 ± 13.9) completed the QFFQ. Mean daily energy intakes for men were 3478 ± 1474 kcal and for women they were 3299 ± 1653 kcal. For both sexes, protein, carbohydrates, and fat provided approximately 16%, 47%, and 28% of energy intake, respectively. NNDFs were the top contributors to energy (39%), fat (40%), carbohydrate (54%), sugar (74%), and sodium (23%) intake. Total traditional foods from the land, sea, and sky such as polar bear and wild birds contributed 11% of energy and 41% of protein intake. Most participants' daily intakes were below recommended levels for dietary fiber; vitamins A, E, and D; potassium; and magnesium. Mean daily energy, saturated fat, and sodium intakes exceeded recommendations. CONCLUSIONS: We identified nutrient inadequacies and characterized food consumption among Inuvialuit. These data support nutritional interventions that encourage consumption of traditional foods. The cultural and ethnic differences in Canadian Arctic populations require specific tailoring of public health interventions and policy using population specific tools to meet local needs.

Food expenditure patterns in the Canadian Arctic show cause for concern for obesity and chronic disease.

BACKGROUND: Little is understood about the economic factors that have influenced the nutrition transition from traditional to store-bought foods that are typically high in fat and sugar amongst people living in the Canadian Arctic. This study aims to determine the pattern of household food expenditure in the Canadian Arctic. METHOD: Local food prices were collected over 12 months in six communities in Nunavut and the Northwest Territories. Dietary intake data were collected from 441 adults using a validated quantitative food frequency questionnaire. Money spent on six food groups was calculated along with the cost of energy and selected nutrients per person. RESULTS: Participants spent approximately 10% of total food expenditure on each of the food groups of fruit/vegetables, grains and potatoes, and dairy, 17% on traditional meats (e.g. caribou, goose, char, and seal liver), and 20% on non-traditional meats (e.g. beef, pork, chicken, fish, and processed meats). Non-nutrient-dense foods (NNDF) accounted for 34% of food expenditure. Younger participants (<30 years) spent more on NNDF and less on traditional meats compared with the older age groups. Participants with higher levels of formal education spent more on fruit and vegetables and less on traditional meats, when compared with participants with lower levels of formal education. CONCLUSIONS: Participants spent most household income on NNDF, a possible consequence of generation discrepancy between younger and older participants. The tendency toward NNDF, particularly among youth, should be addressed with an assessment of predictive factors and the development of targeted approaches to population-based interventions.

Impact of the Healthy Foods North nutrition intervention program on Inuit and Inuvialuit food consumption and preparation methods in Canadian Arctic communities.

BACKGROUND: The 12-month Healthy Foods North intervention program was developed to improve diet among Inuit and Inuvialuit living in Arctic Canada and assess the impact of the intervention established for the communities. METHODS: A quasi-experimental study randomly selected men and women (≥19 years of age) in six remote communities in Nunavut and the Northwest Territories. Validated quantitative food frequency and adult impact questionnaires were used. Four communities received the intervention and two communities served as delayed intervention controls. Pre- and post-intervention changes in frequency of/total intake of de-promoted food groups and healthiness of cooking methods were determined. The impact of the intervention was assessed using analysis of covariance (ANCOVA). RESULTS: Post-intervention data were analysed in the intervention (n = 221) and control (n = 111) communities, with participant retention rates of 91% for Nunavut and 83% for the Northwest Territories. There was a significant decrease in de-promoted foods, such as high fat meats (-27.9 g) and high fat dairy products (-19.8 g) among intervention communities (all p ≤ 0.05). The use of healthier preparation methods significantly increased (14.7%) in intervention communities relative to control communities. CONCLUSIONS: This study highlights the importance of using a community-based, multi-institutional nutrition intervention program to decrease the consumption of unhealthy foods and the use of unhealthy food preparation methods.

Smoking and dietary inadequacy among Inuvialuit women of child bearing age in the Northwest Territories, Canada.

OBJECTIVE: The prevalence of smoking in Aboriginal Canadians is higher than non-Aboriginal Canadians, a behavior that also tends to alter dietary patterns. Compared with the general Canadian population, maternal smoking rates are almost twice as high. The aim of this study was to compare dietary adequacy of Inuvialuit women of childbearing age comparing smokers versus non-smokers. RESEARCH METHODS & PROCEDURES: A cross-sectional study, where participants completed a culturally specific quantitative food frequency questionnaire. Non-parametric analysis was used to compare mean nutrient intake, dietary inadequacy and differences in nutrient density among smokers and non-smokers. Multiple logistic regression analyses were performed for key nutrients inadequacy and smoking status. Data was collected from three communities in the Beaufort Delta region of the Northwest Territories, Canada from randomly selected Inuvialuit women of childbearing age (19-44 years). RESULTS: Of 92 participants, 75% reported being smokers. There were no significant differences in age, BMI, marital status, education, number of people in household working and/or number of self employed, and physical activity between smokers and non-smokers. Non-parametric analysis showed no differences in nutrient intake between smokers and non-smokers. Logistic regression however revealed there was a positive association between smoking and inadequacies of vitamin C (OR = 2.91, 95% CI, 1.17-5.25), iron (OR = 3.16, 95% CI, 1.27-5.90), and zinc (OR = 2.78, 95% CI, 1.12-4.94). A high percentage of women (>60%), regardless of smoking status, did not meet the dietary recommendations for fiber, vitamin D, E and potassium. CONCLUSIONS: This study provides evidence of inadequate dietary intake among Inuvialuit of childbearing age regardless of smoking behavior.

Frequency of consumption of foods and beverages by Inuvialuit adults in Northwest Territories, Arctic Canada.

Limited data exist regarding nutrient intakes and overall dietary quality in Canadian Arctic populations. This cross-sectional study determined the frequency of consumption of traditional meats (e.g. caribou, polar bear, seal, char and whale) and non-traditional store-bought foods including non-traditional meats (e.g. beef, pork and chicken), grains, dairy, fruits, vegetables and non-nutrient dense foods (NNDFs) (e.g. butter, chocolate, chips, candy and pop) by Inuvialuit adults (175 women, mean age 44 ± 14 years; 55 men, mean age 41 ± 13 years) in three remote communities in the Northwest Territories. Using a validated quantitative food frequency questionnaire, frequency of consumption over a 30-day period was determined for 141 commonly reported foods. Mean consumption of traditional meats (1.6 times/day), fruits (1 time/day) and vegetables (0.6 times/day) was less frequent than that of NNDFs (5.0 times/day). Nutritional intervention strategies are needed to promote more frequent consumption of nutrient-rich foods and less frequent consumption of NNDFs in these Arctic communities.

Stomach Cancer Incidence and Mortality Trends among Circumpolar Nations.

BACKGROUND: Stomach cancer incidence and mortality rates are declining across circumpolar nations, but the burden may not be distributed equally across subpopulations, including Indigenous peoples. Our objective was to examine stomach cancer incidence and mortality trends across circumpolar populations. METHODS: Cancer incidence and mortality data from 1999-2016 were obtained from the Canadian Cancer Registry, Canadian Vital Statistics, CDC WONDER, NORDCAN, Northwestern Russian cancer registries, and National Cancer Reports. The direct method was used to calculate 10-year rolling age-standardized incidence and mortality rates to the world (WHO 2000-2025) and 2011 Canadian standard populations. Standardized incidence rate ratios (SRR) were calculated. Data were stratified by sex, year, and region. U.S. data were broken down by race [White; American Indian/Alaska Native (AIAN)]. Race data were not available from non-U.S. cancer registries. RESULTS: Most populations showed declining incidence and mortality rates over time. Incidence rates among Greenland males and females, Alaska AIAN males and females, and Northern Canadian both sexes were elevated compared with regional counterparts and remained stable. The largest male SRR was observed among Alaska AIAN versus Alaska Whites [SRR = 3.82; 95% confidence interval (95% CI), 2.71-5.37]. The largest female SRR was observed among Alaska AIAN versus Alaska Whites (SRR = 4.10; 95% CI, 2.62-6.43). CONCLUSIONS: Despite stomach cancer incidence and mortality rates declining overall, some northern and Indigenous populations experience elevated and stable incidence and mortality rates. IMPACT: There is a need to address disparities observed among circumpolar subpopulations. Given similarities in incidence, mortality, and risk factor prevalence across circumpolar regions, addressing disparities could benefit from coordinated international action.

Carnitine palmitoyltransferase 1A (CPT1A) P479L prevalence in live newborns in Yukon, Northwest Territories, and Nunavut.

Carnitine palmitoyltransferase 1A (CPT1A), encoded by the gene CPT1A, is the hepatic isoform of CPT1 and is a major regulatory point in long-chain fatty acid oxidation. CPT1A deficiency confers risk for hypoketotic hypoglycaemia, hepatic encephalopathy, seizures, and sudden unexpected death in infancy (SUDI). It remains controversial whether the CPT1A gene variant, c.1436C>T (p.P479L), identified in Inuit, First Nations, and Alaska Native infants, causes susceptibility to decompensation, in particular during times of fever and intercurrent illness. Although newborn screening for the P479L variant occurs in some jurisdictions, background knowledge about the presence of the variant in Canadian Aboriginal populations is lacking. In an effort to understand the population implications of the variant in northern Canada, overall frequencies of the variant were assessed. Further studies are underway to determine associated risk. Ethics approval was obtained from university REBs, local research institutes, and with consultation with territorial Aboriginal groups. Newborn screening blood spots from all infants born in 2006 in the three territories were genotyped for the p.P479L variant. p.P479L (c.1436C>T) allele frequencies in the three territories were 0.02, 0.08, and 0.77 in Yukon (n=325), Northwest Territories (n=564), and Nunavut (n=695), respectively. Homozygosity rates were 0%, 3%, and 64%. Aboriginal status was available only in NWT, with allele frequencies of 0.04, 0.44, 0.00, and 0.01 for First Nations, Inuvialuit/Inuit, Métis, and non-Aboriginal populations. Although individual blood spots were not identified for Aboriginal ethnicity in Nunavut infants, ~90% of infants in Nunavut are born to Inuit women. The allele frequency and rate of homozygosity for the CPT1A P479L variant were high in Inuit and Inuvialuit who reside in northern coastal regions. The variant is present at a low frequency in First Nations populations, who reside in areas less coastal than the Inuit or Inuvialuit in the two western territories. The significance of the population and geographic distribution remains unclear, but the high population frequencies of the variant suggest a historically low penetrance for adverse outcomes. Further evidence is needed to determine if there is an increased risk for infant mortality and morbidity and whether newborn screening will be indicated on a population basis.

Dietary intake in a population undergoing a rapid transition in diet and lifestyle: the Inuvialuit in the Northwest Territories of Arctic Canada.

OBJECTIVES: To: 1) characterize diet in Inuvialuit; 2) determine the foods and nutrients to be targeted for a nutritional intervention program; and 3) develop a Quantitative Food Frequency Questionnaire (QFFQ) to evaluate the program and monitor nutrition transition for Inuvialuit in the Northwest Territories (NWT), Canada. METHODS: Twenty-four-hour dietary recalls were collected among 101 Inuvialuit aged 19 years and over in two communities in the NWT. All foods reported in the recall were tabulated for inclusion in the QFFQ. RESULTS: Forty-eight men and 53 women (mean age 49 and 45 yrs, respectively) completed the recalls. Mean energy intake was 2,352 kcal and 1,739 kcal for men and women, respectively. Mean daily intakes of many nutrients including dietary fibre, calcium, and vitamins A, C and E, and total folate were much lower than recommended. The most frequently reported foods were non-nutrient-dense store-bought foods. Most traditional foods (TF) were reported one time by one person. The top two contributors to energy intake, 'sugar added to tea and coffee' and 'sweetened juices and drinks', were targeted by the intervention program. A 145-item QFFQ was developed including 41 TF and 8 categories of consumption frequency. CONCLUSIONS: This study has provided dietary intake data previously unavailable for Inuvialuit and highlighted nutrients and foods to be targeted for the intervention program. The QFFQ is up-to-date, culturally appropriate, and currently being used to evaluate the intervention program, Healthy Foods North, which aims to reduce dietary- and lifestyle-related risk factors for chronic disease in Inuvialuit.

Gastric Cancer in Northern Canadian Populations: A Focus on Cardia and Non-Cardia Subsites.

In northern Canada where there is a high prevalence of Helicobacter pylori infection, there is a paucity of information on gastric cancer by the topographical subsites cardia (CGC) and non-cardia (NCGC). Here we describe the incidence of CGC and NCGC, separately, among northern Canadian populations. We used data from the Cancer Incidence in Five Continents Volumes X (CI5X) and XI (CI5XI) to obtain CGC and NCGC incidence for Canada and for Yukon (YT), a northern Canadian territory. Using these data with those provided by the Government of the Northwest Territories (NT), we estimated standardized incidence ratios comparing northern populations to Canada as a whole. We also estimated age-standardized incidence rates to permit comparisons across populations globally. NT and YT populations were disproportionately impacted by gastric cancer, particularly NCGC. This was especially true for Indigenous populations: NCGC incidence rates among NT Indigenous men were 2.7 times the rates among all men in Canada, while rates among NT Indigenous women were 3.1 times the rates among all women in Canada. Similarly, age-standardized rates of NCGC among Indigenous NT residents were comparable to global regions where there is a high burden of NCGC. This study has, for the first time, quantified the incidence of CGC and NCGC for the NT and YT, providing new insights into the burden of these cancers among northern Canadian populations.

Opportunities for improving patient experiences among medical travellers from Canada's far north: a mixed-methods study.

OBJECTIVES: This paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province. DESIGN: A mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews. PARTICIPANTS: 52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results. RESULTS: Respondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care. CONCLUSIONS: Patients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences.

Comparative global epidemiology of influenza, respiratory syncytial and parainfluenza viruses, 2010-2015.

OBJECTIVES: To improve our understanding of the global epidemiology of common respiratory viruses by analysing their contemporaneous incidence at multiple sites. METHODS: 2010-2015 incidence data for influenza A (IAV), influenza B (IBV), respiratory syncytial (RSV) and parainfluenza (PIV) virus infections were collected from 18 sites (14 countries), consisting of local (n = 6), regional (n = 9) and national (n = 3) laboratories using molecular diagnostic methods. Each site submitted monthly virus incidence data, together with details of their patient populations tested and diagnostic assays used. RESULTS: For the Northern Hemisphere temperate countries, the IAV, IBV and RSV incidence peaks were 2-6 months out of phase with those in the Southern Hemisphere, with IAV having a sharp out-of-phase difference at 6 months, whereas IBV and RSV showed more variable out-of-phase differences of 2-6 months. The tropical sites Singapore and Kuala Lumpur showed fluctuating incidence of these viruses throughout the year, whereas subtropical sites such as Hong Kong, Brisbane and Sydney showed distinctive biannual peaks for IAV but not for RSV and PIV. CONCLUSIONS: There was a notable pattern of synchrony of IAV, IBV and RSV incidence peaks globally, and within countries with multiple sampling sites (Canada, UK, Australia), despite significant distances between these sites.

Helicobacter pylori infection in Canada's arctic: searching for the solutions.

The Canadian North Helicobacter pylori (CANHelp) working group is a team composed of investigators, health officials and community leaders from Alberta and the Northwest Territories. The group's initial goals are to investigate the impact of H pylori infection on Canada's Arctic communities; subsequent goals include identifying treatment strategies that are effective in this region and developing recommendations for health policy aimed at management of H pylori infection. The team's investigations have begun with the Aklavik H pylori Project in the Aboriginal community of Aklavik, Northwest Territories.

Research with Arctic peoples: unique research opportunities in heart, lung, blood and sleep disorders. Working group summary and recommendations.

Arctic peoples are spread over eight countries and comprise 3.74 million residents, of whom 9% are indigenous. The Arctic countries include Canada, Finland, Greenland (Denmark), Iceland, Norway, Russia, Sweden and the United States. Although Arctic peoples are very diverse, there are a variety of environmental and health issues that are unique to the Arctic regions, and research exploring these issues offers significant opportunities, as well as challenges. On July 28-29, 2004, the National Heart, Lung, and Blood Institute and the Canadian Institutes of Health Research co-sponsored a working group entitled "Research with Arctic Peoples: Unique Research Opportunities in Heart, Lung, Blood and Sleep Disorders". The meeting was international in scope with investigators from Greenland, Iceland and Russia, as well as Canada and the United States. Multiple health agencies from Canada and the United States sent representatives. Also attending were representatives from the International Union for Circumpolar Health (IUCH) and the National Indian Health Board. The working group developed a set of ten recommendations related to research opportunities in heart, lung, blood and sleep disorders; obstacles and solutions to research implementation; and ways to facilitate international comparisons. These recommendations are expected to serve as an agenda for future research.

Improving vitamin A and D intake among Inuit and Inuvialuit in Arctic Canada: evidence from the Healthy Foods North study.

BACKGROUND: People in Arctic Canada are undergoing a nutritional transition and increased prevalence of chronic disease. The Healthy Foods North diet and physical activity intervention was developed in 2007-2008 while working with populations in six communities in Nunavut and the Northwest Territories, Canada. METHODS: Four communities received the 1-year intervention (eg, conducting workshops, cooking classes and walking clubs) and two communities served as controls. Among the 263 adult evaluation participants, food frequency questionnaires were used to assess dietary intake at baseline and postintervention. Changes in mean nutrient intakes, nutrient density and dietary adequacy from baseline to postintervention were determined. The intervention impact on nutrient intakes was assessed through multivariate linear regression analysis. RESULTS: Post-intervention assessment showed a reductions in total fat, saturated, monounsaturated and polyunsaturated fatty acids, and increases in iron intake, only in the intervention group. More than a 4%-increase in the percentage of adherence to vitamins A and D recommendations was observed in the intervention group. After adjusting the regression models, respondents in the intervention communities significantly reduced their energy intake and increased their vitamins A and D intake. CONCLUSIONS: The Healthy Foods North is an effective programme to improve dietary quality among populations of the Canadian Arctic. Long-term interventions are expected to be important factors in the prevention of diet-related chronic diseases in these communities.

Organochlorine levels in maternal and umbilical cord blood plasma in Arctic Canada.

A baseline for exposure to organochlorine and metal contaminants has been established for mothers and newborns in the Northwest Territories and Nunavut areas of Arctic Canada. Maternal and umbilical cord blood plasma organochlorine levels are described for Inuit, Dene, Métis, Caucasian and Other non-Aboriginal participants. Overall, 523 women volunteered to participate by giving their written informed consent between May 1994 and June 1999, resulting in the collection of 386 maternal blood samples, 407 cord blood samples and 351 maternal/cord pairs. Nearly half of all the participants regularly smoked cigarettes, including 77% of the Inuit participants. Maternal and cord results are presented for PCBs (as Aroclor 1260 and 14 congeners) and organochlorine pesticides, including p,p'-DDT, p,p'-DDE, beta-hexachlorocyclohexane (beta-HCH), hexachlorobenzene (HCB), cis and trans nonachlor, heptachlor epoxide, oxychlordane, mirex, dieldrin and toxaphene. Maternal PCB levels (as Aroclor 1260) averaged 4.42 (+/-9.03) microg/l in Inuit, which was 3.3 times higher than those found in Dene/Métis, and 3.4 times higher than levels in Caucasians. Mean DDE levels were 2.8 times higher in the Other non-Aboriginal group (Chinese, Filipino, East Indian and multiple ethnicity) than in the Inuit group, at 3.99 microg/l and 1.42 microg/l, respectively. Cord blood PCB levels (as Aroclor 1260) averaged 1.16 (+/-2.42) microg/l for Inuit participants, which was 3.3-4 fold higher than the other ethnic groups. PCBs, p,p'-DDE and hexachlorobenzene were detected in all maternal samples, and p,p'-DDE was detected in all cord samples. Regression coefficients for maternal/cord pairs are presented for selected organochlorines. Other results from this study, including maternal and cord metals data, will be presented elsewhere.

A community-based, environmental chronic disease prevention intervention to improve healthy eating psychosocial factors and behaviors in indigenous populations in the Canadian Arctic.

Diet-related chronic diseases are highly prevalent among indigenous populations in the Canadian Arctic. A community-based, multi-institutional nutritional and lifestyle intervention-Healthy Foods North-was implemented to improve food-related psychosocial factors and behaviors among Inuit and Inuvialuit in four intervention communities (with two comparison communities) in Nunavut and the Northwest Territories, Canada, in 2008. The 12-month program was developed from theory (social cognitive theory and social ecological models), formative research, and a community participatory process. It included an environmental component to increase healthy food availability in local stores and activities consisting of community-wide and point-of-purchase interactive educational taste tests and cooking demonstrations, media (e.g., radio ads, posters, shelf labels), and events held in multiple venues, including recreation centers and schools. The intervention was evaluated using pre- and postassessments with 246 adults from intervention and 133 from comparison communities (311 women, 68 men; mean age 42.4 years; 78.3% retention rate). Outcomes included psychosocial constructs (healthy eating knowledge, self-efficacy, and behavioral intentions), frequency of healthy and unhealthy food acquisition, healthiness of commonly used food preparation methods, and body mass index (kg/m(2)). After adjustment for demographic, socioeconomic status, and body mass index variables, respondents living in intervention communities showed significant improvements in food-related self-efficacy (ß = 0.15, p = .003) and intentions (ß = 0.16, p = .001) compared with comparison communities. More improvements from the intervention were seen in overweight, obese, and high socioeconomic status respondents. A community-based, multilevel intervention is an effective strategy to improve psychosocial factors for healthy nutritional behavior change to reduce chronic disease in indigenous Arctic populations.