Access to land and nature as health determinants: a qualitative analysis exploring meaningful human-nature relationships among Indigenous youth in central Canada.

BACKGROUND: Human relationships with and connections to nature and the "land" are a commonly accepted Social Determinant of Health. Greater knowledge about these relationships can inform public health policies and interventions focused on health equity among Indigenous populations. Two research questions were explored: (1) what are the experiences of meaningful human-nature relationships among Indigenous youth within central Canada; and (2) how do these relationships function as a determinant of health and wellness within their lives. METHODS: Drawing from three community-based participatory research (CBPR) projects within two urban centers in Saskatchewan and Manitoba, the integrated qualitative findings presented here involved 92 interviews with 52 Indigenous youth that occurred over a period of nine years (2014-2023). Informed by "two-eyed seeing," this analysis combined Indigenous Methodologies and a Constructivist Grounded Theory approach. RESULTS: Our integrative analysis revealed three cross-cutting themes about meaningful human-nature relationships: (1) promoting cultural belonging and positive identity; (2) connecting to community and family; and (3) supporting spiritual health and relationships. The experiences of young people also emphasized barriers to land and nature access within their local environments. DISCUSSION: Policies, practices, and interventions aimed at strengthening urban Indigenous young peoples' relationships to and connections with nature and the land can have a positive impact on their health and wellness. Public Health systems and healthcare providers can learn about leveraging the health benefits of human-nature relationships at individual and community levels, and this is particularly vital for those working to advance health equity among Indigenous populations.

Experiences and perspectives of sugar-sweetened beverage consumption among Indigenous adults living in Manitoba.

Sugar-sweetened beverages (SSB) are a health policy target. Indigenous populations are among the highest consumers of SSB in Canada. However, the Truth and Reconciliation Commission calls on governments to recognize health disparities among Indigenous populations as a consequence of colonialism and governmental policies. The purpose of this analysis was to explore emergent perspectives of Indigenous adults on experiences and perspectives of SSB consumption. We conducted a community-based participatory study in partnership with three Indigenous-led organizations. From 2019 to 2022, we completed qualitative interviews with Indigenous adults living in Island Lake Anisininew First Nation, Flin Flon, and Winnipeg's North End, a neighbourhood with high concentration of Indigenous people. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Seventy-four adults participated in interviews, including 46 women, 26 men, and two identifying as two-spirit. Many participants, across all three locations, repeatedly and consistently described SSB or sugar as an addiction, which formed the primary theme for this analysis: addictive-like consumption of SSB. Addictive-like SSB consumption included comparison to other addictive substances, loss of control, and physical symptoms resulting from SSB intake (both positive and adverse) or attempting to reduce SSB intake. We identified two other secondary themes, i) perceived drivers and contexts of SSB consumption, and ii) health outcomes as a motivator for change. Perceived drivers or contexts included consuming SSB as a means to cope with stress, boredom, and poverty; SSB intake as being intertwined with other addictions or addictive substances; and drinking alone. In conclusion, addictive-like SSB consumption was reported by Indigenous adults. To address SSB intake among Indigenous populations, trauma-informed approaches should be explored that consider the colonial context.

Helping Others Facilitates Well-Being for Indigenous Peoples Living With HIV/AIDS in Canada.

Research has found that helping others facilitates well-being for Indigenous peoples living with HIV and AIDS, but limited research exists that investigates the mechanism(s) underlying this relationship. Indigenous perspectives posit that helping others facilitates well-being through the development of an individual's spiritual, physical, emotional, and mental aspects (four aspects). Similarly, self-determination theory posits that helping others facilitates well-being by satisfying basic psychological needs. In the present study, we examined if helping others facilitates well-being through the fulfillment of the spiritual, physical, emotional, and mental aspects among Indigenous peoples living with HIV and AIDS. We used a convergent parallel mixed methods design, coupled with a community-engaged approach grounded in the United Nations Greater Involvement of People Living with HIV and AIDS principles and Indigenous and decolonizing research methodologies. Survey (n = 117) and interview data (n = 9) collected by an Indigenous-led HIV/AIDS organization in Canada were employed to examine the relationship between helping, the four aspects, and well-being. Participants were primarily First Nations leaders and mentors who live with HIV/AIDS, with some Métis and Inuit. A parallel multiple mediation model and reflexive thematic analysis were used to analyze the relationship between helping, the four aspects, and well-being. Mixed-methods findings support the idea that helping others promotes well-being by fulfilling the emotional and mental aspects. Qualitative findings demonstrated this relationship for all four aspects. This research may facilitate the development of programs to support Indigenous peoples living with HIV/AIDS well-being and contribute to the literature on integrating Indigenous perspectives and methodologies within psychological research.

Nature Prescriptions and Indigenous Peoples: A Qualitative Inquiry in the Northwest Territories, Canada.

Nature prescription programs have become more common within healthcare settings. Despite the health benefits of being in nature, nature prescriptions within the context of Indigenous Peoples have received little attention. We therefore sought to answer the following question: What are circumpolar-based physicians' and Indigenous Elders' views on nature prescribing in the Northwest Territories, Canada? We carried out thirteen semi-structured interviews with physicians between May 2022 and March 2023, and one sharing circle with Indigenous Elders in February 2023. Separate reflexive thematic analysis was carried out to generate key themes through inductive coding of the data. The main themes identified from the physician interviews included the importance of cultural context; barriers with nature prescriptions in the region; and the potential for nature prescriptions in the North. Reflections shared by the Elders included the need for things to be done in the right way; the sentiment that the Land is not just an experience but a way of life; and the importance of traditional food as a connection with Nature. With expanding nature prescription programs, key considerations are needed when serving Indigenous communities. Further investigation is warranted to ensure that nature prescriptions are appropriate within a given context, are inclusive of supporting Land-based approaches to health and wellbeing, and are considered within the context of Indigenous self-determination.

The Gigii-Bapiimin Study: resilience and the impacts of COVID-19 on health and wellbeing of Indigenous people living with HIV in Manitoba and Saskatchewan.

The Gigii-Bapiimin study explored the impacts of the COVID-19 pandemic on the health and wellbeing of First Nations, Inuit, and Métis people living with HIV in Manitoba and Saskatchewan, two provinces in Canada with alarmingly high rates of HIV infections. Participants (n = 28 in Manitoba and n = 23 in Saskatchewan) were recruited using various methods, including flyers, community organizations, peers, and social media. The qualitative interviews focused on the pandemic's impact on health, access to services, and ceremonies. The data were analyzed using inductive thematic analysis. The study identified three key themes: (a) resilience and coping; (b) negative impacts on health and substance use; (c) decreased access to health services, HIV care and harm reduction. The participants shared their experiences of social isolation and the loss of community support, which had deleterious effects on their mental health and substance use. The impacts on access to HIV care were exacerbated by poverty, homelessness, and distress over inadvertent disclosure of HIV status. Participants mitigated these impacts by relying on Indigenous knowledges, ceremonies, and resilience within their communities. Service providers must address the impacts of the COVID-19 pandemic on Indigenous people living with HIV and their access to HIV services and ceremonies.

"My feelings and my thoughts are my lived experience, not the numbers they show me on a piece of paper": Indigenous experiences of liver transplantation in British Columbia, Canada.

Indigenous Peoples in Canada face healthcare inequities impacting access to solid organ transplantation. The experiences of Indigenous patients during the liver transplant process, and how transplant professionals perceive challenges faced by Indigenous Peoples, has not been studied. Thirteen semi-structured qualitative interviews were conducted via telehealth with Indigenous liver transplant patients (n = 7) and transplant care providers (n = 6) across British Columbia, Canada between April 2021-May 2022. Themes were identified to inform clinical approaches and transplant care planning and validated by Indigenous health experts. Among patient participants: transplants occurred between 1992-2020; all were women; and the mean age at the time of interview was 60 years. Among transplant care provider participants: roles included nursing, social work, and surgery; 83% were women; and the median number of years in transplant care was ten. Three broad themes were identified: Indigenous strengths and resources, systemic and structural barriers, and inconsistent care and cultural safety across health professions impact Indigenous patient care during liver transplantation. This study contributes insights into systemic barriers and Indigenous resilience in the liver transplant journey. Dismantling structural barriers to early linkage to care is needed, and training for transplant clinicians on Indigenous histories, cultural protocols, and cultural safety is strongly recommended.

Incorporating First Nations, Inuit and Métis Traditional Healing Spaces within a Hospital Context: A Place-Based Study of Three Unique Spaces within Canada's Oldest and Largest Mental Health Hospital.

Globally and historically, Indigenous healthcare is efficacious, being rooted in Traditional Healing (TH) practices derived from cosmology and place-based knowledge and practiced on the land. Across Turtle Island, processes of environmental dispossession and colonial oppression have replaced TH practices with a colonial, hospital-based system found to cause added harm to Indigenous Peoples. Growing Indigenous health inequities are compounded by a mental health crisis, which begs reform of healthcare institutions. The implementation of Indigenous knowledge systems in hospital environments has been validated as a critical source of healing for Indigenous patients and communities, prompting many hospitals in Canada to create Traditional Healing Spaces (THSs). After ten years, however, there has been no evaluation of the effectiveness of THSs in Canadian hospitals in supporting healing among Indigenous Peoples. In this paper, our team describes THSs within the Center for Addiction and Mental Health (CAMH), Canada's oldest and largest mental health hospital. Analyses of 22 interviews with hospital staff and physicians describe CAMH's THSs, including what they look like, how they are used, and by whom. The results emphasize the importance of designating spaces with and for Indigenous patients, and they highlight the wholistic benefits of land-based treatment for both clients and staff alike. Transforming hospital spaces by implementing and valuing Indigenous knowledge sparks curiosity, increases education, affirms the efficacy of traditional healing treatments as a standard of care, and enhances the capacity of leaders to support reconciliation efforts.

Negative Affect and Drinking among Indigenous Youth: Disaggregating Within- and Between-Person Effects.

Negative affect (depression/anxiety) and alcohol use among Indigenous youth in Canada remain a concern for many communities. Disparate rates of these struggles are understood to be a potential outcome of colonization and subsequent intergenerational trauma experienced by individuals, families, and communities. Using a longitudinal design, we examined change in alcohol use and negative affect, and reciprocal associations, among a group of Indigenous adolescents. Indigenous youth (N = 117; 50% male; Mage=12.46-16.28; grades 6-10) from a remote First Nation in northern Quebec completed annual self-reported assessments on negative affect (depression/anxiety) and alcohol use. A Latent Curve Model with Structured Residuals (LCM-SR) was used to distinguish between- and within-person associations of negative affect and alcohol use. Growth models did not support change in depression/anxiety, but reports of drinking increased linearly. At the between-person level, girls reported higher initial levels of depression/anxiety and drinking; depression/anxiety were not associated with drinking. At the within-person level, drinking prospectively predicted increases in depression/anxiety but depression/anxiety did not prospectively predict drinking. When Indigenous adolescents reported drinking more alcohol than usual at one wave of assessment, they reported higher levels of negative affect than expected (given their average levels of depression/anxiety) at the following assessment. Our findings suggest that when Indigenous youth present for treatment reporting alcohol use, they should also be screened for negative affect (depression/anxiety). Conversely, if an Indigenous adolescent presents for treatment reporting negative affect, they should also be screened for alcohol use.

First Nations and Inuit mental health and the Non-Insured Health Benefits program: Urgent priorities for evaluation.

The mental health needs and disparities facing First Nations and Inuit in Canada far exceed those of the general population and yet accessing culturally safe care remains a serious challenge. One means for accessing mental health care is through the Non-Insured Health Benefits (NIHB) mental health counselling program run by Indigenous Services Canada. However, evaluations of the efficacy of the NIHB's mental health counselling program remain entirely absent in the academic literature and this is startling given that this program receives significant federal funding to care for a population that experiences extreme marginalization. The following commentary will present three challenges observed with the present state of the program in the areas of service accessibility, the need for an Indigenous mental health workforce, and culturally safe care. For each challenge presented, we make recommendations on how to improve the program in its current state. The conclusion of this article advocates for a broader evaluation of the NIHB mental health counselling program from the perspective of its service users and its registered mental health professionals. This type of evaluation is commensurate with the Calls to Action outlined by the Truth and Reconciliation Commission of Canada.

RéSUMé: Les besoins en santé mentale et les disparités rencontrés par les Premières Nations et les Inuits au Canada dépassent de loin ceux de la population générale, et pourtant, l'accès à des soins culturellement sécuritaires demeure un sérieux défi. Une des manières d'accéder aux soins de santé mentale est par le biais du programme de counselling en santé mentale des Services de santé non assurés (SSNA), géré par Services aux Autochtones Canada. Cependant, les évaluations de l'efficacité du programme de counselling en santé mentale des SSNA sont entièrement absentes de la littérature académique, ce qui est surprenant compte tenu que ce programme reçoit un financement fédéral important pour prendre en charge une population qui vit une marginalisation extrême. Le commentaire suivant présentera trois défis observés avec l'état actuel du programme dans les domaines de l'accessibilité des services, la nécessité d'une main-d'œuvre en santé mentale autochtone, et des soins culturellement sécuritaires. Pour chaque défi présenté, nous faisons des recommandations sur la manière d'améliorer le programme dans son état actuel. La conclusion de cet article plaide pour une évaluation plus large du programme de counselling en santé mentale des SSNA du point de vue de ses utilisateurs de services et des professionnels de la santé mentale inscrits. Ce type d'évaluation est conforme aux Appels à l'action décrits par la Commission de vérité et réconciliation du Canada.

Perceptions of Beverages With Non-nutritive Sweeteners Among Indigenous Adults Living in Manitoba and Implications for Type 2 Diabetes.

OBJECTIVES: The purpose of this study was to explore the perspectives of Indigenous adults on consuming beverages with non-nutritive sweeteners. METHODS: In this work, we used a community-based, participatory design in partnership with National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W. We conducted 74 qualitative interviews with Indigenous adults living in Manitoba, including Island Lake First Nations (n=39), Flin Flon (n=15), and the North End neighbourhood of Winnipeg (n=20). Data were indexed in NVivo, and transcripts were analyzed thematically. RESULTS: Participants exclusively discussed beverages with non-nutritive sweeteners (BNNSs) as an alternative to regular pop or sugary drinks, which were widely available, accessible, and consumed. Why or how BNNSs were viewed as an alternative comprised 3 subthemes: an alternative for health reasons; divergent taste preferences; and an alternative with mysterious but negative health effects. Participants who reported regular consumption of BNNSs largely described consuming them to manage type 2 diabetes. Fewer participants discussed BNNS as a means of weight management or as a preventive health behaviour. Participants who did not report regular BNNS consumption described not liking the taste of BNNSs. Finally, many participants described negative health impacts of consuming BNNSs, and specifically aspartame, although few articulated what those negative impacts were. CONCLUSIONS: Divergent perspectives among Indigenous adults regarding the health implications of consuming BNNSs may reflect ongoing scholarly debates. These findings have implications for the prevention and dietary management of type 2 diabetes in Indigenous communities.

Decolonizing health in Canada: A Manitoba first nation perspective.

INTRODUCTION & BACKGROUND: Global persistence of health inequities for Indigenous peoples is evident in ongoing discrepancies in health and standards of living. International literature suggests the key to transformation lies in Indigenous efforts to control Indigenous health and healthcare. Previous authors have focused upon participation, structural transformation, and culturally appropriate healthcare recognized as a political right as fundamental tenets of Indigenous control. Contextualizing Indigenous health and wellness falls within a growing discussion on decolonization - a resituating of expertise that privileges Indigenous voice and interests. METHODS: The study is a qualitative, grounded theory analysis, which is a constructivist approach to social research allowing for generation of theory in praxis, through interactions and conversations between researchers and participants. One hundred eighty-three interviews with additional focus groups were held between 2013-15 in eight Manitoba First Nation communities representing different models of health delivery, geographies, accessibilities, and Indigenous language groups. Community research assistants and respected Elders participated in data collection, analysis and interpretation. Line-by-line coding and constant comparative method led to the discovery of converging themes. FINDINGS: Ultimately four main themes arose: 1) First Nation control of healthcare; 2) traditional medicine and healing activities; 3) full and meaningful community participation; and 4) cleaning up impacts of colonization. Joint analyses and interpretation of findings revealed substantial evidence that communities were looking profoundly into problems of improperly delivered services and health inequities. Issues were consistent with those highlighted by international commissions on reconciliation, health, Indigenous rights and liberties. To those documents, these findings add ground upon which to build the transformative agenda. RESULTS & DISCUSSION: Communities discussed the need for creation of protocols, constitution and laws to ensure growth of a decolonizing agenda. Inclusive to the concept are holistic, preventative, traditional health perspectives, and Indigenous languages. Colonization impacts were of critical concern and in need of undoing. Sharing of social and political efforts is seen as pivotal to change and includes all members of communities.

Can scientists and knowledge keepers sit comfortably together? An Indigenous physician's reflections on a decade of participatory research into First Nations nutrition, environment and health.

The author, an Indigenous physician, offers his reflections on the history of scientific research with Indigenous People and its past role in ethical breaches and excesses of colonialism, as a backdrop to the relatively recent advances in collaborative, community-based participatory research involving First Nations and Inuit in Canada. The First Nations Food, Nutrition and Environment Study (2008-2018), introduced in this Special Issue, is presented as an example of an ethical space that was sustained for a decade to collaboratively develop new knowledge by First Nations and scientists working together, respectfully and inspired by shared interest. A short overview of twelve articles of the Special Issue is provided and characterized as creating a previously inaccessible picture of the modern diets of First Nations, along with the suite of environmental factors that are present in food and water in and around communities. Ultimately, the author hopes that Canadian society can set the table with Indigenous Peoples and respectfully set opinions onto each other and do this over and over again. With Canada already being a multicultural and pluralistic society, adding Indigenous realities into the mix only respects and honours the Indigenous roots of this country.

RéSUMé: L'auteur, médecin autochtone, nous livre ses réflexions sur l'histoire de la recherche scientifique avec les peuples autochtones et le rôle que celle-ci a pu avoir dans les violations éthiques et les excès du colonialisme, comme toile de fond aux avancées relativement récentes de la recherche participative collaborative et communautaire avec les Premières Nations et les Inuits au Canada. L'Étude sur l'alimentation, la nutrition et l'environnement des Premières Nations (2008­2018) qui est présentée dans ce numéro spécial, est citée comme un exemple d'un espace éthique maintenu pendant une décennie pour développer de nouvelles connaissances, de manière collaborative, conjointement par les Premières Nations et les scientifiques qui, mus par un intérêt commun, travaillent ensemble dans le respect. L'auteur nous fournit un bref aperçu des douze articles du numéro spécial qui est considéré comme dressant un tableau, jusqu'alors inexistant, des régimes alimentaires modernes des Premières Nations, ainsi que de la suite des facteurs environnementaux présents dans les aliments et l'eau dans et autour des communautés. L'auteur espère que la société canadienne pourra s'asseoir à la table avec les peuples autochtones et faire se confronter, avec respect, les opinions des uns et des autres, et ce, à répétition. Le Canada étant déjà une société multiculturelle et pluraliste, l'ajout des réalités autochtones ne fait que respecter et honorer les racines autochtones de ce pays.

Comparison of measures of diet quality using 24-hour recall data of First Nations adults living on reserves in Canada.

OBJECTIVE: Assess the diet quality of First Nations adults in Canada using percentage energy from traditional foods (TF) and ultra-processed products (UPP), food portions from the 2007 Eating Well with Canada's Food Guide - First Nations, Inuit and Métis (EWCFG-FNIM) and a Healthy Eating Index (HEI). METHODS: Data collection for this participatory research occurred in 92 First Nations reserves across Canada from 2008 to 2016. Percent daily energy intakes were estimated from 24-hour recalls for TF and NOVA food categories. Portions of food groups from the 2007 EWCFG-FNIM were compared to recommendations. A Canadian-adapted HEI was calculated for each participant. RESULTS: The percent energy from TF was 3% for all participants and 18% for consumers. Meat and alternatives were above the EWCFG-FNIM recommendations and all other food groups were below these. HEI was "low" with only older individuals attaining "average" scores. HEI was above "average" in 4 regions. UPP represented 55% of energy, the largest proportion from a NOVA category. CONCLUSION: The diet quality of First Nations adults in Canada is nutritionally poor. The nutrition, food security and health of First Nations would be improved by better access to TF and healthy store-bought food. However, poor diet is only one aspect of the difficulties facing First Nations in Canada. Researchers and policy makers must strive to better understand the multiple challenges facing First Nations Peoples in order to foster empowerment and self-determination to develop First Nations living conditions and lifestyles that are more culturally sound and more conducive to health.

RéSUMé: OBJECTIFS: Évaluer la qualité de l'alimentation des adultes des Premières Nations du Canada en calculant l'énergie provenant des aliments traditionnels (AT) et des produits ultra-transformés, en comparant les portions consommées avec celles recommandées dans Bien manger avec le Guide alimentaire canadien Premières Nations, Inuit et Métis (BMGAC-PNIM) de 2007 et en mesurant l'indice d'alimentation saine. MéTHODE: La collecte de données pour cette recherche participative a eu lieu dans 92 réserves des Premières Nations au Canada entre les années 2008 et 2016. À partir des rappels de 24 heures, la proportion d'énergie provenant des AT pour les individus les ayant consommés ou non a été comparée, les portions des catégories d'aliments proposées par le BMGAC-PNIM ont été comparées aux recommandations, l'indice d'alimentation saine adapté pour le Canada a été calculé pour chaque participant et la proportion d'énergie des produits ultra-transformés a été établie. RéSULTATS: La proportion d'énergie provenant des AT chez les consommateurs et non-consommateurs était de 3 % et celle pour les consommateurs d'AT était de 18 %. Seuls les viandes et substituts dépassaient les recommandations du BMGAC-PNIM tandis que la consommation de toutes les autres catégories était inférieure aux recommandations. L'indice d'alimentation saine était "bas" avec seulement les individus plus âgés atteignant un score "moyen". L'indice d'alimentation saine était supérieur à "moyen" dans 4 régions. Les aliments ultra-transformés représentaient 55 % de l'énergie, la plus grande proportion de toutes les catégories NOVA. CONCLUSION: La qualité de l'alimentation des Premières Nations n'est pas optimale. Leur alimentation pourrait être améliorée avec un meilleur accès aux AT et aux aliments sains provenant du marché. Une mauvaise alimentation n'est toutefois pas la seule difficulté à laquelle font face les Premières Nations du Canada. Les Peuples des Premières Nations doivent être impliquées avec les chercheurs et les responsables politiques pour mieux comprendre les défis multiples auxquels ils font face et instaurer des conditions de vie qui soient culturellement sécuritaires et plus propices à la santé.

The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities.

Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008-2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25-8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94-5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00-3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63-10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04-7.99), violence (HR: 2.54, 95%CI: 1.52-4.27) or overdose (HR: 4.97, 95%CI: 2.96-8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23-1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.

An evaluation of Indigenous Tobacco Program smoking prevention workshops with First Nations youth in Ontario, Canada.

SETTING: The Indigenous Tobacco Program (ITP) operated by the Indigenous Cancer Care Unit at Cancer Care Ontario provides customized tobacco prevention workshops to First Nations youth across Ontario, in partnership with First Nations communities and partner organizations. INTERVENTION: First Nations youth in Canada are more likely than non-Indigenous youth to be smokers. The ITP aims to address the negative health impacts of commercial tobacco, using culturally relevant approaches, tools and resources while remaining respectful to the significance of sacred tobacco. This paper aims to determine whether a culturally tailored tobacco prevention workshop increases tobacco-related knowledge among First Nations youth in Ontario. OUTCOMES: The workshops exhibited promise in impacting First Nations youth knowledge on the harms of commercial tobacco, as after the workshop intervention, all indicators showed improved knowledge. Building strong and ongoing relationships with communities and partner organizations is vital to the success of the program. IMPLICATIONS: Culturally tailored workshops grounded in traditional knowledge and values provide an opportunity to increase the knowledge of the harms of commercial tobacco among First Nations youth in Ontario. With commercial tobacco use and exposure having tremendous health consequences, such interventions are essential.

RéSUMé: CADRE: Le Programme pour la lutte contre le tabagisme chez les peuples autochtones (PLTPA) administré par l'Unité des soins de cancérologie chez les peuples autochtones à Cancer Care Ontario dispense des ateliers personnalisés de prévention du tabagisme aux jeunes Autochtones dans tout l'Ontario, en partenariat avec les communautés et organismes partenaires des Premières Nations. INTERVENTION: Les jeunes des Premières Nations canadiennes sont plus susceptibles de fumer que les jeunes non autochtones. Le PLTPA vise à remédier aux effets négatifs sur la santé du tabac commercial à l'aide d'approches, d'outils et de ressources pertinents sur le plan culturel, tout en demeurant respectueux de l'importance du tabac sacré. Cet article vise à déterminer si un atelier de prévention adapté sur le plan culturel permet d'accroître les connaissances relatives au tabac parmi les jeunes des Premières Nations de l'Ontario. RéSULTATS: Les ateliers ont eu des répercussions prometteuses sur les connaissances des jeunes des Premières Nations ayant trait aux effets néfastes du tabac commercial, puisqu'à la suite de l'atelier d'intervention, tous les indicateurs dénotaient une amélioration des connaissances à ce sujet. L'entretien de relations solides et continues avec les communautés et organismes partenaires est essentiel à la réussite du programme. IMPLICATIONS: Les ateliers culturellement adaptés et fondés sur des connaissances et des valeurs traditionnelles permettent d'accroître les connaissances des jeunes des Premières Nations ontariennes ayant trait aux effets néfastes du tabac commercial. Au vu des impacts énormes sur la santé, liés à la consommation de tabac commercial et à l'exposition à celui-ci, de telles interventions sont essentielles.

Exploring Métis health, spirituality and well-being: a patient-oriented community-based qualitative study with the Métis Nation of Alberta - Region 3.

BACKGROUND: There is a lack of Métis-guided participatory research on factors that contribute to individual, family and community well-being, such as developing social support and engaging in cultural, social and historical processes for healing and health. The purpose of this study was to explore links among health, spirituality and well-being within the Métis Nation of Alberta (MNA) - Region 3. METHODS: In the largest of 12 MNA - Region 3 communities, together with a working group of 9 community members, informal and elected leaders, and an Elder, we codeveloped a qualitative structured survey exploring health, spirituality and well-being. Following face-to-face distribution of the paper survey to community members (February to March 2019), we engaged with 7 working group members in coding and theme development. Results were shared with the community. RESULTS: Thirty-one community members requested surveys, with 29 participants aged 28-80 years (mean 54.77 yr, standard deviation 15.31 yr) completing the surveys (94% completion rate). Six participants were in the working group that codeveloped the survey. An overarching theme of connection and 4 corresponding subthemes were identified; central to well-being was maintaining connection and balance in mental, emotional, spiritual and physical aspects of health. Connection to Métis ancestry required understanding identity; connection to community involved feeling at home; connection to land included belonging; and connection to tradition encompassed blending of cultures. INTERPRETATION: Connection among ancestry, land, community and tradition contributed to well-being in our sample. Under the direction of each MNA region, exploration of health, spirituality and well-being with the use of our survey could be considered in community-specific Métis-guided ways across the remaining 5 MNA regions; the survey may also be of use to other provincial bodies in the Métis Nation.

Explaining the gaps in psychological distress and suicidal behaviours between non-Indigenous and Indigenous adults living off-reserve in Canada: a cross-sectional study.

BACKGROUND: Indigenous people are disproportionately affected by mental health issues in Canada. We investigated factors underlying the difference in psychological distress and suicidal behaviours between non-Indigenous and Indigenous populations living off-reserve in Canada. METHODS: We conducted a cross-sectional study using data from the 2012 Canadian Community Health Survey - Mental Health. Respondents were aged 18 years and older. We measured the variation in psychological distress (10-item Kessler Psychological Distress Scale scores, ranging from 10 [no distress] to 50 [severe distress]) and the prevalence of lifetime suicidal ideation and suicide plan between the Indigenous and non-Indigenous populations and explained these differences using the Blinder-Oaxaca approach. RESULTS: The overall response rate for the survey was 68.9%, comprising 18 300 respondents (933 Indigenous and 17 367 non-Indigenous adults). We found lower mean psychological distress scores among non-Indigenous people than among Indigenous people (15.1 v. 16.1, p < 0.001) and a lower prevalence of lifetime suicidal ideation (9.2% v. 16.8%, p < 0.001) and plan (2.3% v. 6.8%, p < 0.001). We found that if socioeconomic status among Indigenous people were made to be similar to that of the non-Indigenous population, the differences in mean psychological distress scores and prevalence of lifetime suicidal ideation and suicide plan would have been reduced by 25.7% (women 20.8%, men 36.9%), 10.2% (women 11.2%, men 11.9%) and 5.8% (women 7.8%, men 8.1%), respectively. INTERPRETATION: Socioeconomic factors account for a considerable proportion of the variation in mental health outcomes between non-Indigenous and Indigenous populations in Canada. Improving socioeconomic status among Indigenous people through plans like income equalization may reduce the gap in mental health outcomes between the 2 populations in Canada.

Manitoba First Nation peoples' use of hospital-based mental health services: trends and solutions.

OBJECTIVES: The objective of this article is to document patterns and trends of in-hospital mental health service use by First Nations (FN) living in rural and remote communities in the province of Manitoba. METHODS: Our sample included all Manitoba residents eligible under the Manitoba Health Services Insurance Plan living on FN reserves and those living in rural and remote communities from 1986 to 2014. Using administrative claims data, we developed multi-level models that describe hospitalization for mental health conditions shown responsive to primary healthcare interventions. We aggregated the results by First Nation Tribal Councils and remoteness to derive rates of hospitalization episodes, length of stay and readmission rates. RESULTS: Rates of hospitalization for mental health are increasing for FN males and females. This is particularly evident for those affiliated with the Island Lake and Keewatin Tribal Councils. The length of stay has increased. Changes in rates of readmissions were not statistically significant. FNs are admitted for mental health conditions at a younger age when compared with other Manitobans, and trends show that the FNs' average age at admission is decreasing. CONCLUSIONS: Our results raise serious concerns about the responsiveness of community-based mental health services for FNs in Manitoba, because of both increasing rates of episodes of hospitalization and decreasing age of admission. Given the documented lack of mental health services accessible on-reserve, levels of social distress associated with a history of oppressive policies, and continued lack of infrastructure, current trends are alarming.

RéSUMé: OBJECTIFS: L'objectif de cet article est de documenter les caractéristiques et les tendances de l'utilisation des services de santé mentale en milieu hospitalier par les Premières nations (PN) vivant dans les collectivités rurales et éloignées de la province du Manitoba. MéTHODES: Notre échantillon inclus tous les résidents du Manitoba admissibles au Régime d'assurance-maladie du Manitoba vivant dans les réserves des PN et ceux vivant dans des collectivités rurales et éloignées de 1986 à 2014. À partir de données de réclamations administratives, nous avons mis au point des modèles à plusieurs niveaux décrivant l'hospitalisation pour des problèmes de santé mentale qui se sont montrés sensibles aux interventions en soins de santé primaires. Nous avons agrégé les résultats par Conseil de Tribu pour obtenir les taux d'épisodes d'hospitalisation, la durée du séjour et les taux de réadmission. RéSULTATS: Les taux d'hospitalisation liée à la santé mentale augmentent pour les hommes et femmes PN. Cela est particulièrement évident pour les membres des conseils tribaux d'Island Lake et de Keewatin. La durée du séjour a aussi augmenté. Les changements dans les taux de réadmission n'étaient pas statistiquement significatifs. Les PNs sont admis pour des problèmes de santé mentale plus jeunes que les autres Manitobains, et les tendances montrent que l'âge moyen des PNs continue de décroître. CONCLUSIONS: Nos résultats soulèvent des inquiétudes quant à la réactivité des services de santé mentale communautaires pour les PNs au Manitoba, à la fois en raison de la fréquence croissante des épisodes d'hospitalisation et de la diminution de l'âge d'admission. Étant donné le manque documenté de services de santé mentale accessibles dans les réserves, le niveau de détresse sociale associé à des antécédents de politiques oppressives et le manque continu d'infrastructure, les tendances actuelles sont alarmantes.