Assessing the social and physical determinants of circumpolar population health.

INTRODUCTION: Systematic reviews of the social and physical determinants of health provide metrics for evaluation of programs to mitigate health disparities. Previous meta-analyses of the population health literature have identified several proximate social and physical determinants of population health in the circumpolar north including addiction, environmental exposures, diet/nutrition and global climate change. Proximate health determinants are most amenable to early detection and modification or mitigation through disease prevention or health promotion interventions. DESIGN: There is a need for research to replicate these findings based on the latest science. This presentation describes a study applying Dahlgren and Whitehead's (1991) socio-ecological model of health determinants to identify the proximate social and physical determinants of health in the circumpolar north. METHODS: The study consisted of a systematic review of recent studies that link determinants of health with the leading causes of mortality and morbidity in Alaska. Our search strategy employed a keyword search using the Circumpolar Health Bibliographic Database (CHBD) and 4 databases within the Web of Knowledge (WoK) data gateway. Keywords included various terms for the arctic, all relevant nations and territories within the region, as well as leading health outcomes. RESULTS: Studies meeting the following inclusion criteria were reviewed: original research within a circumpolar population, published in English during 2011, and involving a rigorous demonstration of a link between a social determinant and selected health outcomes. CONCLUSIONS: Study conclusions includes a list of determinants identified, their associated outcomes and the study designs implemented to assess that association.

Demographic and contextual factors associated with inhalant use among youth in rural Alaska.

BACKGROUND: Abuse of harmful legal products that can be inhaled or ingested is a serious and growing problem in many rural Alaskan communities, and particularly so among preteens. METHODS: This study analyses data collected during baseline measurements of a 5-year NIH/NIDA-funded study entitled A Community Trial to Prevent Youth's Abuse of Harmful Legal Products in Alaska. Youth in 8 communities located throughout the state participated in a survey during the fall of 2009 to measure the prevalence and availability of harmful legal products (n=697). The goal of the analysis presented here is to compare the contextual factors of inhalant users and non-users in rural Alaskan communities. RESULTS: As reported in national surveys of substance use among youth, participants in this study indicated using alcohol more than any other substance. Inhalants were the second-most common substance abused, higher than either cigarettes or marijuana. Lifetime use varied among demographic factors such as age, gender and ethnicity as well as contextual factors including academic performance, parent employment, household living situation and income. When compared to non-users, significantly larger proportions of participants reporting lifetime inhalant use indicated easy availability of inhalants in their home, school and retail outlets. Users were also significantly more likely than non-users to have consumed alcohol. CONCLUSION: Results of this study may inform the development of effective interventions in other rural communities.

Assessing the influence of health on rural outmigration in Alaska.

OBJECTIVES: This formative study is intended to generate questions and hypotheses regarding the relationship between health and outmigration from Alaska's rural communities. This study is the first to provide perspectives of rural Alaskans in the context of health concerns and health care delivery as determinants of outmigration. STUDY DESIGN: The study collected secondary data through a comprehensive review of the literature and primary data through semi-structured interviews. METHODS: The research design consisted of two iterative phases: a comprehensive review of published and gray literature relevant to rural health and migration in Alaska, and in-depth interviews with rural Alaskans who had recently moved from rural to urban settings. A total of 31 Alaskans aged 18+ from communities throughout the state were interviewed about the factors influencing their decision to move to an urban centre. RESULTS: Three health-related determinants of outmigration from rural to urban Alaska emerged: (1) limited access to primary and specialized health care; (2) perceptions of health risks in rural communities; and (3) ripple effect migration of friends and family providing social support for rural Alaskans requiring health care. These determinants had disproportionate effects on young and female study participants. CONCLUSIONS: We present data describing the growing influence of health concerns and health care delivery on outmigration in this underserved population, and conclude with recommendations for future avenues of research. Expanding the body of knowledge of the link between health and outmigration will provide rural Alaskans the opportunity to live and grow old in their own communities.