Health care utilization differences between First Nations people and the general population with inflammatory bowel disease: a retrospective cohort study from Saskatchewan, Canada.

BACKGROUND: Indigenous people in Canada often face barriers to access specialized care, with limited data in evaluating health care utilization among Indigenous people with inflammatory bowel disease (IBD). We aimed to compare health care utilization between First Nations patients and those in the general population diagnosed with IBD in Saskatchewan. METHODS: We conducted a patient-oriented, population-based, retrospective cohort study by linking administrative health databases of Saskatchewan between fiscal years 1998/99 and 2017/18. We designed and completed this study in partnership with Indigenous patients and family advocates. We applied a validated algorithm to identify IBD incident cases and then used the self-declared First Nations status variable to divide those cases. We applied a 1:5 ratio for age and sex matching and used Cox proportional models to assess associations. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. RESULTS: We created a matched cohort with 696 IBD incident cases: 116 First Nations patients and 580 patients in the general population. We observed differences between the groups for IBD-specific hospital admissions (HR 1.33, 95% CI 1.01-1.75), IBD-related hospital admissions (HR 1.55, 95% CI 1.20-2.01), medication claims for IBD (HR 0.52, 95% CI 0.41-0.65) and 5-aminosalicylic acid claims (HR 0.56, 95% CI 0.45-0.71) adjusting by rural or urban residence and diagnosis type. There were no significant differences in the hazard rate of outpatient gastroenterology visits (HR 1.13, 95% CI 0.90-1.41), colonoscopies (HR 1.14, 95% CI 0.92-1.41) and surgeries for IBD (HR 1.14, 95% CI 0.80-1.64). INTERPRETATION: We identified that First Nations patients diagnosed with IBD had a higher rate of hospital admissions owing to IBD than patients in the general population diagnosed with IBD. We also found an inverse association between First Nations status and having prescription medication claims for IBD.

Food Security Status of Indigenous Peoples in Canada According to the 4 Pillars of Food Security: A Scoping Review.

Food insecurity is a significant public health problem for Indigenous peoples in Canada. A comprehensive literature review is needed to organize the evidence according to the 4 pillars of food security (i.e., availability, access, utilization, and stability) and identify gaps in the published literature on this topic. Therefore, in this scoping review we aimed to summarize the published research discussing any of the 4 pillars of food security among Indigenous peoples in Canada. We conducted a literature search of the following databases: Ovid Medline, EMBASE, Web of Science (Web of Knowledge), and CINAHL, as well as the Indigenous Studies Portal (up to June 19, 2021). Population-based studies of any design were included, except for review-style articles. Articles published in languages other than English were also excluded. Of the 4687 studies identified by the database searches, 91 met our inclusion criteria. Evidence from these studies indicates that all dimensions of food security among Indigenous peoples in Canada have been impacted. Lack of availability of both traditional and market foods is highlighted among Inuit and First Nation communities. Economic disadvantages, high food prices, and lack of access to transportation are major factors affecting the accessibility pillar of food security. Major factors affecting the utilization pillar of food security are the loss of traditional knowledge and skills, lack of knowledge on market foods, low quality of market foods, and food safety issues. Climate change has affected all 4 pillars of food security among Indigenous peoples. These findings suggest that resolving food insecurity issues among Indigenous peoples in Canada, especially those living in remote communities, requires a culturally specific integrated approach targeting food availability, food cost, food knowledge, food safety, and food quality.

Increasing Prevalence and Stable Incidence Rates of Inflammatory Bowel Disease Among First Nations: Population-Based Evidence From a Western Canadian Province.

BACKGROUND: There is limited to no evidence of the prevalence and incidence rates of inflammatory bowel disease (IBD) among Indigenous peoples. In partnership with Indigenous patients and family advocates, we aimed to estimate the prevalence, incidence, and trends over time of IBD among First Nations (FNs) since 1999 in the Western Canadian province of Saskatchewan. METHODS: We conducted a retrospective population-based study linking provincial administrative health data from the 1999-2000 to 2016-2017 fiscal years. An IBD case definition requiring multiple health care contacts was used. The prevalence and incidence data were modeled using generalized linear models and a negative binomial distribution. Models considered the effect of age groups, sex, diagnosis type (ulcerative colitis [UC], Crohn disease [CD]), and fiscal years to estimate prevalence and incidence rates and trends over time. RESULTS: The prevalence of IBD among FNs increased from 64/100,000 (95% confidence interval [CI], 62-66) in 1999-2000 to 142/100,000 (95% CI, 140-144) people in 2016-2017, with an annual average increase of 4.2% (95% CI, 3.2%-5.2%). Similarly, the prevalence of UC and CD, respectively, increased by 3.4% (95% CI, 2.3%-4.6%) and 4.1% (95% CI, 3.3%-4.9%) per year. In contrast, the incidence rates of IBD, UC, and CD among FNs depicted stable trends over time; no statistically significant changes were observed in the annual change trend tests. The ratio of UC to CD was 1.71. CONCLUSIONS: We provided population-based evidence of the increasing prevalence and stable incidence rates of IBD among FNs. Further studies are needed in other regions to continue understanding the patterns of IBD among Indigenous peoples.

Little Earth Strong: A Community-Level, Culturally Appropriate Diabetes Prevention Pilot Targeting Urban American Indians.

PURPOSE: The purpose of this study was to develop a culturally appropriate, community-based diabetes prevention program, named Little Earth Strong, through partnership with an urban, Indigenous, American Indian community and determine its feasibility in lowering diabetes risks. METHODS: Using a community-based participatory research, community-level intervention approach, and after conducting a focus groups with key stakeholders (n = 20), a culturally appropriate health intervention was designed across six stages. This included providing nutrition and physical activity individual, family, and group counseling and conducting individual level biometric tests at a monthly Progress Powwow. Community participants (n = 69) included Indigenous individuals ages 18 to 64 years and their families residing in an urban American Indian housing organization. RESULTS: Findings included the project's feasibility, sustainability, and future needs. Lessons learned included the need the need to situate health interventions within Indigenous culture, engage multiple stakeholders, remain flexible and inclusive of all community members, address cultural concerns regarding biometric testing, and focus on specific ages and groups. The outcome variables included qualitative focus group data regarding feasibility and design and quantitative biometric data including hemoglobin A1C levels and weight in which a significant decrease in A1C values were found among womenConclusions: Little Earth Strong was both feasible and successful in decreasing A1C levels using a community-level approach, especially in high participators who attended most events. These results demonstrate the promise of diabetes prevention fitness and nutrition interventions that are collaboratively designed with the community.

Identifying Perspectives About Health to Orient Obesity Intervention Among Urban, Transitionally Housed Indigenous Children.

Drawing from a socioecological framework of health, this community-based participatory research study examined key cultural health perspectives of transitionally housed, food insecure Indigenous children (aged 8-12 years) by utilizing talking circles and a 4-day photovoice (PV) curriculum. In total, 18 Indigenous children portrayed their health perceptions by taking photographs of their living environment and categorizing photos as healthy, unhealthy, or mixed. And, 10 of the 18 children completed pre- and post-evaluations, where data elucidated that urban Indigenous children experiencing food and housing insecurity demonstrate unique holistic and socioecological perceptions about health. Healthy themes included nutrition, gardening, interpersonal relationships, food sovereignty, water quality, and natural and built environments. Unhealthy themes included cumulative stress, food insecurity, access and cost, screen time, smoking, and violence. We found that implementing these robust insights into urban Indigenous obesity prevention interventions could significantly drive success. This approach may benefit children with similar socioecological strengths and vulnerabilities.

Ode'imin Giizis: Proposing and Piloting Gardening as an Indigenous Childhood Health Intervention.

The Research for Indigenous Community Health Center and the American Indian Housing Organization sought to reduce obesity among Indigenous children and families in a Northern Midwestern urban community who are at risk for homelessness by piloting a gardening health intervention. This community-based participatory research, mixedmethods study examined the feasibility of gardening as an obesity intervention among a school-aged Indigenous population at risk for homelessness through using focus groups, key informant interviews, and valid health measures. The program was found highly feasible and fulfilled a critical need among Indigenous youth and their families, who reportedly suffered from food insecurity and access. This intervention increased healthy food awareness and perceptions, cultural resources, and ancestral food knowledge skills through activities, mentorship, and multigenerational engagement. This study augments the literature on the feasibility of using tribal ecological knowledge and the environment in designing culturally appropriate health interventions.

Developing a Tribal Health Sovereignty Model for Obesity Prevention.

BACKGROUND: Few models for effective health interventions exist for stemming the tide of American Indian (AI) childhood obesity rates; they are among the highest in the United States and are increasing. Obesity-related chronic diseases (i.e., diabetes type II and cardiovascular disease) rates far exceed other U.S. racial groups. Some studies show success with health interventions that center within an AI worldview and approach, rather than those that center on an individualistic Western worldview. The Tribal Health Sovereignty (THS) model presented here defines health through an AI perspective and applicably to food and exercise intervention. The model discussed in this paper is grounded in a study, which used a community-based participatory research (CBPR) photovoice methodology and can be used to design effective health interventions. METHODS: Development of the THS model was guided by Earp and Ennett's representation of concept model development for health education research and intervention. Findings from a CBPR study that used photovoice methodology informed the model. Differences between AI and Western models of health are explored and illuminate how an interventions shaped by Indigenous culture and worldview can lead to better health outcomes among AI people. RESULTS: A THS model was developed to guide future AI interventions embedded within tribal culture. CONCLUSIONS: By using a THS model, tribal communities can engage in identifying barriers and facilitators for health to lower childhood obesity.

Applying indigenous community-based participatory research principles to partnership development in health disparities research.

This case study of community and university research partnerships utilizes previously developed principles for conducting research in the context of Native American communities to consider how partners understand and apply the principles in developing community-based participatory research partnerships to reduce health disparities. The 7 partnership projects are coordinated through a National Institutes of Health-funded center and involve a variety of tribal members, including both health care professionals and lay persons and native and nonnative university researchers. This article provides detailed examples of how these principles are applied to the projects and discusses the overarching and interrelated emergent themes of sharing power and building trust.