Temperature and place associations with Inuit mental health in the context of climate change.

BACKGROUND: Climate change has important implications for mental health globally. Yet, few studies have quantified the magnitude and direction of associations between weather and mental health-related factors, or assessed the geographical distribution of associations, particularly in areas experiencing rapid climatic change. This study examined the associations between air temperature variables and mental health-related community clinic visits across Nunatsiavut, Labrador, Canada, and the place-specific attributes of these associations. METHODS: Daily de-identified community clinic visit data were collected from the provincial electronic health recording system and linked to historical weather data (2012-2018). A multilevel, multivariable negative binomial regression model was fit to investigate associations between temperature variables and mental health-related community clinic visits across the region, adjusting for seasonality as a fixed effect and community as a random effect. A multivariable negative binomial model was then fit for each Nunatsiavut community, adjusting for seasonality. RESULTS: Mental health-related visits contributed to 2.4% of all 228,104 visit types across the study period; this proportion ranged from 0.6% to 11.3% based on community and year. Regionally, the incidence rate of mental health-related community clinic visits was greater after two weeks of warm average (i.e. above -5ᵒC) temperatures compared to temperatures below -5ᵒC (IRR-5≤5ᵒC = 1.47, 95% CI = 1.21-1.78; IRR6≤15ᵒC = 2.24, 95% CI = 1.66-3.03; IRR>15ᵒC = 1.73, 95% CI = 1.02-2.94), and the incidence rate of mental health-related clinic visits was lower when the number of consecutive days within -5 to 5ᵒC ranges (i.e. temperatures considered to be critical to land use) increased (IRR = 0.96; 95% CI = 0.94-0.99), adjusting for seasonal and community effects. Community-specific models, however, revealed that no two communities had the same association between meteorological conditions and the incidence rate of daily mental health-related visits. DISCUSSION: Regionally, longer periods of warm temperatures may burden existing healthcare resources and shorter periods of temperatures critical to land use (i.e. -5 to 5ᵒC) may present enjoyable or opportunistic conditions to access community and land-based resources. The heterogeneity found in temperature and mental health-related clinic visits associations across Nunatsiavut communities demonstrates that place quantitatively matters in the context of Inuit mental health and climate change. This evidence underscores the importance of place-based approaches to health policy, planning, adaptation, and research related to climate change, particularly in circumpolar regions such as Nunatsiavut where the rate of warming is one of the fastest on the planet.

"We're people of the snow:" Weather, climate change, and Inuit mental wellness.

Rapid environmental change due to climate change impacts Inuit mental wellness by altering the relationships between people, place, livelihoods, and culture. Little is known, however, about how fluctuations in weather contribute to the experience of place and the connection to mental wellness in Inuit communities. This study aimed to characterize the importance of changes in weather among Inuit, and how these changes influence mental health and wellness in the context of climate change. Data were drawn from a community-driven and Inuit-led study in the Nunatsiavut region of Labrador, Canada. In-depth interviews (n = 116 people) were conducted between November 2012 to May 2013 in the five Nunatsiavut communities. Qualitative data were thematically analyzed using a constant comparative method. Results indicated that weather impacted mental wellness through three key pathways: 1) shaping daily lived experiences including connection to place and other determinants of wellbeing; 2) altering mood and emotion on a transient basis; and 3) seasonally influencing individual and community health and wellbeing. These results demonstrate the immediate role weather has in shaping mental wellness in Nunatsiavut. In turn, this understanding of the climate-mental wellness relationship points to multiple pathways for action on climate adaptation policy and programming, and underscores the need for more culturally-specific and place-based investigations to appropriately respond to the mental health impacts of climate change.

Promoting Inuit health through a participatory whiteboard video.

SETTING: The Inuit community of Rigolet experiences greater rates of self-reported acute gastrointestinal illness (AGI) compared to southern Canada. INTERVENTION: A whiteboard video tool was collaboratively developed by Rigolet youth, community members, the research team and key regional stakeholders to share public health recommendations for reducing the risk of AGI. The video debuted in Rigolet at a community event in August 2016 and was later provided online for community members and local and regional health departments. Interviews and focus group discussions were used to evaluate the ability of the video to communicate public health information to community members in Rigolet. OUTCOMES: Community and government viewers reported that the whiteboard video was novel and engaging. Evaluation participants believed the video was suitable for promoting Inuit health because of the use of locally relevant visuals and narrative, which reflect Inuit art and storytelling traditions. Furthermore, participants indicated that the video co-development process was critical to ensuring community relevance of the video. Short-term outcome results suggest the video can reinforce health knowledge and potentially encourage behavioural change. IMPLICATIONS: The results suggest this whiteboard video was an effective tool to share information and could increase intention to change behaviours to reduce the risk of AGI in Rigolet. While tools like the whiteboard video are gaining popularity, the participatory approach was used to develop the video, and its use in an Inuit context illustrates its innovation and novelty. This tool may be a useful health promotion tool among Indigenous communities in Canada.

Water quality and health in northern Canada: stored drinking water and acute gastrointestinal illness in Labrador Inuit.

One of the highest self-reported incidence rates of acute gastrointestinal illness (AGI) in the global peer-reviewed literature occurs in Inuit communities in the Canadian Arctic. This high incidence of illness could be due, in part, to the consumption of contaminated water, as many northern communities face challenges related to the quality of municipal drinking water. Furthermore, many Inuit store drinking water in containers in the home, which could increase the risk of contamination between source and point-of-use (i.e., water recontamination during storage). To examine this risk, this research characterized drinking water collection and storage practices, identified potential risk factors for water contamination between source and point-of-use, and examined possible associations between drinking water contamination and self-reported AGI in the Inuit community of Rigolet, Canada. The study included a cross-sectional census survey that captured data on types of drinking water used, household practices related to drinking water (e.g., how it was collected and stored), physical characteristics of water storage containers, and self-reported AGI. Additionally, water samples were collected from all identified drinking water containers in homes and analyzed for presence of Escherichia coli and total coliforms. Despite municipally treated tap water being available in all homes, 77.6% of households had alternative sources of drinking water stored in containers, and of these containers, 25.2% tested positive for total coliforms. The use of transfer devices and water dippers (i.e., smaller bowls or measuring cups) for the collection and retrieval of water from containers were both significantly associated with increased odds of total coliform presence in stored water (ORtransfer device = 3.4, 95% CI 1.2-11.7; ORdipper = 13.4, 95% CI 3.8-47.1). Twenty-eight-day period prevalence of self-reported AGI during the month before the survey was 17.2% (95% CI 13.0-22.5), which yielded an annual incidence rate of 2.4 cases per person per year (95% CI 1.8-3.1); no water-related risk factors were significantly associated with AGI. Considering the high prevalence of, and risk factors associated with, indicator bacteria in drinking water stored in containers, potential exposure to waterborne pathogens may be minimized through interventions at the household level.

How are perceptions associated with water consumption in Canadian Inuit? A cross-sectional survey in Rigolet, Labrador.

Concerns regarding the safety and aesthetic qualities of one's municipal drinking water supply are important factors influencing drinking water perceptions and consumption patterns (i.e. sources used and daily volume of consumption). In northern Canada, Inuit communities face challenges with drinking water quality, and many Inuit have reported concerns regarding the safety of their drinking water. The objectives of this research were to describe perceptions of municipal tap water, examine use of water sources and changes following the installation of a potable water dispensing unit (PWDU) in 2014, and identify factors associated with water consumption in the Inuit community of Rigolet. This study used data from three cross-sectional census surveys conducted between 2012 and 2014. Principal component analysis (PCA) was used to aggregate data from multiple variables related to perceptions of water, and logistic regressions were used to identify variables associated with water consumption patterns. Three quarters of residents reported using the PWDU after its installation, with concomitant declines reported in consumption of bottled, tap, and brook water. Negative perceptions of tap water were associated with lower odds of consuming tap water (ORPCAcomponent1=0.73, 95% CI 0.56-0.94; ORPCAcomponent2=0.67, 95% CI 0.49-0.93); women had higher odds of drinking purchased water compared to men (OR=1.90, 95% CI 1.11-3.26). The median amount of water consumed per day was 1L. Using brook water (OR=2.60, 95% CI 1.22-5.56) and living in a household where no one had full-time employment (OR=2.94, 95% CI 1.35-6.39) were associated with consuming >2L of water per day. Results of this study may inform drinking water interventions, risk assessments, and public health messaging in Rigolet and other Indigenous communities.