To retrospectively examine the barriers faced and opportunities for improvement during the 2009 H1N1 pandemic response experienced by participants responsible for the delivery of health care services in 3 remote and isolated Subarctic First Nation communities of northern Ontario, Canada.
A qualitative community-based participatory approach.
Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the 3 main sectors responsible for health care services (i.e., federal health centres, provincial hospitals and Band Councils). Data were manually transcribed and coded using deductive and inductive thematic analysis.
Primary barriers reported were issues with overcrowding in houses, insufficient human resources and inadequate community awareness. Main areas for improvement included increasing human resources (i.e., nurses and trained health care professionals), funding for supplies and general community awareness regarding disease processes and prevention.
Government bodies should consider focusing efforts to provide more support in terms of human resources, monies and education. In addition, various government organizations should collaborate to improve housing conditions and timely access to resources. These recommendations should be addressed in future pandemic plans, so that remote western James Bay First Nation communities of Subarctic Ontario and other similar communities can be better prepared for the next public health emergency.
Cadmium (Cd), a nonessential toxic metal present in the environment, accumulates in the organs of herbivorous mammals which typically are consumed by Aboriginal populations. The relative contribution of this potential exposure source to concentrations of blood Cd was investigated in 1429 participants (age >7 years) residing in the nine Cree First Nations communities of Eeyou Istchee, northern Quebec, Canada. Analysis of variance identified significant Cd concentration differences between communities, sex, and age groups, although these were complicated by significant 2-way interactions. The percentage of participants with Cd concentrations within the adopted health-based guideline categories of 'acceptable', 'concern' and 'action' pertaining to kidney damage was 56.2%, 38.3%, and 5.5%, respectively. Partial correlations (controlling for age as a continuous variable) did not show a significant association between consumption of traditional foods and Cd concentrations (r = 0.014, df = 105, p = 0.883). A significant and positive partial correlation (r = 0.390, df = 105, p
Canadian Aboriginal youth have poorer diet quality and higher rates of overweight and obesity than the general population. This research aimed to assess the impact of simple food provision programs on the intakes of milk and alternatives among youth in Kashechewan and Attawapiskat First Nations (FNs), Ontario, Canada.
A pilot school snack program was initiated in Kashechewan in May 2009 including coordinator training and grant writing support. A supplementary milk and alternatives program was initiated in Attawapiskat in February 2010. Changes in dietary intake were assessed using Web-based 24-hour dietary recalls in grade 6 to 8 students, pre- and 1-week post-program, with a 1-year follow-up in Kashechewan. Student impressions were collected after 1 week using open-ended questions in the Web survey. Teacher and administrator impressions were collected via focus groups after 1 year in Kashechewan.
After 1 week, calcium intake increased in Kashechewan (805.9 ± 552.0 to 1027.6 ± 603.7 mg, p = .044); however, improvements were not sustained at 1 year; milk and alternatives (1.7 ± 1.7 servings to 2.1 ± 1.4 servings, p = .034) and vitamin D (2.5 ± 2.6 to 3.5 ± 3.4 µg, p = .022) intakes increased in Attawapiskat. Impressions of the programs were positive, though limited resources, staff, facilities, and funding were barriers to sustaining the consistent snack provision of the 1-week pilot phase.
These illustrations show the potential of snack programs to address the low intakes of milk and alternatives among youth in remote FNs. Community-level constraints must be addressed for sustained program benefits.
this article constitutes a report on the comprehensive Nituuchischaayihtitaau Aschii multi-community environment-and-health study conducted among the Cree peoples (Eeyouch) of northern Quebec, Canada.
to interpret observed concentrations of a suite of chemical elements in a multi-media biological monitoring study in terms of sources and predictors.
the concentrations of 5 essential and 6 toxic chemical elements were measured in whole blood, and/or in urine or hair by ICP-MS. Concentrations of essential elements are compared to those considered normal (i.e., required for good health) and, when toxic, deemed acceptable at specified concentrations in public health guidelines. Their dependence on age, sex, the specific community lived-in and diet were explored employing multivariate analysis of variance (MANOVA) involving new variables generated by principle component analysis (PCA) and correspondence analysis (CA).
the 5 most prominent PCA axes explained 67.7% of the variation, compared to 93.0% by 6 main CA factors. Concentrations of the essential elements in whole blood (WB) and iodine(i) and arsenic (As) in urine were comparable to those reported in the recent Canadian Health Measures survey and are assigned to dietary sources. By contrast, WB cadmium (Cd) was elevated even when smoking was considered. Mercury (Hg) concentrations in WB and hair were also higher in adults, although comparable to those observed for other indigenous populations living at northern latitudes. Fish consumption was identified as the prominent source. Of the 5 coastal communities, all but one had lower Hg exposures than the four inland communities, presumably reflecting the type of fish consumed. Use of firearms and smoking were correlated with WB-lead (Pb). The concentrations of both Hg and Pb increased with age and were higher in men, while WB-Cd and smoking prevalence were higher in women when considering all communities. Hg and Pb were low in children and women of reproductive age, with few exceedances of health guidelines. Although individuals with T2D had somewhat lower WB-Cd, there is some indication that Cd may potentiate renal dysfunction in this subgroup. Plots of selected CA axes grouped those elements expected to be in a normal diet and distinguished them from those with well-known unique sources (especially Hg and As in hair; and Hg, Pb and Cd in WB).
the use of multiple biological media in conjunction with the complementary PCA and CA approaches for constructing composite variables allowed a more detailed understanding of both the sources of the essential and toxic elements in body fluids and the dependencies of their observed concentrations on age, sex, community and diet.
A community-based participatory approach and engagement process creates culturally appropriate and community informed pandemic plans after the 2009 H1N1 influenza pandemic: remote and isolated First Nations communities of sub-arctic Ontario, Canada.
Public health emergencies have the potential to disproportionately impact disadvantaged populations due to pre-established social and economic inequalities. Internationally, prior to the 2009 H1N1 influenza pandemic, existing pandemic plans were created with limited public consultation; therefore, the unique needs and characteristics of some First Nations communities may not be ethically and adequately addressed. Engaging the public in pandemic planning can provide vital information regarding local values and beliefs that may ultimately lead to increased acceptability, feasibility, and implementation of pandemic plans. Thus, the objective of the present study was to elicit and address First Nations community members' suggested modifications to their community-level pandemic plans after the 2009 H1N1 influenza pandemic.
The study area included three remote and isolated First Nations communities located in sub-arctic Ontario, Canada. A community-based participatory approach and community engagement process (i.e., semi-directed interviews (n?=?13), unstructured interviews (n?=?4), and meetings (n?=?27)) were employed. Participants were purposively sampled and represented various community stakeholders (e.g., local government, health care, clergy, education, etc.) involved in the community's pandemic response. Collected data were manually transcribed and coded using deductive and inductive thematic analysis. The data subsequently informed the modification of the community-level pandemic plans.
The primary modifications incorporated in the community-level pandemic plans involved adding community-specific detail. For example, 'supplies' emerged as an additional category of pandemic preparedness and response, since including details about supplies and resources was important due to the geographical remoteness of the study communities. Furthermore, it was important to add details of how, when, where, and who was responsible for implementing recommendations outlined in the pandemic plans. Additionally, the roles and responsibilities of the involved organizations were further clarified.
Our results illustrate the importance of engaging the public, especially First Nations, in pandemic planning to address local perspectives. The community engagement process used was successful in incorporating community-based input to create up-to-date and culturally-appropriate community-level pandemic plans. Since these pandemic plans are dynamic in nature, we recommend that the plans are continuously updated to address the communities' evolving needs. It is hoped that these modified plans will lead to an improved pandemic response capacity and health outcomes, during the next public health emergency, for these remote and isolated First Nations communities. Furthermore, the suggested modifications presented in this paper may help inform updates to the community-level pandemic plans of other similar communities.
The World Health Organization (WHO) recommends a mercury (Hg) hair-to-blood ratio of 250 for the conversion of Hg hair levels to those in whole blood. This encouraged the selection of hair as the preferred analyte because it minimizes collection, storage, and transportation issues. In spite of these advantages, there is concern about inherent uncertainties in the use of this ratio.
To evaluate the appropriateness of the WHO ratio, we investigated total hair and total blood Hg concentrations in 1333 individuals from 9 First Nations (Aboriginal) communities in northern Québec, Canada.
We grouped participants by sex, age, and community and performed a 3-factor (M)ANOVA for total Hg in hair (0-2 cm), total Hg in blood, and their ratio. In addition, we calculated the percent error associated with the use of the WHO ratio in predicting blood Hg concentrations from hair Hg. For group comparisons, Estimated Marginal Means (EMMS) were calculated following ANOVA.
At the community level, the error in blood Hg estimated from hair Hg ranged -25% to +24%. Systematic underestimation (-8.4%) occurred for females and overestimation for males (+5.8%). At the individual level, the corresponding error range was -98.7% to 1040%, with observed hair-to-blood ratios spanning 3 to 2845.
The application of the ratio endorsed by the WHO would be unreliable for determining individual follow-up. We propose that Hg exposure be assessed by blood measurements when there are human health concerns, and that the singular use of hair and the hair-to-blood concentration conversion be discouraged in establishing individual risk.
Concerns regarding the persistence, bioaccumulation, long-range transport, and adverse health effects of polybrominated dipheyl ethers (PBDEs) have recently come to light. PBDEs may potentially be of concern to indigenous (First Nations) people of Canada who subsist on traditional foods, but there is a paucity of information on this topic.
To investigate whether the traditional diet is a major source of PBDEs in sub-Arctic First Nations populations of the Hudson Bay Lowlands (James and Hudson Bay),Ontario, Canada, a variety of tissues from wild game and fish were analyzed for PBDE content (n=147) and dietary exposure assessed and compared to the US EPA reference doses (RfDs). In addition, to examine the effect of isolation/industrialization on PBDE body burdens, the blood plasma from three First Nations (Cree Nation of Oujé-Bougoumou, Quebec; Fort Albany First Nation, Ontario; and Weenusk First Nation [Peawanuck], Ontario, Canada) were collected (n=54) and analyzed using a log-linear contingency model.
The mean values of PBDEs in wild meats and fish adjusted for standard consumption values and body weight, did not exceed the US EPA RfD. Log linear modeling of the human PBDE body burden showed that PBDE body burden increases as access to manufactured goods increases. Thus, household dust from material goods containing PBDEs is likely responsible for the human exposure; the traditional First Nations diet appears to be a minor source of PBDEs.
Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity.
A trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach.
Fifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested.
Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed.
The use of lead shotshell to hunt water birds has been associated with lead-contamination in game meat. However, evidence illustrating that lead shotshell is a source of lead exposure in subsistence hunting groups cannot be deemed definitive. This study seeks to determine whether lead shotshell constitutes a source of lead exposure using lead isotope ratios. We examined stable lead isotope ratios for lichens, lead shotshell and bullets, and blood from residents of Fort Albany and Kashechewan First Nations, and the City of Hamilton, Ontario, Canada. Data were analyzed using ANOVA and regression analyses. ANOVA of isotope ratios for blood revealed significant differences with respect to location, but not sex. Hamilton differed from both Kashechewan and Fort Albany; however, the First Nations did not differ from each other. ANOVA of the isotope ratios for lead ammunition and lichens revealed no significant differences between lichen groups (north and south) and for the lead ammunition sources (pellets and bullets). A plot of (206)Pb/(204)Pb and (206)Pb/(207)Pb values illustrated that lichens and lead ammunition were distinct groupings and only the 95% confidence ellipse of the First Nations group overlapped that of lead ammunition. In addition, partial correlations between blood-lead levels (adjusted for age) and isotope ratios revealed significant (p
School snack and breakfast programs may be especially important in remote northern communities where many households are food insecure. Despite the strong potential for school programs to improve the dietary intake and eating behaviours of children and youth, very few studies have reported on the effects of school nutrition programs in Aboriginal communities. The purpose of this study was to examine the impact of a school snack program on the dietary intake of grade six to ten First Nation students living in a remote community in northern Ontario.
Data were collected in November 2004 and December 2007 with grade six to ten (aged 10-18 years) students (n=63 and n=50, respectively) using a validated web-based 24 hour diet recall survey, the WEB-Q. Food group consumption and nutrient intake of students participating in the school snack program on the previous day were compared with students who chose not to participate. In each year, ANOVA was used to assess differences between participants and non-participants, genders, and grade groups. The second data collection in December of 2007 included five questions asking students about their participation, preferences, and impressions of the snack program.
Students participating in the snack program during the 2004 data collection (37%; n=23) compared with those who did not (63%; n=40) had significantly (p