The Aboriginal population in Canada, much younger than the general population, has experienced a trend towards aging over the past decade. Using data from the 2001 Aboriginal Peoples Survey (APS) and the 2000/2001 Canadian Community Health Survey (CCHS), this article examines differences in health status and the determinants of health and health care use between the 55-and-older Aboriginal population and non-Aboriginal population. The results show that the older Aboriginal population is unhealthier than the non-Aboriginal population across all age groups; differences in health status, however, appear to converge as age increases. Among those aged 55 to 64, 7 per cent of the Aboriginal population report three or more chronic conditions compared with 2 per cent of the non-Aboriginal population. Yet, among those aged 75 and older, 51 per cent of the Aboriginal population report three or more chronic conditions in comparison with 23 per cent of the non-Aboriginal population.
This article documents the prevalence and national profile of American Indian/Alaskan Native (AI/AN) grandparents who are raising their grandchildren, based on data from the American Community Survey/Census 2000 Supplementary Survey. In 2000 there were estimated to be nearly 53,000 AI/AN grandparent caregivers age 45 and older in the United States. Almost half of the caregiving grandparents had been raising a grandchild for five years or longer. The findings reveal a portrait of grandparents committed to raising their grandchildren despite the fact that many were living in extreme poverty, with ill health, and with limited resources and services. One-third of grandparent caregivers were living below the poverty line, and only one-quarter of these were receiving public assistance. Even when compared with their noncaregiving AI/AN peers, grandparents raising grandchildren were disproportionately female, poor, living with a functional disability, and living in overcrowded conditions. Implications for social work practice are presented and recommendations for policy and research are discussed.
Unattached patients do not have a regular primary care provider. Initiatives are being developed to increase attachment rates across Canada. Most existing attention paid to patient unattachment has focused on quantifying the problem and health system costs. Our purpose is to qualitatively identify the implications of chronically ill patients' experiences of unattachment for health policy and planning to provide policy-relevant insights for Canadian attachment initiatives.
Three focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city in British Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledge that by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada's health care system Focus groups were structured as an open conversation organized around a series of probing questions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.
Twenty-six individuals participated in the focus groups. The most common chronic illnesses reported were active drug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identified life transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessful attempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having a trusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency. One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access to preventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.
Participants perceived that there are many benefits to be had by having attachment to a regular family doctor and that experiencing unattachment challenged their health and access to health care. We encourage more research to be done on the lived experience of unattachment in order to provide on-the-ground insights that policy-makers require in order to develop responsive, patient-centred supports and programs.
Cites: Can Fam Physician. 2003 Jul;49:890-512901486
Motivated by a shortage of Aboriginal nurses and recurring difficulties in recruitment and retention of Aboriginal peoples in nursing education, a critical ethnography was conducted to examine the experiences of undergraduate Aboriginal nursing students in two Canadian schools of nursing. We conducted audiotaped interviews with Aboriginal nursing students (n=31), Aboriginal nurses (n=5), nursing faculty members (n=24), and individuals who were identified as knowledgeable about the context that might shape the experiences (n=16). Other data sources included reflexive and descriptive fieldnotes from 200 h of fieldwork in classroom and laboratory practice sessions and 135 texts from the participating schools. Nursing textbooks, course syllabi, policies, procedures, clinical evaluation forms and websites were randomly selected and analyzed to explicate how texts shaped the students' experiences. In this paper, we discuss the findings of the study and briefly share our recommendations.
We sought to determine if the rate of increase in body mass index (BMI) differs between first generation immigrant children (child and both parents born outside Canada); second generation immigrant children (child born in Canada with at least one parent born outside Canada); and native-born children (child and both parents born in Canada), and if the rate of increase varies across ethnic groups.
Data were available from the evaluation of a 5-year heart health promotion program targeted to elementary school children from 24 schools in multi-ethnic, disadvantaged, inner-city neighborhoods in Montreal, Canada. Participants were 6392 children aged 9-12 years born in and outside of Canada. Height and weight were measured annually according to a standardized protocol. BMI increases with age were examined using individual growth models stratified by immigrant status grouping (first generation immigrant, second generation immigrant, native-born).
On average, BMI increased by 0.59, 0.73, and 0.82 kg/m2 with each year of age among first generation immigrant, second generation immigrant, and native-born children, respectively. These differences held across four family origin grouping (Europe, Asia, Central/South America, and Other).
The protective effect of immigrant status on BMI increases with age dissipated in second generation immigrant children, whose rate of increase was similar to that of native-born children. Because immigrants constitute the fastest growing segment of the Canadian population, it is important to understand the causes of the higher BMI increases with successive generations.
Studies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Studies have detected high prevalences of HIV-related risk behaviours, self-reported HIV, and HIV seropositivity.
The Trans PULSE Project conducted a multi-mode survey using respondent-driven sampling to recruit 433 trans people in Ontario, Canada. Weighted estimates were calculated for HIV-related risk behaviours, HIV testing and self-reported HIV, including subgroup estimates for gender spectrum and ethno-racial groups.
Trans people in Ontario report a wide range of sexual behaviours with a full range of partner types. High proportions - 25% of female-to-male (FTM) and 51% of MTF individuals - had not had a sex partner within the past year. Of MTFs, 19% had a past-year high-risk sexual experience, versus 7% of FTMs. The largest behavioural contributors to HIV risk were sexual behaviours some may assume trans people do not engage in: unprotected receptive genital sex for FTMs and insertive genital sex for MTFs. Overall, 46% had never been tested for HIV; lifetime testing was highest in Aboriginal trans people and lowest among non-Aboriginal racialized people. Approximately 15% of both FTM and MTF participants had engaged in sex work or exchange sex and about 2% currently work in the sex trade. Self-report of HIV prevalence was 10 times the estimated baseline prevalence for Ontario. However, given wide confidence intervals and the high proportion of trans people who had never been tested for HIV, estimating the actual prevalence was not possible.
Results suggest potentially higher than baseline levels of HIV; however low testing rates were observed and self-reported prevalences likely underestimate seroprevalence. Explicit inclusion of trans people in epidemiological surveillance statistics would provide much-needed information on incidence and prevalence. Given the wide range of sexual behaviours and partner types reported, HIV prevention programs and materials should not make assumptions regarding types of behaviours trans people do or do not engage in.
Cites: J Acquir Immune Defic Syndr. 2001 Dec 1;28(4):380-411707676
Cites: Am J Public Health. 2001 Jun;91(6):915-2111392934
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Previous studies suggest that dietary patterns and the extent of reliance upon traditional food vary among Inuit communities. Inuit traditional foods are an important source of nutrients such as highly unsaturated n-3 fatty acids (HUFA n-3), whose beneficial effects include protection against ischemic heart disease. Dietary transition is occurring with younger generations consuming less traditional foods and more market foods with low nutrient density. Utilizing erythrocyte membrane fatty acid composition as an indicator of body HUFA n-3 status, which reflects dietary intake levels of traditional Inuit foods, we explored the regional and age variability of highly unsaturated n-3 fatty acids (HUFA n-3) in the International Polar Year Inuit Health Survey.
Cross-sectional health survey.
Participants were recruited through random sampling of households. Fatty acid data were available among 2,200 adults (=18 yr).
HUFA n-3 levels in the Eastern Arctic were significantly higher than in the Western Arctic, with Nunatsiavut (northern Labrador) and Baffin showing the highest HUFA n-3 status compared to Kivalliq, Kitikmeot and Inuvialuit Settlement Region (ISR) (p
Comment In: Int J Circumpolar Health. 2011;70(5):444-622208993
Comment In: Int J Circumpolar Health. 2011;70(5):447-922208994
The world's almost 400 million Indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. Inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation. Some Indigenous groups, as they move from traditional to transitional and modern lifestyles, are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. Correction of these inequities needs increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.
OBJECTIVES: To describe changes in infant mortality rates, including birthweight-specific rates and rates by age at death and cause. METHODS: We analyzed US linked birth/infant-death data for 1989-1991 and 1998-2000 for American Indians/Alaska Native (AIAN) and White singleton infants at > or =20 weeks' gestation born to US residents. We calculated birthweight-specific infant mortality rates (deaths in each birthweight category per 1000 live births in that category), and overall and cause-specific infant mortality rates (deaths per 100000 live births) in infancy (0-364 days) and in the neonatal (0-27 days) and postneonatal (28-364 days) periods. RESULTS: Birthweight-specific infant mortality rates declined among AIAN and White infants across all birthweight categories, but AIAN infants generally had higher birthweight-specific infant mortality rates. Infant mortality rates declined for both groups, yet in 1998-2000, AIAN infants were still 1.7 times more likely to die than White infants. Most of the disparity was because of elevated post-neonatal mortality, especially from sudden infant death syndrome, accidents, and pneumonia and influenza. CONCLUSIONS: Although birthweight-specific infant mortality rates and infant mortality rates declined among both AIAN and White infants, disparities in infant mortality persist. Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AIAN communities.