Grace M. Egeland

Environmental contaminants and human health in the Canadian Arctic.

The third Canadian Arctic Human Health Assessment conducted under the Canadian Northern Contaminants Program (NCP), in association with the circumpolar Arctic Monitoring and Assessment Programme (AMAP), addresses concerns about possible adverse health effects in individuals exposed to environmental contaminants through a diet containing country foods. The objectives here are to: 1) provide data on changes in human contaminant concentrations and exposure among Canadian Arctic peoples; 2) identify new contaminants of concern; 3) discuss possible health effects; 4) outline risk communication about contaminants in country food; and 5) identify knowledge gaps for future contaminant research and monitoring. The nutritional and cultural benefits of country foods are substantial; however, some dietary studies suggest declines in the amount of country foods being consumed. Significant declines were found for most contaminants in maternal blood over the last 10 years within all three Arctic regions studied. Inuit continue to have the highest levels of almost all persistent organic pollutants (POPs) and metals among the ethnic groups studied. A greater proportion of people in the East exceed Health Canadas guidelines for PCBs and mercury, although the proportion of mothers exceeding these guidelines has decreased since the previous assessment. Further monitoring and research are required to assess trends and health effects of emerging contaminants. Infant development studies have shown possible subtle effects of prenatal exposure to heavy metals and some POPs on immune system function and neurodevelopment. New data suggest important beneficial effects on brain development for Inuit infants from some country food nutrients. The most successful risk communication processes balance the risks and benefits of a diet of country food through input from a variety of regional experts and the community, to incorporate the many socio-cultural and economic factors to arrive at a risk management decision that will be the most beneficial in Arctic communities.

Food security in Nunavut, Canada: barriers and recommendations.

Abstract Objectives. The food supply of Inuit living in Nunavut, Canada, is characterized by market food of relatively low nutritional value and nutrient-dense traditional food. The objective of this study is to assess community perceptions about the availability and accessibility of traditional and market foods in Nunavut. Study Design. A qualitative study using focus group methodology. Methods. Focus groups were conducted in 6 communities in Nunavut in 2004 and collected information was analyzed. Results. Barriers to increased traditional food consumption included high costs of hunting and changes in lifestyle and cultural practices. Participants suggested that food security could be gained through increased economic support for local community hunts, freezers and education programs, as well as better access to cheaper and higher quality market food. Conclusions. Interventions to improve the dietary quality of Nunavut residents are discussed. (Int J Circumpolar Health 2006; 65(5):416–431)

Video Display Terminals and the Risk of Spontaneous Abortion

BACKGROUND The relation between spontaneous abortion and the use of video display terminals (VDTs) is of great public health concern. Previous investigators of this issue have reported inconsistent findings. METHODS To determine whether electromagnetic fields emitted by VDTs are associated with an increased risk of spontaneous abortion, a cohort of female telephone operators who used VDTs at work was compared with a cohort of operators who did not use VDTs. To obtain reliable estimates of exposure, we determined the number of hours of VDT use per week from company records and measured electromagnetic fields at VDT workstations and, for purposes of comparison, at workstations without VDTs. Operators who used VDTs had higher abdominal exposure to very-low-frequency (15 kHz) electromagnetic fields (workstations without VDTs did not emit very-low-frequency energy). Abdominal exposure to extremely-low-frequency fields (45 to 60 Hz) was similar for both operators who used VDTs and those who did not. Among 2430 women interviewed, there were 882 pregnancies that met our criteria for inclusion in the study. RESULTS We found no excess risk of spontaneous abortion among women who used VDTs during the first trimester of pregnancy (odds ratio = 0.93; 95 percent confidence interval, 0.63 to 1.38), and no dose-response relation was apparent when we examined the womens hours of VDT use per week (odds ratio for 1 to 25 hours per week = 1.04; 95 percent confidence interval, 0.61 to 1.79; odds ratio for greater than 25 hours per week = 1.00; 95 percent confidence interval, 0.61 to 1.64). There continued to be no risk associated with the use of VDTs when we accounted for multiple pregnancies, conducted separate analyses of early abortion, late abortion, and all fetal losses, or limited our analyses to spontaneous abortions for which a physician was consulted. CONCLUSIONS The use of VDTs and exposure to the accompanying electromagnetic fields were not associated with an increased risk of spontaneous abortion in this study.

Food insecurity among Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007–2008

Background: Food security (i.e., a condition in which all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life) has been noted to be lower in indigenous communities in Canada. We investigated the prevalence of inadequate food security, or food insecurity, among Inuit households with preschool children. Methods: We conducted a cross-sectional survey of the health status of 388 randomly selected Inuit children aged three to five years in 16 Nunavut communities during the period from 2007 to 2008. From the survey data, we classified levels of food insecurity specifically among children. We also classified levels of overall food insecurity of the household of each child. We calculated the weighted prevalence of levels of child food insecurity and of household food insecurity. Results: Nearly 70% of Inuit preschoolers resided in households rated as food insecure (69.6%; 95% confidence interval [CI] 64.7%–74.6%). Overall, 31.0% of children were moderately food insecure, and 25.1% were severely food insecure, with a weighted prevalence of child food insecurity of 56.1% (95% CI 51.0%–61.3%). Primary care-givers in households in which children were severely food insecure reported experiencing times in the past year when their children skipped meals (75.8%), went hungry (90.4%) or did not eat for a whole day (60.1%). Primary caregivers in households in which children were moderately food insecure reported experiencing times in the past year when they worried food would run out (85.1%), when they fed their children less expensive food (95.1%) and when their children did not eat enough because there was no money for food (64.3%). Interpretation: We observed a high prevalence of household food insecurity, with a substantial proportion of children with severely food insecure status. Interventions are needed to ensure a healthy start in life for Inuit preschoolers.

Social Support and Thriving Health: A New Approach to Understanding the Health of Indigenous Canadians

OBJECTIVES We examined the importance of social support in promoting thriving health among indigenous Canadians, a disadvantaged population. METHODS We categorized the self-reported health status of 31625 adult indigenous Canadians as thriving (excellent, very good) or nonthriving (good, fair, poor). We measured social support with indices of positive interaction, emotional support, tangible support, and affection and intimacy. We used multivariable logistic regression analyses to estimate odds of reporting thriving health, using social support as the key independent variable, and we controlled for educational attainment and labor force status. RESULTS Compared with women reporting low levels of social support, those reporting high levels of positive interaction (odds ratio [OR]=1.4; 95% confidence interval [CI]=1.2, 1.6), emotional support (OR=2.1; 95% CI=1.8, 2.4), and tangible support (OR = 1.4; 95% CI = 1.2, 1.5) were significantly more likely to report thriving health. Among men, only emotional support was significantly related to thriving health (OR=1.7; 95% CI=1.5, 1.9). Thriving health status was also significantly mediated by age, aboriginal status (First Nations, Métis, or Inuit), educational attainment, and labor force status. CONCLUSIONS Social support is a strong determinant of thriving health, particularly among women. Research that emphasizes thriving represents a positive and necessary turn in the indigenous health discourse.

Birth characteristics of women who develop gestational diabetes : population based study

Women with gestational diabetes are at increased risk of non-insulin dependent diabetes and their babies are at increased risk of adverse perinatal outcomes.1 These risks can be reduced by better detection and control of diabetes.2 Identifying risk factors for gestational diabetes may improve screening programmes. As low birth weight has been related to non-insulin dependent diabetes in elderly populations,3 we decided to investigate whether womens characteristics at birth could predict their subsequent risk of gestational diabetes. We used linked generation data from the medical birth registry of Norway to study all women born in 1967–84 who had given birth between 1988 and 1998. The registry is a compulsory reporting system and files used for analysis are anonymised. Although there were 141 107 women in the cohort, we excluded 2393 who were not singletons. We compared the birth characteristics of women with and without self reported …

The Prevalence of Food Insecurity Is High and the Diet Quality Poor in Inuit Communities

Indigenous peoples experience a disproportionate burden of food insecurity and the Arctic is no exception. We therefore evaluated the prevalence, socio-demographic, and dietary correlates of food insecurity in the most comprehensive assessment of food insecurity in Arctic Canada. A cross-sectional survey of 1901 Inuit households was conducted in 2007-2008. Measurements included food insecurity, 24-h dietary recalls, socio-demographics, and anthropometry. Food insecurity was identified in 62.6% of households (95% CI = 60.3-64.9%) with 27.2% (95% CI = 25.1-29.3%) of households severely food insecure. The percent with an elevated BMI, waist circumference, and percent body fat was lower among individuals from food insecure households compared to food secure households (P ≤ 0.001). Adults from food insecure households had a significantly lower Healthy Eating Index score and consumed fewer vegetables and fruit, grains, and dairy products, and consumed a greater percent of energy from high-sugar foods than adults from food secure households (P ≤ 0.05). Food insecurity was associated with household crowding, income support, public housing, single adult households, and having a home in need of major repairs (P ≤ 0.05). The prevalence of having an active hunter in the home was lower in food insecure compared to food secure households (P ≤ 0.05). Food insecurity prevalence is high in Inuit communities, with implications for diet quality that over the long-term would be anticipated to exacerbate the risk of diet-related chronic diseases. Actions are required to improve food security that incorporate the traditional food system and healthy market food choices.

Food Insecurity and Nutrition Transition Combine to Affect Nutrient Intakes in Canadian Arctic Communities

Food insecurity and the nutrition transition have been noted in arctic communities. We therefore evaluated biomarkers of nutritional status and nutrient intakes by traditional food (TF) and food security status among Inuit in Canada. A cross-sectional health survey of Inuit (≥18 y) in 36 arctic communities was conducted in 2007-2008. Food security was assessed by 24-h dietary recalls using USDA questionnaires and nutrient intakes. Biomarkers included serum 25-hydroxy vitamin D [25(OH)D], hemoglobin, serum ferritin, and erythrocyte RBC fatty acids (FA). Analyses were stratified by past-day TF consumption (yes vs. no) and food security status (secure vs. insecure). Food insecurity was prevalent (62.6%) and associated with higher RBC trans-FA and lower hemoglobin levels and serum ferritin, whereas TF consumption was associated with higher serum 25(OH)D, (n-3) FA, and serum ferritin (P ≤ 0.05). In men, food insecurity was associated with lower intake of energy and energy-adjusted fiber, vitamin C, iron, zinc, and magnesium. In women, food insecurity was associated with a higher intake of carbohydrates and lower intake of fiber, dietary folate equivalent, vitamin C, iron, magnesium, calcium, and vitamin D. For both sexes, when TF was consumed, there was a higher intake of protein, protein-related micronutrients, and vitamins A and C and a lower intake of carbohydrates, saturated fat, and fiber and a lower sodium:potassium ratio (P ≤ 0.05). Nutrition transition and food insecurity are associated with a multifaceted shift in nutrient status and intakes with implications for increased risk of diet-sensitive chronic diseases.

Characteristics of noncontraceptive hormone users.

Because noncontraceptive hormone use is not randomly distributed in the population, selection factors for hormone use need to be critically examined to clarify the nature of the relationship between hormone exposure and disease endpoints. The characteristics of hormone users were examined using sociodemographic and health-related information obtained in a telephone survey of 2,137 women (ages 40-52), randomly selected from a drivers license list of Pittsburgh area women. Results showed that 6% of the women surveyed reported current noncontraceptive hormone use, and that 71% of the users had undergone hysterectomy and/or oophorectomy, hereafter called the surgical group. Among all women, hormone users were older and thinner than nonusers, and the frequency of use was two times as high among whites than among blacks. Because rates of use varied dramatically by surgical status, separate univariate and multivariate analyses were conducted for women with and without a hysterectomy/oophorectomy. Body mass index was inversely related to hormone use, and alcohol consumption was positively related to hormone use among both groups. Whites had higher rates of hormone use than blacks among women with hysterectomy/oophorectomy, and a higher level of education was positively related to hormone use among nonsurgical women. The findings show that the distribution of hormone use varies markedly in the community by surgical status, body mass index, race, education, and alcohol use.

Hypertriglyceridemic-waist phenotype and glucose intolerance among Canadian Inuit: the International Polar Year Inuit Health Survey for Adults 2007–2008

Background Inuit have not experienced an epidemic in type 2 diabetes mellitus, and it has been speculated that they may be protected from obesity’s metabolic consequences. We conducted a population-based screening for diabetes among Inuit in the Canadian Arctic and evaluated the association of visceral adiposity with diabetes. Methods A total of 36 communities participated in the International Polar Year Inuit Health Survey. Of the 2796 Inuit households approached, 1901 (68%) participated, with 2595 participants. Households were randomly selected, and adult residents were invited to participate. Assessments included anthropometry and fasting plasma lipids and glucose, and, because of survey logistics, only 32% of participants underwent a 75 g oral glucose tolerance test. We calculated weighted prevalence estimates of metabolic risk factors for all participants. Results Participants’ mean age was 43.3 years; 35% were obese, 43.8% had an at-risk waist, and 25% had an elevated triglyceride level. Diabetes was identified in 12.2% of participants aged 50 years and older and in 1.9% of those younger than 50 years. A hypertriglyceridemic-waist phenotype was a strong predictor of diabetes (odds ratio [OR] 8.6, 95% confidence interval [CI] 2.1–34.6) in analyses adjusted for age, sex, region, family history of diabetes, education and use of lipid-lowering medications. Interpretation Metabolic risk factors were prevalent among Inuit. Our results suggest that Inuit are not protected from the metabolic consequences of obesity, and that their rate of diabetes prevalence is now comparable to that observed in the general Canadian population. Assessment of waist circumference and fasting triglyceride levels could represent an efficient means for identifying Inuit at high risk for diabetes.