M. Anne George

Appraising and Funding Participatory Research in Health Promotion

Participatory action research combines research, education and social action. Each of these elements reflects health education research and practice. Indeed, health education, health promotion and participatory research have converged in these respects. Participatory research is well suited to the philosophies and theories underpinning community-based health education and health promotion. The nature of participatory research is such that funding agencies, especially those awarding research funds, tend to be challenged in their attempts to assess proposals. This is true at least for those agencies operating under traditional criteria for reviewing standards, which may not be appropriate for participatory research. As well, it may reflect a broader lack of common understanding about the processes and expectations, the apparent untidiness of projects (comparing with traditional research) which by their nature offer no standard methods, deadlines, procedures or predetermined outcome measures. The Study of Participatory Research in Health Promotion [1], commissioned by the Royal Society of Canada, *This article is based partly on a study carried out for, and partially funded by, The Royal Society of Canada. Funding was also provided by the Social Sciences and Humanities Research Council, Health Canada’s National Health Research Development Program, the Alberta Heritage Foundation for Medical Research, and the Vancouver Foundation. Int’l. Quarterly of Community Health Education, Vol. 18(2) 181-197, 1998-99

Preventing Fetal Alcohol Spectrum Disorder in Aboriginal Communities: A Methods Development Project

The authors describe their three-year project working collaboratively with Aboriginal communities to prevent fetal alcohol spectrum disorder.

Injury hospitalizations due to unintentional falls among the Aboriginal population of British Columbia, Canada: incidence, changes over time, and ecological analysis of risk markers, 1991-2010

Background Aboriginal people in British Columbia (BC) have higher injury incidence than the general population. Our project describes variability among injury categories, time periods, and geographic, demographic and socio-economic groups. This report focuses on unintentional falls. Methods We used BC’s universal health care insurance plan as a population registry, linked to hospital separation and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. We identified residents of specific Aboriginal communities by postal code. We calculated crude incidence and Standardized Relative Risk (SRR) of hospitalization for unintentional fall injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics with community SRR of injury by linear regression. Results During 1991 through 2010, the crude rate of hospitalization for unintentional fall injury in BC was 33.6 per 10,000 person-years. The Aboriginal rate was 49.9 per 10,000 and SRR was 1.89 (95% confidence interval 1.85-1.94). Among those living on reserves SRR was 2.00 (95% CI 1.93-2.07). Northern and non-urban HSDAs had higher SRRs, within both total and Aboriginal populations. In every age and gender category, the HSDA-standardized SRR was higher among the Aboriginal than among the total population. Between 1991 and 2010, crude rates and SRRs declined substantially, but proportionally more among the Aboriginal population, so the gap between the Aboriginal and total population is narrowing, particularly among females and older adults. These community characteristics were associated with higher risk: lower income, lower educational level, worse housing conditions, and more hazardous types of employment. Conclusions Over the years, as socio-economic conditions improve, risk of hospitalization due to unintentional fall injury has declined among the Aboriginal population. Women and older adults have benefited more.

The RISC research project: injury in First Nations communities in British Columbia, Canada

Background The project, Injury in British Columbias Aboriginal Communities: Building Capacity while Developing Knowledge, funded by the Canadian Institutes of Health Research (CIHR), aims to expand knowledge on injury rates among First Nations communities in British Columbia (BC), Canada. Objective The purpose is to improve understanding of community differences and to identify community-level risk and protective factors. Generally, injury incidence rates in the Aboriginal population in Canada greatly exceed those found in the non-Aboriginal population; however, variability exists between Aboriginal communities, which have important implications for prevention. Design This study uses administrative records of deaths, hospitalizations, ambulatory care episodes, and workers’ compensation claims due to injuries to identify communities that have been especially successful in maintaining low rates of injury. Results The analysis of risk and protective factors extends the work of Chandler and Lalonde who observed that community efforts to preserve and promote Aboriginal culture and to maintain local control over community life are strongly associated with lower suicide rates. Conclusion The discussion on psychological and cultural considerations on healing and reducing the rates of injury expands the work of McCormick on substance use in Aboriginal communities.

Influence of perceived racial discrimination on health and behaviour of immigrant children in British Columbia

This study examines the influence of perceived discrimination on the health and behaviour of ethnic minority immigrant children in British Columbia, Canada. Using data from the New Canadian Children and Youth Study, we examine perceived discrimination experienced by the parent, family, and cultural group in Canada to test the influence of micro-, meso-, and macrolevels of discrimination on children. Families from 6 ethnic backgrounds participated in the study. Parents’ perceptions of the child’s health and six behavioral scales (hyperactivity, prosocial behaviour, emotional problems, aggression, indirect aggression, and a general combined behaviour scale) were examined as outcome variables. After controlling for ethnicity and background variables, our findings suggest that perceived micro- and macrodiscrimination has the greatest influence on the health and behaviour of our immigrant child sample. Variation among ethnic groups provided the largest explanation of health and behavioural discrepancies in our study.

Does Living in a Neighbourhood With Others of the Same Ethnic Background Contribute to Health of Canada’s Immigrant Children?

ObjectivesTo understand how neighbourhood characteristics affect the health of immigrant children in Canadian cities. We question whether the health of children is influenced by immigrants living in enclaves of people with similar ethnic and socio-economic backgrounds.MethodsTwo datasets were used: the New Canadian Children and Youth Study (NCCYS) and Statistics Canada census data. The NCCYS comprises children from Hong Kong, the Philippines and Mainland China living in Canada’s largest cities. Logistic regression was used to examine the influence of neighbourhood ethnic concentrations and mean income on health.ResultsGirls were more likely to be reported to have excellent health compared to boys, as were children living in neighbourhoods with lower mean parental education. Children from Hong Kong were less likely to have excellent health compared to the reference group. For the Mainland Chinese group only, there was an inverse relationship between reported health status and the concentration of people from the same ethnic background in the neighbourhood.ConclusionThe health of children from different ethnic backgrounds is influenced by different social and economic factors. In practice and in research, “immigrants” and even broadly defined cultural groupings, such as “Asian immigrants”, should be considered as heterogeneous.RésuméObjectifsComprendre l’effet des caractéristiques du quartier sur la santé des enfants immigrants dans les villes canadiennes. Nous nous demandons si la santé des enfants immigrants est influencée par le fait qu’ils vivent dans des enclaves de gens aux antécédents ethniques et socioéconomiques semblables.MéthodeNous avons utilisé deux jeux de données: celles de la Nouvelle Étude canadienne sur les enfants et les jeunes (NECEJ) et celles du Recensement de Statistique Canada. La NECEJ comprend des enfants de Hong Kong, des Philippines et de la Chine continentale vivant dans les plus grandes villes du Canada. Nous avons procédé par régression logistique pour examiner les influences de la composition ethnique du quartier et du revenu moyen sur la santé.RésultatsLes filles étaient plus susceptibles d’être déclarées en excellente santé que les garçons, tout comme les enfants vivant dans des quartiers avec un niveau moyen de scolarité parentale inférieur. Les enfants ayant émigré de Hong Kong étaient moins susceptibles d’être en excellente santé que le groupe témoin. Dans le groupe de la Chine continentale seulement, nous avons observé une relation inverse entre l’état de santé déclaré et la concentration de gens de la même ethnie dans le quartier.ConclusionLa santé des enfants de différents antécédents ethniques est influencée par divers facteurs sociaux et économiques. Dans la pratique comme dans la recherche, les ªimmigrants« et même les groupes culturels au sens large, comme les ªimmigrants asiatiques«, devraient être considérés comme des groupes hétérogènes.

Risk of Hospitalization Due to Unintentional Fall Injury in British Columbia, Canada, 1999–2008: Ecological Associations with Socioeconomic Status, Geographic Place, and Aboriginal Ethnicity

BackgroundAboriginal people in British Columbia (BC), especially those residing on Indian reserves, have higher risk of unintentional fall injury than the general population. We test the hypothesis that the disparities are attributable to a combination of socioeconomic status, geographic place, and Aboriginal ethnicity.MethodsWithin each of 16 Health Service Delivery Areas in BC, we identified three population groups: total population, Aboriginal off-reserve, and Aboriginal on-reserve. We calculated age and gender-standardized relative risks (SRR) of hospitalization due to unintentional fall injury (relative to the total population of BC), during time periods 1999–2003 and 2004–2008, and we obtained custom data from the 2001 and 2006 censuses (long form), describing income, education, employment, housing, proportions of urban and rural dwellers, and prevalence of Aboriginal ethnicity. We studied association of census characteristics with SRR of fall injury, by multivariable linear regression.ResultsThe best-fitting model was an excellent fit (R2 = 0.854, p < 0.001) and predicted SRRs very close to observed values for the total, Aboriginal off-reserve, and Aboriginal on-reserve populations of BC. After stepwise regression, the following terms remained: population per room, urban residence, labor force participation, income per capita, and multiplicative interactions of Aboriginal ethnicity with population per room and labor force participation.ConclusionsThe disparities are predictable by the hypothesized risk markers. Aboriginal ethnicity is not an independent risk marker: it modifies the effects of socioeconomic factors. Closing the gap in fall injury risk between the general and Aboriginal populations is likely achievable by closing the gaps in socioeconomic conditions.

Correction: Hospitalizations due to unintentional transport injuries among Aboriginal population of British Columbia, Canada: Incidence, changes over time and ecological analysis of risk markers

Background Worldwide, Indigenous people have disproportionately higher rates of transport injuries. We examined disparities in injury-related hospitalizations resulting from transport incidents for three population groups in British Columbia (BC): total population, Aboriginal off-reserve, and Aboriginal on-reserve populations. We also examined sociodemographic, geographic and ethnic risk markers for disparities. Methods We identified Aboriginal people through BC’s universal health care insurance plan insurance premium group and birth and death record notations. We calculated crude incidence rate and Standardized Relative Risk (SRR) of hospitalization for unintentional transport injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics of Aboriginal communities with SRR of transport injury by multivariable linear regression. Results During the period 1991–2010, the SRR for the off-reserve Aboriginal population was 1.77 (95% CI: 1.71 to 1.83); and 2.00 (95% CI: 1.93 to 2.07) among those living on-reserve. Decline in crude rate and SRRs was observed over this period among both the Aboriginal and total populations of BC, but was proportionally greater among the Aboriginal population. The best-fitting multivariable risk marker model was an excellent fit (R2 = 0.912, p<0.001), predicted SRRs very close to observed values, and retained the following terms: urban residence, population per room, proportion of the population with a high school certificate, proportion of the population employed; and multiplicative interactions of Aboriginal ethnicity with population per room and proportion of the population employed. Conclusions Disparities in risk of hospitalization due to unintentional transport injury have narrowed. Aboriginal ethnicity modifies the effects of socioeconomic risk factors. Continued improvement of socioeconomic conditions and implementation of culturally relevant injury prevention interventions are needed.

Iatrogenic Injury among the Aboriginal and Total Populations of British Columbia, Canada, 1991–2010: Inequities Associated with Ethnicity and Socioeconomic Status

Abstract:Purpose. Measure population health impact, and socioeconomic, geographic, and ethnic predictors of iatrogenic injury. Methods. Within three groups (total population, Aboriginal off-reserve, and Aboriginal on-reserve) in each of 16 Health Service Delivery Areas (HSDAs) of British Columbia, Canada we calculated crude incidence and Standardized Relative Risk (SRR) of hospitalization for iatrogenic injury. We tested hypothesized associations between HSDA census characteristics and SRR, by multivariable regression. Results. Among hospitalizations due to any injury, 22.2% were iatrogenic. Crude rate of iatrogenic injury hospitalization was 20.4 per 10,000 person-years. Aboriginal rate was 24.4 per 10,000 and SRR was 1.57 (1.76 among females, 1.38 among males). Non-metropolitan HSDAs had higher SRRs. The best-fitting regression model was an excellent fit (R=0.836, p<.001) and included education, income, house needs major repairs, population per room, and Aboriginal ethnicity. Conclusions. Iatrogenic injury has significant population health impact. Aboriginal people, especially females, have higher risk. Ethnicity and socioeconomic factors explain regional disparities.

Canadian university-based study of characteristics of students with STIs.

Conclusions: This study indicates that students who have been diagnosed with STI’s take more risks than others in that they became sexually active at a younger age and in the past year have more sexual partners. They are also less likely to use condoms or birth control and engage in other health risk behaviours such as smoking. The study has implications for policy and practices in the areas of university student health services and health-education. (excerpt)