Martin Cooke

Indigenous well-being in four countries: An application of the UNDP'S Human Development Index to Indigenous Peoples in Australia, Canada, New Zealand, and the United States

BackgroundCanada, the United States, Australia, and New Zealand consistently place near the top of the United Nations Development Programmes Human Development Index (HDI) rankings, yet all have minority Indigenous populations with much poorer health and social conditions than non-Indigenous peoples. It is unclear just how the socioeconomic and health status of Indigenous peoples in these countries has changed in recent decades, and it remains generally unknown whether the overall conditions of Indigenous peoples are improving and whether the gaps between Indigenous peoples and other citizens have indeed narrowed. There is unsettling evidence that they may not have. It was the purpose of this study to determine how these gaps have narrowed or widened during the decade 1990 to 2000.MethodsCensus data and life expectancy estimates from government sources were used to adapt the Human Development Index (HDI) to examine how the broad social, economic, and health status of Indigenous populations in these countries have changed since 1990. Three indices – life expectancy, educational attainment, and income – were combined into a single HDI measure.ResultsBetween 1990 and 2000, the HDI scores of Indigenous peoples in North America and New Zealand improved at a faster rate than the general populations, closing the gap in human development. In Australia, the HDI scores of Indigenous peoples decreased while the general populations improved, widening the gap in human development. While these countries are considered to have high human development according to the UNDP, the Indigenous populations that reside within them have only medium levels of human development.ConclusionThe inconsistent progress in the health and well-being of Indigenous populations over time, and relative to non-Indigenous populations, points to the need for further efforts to improve the social, economic, and physical health of Indigenous peoples.

Public Policy and Aboriginal Peoples in Canada: Taking a Life-Course Perspective

L’état de santé et les conditions sociales des Premières nations, des Inuits et des Métis au Canada reste une question de politiques sociales préoccupante. Certains chercheurs ont proposé l’approche des parcours de vie comme cadre d’analyse pour la conception de politiques qui favoriseraient l’inclusion sociale des peuples autochtones. Dans cet article, tout en expliquant que nous sommes d’accord avec cette démarche, nous soutenons que le cadre d’analyse doit aussi prendre en compte la situation particulière des peuples autochtones en matière de politiques sociales. Nous illustrons notre propos en donnant quelques exemples que nous avons élaborés à partir des données de l’Enquête auprès des peuples autochtones de 2001.

Predictors of Obesity Among Métis Children: Socio-economic, Behavioural and Cultural Factors

OBJECTIVES: To examine the socio-economic, behavioural and Métis-specific factors that predict obesity among Métis children aged 6 to 14 years. Socio-economic factors included household structure and income, parental education and food insecurity. Cultural factors included knowledge of an Aboriginal language, participation in cultural activities, time spent with Elders and parental residential school attendance.METHODS: The 2006 Aboriginal Peoples Survey, Children and Youth component collected data about Métis children, including child height and weight, reported by the person most knowledgeable about the child (PMK). Multivariate binary logistic regression was used to predict obesity, defined using IOTF BMI cut-offs. After testing for interactions, models were stratified by age (6-10, 11-14) and gender.RESULTS: An estimated 18.5% of Métis boys and 14.4% of girls were obese. The effects of socio-economic factors and region varied across age and gender groups, although living in a lone-parent family and rural residence had consistent effects. Many effects of cultural variables were unexpected. Although PMK residential schooling was positively associated with obesity generally, the effects were negative among older girls. As expected, children participating in frequent physical activity generally had lower risk, independent of other factors.CONCLUSIONS: Although socio-economic factors are related to risk of obesity among Métis children, the effects may not be the same across age groups and for boys and girls. There is some evidence of independent effects of Métis-specific cultural factors, including parental residential schooling, on the risk of child obesity, but further investigation and better data are needed to understand these relationships.RésuméOBJECTIFS: Examiner les facteurs socioéconomiques, comportementaux et culturels prédisant l’obésité chez les enfants métis de 6 à 14 ans. Les facteurs socioéconomiques étaient la structure et le revenu des ménages, l’instruction parentale et l’insécurité alimentaire. Les facteurs culturels étaient la connaissance d’une langue autochtone, la participation à des activités culturelles, le temps passé avec les Aînés et la fréquentation parentale des pensionnats.MÉTHODE: Le volet sur les enfants et les jeunes de l’Enquête auprès des peuples autochtones (2006) présente des données sur les enfants métis, y compris leur taille et leur poids, déclarées par la personne connaissant le mieux l’enfant (PCME). Par régression logistique binaire multivariée, nous avons prédit l’obésité (définie selon les points-limites d’IMC de l’IOTF) chez ces enfants. Après évaluation des interactions, les modèles ont été stratifiés par âge (6-10 ans, 11-14 ans) et par sexe.RÉSULTATS: Environ 18,5 % des garçons métis et 14,4 % des filles étaient obèses. Les effets des facteurs socioéconomiques et régionaux variaient selon les groupes d’âge et de sexe, mais vivre dans une famille monoparentale et résider en milieu rural produisaient des effets uniformes. De nombreux effets des variables culturelles étaient inattendus. Bien que la fréquentation d’un pensionnat par la PCME soit associée positivement à l’obésité en général, son effet était négatif chez les filles de 11 à 14 ans. Comme prévu, les enfants s’adonnant fréquemment à l’activité physique avaient un risque d’obésité inférieur dans l’ensemble, indépendamment des autres facteurs.CONCLUSIONS: Bien que les facteurs socioéconomiques soient liés au risque d’obésité chez les enfants métis, leurs effets peuvent ne pas être les mêmes dans tous les groupes d’âge ou entre les garçons et les filles. Il semble que les facteurs culturels propres aux Métis, dont la fréquentation parentale des pensionnats, exercent des effets indépendants sur le risque d’obésité chez les enfants, mais il faudrait pousser la recherche et obtenir de meilleures données pour comprendre ces liens.

The correlates of current smoking among adult Métis: Evidence from the Aboriginal Peoples Survey and Métis Supplement

ObjectiveTo examine the correlates of current smoking among Métis aged 18 years and older, with a particular focus on culturally-specific factors. Cultural factors included spirituality, knowledge of an Aboriginal language, membership in a Métis organization and attendance at Métis cultural events. Demographic, geographic, socio-economic and health-related variables were also considered.MethodsData from 6,610 adult Métis aged 18 years and older who responded to the 2006 Aboriginal Peoples Survey and Métis supplement were used to examine the correlates of current smoking using sequential binary logistic regression modelling.ResultsOverall, 39.9% of adult Métis respondents in the sample were current smokers. Adult Métis who reported a high level of spirituality were less likely to be current smokers. Those who spoke an Aboriginal language, or lived in a house where an Aboriginal language was spoken, were more likely to be current smokers. Being a member of a Métis organization and attending cultural events were not independently associated with current smoking. Métis with higher household income, greater education, higher self-perceived health, and greater physical activity participation were less likely to be current smokers, whereas those who reported heavy alcohol consumption were more likely to be current smokers.ConclusionsThe results of this study suggest that interventions aimed at reducing smoking among adult Métis might be more successful if they include some connection to spirituality. It is also evident that co-occurring risk behaviours, in addition to demographic and socio-economic factors, are important considerations when developing interventions to reduce smoking among this population.RésuméObjectifExaminer les corrélats du tabagisme actuel chez les Métis de 18 ans et plus, en accordant une attention particulière aux facteurs propres à la culture. Les facteurs culturels étaient la spiritualité, la connaissance d’une langue autochtone, l’appartenance à une organisation métisse et la participation à des activités culturelles métisses. Des variables démographiques, géographiques, socioéconomiques et sanitaires ont aussi été prises en compte.MéthodeLes données des 6 610 Métis adultes de 18 ans et plus ayant répondu à l’Enquête auprès des peuples autochtones de 2006 et au Supplément destiné aux Métis ont servi à examiner les corrélats du tabagisme actuel selon un modèle de régression logistique binaire séquentielle.RésultatsGlobalement, 39,9 % des répondants métis adultes de l’échantillon étaient des fumeurs actuels. Les Métis adultes ayant déclaré un haut niveau de spiritualité étaient moins susceptibles d’être des fumeurs actuels. Ceux qui parlaient une langue autochtone ou qui vivaient dans une maison où l’on parlait une langue autochtone étaient plus susceptibles d’être des fumeurs actuels. L’appartenance à une organisation métisse et la participation à des manifestations culturelles n’étaient pas indépendamment associées au tabagisme actuel. Les Métis dont le revenu du ménage, le niveau de scolarité, la santé autoperçue et le niveau d’activité physique étaient plus élevés étaient moins susceptibles d’être des fumeurs actuels, tandis que ceux ayant déclaré une forte consommation d’alcool étaient plus susceptibles d’être des fumeurs actuels.ConclusionsLes interventions visant à réduire le tabagisme chez les Métis adultes pourraient être plus fructueuses si elles incluaient un lien avec la spiritualité. On voit aussi que les comportements à risque concomitants, en plus des facteurs démographiques et socioéconomiques, sont d’importants facteurs à prendre en compte lorsqu’on élabore des interventions pour réduire le tabagisme dans cette population.

Healthy Weights Interventions in Aboriginal Children and Youth: A Review of the Literature.

There is evidence that Aboriginal children and youth in Canada and elsewhere are at higher risk of obesity and overweight than other children. However, there has been no review of healthy weights interventions specifically aimed at Aboriginal children. A structured search for peer-reviewed articles presenting and evaluating healthy weights interventions for Aboriginal children and youth was conducted. Seventeen articles, representing seven interventions, were reviewed to identify their main characteristics, evaluation design, and evaluation outcomes. Interventions included several large community-based programs as well as several more focused programs that all targeted First Nations or American Indians, rather than Metis or Inuit. Only 1 program served an urban Aboriginal population. None of the published evaluations reported significant reductions in obesity or overweight or sustained increases in physical activity, although some evaluations presented evidence of positive effects on childrens diets or o...There is evidence that Aboriginal children and youth in Canada and elsewhere are at higher risk of obesity and overweight than other children. However, there has been no review of healthy weights interventions specifically aimed at Aboriginal children. A structured search for peer-reviewed articles presenting and evaluating healthy weights interventions for Aboriginal children and youth was conducted. Seventeen articles, representing seven interventions, were reviewed to identify their main characteristics, evaluation design, and evaluation outcomes. Interventions included several large community-based programs as well as several more focused programs that all targeted First Nations or American Indians, rather than Metis or Inuit. Only 1 program served an urban Aboriginal population. None of the published evaluations reported significant reductions in obesity or overweight or sustained increases in physical activity, although some evaluations presented evidence of positive effects on childrens diets or o...There is evidence that Aboriginal children and youth in Canada and elsewhere are at higher risk of obesity and overweight than other children. However, there has been no review of healthy weights interventions specifically aimed at Aboriginal children. A structured search for peer-reviewed articles presenting and evaluating healthy weights interventions for Aboriginal children and youth was conducted. Seventeen articles, representing seven interventions, were reviewed to identify their main characteristics, evaluation design, and evaluation outcomes. Interventions included several large community-based programs as well as several more focused programs that all targeted First Nations or American Indians, rather than Métis or Inuit. Only 1 program served an urban Aboriginal population. None of the published evaluations reported significant reductions in obesity or overweight or sustained increases in physical activity, although some evaluations presented evidence of positive effects on childrens diets or on nutrition knowledge or intentions. We conclude that broader structural factors affecting the health of Aboriginal children may limit the effectiveness of these interventions, and that more evidence is required regarding interventions for Aboriginal children in various geographic and cultural contexts in Canada including Inuit and Métis communities.

Clustering of risk-related modifiable behaviours and their association with overweight and obesity among a large sample of youth in the COMPASS study

BackgroundCanadian youth exhibit a number of risky behaviours, some of which are associated with overweight and obesity. The purpose of this study was to examine the prevalence of 15 modifiable risk behaviours in a large sample of Canadian youth, to identify underlying subgroups based on patterns of health behaviours, and to examine the association between identified subgroups and overweight/obesity.MethodsData from 18,587 grades 9–12 students in Year 1 (2012–13) of the COMPASS study and latent class analysis were used to identify patterns and clustering among 15 health behaviours (e.g., physical inactivity, sedentary behaviour, unhealthy eating, substance use). A logistic regression model examined the associations between these clusters and overweight/obesity status.ResultsFour distinct classes were identified: traditional school athletes, inactive screenagers, health conscious, and moderately active substance users. Each behavioural cluster demonstrated a distinct pattern of behaviours, some with a greater number of risk factors than others. Traditional school athletes (odds ratio (OR) 1.15, 95% CI 1.03–1.29), inactive screenagers (OR 1.33; 1.19–1.48), and moderately active substance users (OR 1.27; 1.14–1.43) were all significantly more likely to be overweight/obese compared to the health conscious group.ConclusionsFour distinct subpopulations of youth were identified based on their patterns of health and risk behaviours. The three clusters demonstrating poorer health behaviour were all at an increased risk of being overweight/obese compared to their somewhat healthier peers. Obesity-related public health interventions and health promotion efforts might be more effective if consideration is given to population segments with certain behavioural patterns, targeting subgroups at greatest risk of overweight or obesity.

Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review

BackgroundThe history of residential schools has been identified as having long lasting and intergenerational effects on the physical and mental well-being of Indigenous populations in Canada. Our objective was to identify the extent and range of research on residential school attendance on specific health outcomes and the populations affected.MethodsA scoping review of the empirical peer-reviewed literature was conducted, following the methodological framework of Arksey and O’Malley (2005). For this review, nine databases were used: Bibliography of Native North Americans, Canadian Health Research Collection, CINAHL, Google Scholar, Indigenous Studies Portal, PubMed, Scopus, Statistics Canada, and Web of Science. Citations that did not focus on health and residential school among a Canadian Indigenous population were excluded. Papers were coded using the following categories: Indigenous identity group, geography, age-sex, residential school attendance, and health status.ResultsSixty-one articles were selected for inclusion in the review. Most focused on the impacts of residential schooling among First Nations, but some included Métis and Inuit. Physical health outcomes linked to residential schooling included poorer general and self-rated health, increased rates of chronic and infectious diseases. Effects on mental and emotional well-being included mental distress, depression, addictive behaviours and substance mis-use, stress, and suicidal behaviours.ConclusionThe empirical literature can be seen as further documenting the negative health effects of residential schooling, both among former residential school attendees and subsequent generations. Future empirical research should focus on developing a clearer understanding of the aetiology of these effects, and particularly on identifying the characteristics that lead people and communities to be resilient to them.

Community perspectives on food insecurity and obesity: Focus groups with caregivers of metis and Off-reserve first nations children.

IntroductionAboriginal children in Canada are at a higher risk for overweight and obesity than other Canadian children. In Northern and remote areas, this has been linked to a lack of affordable nutritious food. However, the majority of Aboriginal children live in urban areas where food choices are more plentiful. This study aimed to explore the experiences of food insecurity among Métis and First Nations parents living in urban areas, including the predictors and perceived connections between food insecurity and obesity among Aboriginal children.MethodsFactors influencing children’s diets, families’ experiences with food insecurity, and coping strategies were explored using focus group discussions with 32 parents and caregivers of Métis and off-reserve First Nations children from Midland-Penetanguishene and London, Ontario. Four focus groups were conducted and transcribed verbatim between July 2011 and March 2013. A thematic analysis was conducted using NVivo software, and second coders ensured reliability of the results.ResultsCaregivers identified low income as an underlying cause of food insecurity within their communities and as contributing to poor nutrition among their children. Families reported a reliance on energy-dense, nutrient-poor foods, as these tended to be more affordable and lasted longer than more nutritious, fresh food options. A lack of transportation also compromised families’ ability to purchase healthful food. Aboriginal caregivers also mentioned a lack of access to traditional foods. Coping strategies such as food banks and community programming were not always seen as effective. In fact, some were reported as potentially exacerbating the problem of overweight and obesity among First Nations and Métis children.ConclusionFood insecurity manifested itself in different ways, and coping strategies were often insufficient for addressing the lack of fruit and vegetable consumption in Aboriginal children’s diets. Results suggest that obesity prevention strategies should take a family-targeted approach that considers the unique barriers facing urban Aboriginal populations. This study also reinforces the importance of low income as an important risk factor for obesity among Aboriginal peoples.

Factors associated with heavy drinking among off-reserve First Nations and Métis youth and adults: Evidence from the 2012 Canadian Aboriginal Peoples Survey.

Objective . Aboriginal people in Canada are at higher risk to heavy alcohol consumption than are other Canadians. The objective of this study was to examine a set of culturally specific correlates of heavy drinking among First Nations and Métis youth and adults. Methods . Demographic, geographic, socioeconomic and health-related variables were also considered. Data were used from Statistics Canadas 2012 Aboriginal Peoples Survey to predict heavy drinking among 14,410 First Nations and Métis 15years of age and older. Separate sets of binary sequential logistic regression models were estimated for youth and adults. Results . Among youth, those who had hunted, fished or trapped within the last year were more likely to be heavy drinkers. In addition, current smokers and those who most frequently participated in sports were at higher odds of heavy alcohol consumption. Among adults, respondents who had hunted, fished or trapped within the last year were more likely to drink heavily. On the other hand, those who had made traditional arts or crafts within the last year were less likely to drink heavily. Conclusions . Men, younger adults, smokers, those who were unmarried, those who had higher household incomes, and those who had higher ratings of self-perceived health were more likely to be heavy drinkers. Efforts aimed at reducing the prevalence of heavy drinking among this population may benefit from considering culturally specific factors, in addition to demographic variables and co-occurring health-risk behaviors.

Effect of religious involvement on cognition from a life-course perspective: protocol for a systematic review and meta-analysis

Introduction Preserving cognitive health is a crucial aspect of healthy ageing. Both abnormal and normal cognitive decline can adversely affect the health of ageing populations. Evidence suggests religious involvement (RI) can preserve cognition in ageing populations. The primary purpose of this review is to examine the evidence regarding the association between RI and cognition from a life-course perspective. Methods and analysis This systematic review and meta-analysis has been registered with PROSPERO (registration number CRD42016032331). We will search MEDLINE, PSYCHINFO and EMBASE, and include primary studies with a comparison group, for example, cohort, cross-sectional and case–control studies. To supplement the database search, we will also search the grey literature and the reference lists of included studies. Two reviewers will independently assess and extract data from the articles. Risk of bias and the strength of evidence will be assessed. For sufficiently homogeneous data in domains such as study methods and measures of RI and cognition, we will pool the results using DerSimonian and Laird meta-analysis. Ethics and dissemination Since this is a protocol for a systematic review, ethics approval is not required. The findings of this review will be extensively disseminated through peer-reviewed publications and conference presentations.