Nicholas Spence

Racial Discrimination, Cultural Resilience, and Stress

Objective: Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome). Methods: Data were collected from October 2012 to February 2013 (N = 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression. Results: The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R2 = 0.21 and adjusted R2 = 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively. Conclusions: In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.

Modeling Educational Success of First Nations Students in Canada: Community Level Perspectives

Canadian assessments of First Nation and Aboriginal education lack any real modelling of reasons for the particular patterns of attainment — it is this void that we wish to fill. This paper examines educational attainment in First Nations communities using combined data from the 1996 Census and Department of Indian Affairs and Northern Development Education Survey for the school year 1995/1996, aggregated to the band level, for registered and non-registered Indian and Inuit students who live on reserve in Canada. Multiple sequential regression analysis is used to model the educational success of grade 12 and 13 students with community level characteristics, including an isolation variable, school type variable, demographic variables, economic variables, and human capital variables. We use three measures of educational success: the age appropriate rate, graduate rate, and withdrawal rate. It is shown that the community level variables are similar in their explanatory power of educational success; however, the effects of variables within blocks on measures of educational success differ. The demography and human capital blocks play a particularly important role for all three measures of educational success. Additional analysis includes an examination of standardized regression weights. The paper discusses research and policy implications and articulates future avenues for research.

Back to the future – a case for home visits for managing severe paediatric obesity

1.Department of Pediatrics, University of Alberta, Edmonton, AB, Canada 2.Department of Pediatrics, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada 3.SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada 4.Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada 5.Stollery Children’s Hospital, Alberta Health Services, Edmonton, AB, Canada

Putting eggs and cigarettes in the same basket; are you yolking?

Dr. Spence and colleagues (2012) completed a retrospective cohort study, using patient questionnaire and total plaque area (TPA) data from a vascular disease prevention database [1]. They aimed to address whether egg yolk intake relates to vascular damage. There was no stated hypothesis. It was determined that “the effect of the upper quintile of egg consumptionwas equivalent in terms of atheroma development to 2/3 the effect of the upper quintile of smoking”.

Potential Cardioprotective Effects of Sumac Capsule in Patients With Hyperlipidemia: A Triple-Blind Randomized, Placebo-Controlled Crossover Trial

ABSTRACT Objective: Alternative medicine and herbal drugs have been taken into account for managing cardiovascular risk factors. Sumac (Rhus coriaria L.) is rich in biologically active ingredients known to improve cardiovascular health. We investigated the effect of sumac on systolic (SBP) and diastolic (DBP) blood pressure, flow-mediated dilation (FMD), body mass index (BMI), and serum concentrations of lipids and fasting blood sugar (FBS) in participants with hyperlipidemia in a triple-blind randomized placebo- controlled crossover trial. Methods: Thirty adults with dyslipidemia (mild to moderate elevation of plasma total cholesterol and/or triglycerides [TG; total cholesterol ≥ 6.0 mmol/L or TG ≥ 1.7 mmol/L and TG ≤ 5.0 mmol/L]) were assigned randomly to a sumac or a placebo group. Participants in the sumac group received sumac capsules (500 mg/twice daily) for the first 4 weeks, followed by 2 weeks’ washout period; the patients were then switched to a 4-week interval and received placebo for 4 weeks in the second period. The placebo group received these treatments in reverse order. FMD, BMI, SBP, DBP, lipids, and FBS were measured at baseline and after each period. Results: Differences between placebo group and sumac group (placebo-sumac) were significantly decreased for BMI (0.21 ± 0.075 kg/m2), SBP (1.87 ± 0.83 mm Hg), DBP (1.32 ± 0.46 mm Hg), and total cholesterol (14.42 ± 4.95 mmol/L) and significantly increased for FMD (−0.23% ± 0.065%). Plasma level of TG did not change significantly across the treatment. Conclusion: Sumac consumption may decrease cardiovascular risk factors in persons with mild to moderate hyperlipidemia.

Does Social Context Matter? Income Inequality, Racialized Identity, and Health Among Canada’s Aboriginal Peoples Using a Multilevel Approach

ObjectivesDebates surrounding the importance of social context versus individual level processes have a long history in public health. Aboriginal peoples in Canada are very diverse, and the reserve communities in which they reside are complex mixes of various cultural and socioeconomic circumstances. The social forces of these communities are believed to affect health, in addition to individual level determinants, but no large scale work has ever probed their relative effects. One aspect of social context, relative deprivation, as indicated by income inequality, has greatly influenced the social determinants of health landscape. An investigation of relative deprivation in Canada’s Aboriginal population has never been conducted. This paper proposes a new model of Aboriginal health, using a multidisciplinary theoretical approach that is multilevel.MethodsThis study explored the self-rated health of respondents using two levels of determinants, contextual and individual. Data were from the 2001 Aboriginal Peoples Survey. There were 18,890 Registered First Nations (subgroup of Aboriginal peoples) on reserve nested within 134 communities. The model was assessed using a hierarchical generalized linear model.ResultsThere was no significant variation at the contextual level. Subsequently, a sequential logistic regression analysis was run. With the sole exception culture, demographics, lifestyle factors, formal health services, and social support were significant in explaining self-rated health.ConclusionsThe non-significant effect of social context, and by extension relative deprivation, as indicated by income inequality, is noteworthy, and the primary role of individual level processes, including the material conditions, social support, and lifestyle behaviors, on health outcomes is illustrated. It is proposed that social structure is best conceptualized as a dynamic determinant of health inequality and more multilevel theoretical models of Aboriginal health should be developed and tested.

Why Do Some First Nations Communities Have Safe Water and Others Not? Socioeconomic Determinants of Drinking Water Risk

Securing safe and adequate drinking water is an ongoing issue for many Canadian First Nations communities despite nearly 15 years of reports, studies, policy changes, financial commitments, and regulations. The federal drinking water evaluation scheme is narrowly scoped, ignoring community level social factors, which may play a role in access to safe water in First Nations. This research used the 2006 Aboriginal Affairs and Northern Development Canada First Nations Drinking Water System Risk Survey data and the Community Well-Being Index, including labour force, education, housing, and income, from the 2006 Census. Bivariate analysis was conducted using the Spearman’s correlation, Kendall’s tau correlation, and Pearson’s correlation. Multivariable analysis was conducted using an ordinal (proportional or cumulative odds) regression model. Results showed that the regression model was significant. Community socioeconomic indicators had no relationship with drinking water risk characterization in both the bivariate and multivariable models, with the sole exception of labour force, which had a significantly positive effect on drinking water risk rankings. Socioeconomic factors were not important in explaining access to safe drinking water in First Nations communities. Improvements in the quality of safe water data as well as an examination of other community processes are required to address this pressing policy issue.

The engagement pathway: A conceptual framework of engagement-related terms in weight management

Engagement denotes the extent to which, and how, individuals participate in weight management (WM) services. Effective WM services should generate meaningful outcomes and promote high participant engagement; however, research is predominantly focused on the former. Given that engagement is a poorly understood phenomenon, and that engagement-related concepts are often used synonymously (e.g., dropout and attrition), the engagement pathway is hereby introduced. This pathway defines key concepts (e.g., recruitment, adherence, attrition) and their relationships in the enrolment, intervention, and maintenance stages of treatment. The pathway will help researchers and practitioners better understand engagement-related concepts whilst encouraging greater conceptual consistency between studies.

Families’ perceived benefits of home visits for managing paediatric obesity outweigh the potential costs and barriers

Home visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management? Low treatment initiation and high attrition prompted our multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits.

Letter to the Editor: "Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline"

We read with interest the recently published clinical practice guidelines for preventing and treating childhood obesity (1). The authors reported their evaluation of the quality of the evidence and an assessment of the strength of recommendations according to objective criteria across a diverse literature. In our view, however, this excellent and comprehensive report does not mention two relevant issues: attrition and enrollment. These issues are likely to be of concern for clinicians, administrators, and researchers because they can have a substantial impact on clinical care.