Indigenous Health Research Monitoring, January 2024

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Article Summaries: Subject Areas

Lifestyles and health behaviours

Examining attitudes toward a proposed sugar-sweetened beverage tax among urban Indigenous adults: A qualitative study using a decolonizing lens

Kisselgoff, M., Champagne, M. R., Dubois, R., Turnbull, L., LaPlante, J., Schultz, A., Bombak, A., and Riediger, N. (2023). Examining attitudes toward a proposed sugar-sweetened beverage tax among urban Indigenous adults: A qualitative study using a decolonizing lens. Canadian Medical Association Open Access Journal, 11(5), E922–E931.


Indigenous people in Canada living off-reserve consume sugar-sweetened beverages more often and in greater quantities than other racialized groups. Moreover, they are disproportionately affected by food insecurity and poverty, two factors associated with the consumption of sugar-sweetened beverages. Taxing sugar-sweetened beverages is a public health measure aimed at reducing consumption as part of a broader series of actions. To be effective, however, this strategy must first be embraced by the target population.


Explore the acceptability and perceived effects of a tax on sugar-sweetened beverages among Indigenous adults living in the North End neighbourhood of Winnipeg, Manitoba.


This community-based participatory research was conducted in partnership with two Indigenous organizations working to prevent diabetes and support families. The organizations specifically collaborated in formulating the research question, interpreting the data and sharing the knowledge learned. Given that many health organizations view taxing sugar‑sweetened beverages as a promising measure, they were hoping to develop a fuller understanding of this strategy.

Drawing on Indigenous perspectives, the research team conducted semi-structured interviews in person or by telephone of 20 Indigenous adults between November 2019 and August 2020. The interviews were then transcribed and analyzed to reflect power structures. Participants in the sample included 10 women, 8 men and 2 two-spirit individuals between the ages of 20 and 65. A majority of the participants drank sugar-sweetened beverages or experienced food insecurity.

What was learned?

In general, the participants expressed limited acceptance of the measure and doubted that it would have positive effects. Three interconnected themes emerged from the interviews.

  • The government is not trustworthy: Some participants were concerned that taxing sugar‑sweetened beverages was simply a way to generate a new revenue stream in the guise of a health initiative. A lack of transparency about the use of tax revenues was mentioned. The Indigenous participants used rather pejorative terms to describe public decision makers, ranging from privileged and elitist to condescending and paternalistic.
  • Taxes are ineffective and lead to inequitable outcomes: According to the participants, this type of measure does not take into consideration needs and determinants specific to the Indigenous population, including, for example, poverty and food insecurity. Some participants pointed out that drinking sugar-sweetened beverages is a form of harm reduction that some people transition to when they stop using substances. There was also concern that a tax on sugar-sweetened beverages could transform their only socially acceptable vice into an unaffordable taboo. Moreover, participants felt that such a tax would affect Indigenous people disproportionately, especially low-income individuals. Some said that they would not necessarily reduce consumption, which would leave less money for other purchases.
  • Indigenous self-determination is critical: The negative perceptions of participants opposed to taxation changed when questioned about how the revenue generated could be redistributed. They expressed greater support for sugar-sweetened beverage taxation when they were able to earmark initiatives that are important to themselves and their peers.


The authors point out the impossibility of generalizing the results to all Indigenous people living in an urban setting. In addition, health restrictions associated with the pandemic limited in-person relationship building and discouraged the engagement of participants, both of which are critical in community-based participatory research.

The impact of cultural identity, parental communication, and peer influence on substance use among Indigenous youth in Canada

Reynolds, A., Keough, M. T., Blacklock, A., Tootoosis, C., Whelan, J., Bomfim, E., Mushquash, C., Wendt, D. C., O’Connor, R. M., and Burack, J. A. (2023). The impact of cultural identity, parental communication, and peer influence on substance use among Indigenous youth in Canada. Transcultural Psychiatry.


Heavy drinking and smoking are among the leading causes of morbidity and mortality within Indigenous youth in North America. In 2019, Indigenous youth in Canada were more likely to report regular alcohol and cigarette use during the previous year compared with their non‑Indigenous peers. Adolescents spend a significant amount of time with their peers, hence the potential protective role of the peer group with respect to substance abuse. This study continues the work of Chandler and Lalonde showing that community engagement and cultural identity can contribute to the wellbeing of Indigenous youth.


Examine the role of cultural identity, parent–child communication and perception of peers’ opinions on heavy drinking and cigarette smoking among Indigenous youth in Québec.


Students (n = 157) from two schools located in northern Québec Indigenous communities were recruited for a research program addressing several themes, including cultural identity and academic success. A total of 117 students (52% boys and an average age of 14.07) completed a questionnaire on a voluntary basis with the approval of their parents.

Statistical analyses were conducted to determine the effects of three variables on the use of alcohol and cigarettes:

  • Identification with Indigenous culture
  • Parent–child communication about the harms of substance use
  • Peers' perception of alcohol and tobacco consumption and their attitude towards it.

What was learned? 

Participants with a strong cultural identity are less inclined to drink and smoke heavily. Negative beliefs about alcohol and tobacco use played a role in reducing those risky behaviours. Parental communication appears to have little influence over patterns of use, serving as a reminder of the important influence peers have on substance use attitudes and behaviour.

Specifically, concerning alcohol and tobacco use among respondents:

  • A strong identification with Indigenous culture is associated with negative perceptions of alcohol and tobacco.
  • Negative perceptions of alcohol and tobacco are, in turn, associated with a lower probability of having used alcohol to the point of intoxication or smoked tobacco within the past year.
  • A positive perception among peers of alcohol and tobacco use is associated with positive personal perceptions of drinking and smoking.

Strengthening cultural identity, building relationships with peers who are not users and reinforcing negative perceptions of drinking and smoking offer avenues for prevention initiatives among Indigenous youth.


The authors note that only young people attending school were recruited. Data from the two communities was combined and therefore does not represent the specific situation of either community. The evaluation of young people’s perceptions about what it means to identify with their culture and of the different facets of cultural identity was limited. The use of Indigenous measurement tools and the collection of qualitative data could open the way to study the subject in greater depth. Only communication directly between young people and their parents was studied, thereby excluding relations with the extended family. Finally, the cross-sectional design did not make it possible to observe the evolution of variables over time.

Social inequalities and determinants of health

Amplifying older Aboriginal and Torres Strait Islander women’s perspectives to promote digital health equity: Co‑designed qualitative study

Henson, C., Chapman, F., Shepherd, G., Carlson, B., Rambaldini, B., and Gwynne, K. (2023). Amplifying older Aboriginal and Torres Strait Islander women’s perspectives to promote digital health equity: Co-designed qualitative study. Journal of Medical Internet Research, 25, e50584.


Digital health technologies are revolutionizing the way healthcare is delivered, especially when it comes to access. The benefits of those technologies may be distributed inequitably across the population, particularly for those experiencing the greatest barriers to access. However, research into digital health up to this point has excluded the needs and preferences of older Aboriginal and Torres Strait Islander women. Not only could those women benefit from advances in health technologies, they are also authority figures who share knowledge with and provide support for their family and community.


  • Determine how older Aboriginal and Torres Strait Islander women use digital technologies to improve their health.
  • Highlight case studies on the use of digital technologies by those women to improve their health.
  • Develop a culturally relevant working model to guide the development of digital health technologies that meet the needs of that population.


The project was codesigned in keeping with Aboriginal governance principles. An Aboriginal Project Governance (APG) group was set up to strengthen and amplify Aboriginal and Torres Strait Islander perspectives, as well as to integrate citizen scientists, who were primarily older women from various communities who supervised and participated in the study.

Aboriginal women who use digital technologies as a means of communication were recruited from four virtual communities using the snowball sampling method until data saturation was achieved. Data was gathered through yarning circle meetings held on Zoom. Discussions were led jointly by an Aboriginal member of the group and the non-Aboriginal lead researcher. Sessions were transcribed and then analyzed over iterative discussion cycles involving members of the Aboriginal Project Governance group and researchers. A total of 24 older Aboriginal and Torres Strait Islander women participated. In this context, “older” refers to women over the age of 41 who grew up without Internet access.

What was learned? 

Four findings emerged:

  • These older women use a variety of digital technologies to improve their own health and wellbeing, as well as that of their families and communities (search engines, social media and wearable devices such as connected watches).
  • The use of digital health technologies by older women is constrained by various obstacles, such as access barriers, which may be financial or associated with technological issues in serving remote areas Access barriers may also emerge from lateral violence encountered on social media.
  • Older women expect and need cultural sensitivity, relevance and efficiency in digital health technologies. They want safe resources adapted to their needs, for example, confidential tools that incorporate traditional and Western healing, and tools that provide information about women’s health.
  • Older women have unique strengths. The case studies presented attest to the agency of women to mobilize in order to influence the wellbeing of their peers and their community, for example, during a social media campaign to mobilize citizens against a nuclear waste dump.

The Djurali model for digital health equity, developed in the context of this study, may prove useful to digital developers committed to integrating underrepresented groups, including older Aboriginal women. The model comprises five components: safety, accessibility, relevant content, practicality and cultural sensitivity.


Only technologically competent women with access to Zoom participated, which resulted in a sample group that is not representative of older women as a whole. That said, the principle of equity holds that we listen to all women, even those who are more comfortable with technology.

Promotion of wellbeing and mental health

Mental health and educational attainment: Learning from Indigenous youth who are homeless

Mirza, S. (2023). Mental health and educational attainment: Learning from Indigenous youth who are homeless. International Journal of Indigenous Health, 18(2).


In 2016, 20% of Canada’s homeless population of 235,000 were young people. In a study of more than 1,100 homeless young people, about one third self-identified as Indigenous. Despite those statistics, the situation of homeless Indigenous youth and the consequences on their health and education have received little attention from researchers.


Explore the experiences and perspectives of homeless Indigenous youth in Toronto’s York Region with respect to physical and mental health, as well as education.


This research project was approved by the York University Ethics Committee and by the participating shelters. The author conducted 11 interviews with Indigenous youth between the ages of 13 and 29, some of whom lived at the shelters. Others were homeless at the time the research was carried out.

The thematic analysis employed the concept of social exclusion to understand the many barriers to health and wellbeing faced by homeless Indigenous youth.

What was learned?

All of the Indigenous youth in this study reported facing complex health challenges that fall into three categories.

  • Deprivation, health and school: Their decline in overall health can be explained by difficulty in finding a place to sleep, as well as by food deprivation and a lack of sleep. The efforts required to meet those basic needs are a barrier to good health and pursuing an education, and even exacerbate existing health issues, as explained by a 23-year-old participant who deals with chronic neural disorders and leg pain following an accident—all of which makes it difficult to find a way out of homelessness.
  • Mental health, anxiety, depression and school: A majority of participants reported experiencing anxiety and depression, conditions that are likely to be aggravated by racism, discrimination and stigma. Those health issues are associated with neglect during childhood, family problems and intergenerational trauma.

The isolation and social exclusion experienced by these young people are associated with a higher probability of suicidal ideation. Despite the participants’ strong desire to study and work, the different factors identified result in a lack of resources and the support required to face their health problems. This phenomenon has repercussions not only on their work and education but also on their long-term stability.

  • Health adversities, resilience and school: All the participants face health challenges related to homelessness. One 26-year-old described difficulty in obtaining medications due to being trapped in a constant cycle between being housed and homeless. Homelessness forced him to drop out of school early. Several participants feel that their motivation and skills have been wasted. Despite their resilience, these young people do not receive the support needed to pursue their studies. They feel misunderstood by teachers, administrative services and their peers to the extent that their specific health and education needs are not taken into consideration. In point of fact, most services for homeless youth are designed to meet basic needs and have only limited resources and capacities to promote academic success and encourage overall wellbeing.

For Indigenous youth, becoming homeless is a complex and traumatizing experience that is interconnected with the history of colonization and its ongoing consequences. Health problems resulting from traumatic family experiences are amplified by homelessness. A lack of food and housing prevents young people from pursuing an education, which inevitably leads to other vulnerabilities.


The limited number of participants, nearly all of whom used shelters, makes it impossible to have a complete perspective of all Indigenous youth experiencing homelessness in the York Region. Several of the young people had already participated in studies of this type. A weariness with studies and interviews may have influenced their responses, over and above their state of health at the time of the interviews.

If you are experiencing emotional distress, you can call the Hope for Wellness Help Line (1-855-242-3310) or chat online. This service is available 24/7 for all Indigenous people in Canada.

For other available services, see the list of Centres d’écoute par région (regional support lines).

The inclusion of articles presented in this monitoring newsletter does not represent their endorsement by the Institut. Professional judgment remains essential in assessing the value of these articles for your work. You can also consult the Methodology for Indigenous Health Research Monitoring.