Indigenous Health Research Monitoring, October 2024

Just published

New scientific publications and articles

• Dias, T., Mackay, D., Canuto, K., Boyle, J. A., D’antoine, H., Hampton, D., Martin, K., Phillips, J., Bartlett, N., Mcintyre, H. D., Graham, S., Corpus, S., Connors, C., McCarthy, L., Kirkham, R., and Maple-Brown, L. J. (2024). Supporting healthy lifestyles for First Nations women and communities through co-design: Lessons and early findings from remote Northern Australia. Frontiers in Clinical Diabetes and Healthcare, 5.
• Domingo, A., Yessis, J., Zupko, B., McEachern, L. W., Valaitis, R., Skinner, K., and Hanning, R. M. (2024). Scale up of the learning circles: A participatory action approach to support local food systems in four diverse First Nations school communities within Canada. BMC Public Health, 24(1), 2222.
• Fatima, K., Varela, S., Fatima, Y., Lindsay, D., Gray, M., and Cairns, A. (2024). Impact of sleep on educational outcome of Indigenous Australian children: A systematic review. Australian Journal of Rural Health, 32(4), 672–683.
• Fournier, C., Mirza, S., Naidoo, K., Green, S., Shirt, C., Cameron, S., Stewart, S. L., and Gaetz, S. (2024). Endaayaang: The importance of “Indigenizing” housing first for youth. AlterNative: An International Journal of Indigenous Peoples, 0(0).
• Kelley, A., Webb, K., Hirchak, K., Witzel, M., Bajet, K., and Posey, S. (2024). Tribally-led mobile outreach: Improving access to harm reduction services in one rural reservation community. Frontiers in Public Health, 12.
• Kennedy, M., Morton Ninomiya, M.,, Brascoupé, S., Smylie, J., Calma, T., Mohamed, J., Stewart, P. J., and Maddox, R. (2024). Knowledge translation in Indigenous health research: Voices from the field. Medical Journal of Australia, 221(1), 61–67.
• Luke, J. N., Bessarab, D., Smith, K., LoGiudice, D., Flicker, L., Gilchrist, L., Dow, B., and Temple, J. (2024). Counting the ways that Aboriginal and Torres Strait Islander older people participate in their communities and culture. The Journals of Gerontology: Series B, 79(8), gbae100.
• McCormack, H., Dickson, M., Harrington, T., Garay, M., Whybrow, R., Mooney-Somers, J., Aggleton, P., Lafferty, L., Mitchell, E., Morris, J., and Haire, B. (2024). Sexual healthcare to meet the needs of sexuality and gender diverse Aboriginal young people: Imagined possibilities. Culture, Health & Sexuality, 1–16.
• Shafiee, M., Al-Bazz, S., Lane, G., Szafron, M., and Vatanparast, H. (2024). Exploring healthy eating perceptions, barriers, and facilitators among urban Indigenous peoples in Saskatchewan. Nutrients, 16(13), 2006.
• Tahatikonhsontóntie’ Quebec Network for Indigenous Health Research (2024). Cultural Safety in an Indigenous Health Research Context. Final Report of the Roundtable Discussions.

New publication from INSPQ

• Fournier, C., and Lafrenaye-Dugas, A.-J. (2024). Social inequalities in health: The perspective of Indigenous girls and women. Institut national de santé publique du Québec.

Article Summaries: Subject Areas

Lifestyles and health-promoting behaviours

Countering stereotypes: Exploring the characteristics of Aboriginal Australians who do not drink alcohol in a community representative sample

Conigrave, J. H., Wilson, S., Conigrave, K. M., Perry, J., Hayman, N., Chikritzhs, T. N., Wilson, D., Zheng, C., Weatherall, T. J., and Lee, K. S. K. (2024). Countering stereotypes: Exploring the characteristics of Aboriginal Australians who do not drink alcohol in a community representative sample. Drug and Alcohol Review, 43(6), 1523–1533. 

Context

Contrary to common stereotypes, Aboriginal Australians and Torres Strait Islanders are more likely to abstain from drinking alcohol than other Australians. Despite this reality, few studies look into the experiences of non-drinkers, a majority focusing on risky drinking. 

Objective

Describe the demographic characteristics of Aboriginal Australians and Torres Strait Islanders who do not drink alcohol, their reasons for abstaining, and their experiences with alcohol-related harm.

Methodology

A cross-sectional survey was conducted of 775 Aboriginal Australians and Torres Strait Islanders aged 16 and over living in two South Australian communities: one remote and the other urban (Adelaide).

With the help of local service providers, participants were recruited during community events and in public spaces (such as parks, grocery stores, community centres and beaches). The sampling strategy aimed to be representative by reflecting the results of the 2016 census in terms of age, sex, and socioeconomic status. The data was collected with the help of Grog Survey App, whereby participants answered the survey on an iPad that displayed images and played voice recordings adapted to their sex and language.

The survey comprised only closed questions. For example, participants had to choose one or more out of eight reasons why they do not drink. The analysis was conducted using multi-level logistic regression.

What was learned?

Out of 888 individuals invited to participate, 775 completed the survey (706 in an urban setting and 69 in a remote community). The average age was 38.04. Close to one quarter (178) of participants had not consumed alcohol in the previous 12 months. 

• Non-drinkers tend to be older than regular drinkers.
• Those who speak an Aboriginal language in the home are about three times more likely to be lifetime abstainers than those who speak other languages. 
• Lifetime abstainers are less likely to hold a job. This confirms that the notion of unemployed Aboriginal Australians being heavy drinkers is a stereotype. 
• While “health” and “family” are common reasons cited for not drinking, many participants selected “other reason,” suggesting that there may be further explanations that lie beyond the scope of the proposed reasons. 
• Most participants who are abstainers did not report harm from others’ alcohol consumption within the last 12 months. The most common harm reported in the two communities was stress caused by others drinking alcohol. 

Understanding the reasons for abstaining from alcohol cited at the local level may be useful in adapting health promotion campaigns. For example, messages targeting the protective effects on family members may prove more effective in communities where individuals choose to abstain because of their family.

Limitations

Drinking habits, cultural practices and lifestyle are quite heterogenous from one community to another. Abstinence rates and the reasons given can therefore vary greatly. Alcohol access restrictions in some communities also need to be considered. The results are more reflective of Aboriginal Australians, since the two sites included in the sample are home to few Torres Strait Islanders. Finally, the lower rate of participation in the remote community—possibly related to concerns about privacy—may have introduced a bias into the results. 

Prevention of infectious and chronic disease  

Land-based retreats as a method for building enabling environments for HIV prevention with Northern and Indigenous adolescents in the Northwest Territories, Canada: Mixed-methods findings

Logie, C. H., Lys, C. L., Taylor, S. B., Lad, A., Mackay, K. I., Hasham, A., Gittings, L., Malama, K., Pooyak, S., Monchalin, R., and Adamassu, Z. (2024). Land-based retreats as a method for building enabling environments for HIV prevention with Northern and Indigenous adolescents in the Northwest Territories, Canada: Mixed-methods findings. AIDS and Behavior, 28(9), 3112–3127.  

Context   

In Canada’s Northwest Territories, the proportion of people with a sexually transmitted infection (STI) is seven times higher than the national average. Those 15 to 24 years old are most affected by this issue. Given that the risk of contracting the human immunodeficiency virus (HIV) is higher in someone with an STI, the prevention of STIs and HIV go hand in hand. Half of the population of the Northwest Territories are Indigenous, a demographic exposed to sexual health disparities.  

Objective   

Promote the sexual health of Northern and Indigenous adolescents by exploring how land-based retreats can provide environments conducive to HIV prevention. 

Methodology

Every summer from 2016 to 2021, land-based retreats lasting nine days were organized for adolescents aged 13 to 17 in the Northwest Territories, Yukon, and Nunavut through the FOXY program (Fostering Open eXpression among Youth). Developed using an approach that values Indigenous knowledge, strengths and resilience, the retreats were facilitated by researchers, a care professional, a mental health professional and volunteers who had previously participated in the program (peer leaders). Retreat activities focus on the arts (e.g., drumming, traditional stories and photography) and education about STIs and HIV, as well as healthy relationships. Mixed methods were used to assess the influence of the retreats on participants’ knowledge about HIV and safer sex efficacy.

Quantitative data was collected using questionnaires that participants completed before and after the intervention. Paired sample t-tests served to verify whether pre- and post-retreat differences were statistically significant. Changes in participant knowledge about STIs and HIV, as well as safer sex efficacy, were evaluated using multivariable linear regression. 

Qualitative data came from focus groups composed of participants and peer leaders held following the retreat. Participants in the groups addressed their experiences and perception of learning about sexual health and relationships. Qualitative data was processed using thematic content analysis. 

What was learned?    

A total of 353 adolescents (66.2% female and 70.5% Indigenous) with an average age of 14.4 participated in the retreats. A majority of them had previously participated in a similar retreat. A total of 232 peer leaders took part in the focus groups. An analysis of the results revealed the following effects: 

• Improved knowledge about STIs and HIV
• Better technical communication, specifically about practical aspects of HIV and STI prevention (e.g., proper condom use)
• Improved transformative communication, for example interpersonal exchanges about sexual consent
• Greater understanding of safe sex practices. However, there was less improvement among young men, non-heterosexual participants and those experiencing food insecurity.  

The authors conclude that the land-based retreats build enabling environments for HIV prevention with Northern and Indigenous adolescents. Similarly, peer-led retreats allow young participants to learn from models who are the same age.  

Limitations   

Given that the selection of participants was not random, the results cannot be generalized. Young people who are comfortable talking about sexuality are more likely to participate in the retreats. More long-term follow-up would have made it possible to determine whether the effects continued over time. The lack of a control group makes it difficult to establish a causal relationship between the retreats and the effects.   

Promotion of wellbeing and mental health 

An environmental scan of mental health services for Indigenous youth in Canada 

Perez, S. H., Kakish, I., Brass, G., MacDonald, K., Mushquash, C., and Iyer, S. N. (2024). An environmental scan of mental health services for Indigenous youth in Canada. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 33(2), 93–130. 

Context 

The Indigenous population is one of Canada’s youngest demographics, with nearly half of the population under the age of 25. At the same time, Indigenous youth have suicide rates 3 to 9 times higher than those of non-Indigenous young people. ACCESS Open Minds was founded in 2014 to forge a network of national stakeholders in order to improve mental health care for young people. An Indigenous Council, which was launched to inform the network’s activities, identified a need to map existing mental health and wellbeing services for First Nations, Inuit and Métis youth.

Objective 

Identify mental health and wellbeing services available to Indigenous youth across Canada. 

Methodology 

For this environmental scan, the websites of organizations offering mental health-related programs for Indigenous youth were analyzed. After first conducting general searches with Google, online resource locators (e.g., the “Search programs near me” function on Kids Help Phone) were used, and lists of partner organizations referenced on those websites were consulted. Finally, some organizations were mentioned in reports on Indigenous wellbeing. 

Youth were defined as individuals between the ages of 11 and 25. Programs that mention serving young people without specifying an age range were included. Organizations without a website were excluded, as were crisis helplines if that was the only service offered. Synthesized information, including keywords used to present a program’s mission, was collected from the websites of the various organizations identified, as well as from their annual reports and online brochures.  

What was learned? 

A total of 117 programs were identified, more than half of which (54%) are not-for-profit and a third (34%) community-based. A majority of programs serve Indigenous youth in general, while 32% specifically target First Nations, 8% Inuit, and 1% Métis. The researchers determined four core features of these programs. 

• A strengths-based focus: The terms used in the programs’ mission statements reflected a strengths-based ideology. The most common keywords were community, holistic and wellbeing, with more than twenty occurrences of each term. 
• A range of other services: In addition to services specifically related to mental health, 87% of programs also offer other services in the areas, for example, of employment or housing. Moreover, the analysis reveals a wide range of available services. Some services are more “Western” in nature (e.g., sessions with a psychologist or social worker), while others are more traditional (e.g., cultural activities or sessions with Elders).
• Land-based programming: A third of programs offer land-based activities that promote wellbeing, healing, or identity building. These include hunting, fishing, trapping, learning about medicinal plants, gathering, snowshoeing, and wild game preparation. Such land-based activities are generally found in the larger mental health and addiction prevention programs. 
• The role of community members: About two in five programs (42%) described people without formal mental health training being involved in service provision (e.g., Elders, Knowledge Keepers or youth leaders). This may be explained by the value placed on Indigenous knowledge, as well as by a lack of specialists in Indigenous communities. 

Finally, the Google searches found only a small proportion of the programs identified in the study, suggesting that some organizations have a limited online presence. This may make it more difficult for Indigenous youth to find the mental health programs designed for them.

Limitations 

The scope of this study does not allow for a discussion of program effectiveness or accessibility, for example the wait time to participate in activities. In addition, the authors point out that the information presented on the websites may not reflect the programs currently available, for instance because of delays in updating that information. 

O le tagata ma lona aiga, o le tagata ma lona fa'asinomaga (Every person belongs to a family and every family belongs to a person): Development of a parenting framework for adolescent wellbeing in American Samoa  

Mew, E. J., Hunt, L., Toelupe, R. L. M., Blas, V., Winschel, J., Naseri, J., Soliai-Lemusu, S., Tofaeono, J. F., Seui, M. A., Ledoux-Sunia, T., Sunia, F., Reid, A., Helsham, D., Lowe, S. R., Poulin, R., Hawley, N. L., and McCutchan-Tofaeono, J. (2024). O le tagata ma lona aiga, o le tagata ma lona fa’asinomaga (Every person belongs to a family and every family belongs to a person) : Development of a parenting framework for adolescent mental wellbeing in American Samoa. Children and Youth Services Review, 160, 107502.  

Context 

Many Samoan adolescents live with symptoms of depression or anxiety, in addition to dealing with issues related to substance abuse. High suicide rates have made adolescent mental health a priority for Samoan communities. While it is necessary to implement mental health promotion strategies, the family also has an influence on mental health.  

Objectives 

• Identify family-based factors acting to protect the mental health of adolescents in American Samoa. 
• Develop a framework for supporting programs to develop parenting skills with a view to promoting the mental health of adolescents. 

Methodology 

The study took a collaborative participatory approach under the fa'afaletui framework developed for research in Samoan communities. Qualitative data was collected in a two-stage process.  

The first involved semi-structured virtual interviews with adult key informants, Samoan for the most part, to establish preliminary themes. These participants were recruited by partners from the health network and using snowball sampling.

The second stage comprised virtual focus groups of Samoan adolescents aged 13 to 18, which served to validate the themes and explore discrepancies. In addition, five adolescents and two adult key informants were recruited to serve as a Community Action Board to help guide the research and data analysis. Five focus groups based on gender (female, male and non-binary) were organized comprising 35 adolescent students who had lived in American Samoa for more than a year. The focus groups were led by two experienced American Samoan moderators using the Dotmocracy tool.  

Deductive thematic analysis was conducted with the help of the fonofale model. This model promotes holistic health, in which the fale represents the family (or house) and is composed of the roof (falealuga), foundation (fa'avae) and pillars (pou).

What was learned?  

The parenting role is described as a broader community responsibility that extends beyond the immediate family. The results suggest that to improve their parenting abilities, parents need to strengthen their own mental health, enhance their relational and emotional skills, and develop a better understanding of mental health. 

From a mental health promotion perspective, six pillars for supporting adolescents were identified.

1. Provide emotional safety and security. 
   • Reduce parental pressure on adolescents to be perfect. 
   • Listen to adolescents non-judgmentally and try to understand them. 
   • Avoid a tough-love approach and fulfill the need for physical and verbal affection. 
2. Provide physical safety and security.  
   • Prevent sexual abuse by listening compassionately to victims, who may fear being blamed.  
   • Avoid corporal punishment in disciplining children.
3. Encourage sense of self.  
   • See adolescents as people in their own right who can be involved in the community. 
   • Reconnect with one’s cultural identity as a source of pride. 
   • Recognize adolescents’ feelings of inadequacy and sense of being caught between two cultures (not fully American or Samoan). 
4. Strengthen intergenerational communication skills. 
5. Prioritize quality time. 
6. Cultivate healthy coping strategies by expressing emotions and participating in positive activities such as sports, the arts, and spending time with friends.

Limitations 

Given that the data was collected during the COVID-19 pandemic following a series of adolescent suicides, sensitivity to and emotions around mental health and adolescent suicide may have been exacerbated. The perspective of parents—other than that of adult key informants, who may also be parents—was not collected. The need to have Internet access to participate in the focus groups may have skewed adolescent participation towards more privileged families.  

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 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.