Cedar Project Research Articles

The Cedar Project: Racism and its impacts on health and wellbeing among young Indigenous people who use drugs in Prince George and Vancouver, BC.

Racism continues to drive health disparities between Indigenous and non-Indigenous peoples in Canada. This study focuses on racism experienced by young Indigenous people who have used drugs in British Columbia (BC), and predictors of interpersonal racism. Cedar Project is a community-governed cohort study involving young Indigenous people who use drugs in Vancouver and Prince George, BC. This cross-sectional study included data collected between August 2015-October 2016. The Measure of Indigenous Racism Experiences (MIRE) scale was used to assess experiences of interpersonal racism across 9 unique settings on a 5-point Likert scale, collapsing responses into three categories (none/low/high). Multinomial logistic regression models were used to examine associations between key variables and interpersonal racism. Among 321 participants, 79% (n = 255) experienced racism in at least one setting. Thirty two percent (n = 102) experienced high interpersonal racism from police, governmental agencies (child 'welfare', health personnel), and in public settings. Ever having a child apprehended (AOR:2.76, 95%CI:1.14-6.65), probable post-traumatic stress (AOR:2.64; 95%CI:1.08-6.46), trying to quit substances (AOR:3.69; 95%CI:1.04-13.06), leaving emergency room without receiving treatment (AOR:3.05; 95%CI:1.22-7.64), and having a traditional language spoken at home while growing up (AOR:2.86; 95%CI:1.90-6.90) were associated with high interpersonal racism. Among women, experiencing high interpersonal racism was more likely if they lived in Prince George (AOR:3.94; 95%CI:1.07-14.50), ever had a child apprehended (AOR:5.09; 95%CI:1.50-17.30), and had probable post-traumatic stress (AOR:5.21; 95%CI:1.43-18.95). Addressing racism experienced by Indigenous peoples requires immediate structural systemic, and interpersonal anti-racist reforms.

Implementing UNDRIP in British Columbia in a Post-Yahey Context: What to Expect After the Yahey v. BC Litigation (S151727) and the Agreement on Industrial Development and Cumulative Effects Management

Almost two years after the ground-breaking verdict that the Supreme Court of British Columbia issued in the context of the Yahey v. BC litigation, on January 18, 2023, the Province of British Columbia signed a historic agreement with Blueberry River First Nation (BRFN) to address the cumulative effects of industrial development on the meaningful exercise of Treaty 8 rights in the Nation’s traditional territory while establishing collaborative approaches to land and resource planning. At the same time, the Province concluded agreements with other Treaty 8 First Nations (Doig River, Fort Nelson, McLeod Lake, Prophet River, Saulteau and West Moberly First Nations) concerning cumulative effects management, land planning and resource exploitation. These agreements have been praised as ground-breaking steps towards a new relationship that Government and Industry are eager to build with First Nations while healing the land and ensuring certainty for Industry to carry on resource development in British Columbia. This happens as the Province and the Federal Government move forward with their action plans to implement the United Nations Declaration on the Rights of Indigenous Peoples (hereafter UNDRIP) at the provincial and federal levels. It also comes at a time of significant challenges British Columbia must face, between new First Nations development projects (i.e., the Cedar LNG project) that the Province is actively supporting and recent litigations initiated by some First Nations to see UNDRIP adequately implemented in the BC legal framework (i.e., the trial initiated by Gitxaala and Ehattesaht First Nations concerning the lack of consultation regarding how BC grants mineral claims).

Overcoming the soul wound: Reflecting on experiences and resilience of intergenerational residential school survivors

BackgroundBetween 1883 and 1996, thousands of Indigenous children were apprehended into Canada's Residential School System. Survivors and their descendants have testified to genocidal harms caused across generations. Yet, Indigenous Peoples continue to exist and resist through inherent resilience described by intergenerational survivors in this paper. ObjectiveThis article focuses on stories demonstrating the strength, power, and resilience of intergenerational residential school survivors. Participants & settingCedar Project is an Indigenous-led cohort study that began as a HIV/AIDS response and contributes to healing among young Indigenous people who use drugs in British Columbia, Canada. It is governed by the Cedar Project Partnership, an Indigenous body of Elders, leaders, and health/social services experts. MethodsWe present qualitative research involving in-depth interviews carried out with Cedar participants who have experienced significant and complex adversities including childhood maltreatment and illicit drug use. Woven throughout, Indigenous scholars who are themselves intergenerational (children and grandchildren) of residential school survivors provide first-person reflections on the findings. ResultsAnalysis focused on narratives of resilience and resistance to stresses of intergenerational traumas across three broad themes: working to break cycles of intergenerational trauma; foundations of resilience and making positive changes and; hopes and dreams. ConclusionsFindings establish deeper understanding of processes that enable young people to cope with stresses of intergenerational traumas while facing institutional and structural barriers to wellness. Reflections provide context about how intergenerational experiences intersect with challenges that young intergenerational survivors continue to face. We highlight pathways to healing and sources of strength that inform recommendations for wellness.

The cedar project: indigenous experiences of connection and survival amidst conflicting colonial responses to the opioid, housing, and health crises of the COVID-19 pandemic

The cedar project: indigenous experiences of connection and survival amidst conflicting colonial responses to the opioid, housing, and health crises of the COVID-19 pandemic

The Cedar Project: Vaccine Perceptions and the Impact of Colonialism on COVID-19 Vaccine Uptake Among Indigenous People Who Use Drugs in British Columbia

The Cedar Project: Vaccine Perceptions and the Impact of Colonialism on COVID-19 Vaccine Uptake Among Indigenous People Who Use Drugs in British Columbia

Pharmacists' role in detection and evaluation of adverse drug reactions: Developing proactive systems for pharmacosurveillance.

To identify current challenges in detection of medication-related symptoms, and review technology-based opportunities to increase the patient-centeredness of postmarketing pharmacosurveillance to promote more accountable, safer, patient-friendly, and equitable medication prescribing. Pharmacists have an important role to play in detection and evaluation of adverse drug reactions (ADRs). The pharmacist's role in medication management should extend beyond simply dispensing drugs, and this article delineates the rationale and proactive approaches for pharmacist detection and assessment of ADRs. We describe a stepwise approach for assessment, best practices, and lessons learned from a pharmacist-led randomized trial, the CEDAR (Calling for Detection of Adverse Drug Reactions) project. Health systems need to be redesigned to more fully utilize health information technologies and pharmacists in detecting and responding to ADRs.

Pre-processed and quality controlled eQTL dataset from the CEDAR project

Pre-processed and quality controlled eQTL dataset from the CEDAR project

新疆典型蝗虫适生区分布预测

PDF HTML阅读 XML下载 导出引用 引用提醒 新疆典型蝗虫适生区分布预测 DOI: 10.5846/stxb202010192661 作者: 作者单位: 作者简介: 通讯作者: 中图分类号: 基金项目: 天山雪松项目（2020XS04）；新疆草原生物灾害遥感监测项目（2021） Prediction of potential living area of typical locusts in Xinjiang based on species distribution model Author: Affiliation: Fund Project: Tianshan Cedar Project 摘要 | 图/表 | 访问统计 | 参考文献 | 相似文献 | 引证文献 | 资源附件 | 文章评论 摘要:新疆草原面积广阔，农牧业地位突出，蝗灾对当地经济、生态威胁很大，近年新疆极端天气日渐频发，蝗灾监测与防治任务艰巨。以意大利蝗、西伯利亚蝗和亚洲飞蝗为代表的蝗虫数据为基础，综合考虑对蝗虫各生命周期有重要影响的环境因素，运用BIOCLIM模型、领域模型（DOMAIN）、马氏距离模型（MAHAL）、广义线性模型（GLM）、随机森林模型（RF）、提升回归树模型（BRT）、支持向量机模型（SVM）、最大熵模型（MaxEnt）等八种经典物种分布模型及集成模型对新疆典型蝗虫适生区展开了预测。结果表明：（1）不同模型对新疆典型蝗虫适生区预测存在差异，其中DOMAIN最差（曲线下面积（AUC）=0.688，真实技巧统计（TSS）=0.301），而提升回归树（BRT）最佳（AUC=0.920，TSS=0.910），基于BRT、SVM和MaxEnt 3个集成模型预测的新疆蝗虫适生区可靠性更高；（2）新疆典型蝗虫不同等级适生区面积约56.844万km2，占新疆总面积的36%，其中高适生区面积16.568万km2；（3）新疆典型蝗虫适生区主要集中于北疆阿勒泰、塔城地区，此外东部哈密地区及南疆绿洲边缘地带亦有分布。研究可为新疆草原工作部门推进蝗虫监测防治工作提供支持。 Abstract:Xinjiang grassland covers a vast area and occupies a prominent position in agriculture and animal husbandry. Locust plague is a great threat to the local economy and ecology. Furthermore, extreme weather in Xinjiang has become more frequent, the task of monitoring and preventing locust plagues is difficult. Based on the data of locusts represented by Italian locust, Siberian locust and Asian migratory locust, we comprehensively considered the environmental factors that had important influence on the different life cycles of locusts, and used eight typical species distribution models of BIOCLIM, DOMAIN, MAHAL, GLM, RF, BRT, SVM, MAXENT, and ensembled models to predict typical locust suitable areas in Xinjiang. The results showed that:(1) different models had differences in the prediction of typical locust suitable areas in Xinjiang, in which DOMAIN was the worst (AUC=0.688, TSS=0.301), and the BRT was the best (AUC=0.920, TSS=0.910). The prediction of the suitable area based on the three ensembled models of the BRT, SVM and MaxEnt was more reliable. (2) The suitable area of typical locusts of different grades in Xinjiang was about 568440 km2, accounting for 36% of the total area of Xinjiang, among which the high adaptable area was 165680 km2. (3) The typical locust breeding areas were mainly concentrated in the Altay and Tacheng areas of northern Xinjian. In addition, they were also distributed in Hami and the edge of oasis in southern Xinjiang. This study may provide support to the Xinjiang grassland authorities in their efforts to monitor and control locusts. 参考文献 相似文献 引证文献

The Cedar Project: exploring the role of colonial harms and childhood maltreatment on HIV and hepatitis C infection in a cohort study involving young Indigenous people who use drugs in two Canadian cities

ObjectivesThis study examined associations between childhood maltreatment, colonial harms and sex/drug-related risks for HIV and hepatitis C virus (HCV) infection among young Indigenous people who use drugs.DesignThe Cedar Project is...

Cedar Project: Conducting Health Research with Indigenous Peoples in a Good Way

The Cedar Project is an interdisciplinary, community-driven research project responding to the crises of HIV and Hepatitis C infection and contributing to the healing of young Indigenous people who use or have used drugs. We are a collective membership of Indigenous Elders, health/social service experts, researchers, and non-Indigenous allies. We situate our work in the context of strength, resilience, and rights to self-determination for Indigenous peoples while also acknowledging the ongoing impacts of historical, intergenerational, and current trauma, specifically those related to the child welfare systems. We provide epidemiological and qualitative evidence that reflects Indigenous perspectives of health and wellness. In this paper, we highlight over seventeen years of shared learnings on conducting research with Indigenous communities in a good way. Specifically, we elaborate on four key components of our unique project. First, our paradigm is to build on young Indigenous people's strengths while acknowledging grief and historical trauma. We recognize that Cedar participants are not statistics—they are relatives of Indigenous partners governing this study. Second, our processes are determined by Indigenous governance, led by Elders and rooted in cultural safety. Third, our research ethics are determined by terms of reference created by the Cedar Project Partnership and by embracing guidelines of TCPS and community-based research. Fourth, we are informed by multiple perspectives and research relationships between Elders, partners, students, academics, and research staff. Sharing our learnings with the larger research community can contribute to decolonizing research spaces by centering Indigenous knowledges and privileging Indigenous voice.

The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities.

Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada’s child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008–2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25–8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94–5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00–3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63–10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04–7.99), violence (HR: 2.54, 95%CI: 1.52–4.27) or overdose (HR: 4.97, 95%CI: 2.96–8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23–1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.

The Cedar Project: Historical, structural and interpersonal determinants of involvement in survival sex work over time among Indigenous women who have used drugs in two Canadian cities

BackgroundIndigenous women involved in survival sex work face multiple layers of discrimination, criminalization and alarming levels of intergenerational and lifetime trauma. This longitudinal study examined historical, structural and interpersonal factors associated with survival sex work involvement among Indigenous women who have used drugs in British Columbia (BC), Canada. MethodsThe Cedar Project is an ongoing cohort study involving young Indigenous people who have used illicit drugs in Vancouver and Prince George, BC. Data was collected every 6 months from 2007 to 2016 . Generalized linear mixed-effects modeling was used to model survival sex work involvement, defined as exchanging sex for money, drugs, food or shelter in the previous six months. ResultsAmong 292 participants, 34% reported their family always/often lived by traditional culture and 37% reported their family always/often spoke their traditional language. In contrast, 48% had a parent in residential school and 72% were removed from their biological parents. In total, 55% of women were involved in survival sex work at baseline. In adjusted analyses, those who were single (ARR: 1.91; 95% CI: 1.50–2.35), identified as two-spirit (ARR: 2.16; 95% CI: 1.36–2.91), experienced sexual assault (ARR: 1.90; 95% CI: 1.22–2.58), were denied access to shelter (ARR: 1.71; 95% CI: 1.18–2.28), used crack daily (ARR: 2.85; 95% CI: 2.36–3.31), used injection drugs (ARR: 2.52; 95% CI: 1.98–3.07), and were unable to access substance use treatment (ARR: 1.58; 95% CI: 1.15–2.05) were more likely to be involved in sex work. ConclusionIndigenous-governed, wellness-based harm-reduction interventions, and structural reforms addressing housing insecurity and normalization of a culture of violence against Indigenous women, especially those involved in survival sex work, are urgently needed in Canada.

The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study.

BackgroundIndigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment.ObjectiveThis study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population.MethodsThe Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth.ResultsLess than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services.ConclusionsWe observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.

“Another thing to live for”: Supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities

BackgroundColonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. MethodsForty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. ResultsTaken together, participants’ stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. ConclusionThere are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.

Improving Access to the Dutch Historical Censuses with Linked Open Data

The Dutch Historical Censuses (1795–1971) contain statistics that describe almost two centuries of History in the Netherlands. These censuses were conducted once every 10 years (with some exceptions) from 1795 to 1971. Researchers have used its wealth of demographic, occupational, and housing information to answer fundamental questions in social economic history. However, accessing these data has traditionally been a time consuming and knowledge intensive task. In this paper, we describe the outcomes of the cedar project, which make access to the digitized assets of the Dutch Historical Censuses easier, faster, and more reliable. This is achieved by using the data publishing paradigm of Linked Data from the Semantic Web. We use a digitized sample of 2,288 census tables to produce a linked dataset of more than 6.8 million statistical observations. The dataset is modeled using the rdf Data Cube, Open Annotation, and prov vocabularies. The contributions of representing this dataset as Linked Data are: (1) a uniform database interface for efficient querying of census data; (2) a standardized and reproducible data harmonization workflow; and (3) an augmentation of the dataset through richer connections to related resources on the Web.

The Cedar Project: exploring determinants of psychological distress among young Indigenous people who use drugs in three Canadian cities.

Mental health and wellbeing, including addressing impacts of historical trauma and substance use among young people, has been identified as a key priority by Indigenous communities and leaders across Canada and globally. Yet, research to understand mental health among young Indigenous people who have used drugs is limited. To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs. The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress. Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood maltreatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men. Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs.

The Cedar Project: mortality among young Indigenous people who use drugs in British Columbia.

Young Indigenous people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time. We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression. Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person-years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2-17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6-10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47-5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01-3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00-8.09). Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.

The Cedar Project: Using Indigenous-Specific Determinants of Health to Predict Substance use among Young Pregnant-Involved Indigenous Women In Canada

BackgroundIndigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; however, little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. The objectives of this study were to describe the social contexts of pregnant-involved young Indigenous women who use substances and to explore if an Indigenous-Specific Determinants of Health Model can predict substance use among this population.MethodsUsing descriptive statistics and hierarchical logistic regression guided by mediation analysis, the social contexts of pregnant-involved young Indigenous women who use illicit drugs’ lives were explored and the Integrated Life Course and Social Determinants Model of Aboriginal Health’s ability to predict heavy versus light substance use in this group was tested (N = 291).ResultsImportant distal determinants of substance use were identified including residential school histories, as well as protective factors, such as sex abuse reporting and empirical evidence for including Indigenous-specific determinants of health as important considerations in understanding young Indigenous women’s experiences with pregnancy and substance use was provided.ConclusionsThis analysis provided important insight into the social contexts of women who have experiences with pregnancy as well as drug and/or alcohol use and highlighted the need to include Indigenous-specific determinants of health when examining young Indigenous women’s social, political and historical contexts in relation to their experiences with pregnancy and substance use.

The Cedar Project WelTel mHealth intervention for HIV prevention in young Indigenous people who use illicit drugs: study protocol for a randomized controlled trial.

BackgroundDespite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers.MethodsThe Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat.DiscussionCulturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way mHealth programs have yet to be tested for HIV prevention in a community-based setting with this population.Trial registrationClinicalTrials.gov NCT02437123 https://clinicaltrials.gov/show/NCT02437123 (registered 4 May 2015). Protocol version: 24 July 2015.

The Cedar Project: resilience in the face of HIV vulnerability within a cohort study involving young Indigenous people who use drugs in three Canadian cities.

BackgroundIndigenous scholars have long argued that it is critical for researchers to identify factors related to cultural connectedness that may protect against HIV and hepatitis C infection and buffer the effects of historical and lifetime trauma among young Indigenous peoples. To our knowledge, no previous epidemiological studies have explored the effect of historical and lifetime traumas, cultural connectedness, and risk factors on resilience among young, urban Indigenous people who use drugs.MethodsThis study explored risk and protective factors associated with resilience among participants of the Cedar Project, a cohort study involving young Indigenous peoples who use illicit drugs in three cities in British Columbia, Canada. We utilized the Connor-Davidson Resilience Scale to measure resilience, the Childhood Trauma Questionnaire to measure childhood maltreatment, and the Symptom-Checklist 90-Revised to measure psychological distress among study participants. Multivariate linear mixed effects models (LME) estimated the effect of study variables on mean change in resilience scores between 2011-2012.ResultsAmong 191 participants, 92 % had experienced any form of childhood maltreatment, 48 % had a parent who attended residential school, and 71 % had been in foster care. The overall mean resilience score was 62.04, with no differences between the young men and women (p = 0.871). Adjusted factors associated with higher mean resilience scores included having grown up in a family that often/always lived by traditional culture (B = 7.70, p = 0.004) and had often/always spoken their traditional language at home (B = 10.52, p < 0.001). Currently knowing how to speak a traditional language (B = 13.06, p = 0.001), currently often or always living by traditional culture (B = 6.50, p = 0.025), and having recently sought drug/alcohol treatment (B = 4.84, p = 0.036) were also significantly associated with higher mean resilience scores. Adjusted factors associated with diminished mean resilience scores included severe childhood emotional neglect (B = −13.34, p = 0.001), smoking crack daily (B = −5.42, p = 0.044), having been sexual assaulted (B = −14.42, p = 0.041), and blackout drinking (B = −6.19, p = 0.027).ConclusionsYoung people in this study have faced multiple complex challenges to their strength. However, cultural foundations continue to function as buffers that protect young Indigenous people from severe health outcomes, including vulnerability to HIV and HCV infection.