Inuit In Nunavut Research Articles

Inborn errors of immunity in Canadian First Nations and Nunavut Inuit Children: the tip of the iceberg

Abstract Objectives Inborn errors of immunity (IEI) are a heterogeneous group of genetic diseases that impact normal immune development and function. Individual IEI are rare, but collectively, can represent an important health burden. Little is known about the types of IEI seen in Canadian First Nations (FN) and Inuit populations. We sought to understand the spectrum of serious IEI in FN and Nunavut Inuit children, as a starting point for improving the awareness of these conditions in the community and for health care workers. Methods A questionnaire was distributed to participating Canadian pediatric tertiary-care centers. Providers were asked to report cases of confirmed or suspected severe immunodeficiencies seen in FN and Nunavut Inuit children. Results From 2004 to 2022, IEI were reported in 63 FN and 21 Inuit children by 4 pediatric hospitals across 3 Canadian provinces. The majority of cases were immunodeficiencies affecting cellular and humoral immunity (62% of cases in FN and 57% in Inuit children). IKBKB deficiency, adenosine-deaminase severe combined immune deficiency (SCID), and chronic granulomatous disease were the most common IEI. A wide variety of other IEI was reported, many of which would not be detected by current newborn screening for SCID and for which live-attenuated vaccines would have been contraindicated. Conclusions IEI occur in FN and Inuit children and may be underrecognized. Better understanding the prevalence of these conditions in specific communities could help inform public health policies including newborn screening and immunization programs and ultimately improve the health of FN and Inuit children in Canada.

Re-Considering Market Development Approaches to Support Nunavut Inuit Priorities in the Seal Market

Seal hunting is a long-standing cultural practice for Inuit, who have also long participated in the commercial seal market. Inuit were negatively impacted by anti-sealing campaigns that resulted in international trade bans and subsequent market collapses for seal products. To improve market access for Inuit seal products, the Canadian government established the Certification and Market Access Program for Seals (CMAPS) to support export of Inuit seal products in European Union markets. In 2015, the Government of Nunavut became an Attestation Body under the EU Indigenous Communities Exemption, which enables the Government to certify Nunavut seal products for export into EU markets. To date, market development efforts have largely focused on supporting the export market for Nunavut sealskins, while less attention has focused on how such efforts impact the local value chain and meet the needs of Nunavut Inuit involved in the seal market. Focus group discussions with Inuit value chain actors in Iqaluit and Qikiqtarjuaq provide insight into the Nunavut seal value chain and explore perspectives of how government policies and programmes are meeting the needs of Nunavut Inuit. Findings revealed multiple gaps in the local value chain that have gone largely unaddressed due to a priority on export markets over the local value chain. These gaps limit export development opportunities and the ability for the seal market to adequately meet the needs of Nunavut Inuit and Nunavummiut alike. Collectively, this study demonstrates the importance of centralizing Inuit in economic development policies to support local economies and ensure Inuit priorities are met.

Cross-jurisdictional pandemic management: providers speaking on the experience of Nunavut Inuit accessing services in Manitoba during the COVID-19 pandemic

ABSTRACT Across Canada, the COVID-19 pandemic placed considerable stress on territorial and provincial healthcare systems. For Nunavut, the need to continue to provide access to critical care to its citizens meant that medical travel to provincial points of care (Edmonton, Winnipeg and Ottawa) had to continue through the pandemic. This complexity created challenges related to the need to keep Nunavut residents safe while accessing care, and to manage the risk of outbreaks in Nunavut resultant from patients returning home. A number of strategies were adopted to mitigate risk, including the expansion of virtual care, self-isolation requirements before returning from Winnipeg, and a level of cross-jurisdictional coordination previously unprecedented. Structural limitations in Nunavut however limited opportunities to expand virtual care, and to allow providers from Manitoba to access the Nunavut’s electronic medical records of patients requiring follow up. Thus, known and long-standing issues exacerbated vulnerabilities within the Nunavut healthcare system. We conclude that addressing cross-jurisdictional issues would be well served by the development of a more formal Nunavut-Manitoba agreement (with similar agreements with Ontario and Alberta), outlining mutual obligations and accountabilities.

Using collaborative critical autoethnography to decolonise through “seeing” and doing: Social work, community engagement, and ethical practice

INTRODUCTION: This article reports on a collaborative critical autoethnographic study that we, two white settler social workers, conducted about our engagement with Inuit youth in Nunavut. APPROACH: We facilitated three digital storytelling projects with youth living in three different Nunavut communities. By engaging in a collaborative critical autoethnography study, we were able to attend to the ways in which we were entering into communities, paying particular attention to the ways in which white supremist colonial thought has impacted our training and our locations within larger structures—shaped by colonising histories with consequences that mould day-to-day life and opportunity for the Inuit youth engaged in the digital storytelling. FINDINGS: Through collaborative critical autoethnography, using individual research memos and guided dialogue, we considered the ways in which commodification was structured into our relationships, how these structures continue to be colonising, and consider the impact of the past and current colonisation. We also encountered the many strengths and resistances of the Inuit of Nunavut. IMPLICATIONS: By bringing these considerations to light, we hope to enter into relationships with Inuit communities with fewer of the biases and assumptions that underlay and rationalise the structures that we have critically examined.

Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study.

Background:Structural aspects of health care systems, such as limited access to specialized surgical and perioperative care, can negatively affect the outcomes and resource use of patients undergoing elective and emergency surgical procedures. The aim of this study was to compare postoperative outcomes of Nunavut Inuit and non-Inuit patients at a Canadian quaternary care centre.Methods:We conducted a retrospective cohort study involving adult (age ≥ 18 yr) patients undergoing inpatient surgery from 2011 to 2018 at The Ottawa Hospital, the quaternary referral hospital for the Qikiqtaaluk Region of Nunavut. The study was designed and conducted in collaboration with Nunavut Tunngavik Incorporated. The primary outcome was a composite of in-hospital death or complications.Secondary outcomes included postoperative length of stay in hospital, adverse discharge disposition, readmissions within 30 days and total hospitalization costs.Results:A total of 98 701 episodes of inpatient surgical care occurred among patients aged 18 to 104 years; 928 (0.9%) of these involved Nunavut Inuit, and 97 773 involved non-Inuit patients. Death or postoperative complication occurred more often among Nunavut Inuit than non-Inuit patients (159 [17.2%] v. 15 691 [16.1%]), which was significantly different after adjustment for age, sex, surgical specialty, risk and urgency (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.03–1.51). This association was most pronounced in cases of cancer (OR 1.63, 95% CI 1.03–2.58) and elective surgery (OR 1.58, 95% CI 1.20–2.10). Adjusted rates of readmission, adverse discharge disposition, length of stay and total costs were significantly higher for Nunavut Inuit.Interpretation:Nunavut Inuit had a 25% relative increase in their odds of morbidity and death after surgery at a major quaternary care hospital in Canada compared with non-Inuit patients, while also having higher rates of other adverse outcomes and resource use. An examination of perioperative systems involving patients, Inuit leadership, health care providers and governments is required to address these differences in health outcomes.

How icebreaking governance interacts with Inuit rights and livelihoods in Nunavut: A policy review

Sea ice is a contested space when it comes to navigation in ice-covered regions. For Inuit in Nunavut, Canada, sea ice is an integral platform of coastal connectivity, allowing access to areas of subsistence and cultural value. For vessels transiting Arctic waters, sea ice poses potential risks to vessel, crew, and passenger safety consequently, icebreaking is considered an essential service. Yet, many communities in Nunavut have described icebreaking as having, or potentially having significant negative impacts on community and ecological wellbeing. Several policies regulate and provide guidance to icebreakers operating in ice-covered waters. With anticipated increases to icebreaking demand in Arctic waters supporting destinational shipping, a policy review was conducted to explore how current regulations governing icebreaking activities in the Canadian Arctic interact with the rights and livelihoods of Inuit who live in Nunavut. Policy instruments governing icebreaking activities were framed, assessed, and aligned to Inuit rights, as set forth by international, national, and territorial provisions. International instruments provide minimal attention to environmental impacts of icebreaking and even less to its cultural and social impacts. Canadian instruments refer to both environmental impacts and Inuit use of sea ice for winter travel routes, framing both as elements that should be taken into consideration during route planning. Despite this, Inuit have had little involvement in developing current icebreaking regulations and guidelines beyond those under territorial jurisdiction. From this review, opportunities and recommendations are identified that could allow for future icebreaking policies to better account for Inuit rights and governance values.

"Sewing Is Part of Our Tradition": A Case Study of Sewing as a Strategy for Arts-Based Inquiry in Health Research With Inuit Women.

In this article, we present a case study of sewing as a strategy for arts-based inquiry in health research, situated within a broader project that highlighted Nunavut Inuit women’s childbirth experiences. Five focus groups were hosted as sewing sessions with pregnant women (N = 19) in Iqaluit, Nunavut (2017–2018). Women’s reflections on the sessions, and the significance of sewing to Inuit, were integrated with researchers’ critical reflections to examine the value of sewing as a strategy for arts-based inquiry within a focus group method: results related to the flexibility of the sessions; how collective sewing created space for voicing, sharing, and relating; sewing as a tactile and place-specific practice tied to Inuit knowledge and tradition; and lessons learned. Our results underscore the possibilities of arts-based approaches, such as sewing, to enhance data gathering within a focus group method and to contribute to more locally appropriate, place-based methods for Indigenous health research.

Honouring Inuit Women’s Educational and Employment Experiences through Indigenous Storywork Methodology

The legacy of the Arctic Residential School system is still present in Nunavut education today. Inuit in Nunavut continue to receive a westernized education that does not fully encompass traditional Inuit learning principles. However, a group of Inuit women, enrolled in a Northern College Early Childhood Education (ECE) Diploma Program from 2015-2017, uniquely blended a child-centred educational approach with traditional Inuit learning methods. Through the Inuit women’s practicum placements completed at a preschool, they developed self-confidence and a skill set that led to their employment and self-reliance. 
 The Oxford dictionary defines self-reliance as “the ability to do or decide things by yourself, rather than depending on other people for help” (Oxford University Press 2021). This definition does not fully capture the essence of self-reliance from Inuit women’s perspectives. Their self-reliance is greatly tied to a combination of domestic work, wage work, and land-related work that forms a unique framework to capture the specificity of northern women’s self-reliance. My research study will explore the personal experiences of these Inuit women graduates. The study intends to inform institutional decision-making, determine how to best support the Inuit women’s educational access and success, contribute to the scholarly work in the field of education and advance future Inuit training and employment initiatives. 
 My research questions are: What does self-reliance look like from an Inuit woman’s point of view? How did participating in the 2015-2017 ECE Diploma Program influence the Inuit women’s lives?
 Indigenous Storywork is grounded in Indigenous Research Framework (Lavallée 2009) which allows for connections between people, their ancestors, and the natural world. Indigenous Storywork guides my study theoretically and methodologically. I will use Storywork to engage in holistic meaning-making that involves the heart (emotions), mind (intellect), body (physical actions), and spirit (spirituality) (Archibald et al. 2019). 
 Storywork is essentially a three-part framework: story-making, storytelling, and connecting with specific cultures and peoples experiences through stories (Archibald et al. 2019). This framework honours distinctive traditional Inuit knowledge and these Inuit women’s holistic identity regarding their relationships with themselves, family, community, land, environment, and the wider society. Indigenous Storywork methodology creates space for my participants to share dreams, visions, spiritual encounters, and lived experience stories through interviews. My research honours the Storywork of Inuit women through their culturally responsive and unique educational opportunities. 

Of Kale and Caribou

Rates of food insecurity in Nunavut are the highest in Canada. This paper will focus on the federal government’s role in solving this problem, arguing that a thorough examination of the coherence of existing arrangements, institutions, programs, and regulations that impact food insecurity in Nunavut is needed. As an example, this paper will focus on three factors that contribute to food insecurity among the Inuit of Nunavut and policies that seek to address them or that exacerbate them: 1) high prices of food sourced from southern Canada, and the efficacy of the Government of Canada’s program, Nutrition North Canada, in decreasing those prices; 2) decreased rates of country food consumption and possible programming to increase that consumption; and 3) the role of large-scale infrastructure projects in damaging the Inuit traditional food system, followed by recommendations for the types of infrastructure projects that would strengthen food security, rather than harm it.

PL03.06 Improving Outcomes with Immunotherapy: Lessons from Other Diseases

The Ottawa Hospital (TOH) in Canada’s capital city is the tertiary cancer care center for the Baffin Island area of Nunavut- a Territory located in Canada’s north accessed by a 3-hour flight. The Inuit of Canada’s north have dramatically higher social and economic inequities compared to mainstream Canada (ITK, 2018). [GB1] [CR2] [CR3] For example, 70% of Nunavut Inuit households experience food insecurities compared to 8% of the remainder of Canada. 63% of adult Inuit smoke compared to 16% of mainstream Canada. Approximately 30% of Inuit living in Nunavut diagnosed with cancer between 2000 and 2010 did not access any cancer services (Asmis, 2016). Building productive relationships is one of the key pillars of our organization’s cancer strategy. This is demonstrated by the efforts that have taken place among key partners including: 1) TOH’s interdisciplinary teams; 2) the Indigenous Cancer Control Unit of Cancer Care Ontario (CCO), a provincial agency responsible for addressing the cancer burden of First Nations, Inuit and Metis (FNIM) peoples; 3) the Qikiqtani General Hospital (QGH) in Nunavut, providing inpatient and ambulatory care in the Baffin Island and 4) Ottawa-based Inuit service provider organizations. The collaborative relationship developed among the multiple partners resulted in the following positive outcomes: The establishment of a ‘Relationship Table’ where Inuit service provider stakeholders in Ottawa and Nunavut meet quarterly to review cancer related issues and to provide advice on service delivery challenges. The Table is grounded in a formalized relationship protocol with the Inuit community and organizational leaders. Significant increase in the number of patients and family members supported by the Indigenous Cancer Program at TOH. Many cases present with very complex physical and psychosocial issues and require extensive and long-term intervention. TOH is involved in several research initiatives related to Inuit and cancer care, with the goals of 1) better understanding barriers to accessing cancer care: 2) developing tools to support the patients’ understanding of their illness and prognosis, and 3) encouraging FNIM involvement in shared decision making. Over the past year, TOH experts in cancer care have delivered introductory education to health care providers in Nunavut. This initial education event led to TOH hosting nine physicians and nurses for a week of onsite training in the Cancer Care environment, thereby solidifying relationships with oncology staff, and enhanced their ability to provide care closer to home for their patients. A significant milestone was achieved in September 2020 when the first dose of trastuzumab was delivered in Nunavut. This was the first cancer-related medication administered in the Territory, and required education of the QGH Team in the areas of HER2 positive breast cancer assessment, clinical monitoring for toxicity, and administration of sc trastuzumab including relevant symptom/self-management strategies and resources. A policy and standard operating procedure for administration, order set, and confirmation of administration documents were finalized and distributed to support the care process. These were a collaboration between nursing and pharmacy (both TOH and in the QGH Medical Day Unit) and were vetted by other key stakeholders in Ottawa (breast disease site lead and medical oncology division head) as well as in Nunavut. The collaborative effort to provide breast cancer therapy in Nunavut was groundbreaking and lays the foundation to provide treatment for other cancers, such as lung cancer. In May 2020, The Ottawa Hospital took the lead in organizing the first ever Oncology conference in Nunavut. It was anticipated that approximately 100 health care providers from across Canada and other international locations would be meeting in Iqaluit, Nunavut to discuss models of care and strategies to improve access to care, health outcomes, and overall patient experience with cancer care. The outcome of this conference was planned to be shared at the WCLC but due to Covid-19, the conference has been postponed.

Healthy Dietary Choices and Physical Activity Participation in the Canadian Arctic: Understanding Nunavut Inuit Perspectives on the Barriers and Enablers.

Background: Research shows that unhealthy diets and low physical activity are associated with high rates of obesity-linked chronic diseases amongst Nunavut Inuit. To provide contextual insights and deepen our understanding of the factors that underlie these lifestyle choices, we explored the perspectives of Nunavut Inuit on the barriers and enablers of healthy diets and physical activity participation in the community of Iqaluit. Methods: One-on-one semi-structured photo-elicitation interviews were conducted with 16 participants of 18 years and over (10 women, six men). The interviews uncovered the participants’ perspectives on the factors influencing healthy diets and physical activity in their community. Interviews were audio-recorded, transcribed, and uploaded to QSR NVIVO Version 12. Data analysis was achieved using an inductive thematic approach. Results: Six main factors were identified as barriers or enablers to energy balance-related behaviors: cost and affordability of healthy choices; availability of traditional foods and activities; weather conditions and climate change; infrastructure and community resources; social networks of family and friends; and effect of substance use. Conclusion: This study identified six broad areas that should be considered while mapping out interventions to reduce the burden of obesity-related chronic diseases in Nunavut communities.

Determinants, effects, and coping strategies for low-yield periods of harvest: a qualitative study in two communities in Nunavut, Canada

Food sovereignty among Inuit in Nunavut, Canada has long meant year-round harvest of country (hunted, fished, or gathered) food. In recent decades, climatic and non-climatic challenges have complicated these subsistence activities, threatening food security. We examine the meaning of country food, identify determinants of low-yield periods of country food harvest and their effects on community health, and summarize coping strategies and ideas for sustaining food security during these “leaner” periods. Thirty semi-structured interviews were conducted in July and August of 2018 with elders and/or hunters and trappers in Cambridge Bay and Pond Inlet. We found country food holds diverse meanings in the lives of our participants, including for their diet and nutrition, health, Inuit identity and traditions, practice of harvest and subsistence, and spirituality. Participants reported reduced wildlife populations, environmental or weather issues, changing wildlife migration patterns, and financial or equipment-related constraints as determinants of low-yield periods of harvest. Community health is impacted during lean periods across four interrelated dimensions: “craving” of country food, physical health, mental health, and nutrition. Due to their lifelong reliance on country food, elders were described as being particularly vulnerable and are prioritized within the traditional food sharing system. The most commonly cited coping strategies were turning to intra- or inter-community food sharing networks for country food and purchasing groceries. To support communities during low-yield periods of harvest, participants suggested increased support for Hunters and Trappers Organizations to acquire country food for community distribution, as well as greater financial and equipment support for harvesters.

Her Majesty’s Ships Erebus and Terror and the Intersection of Legal Norms

This article examines three main bodies of law that apply to the discovery of Her Majesty’s Ships Erebus and Terror. These ships set sail from England in 1845, became trapped in ice in what is now the Canadian Arctic Archipelago, and were not re-discovered until 2014 and 2016. Public international law is relevant to the inquiry insofar as this body of law deals with immunity claims with respect to warships and state owned ships and property, and also establishes the rights of the coastal state with respect to the various maritime zones and activities within those zones. The UNESCO Convention of 2001 on the Protection of the Underwater Cultural Heritage is also relevant when considering the rights and obligations of states with respect to sunken vessels. In addition to the general body of public international law, the article also examines three bilateral agreements between the United Kingdom of Great Britain and Northern Ireland and Canada with respect to the wrecks. These agreements—part treaty, part private law arrangements—form a second specialized body of relevant law. The final part of the paper examines how the status of the vessels is also governed by the terms of the Nunavut Land Claims Agreement between Canada and the Inuit of Nunavut, the source of the third body of relevant laws.

Suicide amongst the Inuit of Nunavut: An Exploration of Life Trajectories.

This article reports results of the life trajectories from 92 Inuit who died by suicide, matched for age and gender with 92 living-controls. A proxy-based procedure and semi-structured interviews with informants were conducted to obtain trajectories of developmental events occurring over the life course for suicide and community-matched controls. Results from this research indicate two different trajectories that differentiate the control-group from the suicide-group throughout the life course. Even though the number of suicide attempts are similar between both groups, the suicide-group had a more important burden of adversity, which seemed to create a cascading effect, leading to suicide.

A review of health and wellness studies involving Inuit of Manitoba and Nunavut

ABSTRACT The purpose of this review is to summarise past Inuit health and wellness studies in Manitoba and the Kivalliq region of Nunavut to provide a snapshot of the types of studies available and identify the gaps in knowledge. Research to date has largely been disease-based and often provides comparisons between Indigenous and non-Indigenous people. Distinct Inuit experiences are rarely written about from an Inuit perspective. However, Inuit Tapiriit Kanatami, the national organisation of Inuit in Canada, and Pauktuutit Inuit Women of Canada have been leaders in strengths-based community research and publications that address priorities determined by the Inuit, including the 2018 Inuit Tapiriit Kanatami document National Inuit Strategy on Research (132).

EP1.11-01 Lung Cancer Screening and Canada’s Inuit: A Missed Opportunity

Inuit peoples account for 0.2% of Canada’s population. Lung cancer rates in this population are disproportionately high for both genders with Canada’s Inuit having the highest incidence of lung cancer in the world. Outcomes are also poor with median survival for all stages combined in Nunavut being approximately 10 months. Lung cancer screening with low dose CT scan is being implemented in many countries, and a pilot program exists in Ontario, Canada. However, the screening model may not be appropriate for the Inuit. A literature review was performed regarding lung cancer screening, specifically with reference to the Inuit. Several challenges must be considered for implementation of lung cancer screening with the Inuit population. The Prostate, Lung, Colorectal and Ovarian Screening Trial model (PLCO[M2012]) is the risk prediction model used in the Ontario Lung Cancer Screening Pilot for People at High Risk. This requires individuals to be between ages 55-74 and to have smoked daily for at least 20 years during their life. The average life expectancy among Inuit is 72 years, compared to 82 years for Canadians overall. Using this model where the average life expectancy is lower than the upper limit of eligibility restricts its applicability. Smoking rates among this indigenous group are approximately 3 times higher than the rest of Canada, which indicates a clear need for screening where a higher proportion of the population would be eligible. Nunavut is a vast land area of around 2 million square kilometres, with a population of approximately 35,000. The logistics of providing screening in remote communities only connected by air travel is therefore daunting. Other dominant health issues among the Inuit of Nunavut are high rates of tuberculosis, therefore screening CT scans may be further complicated by higher false positive scans requiring established algorithms for management of all abnormal scans. With the Inuit population growing faster than the rest of Canada, yet experiencing a reduced lifespan as compared to other Canadians, there is an opportunity to address the inequity that may be created with the current eligibility model used for screening in Ontario. Furthermore, current recruitment strategies and eligibility assessments are not well suited to this group’s unique background. The current PLCO risk prediction model used in Ontario may not offer the best benefit for screening in this population while careful thought about how this group is recruited is also required to minimize barriers experienced by this vulnerable population.

MA22.07 A Culturally Safe Advocacy Model of Care for Inuit Cancer Patients and Their Families

The Ottawa Hospital is the tertiary care center for Inuit living in the Baffin Island region of Nunavut, in Canada’s far North. Inuit – once relatively cancer free – now have among the highest lung cancer rates in the world (Young et al., 2016). Approximately 30% of Inuit diagnosed with cancer between 2000 and 2010 did not access any cancer services (Asmis, 2016), for which they must travel thousands of kilometers where they are displaced from family, community and culture. Colonization has had a detrimental impact on the social determinants of health for Inuit in Nunavut and has created a lack of trust in government institutions. This context creates an advocacy need at the individual and systems level to address access and equity issues, with the goal of advancing positive health outcomes. The Champlain Indigenous Cancer Program (CICP) team has developed a patient-centered, culturally appropriate, land-based approach to support Inuit patients using the principles of the “Supportive Care Framework” (Fitch, 1994) as a guiding ideology. Recognizing the social and economic inequities (Inuit Tapiriit Kanatami, 2019), the Nurse Navigator developed an unconventional approach to connect with Inuit patients. She prioritizes developing therapeutic, trusting relationships with patients and families based on the observation that Inuit patients often feel most comfortable outside the confines of a hospital office. Developing these relationships on the land has become a cornerstone of her work. The approach that the CICP has implemented has achieved far-reaching success. Between the first six months and latest six months of tracking (through 2017-2018) there has been a 400%+ increase in patient encounters with the Nurse Navigator role. Clinicians report an increased awareness and understanding of the unique context of Inuit patients and families, resulting in increased numbers of referrals to CICP. Within the Inuit community, there is a recognition and appreciation of the Inuit-specific approach, leading to an increase in self-referrals. The CICP is continuing to actively pursue tracking and reporting initiatives to demonstrate a shift in access to cancer care and the long-term outcomes for Inuit patients and families. The program is also continuing to increase access to cultural awareness education for staff to combat misunderstandings about Inuit. By sharing experiences and stories garnered through this work, the Nurse Navigator will help attendees to question and redefine the perception of the traditional role of a cancer nurse.

Environmental and Motivational Determinants of Physical Activity among Canadian Inuit in the Arctic.

Background: Canadian Inuit have transited from a physically active hunter-gatherer subsistence lifestyle into sedentary ways of life. The purpose of the current study was to measure physical activity levels among Nunavut Inuit adults, and explore the socio-cognitive and environmental factors influencing the number of steps taken per day. Method: Inuit and non-Inuit adults (N = 272) in Nunavut participated in a seven-day pedometer study during summer and winter seasons. Participants were asked to complete the Neighbourhood Environmental Walkability Scale (NEWS) and Behavioral Regulation in Exercise Questionnaire (BREQ-3). Data analyses included descriptive statistics, hierarchical linear regression, and tests of mediation effects. Results: Participants had limited to low activity at a rate of 5027 ± 1799 and 4186 ± 1446 steps per day, during summer and winter, respectively. There were no seasonal and age effects on the number of steps. Gender effects and community differences were observed. Perceived infrastructure and safety as well as land use mix diversity were found to be positive environmental correlates of steps taken, which were partially mediated by identified motivational regulation. Conclusion: Physical activity levels among Nunavut adults are generally low, but can be promoted by improving the external physical environment and internal motivational regulation.

A Scoping Review of Obesity among Indigenous Peoples in Canada.

Indigenous populations in Canada are heavily affected by the burden of obesity, and certain communities, such as First Nations on reserve, are not included in the sampling framework of large national health surveys. A scoping review of ever published original research reporting obesity rates (body mass index ≥ 30), among adult Indigenous peoples in Canada, was conducted to identify studies that help close the Canadian Community Health Survey (CCHS) data gap for obesity prevalence in Indigenous populations in Canada and to make comparisons based on ethnicity, sex, time, and geography. First Nations on reserve with self-reported height and weight had higher rates of obesity (30%–51%) than First Nations off reserve (21%–42%) and non-Indigenous populations (12%–31%) in their respective province or territory, with the exception of Alberta, where rates in First Nations on reserve (30% and 36%) were lower or similar to those reported in First Nations off reserve (38%). First Nations on reserve with predominantly measured height and weight (42%–66%) had higher rates of obesity compared to Inuit in Quebec (28%), Nunavut (33%), and Newfoundland and Labrador (41%), while the rates were similar to those in Inuit in Northwest Territories (49%). Obesity in these large studies conducted among Inuit was based solely on measured height and weight. Studies in First Nations and Inuit alike showed higher prevalence of obesity in women, as well as an increase with time. No recent studies measured the obesity rates for First Nations in Yukon and Northwest Territories and for Métis living in settlements of Northern Alberta. Researchers are encouraged to conduct total diet studies in these regions, and to use existing data to analyze the associations between obesity, road access, latitude, food environment, and traditional food intake, to further inform community planning and development.

Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study

Tuberculosis continues to disproportionately affect many Indigenous populations in the USA, Canada, and Greenland. We aimed to investigate whether population-based tuberculosis-specific interventions or changes in general health and socioeconomic indicators, or a combination of these factors, were associated with changes in tuberculosis incidence in these Indigenous populations. For this population-based study we examined annual tuberculosis notification rates between 1960 and 2014 in six Indigenous populations of the USA, Canada, and Greenland (Inuit [Greenland], American Indian and Alaska Native [Alaska, USA], First Nations [Alberta, Canada], Cree of Eeyou Istchee [Quebec, Canada], Inuit of Nunavik [Quebec, Canada], and Inuit of Nunavut [Canada]), as well as the general population of Canada. We used mixed-model linear regression to estimate the association of these rates with population-wide interventions of bacillus Calmette-Guérin (BCG) vaccination of infants, radiographic screening, or testing and treatment for latent tuberculosis infection (LTBI), and with other health and socioeconomic indicators including life expectancy, infant mortality, diabetes, obesity, smoking, alcohol use, crowded housing, employment, education, and health expenditures. Tuberculosis notification rates declined rapidly in all six Indigenous populations between 1960 and 1980, with continued decline in Indigenous populations in Alberta, Alaska, and Eeyou Istchee thereafter but recrudescence in Inuit populations of Nunavut, Nunavik, and Greenland. Annual percentage reductions in tuberculosis incidence were significantly associated with two tuberculosis control interventions, relative to no intervention, and after adjustment for infant mortality and smoking: BCG vaccination (-11%, 95% CI -6 to -17) and LTBI screening and treatment (-10%, -3 to -18). Adjusted associations were not significant for chest radiographic screening (-1%, 95% CI -7 to 5). Declining tuberculosis notification rates were significantly associated with increased life expectancy (-37·8 [95% CI -41·7 to -33·9] fewer cases per 100 000 for each 1-year increase) and decreased infant mortality (-9·0 [-9·5 to -8·6] fewer cases per 100 000 for each death averted per 1000 livebirths) in all six Indigenous populations, but no significant associations were observed for other health and socioeconomic indicators examined. Population-based BCG vaccination of infants and LTBI screening and treatment were associated with significant decreases in tuberculosis notification rates in these Indigenous populations. These interventions should be reinforced in populations still affected by tuberculosis, while also addressing the persistent health and socioeconomic disparities. Public Health Department of the Cree Board of Health and Social Services of James Bay.