Aboriginal People Research Articles

Factors Influencing the Choice Between Multi-Target Stool DNA and Colonoscopy for Colorectal Cancer Screening Among Alaska Native Peoples

The Alaska Tribal Health System is increasing colorectal cancer (CRC) screening among Alaska Native (AN) peoples, who experience the highest CRC rate in the world. Through a clinical trial (NCT04336397), AN people living in rural/remote Alaska were offered either the previously unavailable multi-target stool DNA test (mt-sDNA; Cologuard®) or colonoscopy. From April 2022 to August 2024, 113 (59%) people who completed mt-sDNA testing and 51 (39%) who completed a colonoscopy procedure participated in a survey on factors influencing their screening test choice. The majority of mt-sDNA participants (79%) were aware of the colonoscopy option, while most colonoscopy participants (72%) reported being unaware of the mt-sDNA option. Key mt-sDNA preference themes included not having to travel, less time commitment, childcare and work responsibilities, physical limitations, greater convenience, and the test being less invasive and dangerous than a colonoscopy. In contrast, colonoscopy preference themes included wanting to adhere to screening recommendations, be proactive about preventative health, family history of cancer, awareness of the higher CRC risk among AN peoples, as well as the belief that colonoscopy is more reliable and accurate since it is performed by medical providers. These findings underscore the complex factors influencing CRC screening preferences among rural and remote AN people. Limited access to medical facilities, financial burdens, and personal commitments, along with personal factors, have a substantial bearing on the screening decision-making process. Recognizing and addressing these multifaceted influences can help CRC screening programs better meet community member needs and preferences, ultimately improving screening rates and colorectal health outcomes.

Impact of a multidisciplinary diabetes care programme on glycaemic and metabolic outcomes in regional and First Nations communities: a retrospective observational study.

Type 2 diabetes mellitus (T2DM) poses a significant public health challenge in Australia, particularly among underserved populations such as First Nations people and rural communities. In response, the Together Strong Connected Care (TSCC) programme was developed to address these disparities by offering a culturally appropriate, multidisciplinary approach to diabetes management in a regional hospital setting. The aim of the study was to assess the impact of the TSCC programme on glycaemic and metabolic control in people living with diabetes. This was a retrospective observational study. Baseline characteristics, including age, gender, ethnicity and clinical measures, were collected. The primary outcome was the change in HbA1c over 12 months. Statistical analysis included descriptive analysis, univariate comparative analysis, paired t-tests for change in outcomes and multivariate linear regression analysis. The study included 119 patients, divided into those who participated in the TSCC programme (n = 68) and those who declined participation (n = 51). The study participants had a mean age of 55.71 years, with 58.82% identifying as female. The mean baseline HbA1c was 8.25% (SD = 2.60) and mean baseline weight was 97.38 kg (SD = 28.81). People in the TSCC group had significantly greater reductions in HbA1c (-1.65%, P < 0.001) compared to the no-TSCC group (+0.02%, P < 0.001). After adjusting for confounders, TSCC participation remained independently associated with improved glycaemic control (β = -0.78, P < 0.001), particularly in patients with T2DM. The TSCC programme significantly improved glycaemic control in regional First Nations patients, supporting the effectiveness of culturally appropriate, multidisciplinary care models in managing diabetes in underserved communities. Further research is warranted to evaluate long-term outcomes of similar interventions.

Dispossession Cycles and Resistance: Historical Continuums in the Deportation of First Nations Peoples

This article surveys the historical and contemporary context of Indigenous peoples’ entanglement in systems of criminal justice and migration control. Government attempts to remove First Nations peoples from Australia under visa cancellation provisions present a striking contemporary development in border control. Despite the High Court of Australia’s ruling that ‘Aboriginal Australians’ cannot be ‘aliens’ and therefore subject to visa cancellation provisions, Indigenous peoples continue to be targeted for exclusion and subject to the gaze of border control authorities. We use documentary research and draw on two case studies to explore the historical use of deportation to target First Nations peoples. We identify previous attempts to achieve law reform to rectify past injustices and prevent Indigenous peoples from being caught up in migration laws aimed at excluding non-citizens. We review the extensive literature on Love v Commonwealth and analyse the expanded visa cancellation provisions that have resulted in increased numbers of people being targeted for removal, and removed, from Australia. When analysed against the long shadow of colonisation, we argue that these applications of criminal and migration law represent a continuation of attempted exclusion and dispossession that has been, and continues to be, actively resisted by Indigenous peoples. In analysing the cyclical nature of dispossession and its resistance, the complex interaction of criminal and migration law can be seen to have created novel impacts for First Nations peoples in Australia.

Accumulation by repossession: Capitalist settler colonialism in Coast Salish territory

Several Coast Salish First Nations are actively involved in land reclamation and redevelopment in the greater Vancouver region (Canada). Through their for-profit development corporations, entities like Nch’ḵay̓ Development Corporation (Squamish Nation) and the joint-venture Musqueam, Squamish and Tsleil-Waututh Development Corporation have become key players in the lucrative Vancouver property market in partnership with other public and private land developers. Situating multibillion-dollar holdings like the Jericho and Sen̓áḵw projects that further highest-and-best-use appraisal within the context of the area’s settler colonial history, we argue that land repossession and its associated development was made possible through settler colonial forms like corporate decisions, legal judgements and political frameworks that rendered land ready for disposal. Repossession thus created options for new types of reintegration into capitalist spheres, primarily as residential real estate projects, independent from specific configurations of land tenure as fee simple or reserve land. Advancing the concept of ‘accumulation by repossession,’ a recursive moment associated with dispossession, we describe how First Nations peoples are regaining land title and political-economic control at the same time as their development corporations are promoting urban capital accumulation through privatized profit-making. Land ‘improvement’, speculation, and the creation of private real property have driven Indigenous dispossession in Coast Salish territory just as they now shape repossession.

Cancer statistics, 2025.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2021) and mortality data collected by the National Center for Health Statistics (through 2022). In 2025, 2,041,910 new cancer cases and 618,120 cancer deaths are projected to occur in the United States. The cancer mortality rate continued to decline through 2022, averting nearly 4.5 million deaths since 1991 because of smoking reductions, earlier detection for some cancers, and improved treatment. Yetalarming disparities persist; Native American people bear the highest cancer mortality, including rates that are two to three times those in White people for kidney, liver, stomach, and cervical cancers. Similarly, Black people have two-fold higher mortality than White people for prostate, stomach, and uterine corpus cancers. Overall cancer incidence has generally declined in men but has risen in women, narrowing the male-to-female rate ratio (RR) from a peak of 1.6 (95% confidence interval, 1.57-1.61) in 1992 to 1.1 (95% confidence interval, 1.12-1.12) in 2021. However, rates in women aged 50-64 years have already surpassed those in men (832.5 vs. 830.6 per 100,000), and younger women (younger than 50 years) have an 82% higher incidence rate than their male counterparts (141.1 vs. 77.4 per 100,000), up from 51% in 2002. Notably, lung cancer incidence in women surpassed that in men among people younger than 65 years in 2021 (15.7 vs. 15.4 per 100,000; RR, 0.98, p = 0.03). In summary, cancer mortality continues to decline, but future gains are threatened by rampant racial inequalities and a growing burden of disease in middle-aged and young adults, especially women. Continued progress will require investment in cancer prevention and access to equitable treatment, especially for Native American and Black individuals.

La condition des communautés minoritaires dans le roman africain contemporain : une analyse de Gahi ou l’affaire autochtone de Henri Djombo

This study analyses the condition of minorities, especially those of the indigenous (pygmies) in the novel Gahi ou l’affaire autochtone by Henri Djombo. Disenfranchised, oppressed and threatened with extinction, Aboriginal people are seen through the lens of stereotypes based on their sociological, cultural and identity differences. Considered as savages, they are ostracized by the Bantu people who deny them the right to exist. But the destruction of indigenous people leads to the destruction of the forest which is their natural living space. By the survival instinct they don’t allow themselves to be destroyed; they put in place strategies of resistance to keep themselves alive and to save their culture and identity. Based on that application of postcolonial criticism and ecocriticism, the study analyses the modalities of fictionalizing of the condition of this social category. The author calls for humanization of relationship between communities, despite their differences, and for a better consideration of human and environmental concerns.

Characteristics, care and support needs of older Victorians requiring a government-funded Home Care Package: An observational study.

To describe sociodemographic characteristics and comprehensive day-to-day care and support needs of older Victorians requiring government-funded home-based aged-care, and to explore associations between vulnerability factors and complexity indicators in this population. A population-based observational study was conducted using de-identified, routinely collected aged-care assessment data for Victorians approved for a Home Care Package (HCP) between January 2019 and June 2022. The study population (n = 94,975 individuals), approved for one of four HCP levels (Levels 1 (5%), 2 (38%), 3 (34%) or 4 (24%)), was aged 82 years on average (SD 7.6), commonly born outside Australia (48%), with people of higher socio-economic status more likely to be approved for a high-level HCP. Advanced care and support needs such as for showering (53%) and dressing (43%) were common, with higher overall needs when cognitive and behavioural concerns such as short-term memory loss (75%) or agitation (21%) were present. 79% reported at least one vulnerability factor such as being socially isolated, culturally and linguistically diverse, or Aboriginal and Torres Strait Islander peoples, and 49% reported at least one complexity indicator. The three most prevalent complexity indicators were significant cognitive changes (29%), self-neglect (17%) and emotional/mental health issues (11%), which were generally positively associated with vulnerability factors. This population-based study provides evidence of the diverse sociodemographics, and often advanced day-to-day mobility, functional, physical, cognitive, behavioural, psychological and psychosocial care and support needs of people requiring home-based aged-care. It also highlights the multifaceted complexities within this population. Results could inform home care service-delivery models and workforce skill-mix requirements to efficiently and safely meet these needs.

How do midwives learn about, understand, and integrate Cultural Safety into their care of First Nations women and families? A qualitative exploration.

Midwives are required to provide care based on Cultural Safety for First Nations women and families. Recent literature has suggested that midwives' understanding of Cultural Safety and how it translates into their practice differs widely. This disparity requires further exploration. The Australian professional midwifery codes and standards state that there is a requirement to provide care based on Cultural Safety. It is critical to understand how First Nations people's history and culture impacts their health and wellbeing, requiring midwives to recognise how this may impact care. To determine Australian midwives' knowledge and understanding of Cultural Safety and how this translates into their practice when caring for First Nations women and families. A qualitative study was undertaken. Data were collected via semi-structured interviews with 12 midwives practicing in Australia. Data were transcribed and thematically analysed. Three themes were identified: 'Society and Systems', 'Knowingness versus Understanding', and 'Personal Qualities, Engagement and Partnerships' which highlight the strengths and deficits of Cultural Safety education and its integration into midwifery practice in Australia. Health systems providing maternity care remain rooted in Western biomedical philosophies, which influences the practice of Cultural Safety at all levels. Midwives are beginning to understand the ongoing impact of colonisation on the health and wellbeing of First Nations families, but still face challenges when striving to provide culturally safe care. Cultural Safety must be valued at an organisational level, in which midwives can engage in authentic, maternity-based educational programs led by suitably prepared educators.

A cross-sectional study of differences in medication for opioid use disorder receipt among pregnant people enrolled in Medicaid in Oregon, United States.

Medication is the gold standard to support a healthy pregnancy for pregnant people with opioid use disorder (OUD). This study measured inequities and differences in OUD medication treatment among pregnant people in Oregon, USA. Our study population consisted of Medicaid enrollees across the US state of Oregon who had at least one live hospital birth between 2012 and 2020 and one diagnosis of OUD prenatally (n = 4363). We measured differences in demographic characteristics (age, race, ethnicity, location) among those with and without medication for OUD in the prenatal through 3-months postpartum period (any medication use, and by type), and compared exclusive methadone versus buprenorphine receipt. We report unadjusted and adjusted odds ratios. Adjusted odds ratios for medication for OUD were lower among American Indian/Alaska Native pregnant people compared with White pregnant people [adjusted odds ratio (aOR) 0.59 (95% confidence interval [CI] = 0.42, 0.83)], younger pregnant people compared with those aged 30-34 years [aOR, ages 15-19: 0.1 (95 CI = 0.06, 0.18); aOR, ages 20-24: 0.58 (95 CI = 0.49, 0.69)] and rural pregnant people compared with those in urban communities [aOR 0.58 (95 CI = 0.5-0.67)]. Rural pregnant people with OUD also had lower odds of methadone receipt [aOR 0.23 (95 CI = 0.17, 0.3)] and higher odds of buprenorphine receipt [aOR 3.99 (95 CI = 2.97, 5.35)] than other people in this study. Among those who received medication, Black pregnant people had increased odds of receiving methadone compared with buprenorphine [aOR 2.09 (95 CI = 1.1-3.97)]. In Oregon, USA, inequities in receipt of any medication for opioid use disorder were observed among pregnant people who identified as American Indian or Alaska Native, younger than 25, and living in rural communities. Black pregnant people in Oregon, USA, were more likely to receive methadone than buprenorphine.

'Mob aren't staying when there's no support': Enablers and barriers of recruitment and retention of First Nations midwifery students - A qualitative study.

Aboriginal and Torres Strait Islander (hereafter referred to as First Nations) childbearing women report negative experiences from a lack of culturally safe maternity care. Evidence supports improved health outcomes for First Nations women and infants when cared for by First Nations midwives. There are barriers to First Nations students accessing university, particularly nursing and midwifery students, with a lack of evidence exploring the experiences of First Nations midwifery students. This study aims to understand the impact of the current strategies to improve recruitment and retention of First Nations midwifery students and identify further innovations. A semi-structured yarning circle was held with six Bachelor of Midwifery students at a university in Queensland, Australia. Three key categories emerged: student recruitment, student retention and student success. Enablers included culturally appropriate recruitment, partnerships with other First Nations peoples, incorporating First Nations ways of Knowing, Being, and Doing, culturally safe support, placements and mentorship, and identification and representation. Barriers included financial impacts, experiences of racism and lack of Cultural Safety and humility. Overall, students felt the university provided a culturally safe environment and implemented strategies that supported students' recruitment, retention and success in the degree. They suggested improvements to current strategies and new ideas for implementation. Strategies to improve recruitment and retention of First Nations midwifery students are imperative to close the gap in educational attainment and improve health outcomes for First Nations peoples. These strategies need to be multi-layered, culturally appropriate and implement a whole of university approach.

Racial and Ethnic Trends in Cesarean Delivery on Maternal Request.

To evaluate race and ethnicity differences in rates of cesarean delivery on maternal request (CDMR) in nulliparous, term, singleton, vertex presentation (NTSV) cesarean deliveries. We conducted a retrospective cohort study of NTSV cesarean deliveries within our institution from 2016 to 2020. The primary outcome was CDMR and the primary predictor was maternal race and ethnicity. Multivariable logistic regression models were used to evaluate associations between race and ethnicity, CDMR, and various maternal and perinatal factors. Among 12,351 NTSV cesarean deliveries, 594 (4.81%) underwent CDMR; 4605 (37.28%) identified as non-Hispanic White, 3731 (30.21%) as Asian/Hawaiian/Pacific Islander, 2840 (22.99%) as Hispanic, 785 (6.36%) as Black, and 390 (3.16%) as multiple races/American Indian/Alaskan Native. Adjusted models showed increased odds of CDMR among non-Hispanic White people. Multiple races/American Indian/Alaskan Native people had the lowest odds of CDMR compared to non-Hispanic White people (adjusted OR [aOR] = 0.48, 95% CI 0.26-0.82), followed by Asian/Hawaiian/Pacific Islander (aOR = 0.58, 95% CI 0.47-0.72), Black (aOR = 0.61, 95% CI 0.40-0.89), and Hispanic (aOR = 0.70, 95% CI 0.55-0.88) people. Non-Hispanic White people undergo CDMR more frequently compared to Asian/Hawaiian/Pacific Islander, Black, and Hispanic people. Our findings are notable in light of the growing body of research demonstrating that White people have the lowest odds of cesarean delivery overall. Profound racial disparities in maternal obstetric outcomes exist in the United States. It is well established that non-Hispanic Black people have disproportionately higher cesarean birth rates and higher rates of birth complications, including maternal death. Racial and ethnic differences in rates of primary elective cesarean delivery, or cesarean delivery on maternal request, are not well understood. This research shows that non-Hispanic White people have more cesarean deliveries on maternal request than other racial and ethnic groups among low-risk nulliparous patients.

Culturally safe physiotherapy care: how this looks and feels for Aboriginal and Torres Strait Islander peoples.

Background Understanding the experiences of Aboriginal and Torres Strait Islander peoples as healthcare recipients is essential for delivering culturally safe physiotherapy care; however, the literature inadequately explores these experiences. This study aimed to explore the experiences of Aboriginal and Torres Strait Islander peoples who have engaged with physiotherapists and understand their perspectives on how physiotherapists can provide culturally safe care in the community. Methods Semi-structured interviews were conducted with adult (aged >18years) self-identified Aboriginal and Torres Strait Islander peoples (n =12) who had received physiotherapy care within a community setting within the previous 3months. A First Nations methodology approach alongside reflexive thematic analysis was used to interpret the data. Results Four themes were generated: (1) building trust through yarning; (2) acknowledging and respecting culture; (3) creating a culturally safe environment; and (4) the importance of professional training. Conclusions Aboriginal and Torres Strait Islander peoples have expressed that physiotherapists can establish trust with their patients by dedicating time to develop a therapeutic relationship and by demonstrating respect for their culture. It is essential for physiotherapists to carefully consider the physical environment in which they deliver care to ensure it is welcoming and culturally safe for Aboriginal and Torres Strait Islander peoples. Physiotherapists should undertake professional development to immerse themselves in First Nations culture and history through connecting with community. This study offers insights into the lived experiences of Aboriginal and Torres Strait Islander peoples receiving care in the community and provides recommendations that may assist physiotherapists, alongside other community-based health professionals, to provide culturally safe care.

Describing COVID-19 immunizations for First Nations people on-reserve in Alberta using real-time integration of point of care and provincial data.

COVID-19 profoundly impacted First Nation peoples. Historically, records of on- and off-reserve vaccine delivery have been fragmented. For the first time in Canada, we aimed to describe complete immunization rates, on- and off-reserve vaccine delivery, for COVID-19 in Alberta, Canada among First Nations on-reserve. Fifteen First Nations in Alberta, Canada participated in this prospective, descriptive cohort study whereby real-time integration (RTI) was deployed to reconcile COVID-19 vaccine delivery records on-reserve (local database) to those reported off-reserve (provincial database) between January 3, 2021-December 1, 2022. Immunization data (individuals ≥6months) were aggregated into 100 one-week intervals. Weekly immunization rates were assessed by age, sex, community size, and location of vaccine administration (on- or off-reserve) using multiple linear regressions and chi2 tests. 50,758 First Nation people were included, approximately 50% of whom were female. RTI data showed that 64% received at least one dose of vaccine with higher rates in older First Nation adults. No sex differences were observed. Nearly half received their first dose off-reserve and would have been missed by local public health on-reserve (local database) without the implementation of RTI. First dose immunization rates rapidly increased with graduated First Nation-specific eligibility and provincial incentives promoting uptake (p<0.001). We accurately assessed complete immunization rates among First Nation people receiving services on-reserve irrespective of delivery of immunizations on- or off-reserve through deployment of an innovative RTI approach. Without these RTI advances, immunization rates would have been substantially under-reported and may have misdirected public health initiatives around vaccine uptake. RTI should be a priority for all provinces in Canada to ensure accurate coverage rates for First Nation people.

Oral health services provided for Aboriginal and Torres Strait Islander peoples in Australia: a scoping review.

ObjectiveThe shortage of oral health professionals in rural and remote regions of Australia directly impacts the access to oral health services for people who live in these regions, including Aboriginal and Torres Strait Islander peoples. This scoping review aims to explore where and how these services are provided for Aboriginal and Torres Strait Islander peoples and the relevant workforce model used.MethodsElectronic databases, including MEDLINE, EMBASE, Cochrane, and CINAHL, were searched. Grey literature searches included the Australian Indigenous HealthInfoNet webpage, Australian Institute of Health and Welfare, and Advanced Google search.ResultsOral health services were classified into the following categories: (1) clinical oral health services, (2) oral health promotion to improve oral health awareness, knowledge, attitudes, behaviours, or skills at patient/community level, and (3) oral health promotion including the use of single clinical interventions (e.g. fluoride varnish). Services were delivered in a variety of settings including community health clinics and schools or using mobile dental equipment. Both the dental and non-dental workforce were utilised to provide these services. Limited data were found on the experiences and challenges faced by the workforce that provide these services.ConclusionOral health services provided for Aboriginal and Torres Strait Islander peoples in rural and remote regions of Australia vary in service type, location, and workforce involved. Future research is required to explore the experiences and support of this workforce. This can enhance delivery of culturally and clinically safe oral health services for Aboriginal and Torres Strait Islander peoples, particularly in rural and remote regions.

Value-based health care for Aboriginal peoples with chronic conditions in the Northern Territory: a cohort study.

ObjectiveThis study aimed to investigate associations between patient activation, healthcare use and clinical outcomes for Aboriginal peoples living with a chronic condition in remote Northern Territory (NT) communities.MethodsA retrospective cohort study was undertaken between 2 April 2020 and 1 April 2022 to measure activation and its associations with chronic conditions secondary prevention treatment targets and healthcare usage: hospitalisations, potentially preventable hospitalisations and patient travel. All Aboriginal peoples enrolled at NT Government health services, who had one or more preventable chronic conditions and were prescribed one or more oral chronic condition medications identified in the Primary Care Information System, were included in the study. Patient activation was defined as a 90-day medicine possession ratio ≥80%. An activated patient has the belief, knowledge, skills and behaviours to manage their chronic conditions.ResultsA total of 5356 patients met the inclusion criteria; 9% of these patients were activated. Activated patients were older and sicker but were significantly more likely to achieve treatment targets for glycosylated haemoglobin, blood pressure and total and low-density lipoprotein cholesterol. Activated patients used more primary healthcare and outpatient resources and had a non-significant trend for less acute care use.ConclusionsThe remote NT Government primary healthcare system is providing low-value chronic conditions care for patients. As identified by Aboriginal peoples, strengthening culturally appropriate self-management support could lead to more patients becoming activated, better health outcomes and decreased acute care demand.

Exploring a new Biocultural Credit Assessment Framework: case study for Indigenous-led fauna management from the Laynhapuy Indigenous Protected Area, Australia

Warning This article contains names and/or images of deceased Aboriginal Peoples. Context The global biological-diversity crisis has resulted in a widespread uptake of market mechanisms to promote conservation. Despite widespread recognition of Indigenous-led contribution to biodiveristy conservation, market mechanisms are often derived from Western scientific approaches that do not appropriately incorporate Indigenous cultural values and objectives. Aims This research sought to produce a proof-of-concept case study for a novel ‘Biocultural Credit Assessment Framework’ (BCAF) to facilitate design of an Indigenous-led biocultural conservation project in response to ongoing decline of culturally significant fauna in north-eastern Arnhem Land, Australia. The BCAF is underpinned by Indigenous identification of project dimensions, combining biological and cultural values and aspirations, which could form assessable foundations of a potential Indigenous-led biocultural credit project. Methods Semi-structured interviews were conducted with nine Yolŋu Elders over 2 days. A three-stage thematic analysis using pre-defined coding categories and both latent and semantic level analysis were used to elucidate key components of a biocultural project from Elder responses, including biocultural concerns, actions, targets and indicators. Key results Yolŋu Elders expressed six key concerns about local fauna, including the following: that some animals were no longer seen; youth were not learning cultural knowledge; invasive-species impacts; reliance on shop food; and Western influences. These concerns were linked to three key targets, including improved cultural transmission, access and use of more bush foods, and seeing ‘species of decline’ again. Ten key indicator groups assessed by a mix of Indigenous and Western methodologies were identified and revolved around biophysical and cultural learning parameters to measure the impact of actions to progress targets. In total, six actions were identified, including spending more time on Country, science-based environmental management strategies and knowledge sharing. Conclusions The BCAF elucidated key components of an Indigenous-led biocultural conservation project as identified by Elders. A mix of biophysical and cultural learning indicators assessed both qualitatively and quantitatively could be used to feed into a potential biocultural credit market to enhance project delivery. Implications Further research is required to progress this conceptual framework with Cultural Advisors and real financial partners to further elucidate challenges, opportunities, and next steps towards an inclusive biocultural market.

Trace elements in Alaska's ice seals in the 2000s and 2010s.

Ringed (Pusa hispida), bearded (Erignathus barbatus), spotted (Phoca largha), and ribbon (Histriophoca fasciata) seals are ice-associated seals that are important subsistence resources for coastal Alaska Native people. These seals are also mid- to upper trophic level Arctic predators and primary prey of polar bears (Ursus maritimus). We analyzed concentrations of 19 trace elements in seal liver, kidney, muscle, and blubber, including arsenic, cadmium, lead, mercury, and vanadium due to their potential toxicity. We also measured monomethyl mercury, the more biologically available and toxic form of mercury, in a subsample of seals. We tested for differences in elemental concentrations by seal sex, age, and two periods, 2003-2007 and 2011-2016, to detect environmental trends, assess seal health, and explore trace elements in seal tissues as indicators of seal diet. Trace element concentrations were within ranges that were similar or below that previously measured for these species throughout their range in the Arctic and subarctic. We found relationships between concentration and seal sex or age, as well as differences between periods, with a notable decline over time in magnesium for bearded seal liver and kidney, and ringed and spotted seal liver. Relative concentrations of methyl mercury and total mercury among the four seal species matched known patterns of piscivory and pelagic feeding. Cadmium concentrations were highest in bearded and ribbon seals, possibly due to greater benthic feeding and consumption of squid, respectively. Tissue trace element concentrations from sick seals collected during the 2011-2016 Northern Alaska Pinnipeds Unusual Mortality Event did not differ from those of healthy subsistence harvested seals. Our analysis of trace elements in four Alaskan ice seal species can inform toxicological risk assessments regarding non-essential elements of concern and assessments of nutritional benefits regarding essential elements for seals and for the people and polar bears that eat them.

Sleep patterns among Aboriginal and Torres Strait Islander Peoples and non-Indigenous Australians: A South Australian descriptive exploratory study.

Irregularities with sleep patterns and behaviours are commonly observed in Australia, but there is lack of information regarding sleep patterns among Aboriginal or Torres Strait Islander adults. This study explores sleep patterns in Aboriginal or Torres Strait Islander adults, comparing it with non-Indigenous Australian adults in addition to investigating any potential effects on daytime behaviour. A total of 730 Aboriginal and Torres Strait Islander Peoples aged 18 years and above were included in the study. The participants completed a self-reported questionnaire on various aspects of sleep, such as difficulty falling asleep, waking up during the night, feeling well-rested upon waking, snoring loudly, gasping/choking during sleep, use of prescription medication and experiencing fatigue or sleepiness during the day. Additionally, the participants were interviewed using the 'Top End Sleepiness Scale' to report increased sleepiness during daily activities. The responses were compared with those of non-Indigenous Australians in the 2016 Sleep Health Foundation national survey, using questions that measures similar variables. Aboriginal and Torres Strait Islander Peoples experienced higher rates of sleep disturbances, including difficulty in falling asleep and waking in the night. Snoring and breathing pauses during sleep were more common in middle-aged men, and sleeping difficulties and daytime symptoms related to insufficient or unrefreshing sleep were more common in women. Sleep issues increased with age among adult Australians but were more common in the age group of 25-34 years for Aboriginal and Torres Strait Islander Peoples. The data suggest that Aboriginal and Torres Strait Islander adults report irregularities in sleep patterns. Early interventions and management of sleep habits could potentially have benefits for overall physical and mental health.

Evidence-based screening, clinical care and health education recommendations for Alaska Native peoples with prediabetes living in southcentral Alaska: findings from the Alaska EARTH follow-up study

ABSTRACT Pre-diabetes (pre-DM) is a strong predictor of diabetes (DM) over time. This study investigated how much of the recent increase in pre-DM identified among Alaska Native (AN) peoples living in urban southcentral Alaska may be due to changes in diagnostic methods. We used clinical and demographic data collected at baseline between 2004 and 2006 and at follow-up collected between 2015 and 2017 from the urban southcentral Alaska Education and Research Towards Health (EARTH) cohort. We used descriptive statistics and logistic regression to explore differences in demographic and clinical variables among the identified pre-DM groups. Of 388 participants in the follow-up study, 243 had A1c levels indicating pre-DM with only 20 demonstrating pre-DM also by fasting blood glucose (FBG). Current smoking was the sole predictor for pre-DM by A1c alone while abdominal obesity and elevated FBG-predicted pre-DM by A1c+FBG. No participants had an elevated FBG without an A1c elevation. A substantial portion of the rise in pre-DM found among urban southcentral AN peoples in the EARTH follow-up study was due to the addition of A1c testing. Pre-DM by A1c alone should be used to motivate behavioural changes that address modifiable risk factors, including smoking cessation, physical activity and weight management.

LIFE EXPECTANCY AND COVID-19 MORTALITY DISPARITIES AMONG NATIVE AMERICAN OLDER ADULTS IN WYOMING

Abstract Accumulated inequities contribute to health disparities. Striking evidence of this is found in Native older adults in Wyoming. The history of violence and racism against Native peoples in the US is a national shame. Documenting the health challenges experienced by Native older adults brings awareness and potential remedy to this racist history. American Indian and Alaska Native communities are a historically under-researched population and are at greater risk than non-Hispanic white older adults for many chronic conditions. The current study reports on results from the Wyoming Healthy Aging Data Reports (healthyagingdatareports.org). We compared community rates of life expectancy and COVID-19 mortality in Wyoming and in Fremont County (home to the largest proportion of older Native adults in WY). Data sources include US Census Bureau American Community Survey 2016-2020 (population characteristics), Robert Wood Johnson Foundation (community life expectancy), and the Wyoming Department of Health (COVID-19 infection and mortality rates). Small area estimation techniques were used to calculate rates, and ArcGIS software was used for mapping and geographic analyses. Results show an estimated 2,430 Native American older adults who are 55+ are living in Wyoming, and 56% of them reside in Fremont County. Life expectancy rates in Fremont County (73) are 5 years lower than the state average (78.1). There is also a 1.5x higher COVID mortality rate in Fremont County (513.7) as opposed to the state average (340.4). Communities that have experienced systematic discrimination and inadequate health care services have poor outcomes. Policy interventions to address such inequities are warranted.