Nations Communities In Ontario Research Articles

Indoor air quality in remote first nations communities in Ontario, Canada.

A recent study of the health of Indigenous children in four First Nations Communities in remote northwestern Ontario found that 21% of children had been admitted to hospital for respiratory infections before age 2 years. Here we report a detailed analysis of the housing conditions in these communities. We employed a variety of statistical methods, including linear regression, mixed models, and logistic regression, to assess the correlations between housing conditions and loadings of biocontaminants (dust mite allergens, fungal glucan, and endotoxin) and indoor concentrations of PM2.5, CO2, benzene, and formaldehyde. The houses (n = 101) were crowded with an average of approximately 7 people. Approximately 27% of the homes had sustained CO2 concentrations above 1500 ppm. Most homes had more than one smoker. Commercial tobacco smoking and the use of non-electric heating (e.g., wood, oil) were associated with increased fine particle concentrations. Over 90% of the homes lacked working Heat Recovery Ventilators (HRVs), which was associated with increased fine particle concentrations and higher CO2. Of the 101 homes, 12 had mold damage sufficient to increase the relative risk of respiratory disease. This resulted from roof leaks, through walls or around the windows due to construction defects or lack of maintenance. A similar percentage had mold resulting from condensation on windows. Endotoxin loadings were much higher than any previous study in Canada. This work provides evidence for the need for more effort to repair existing houses and to ensure the HRVs are properly installed and maintained.

Collaboration with First Nations Communities to Produce Tailored Community-Driven Results

IntroductionWhile First Nations communities are well aware of the unique health challenges and requirements of their populations, research evidence is often needed to support this knowledge. First Nations communities face continual challenges accessing data pertaining to the health of their people that is held by the government or other organizations.
 Objectives and ApproachThrough the Applied Health Research Question (AHRQ) program at ICES, First Nations communities in Ontario, Canada, have an avenue to access vital population health information about their people. While keeping questions of privacy, data sovereignty, data governance, and the OCAP® principles at the forefront, First Nations partners are active members and collaborators on community driven projects that are of importance to their communities. An Indigenous health data training program has also been developed to run concurrently with these projects, to enhance research knowledge and capacity within partner First Nations communities.
 ResultsFirst Nations community partners are the main drivers in deciding and refining the research questions for their projects. They are engaged throughout the project process to ensure the production of results that suit the specific needs of the partners. Project results are only shared with the partners, who utilize and disseminate them as appropriate within their communities.
 Conclusion / ImplicationsWith access to previously difficult to access population health data sources, First Nations communities are able to use health system data as an additional tool to better plan and implement community health programs, to lobby for additional funding, and ultimately to contribute to positive policy change.

Moving towards Effective First Nations’ Source Water Protection: Barriers, Opportunities, and a Framework

It is well known that watershed-based source water protection programs are integral to the provision of clean drinking water. However, the involvement of Indigenous communities in these programs is very limited in Canada, which has contributed to the vulnerability of Indigenous source waters to contamination. Through a partnership with an Anishinaabe community, this research aimed to identify challenges and opportunities for communities and practitioners to improve the protection of Indigenous source waters in the province of Ontario. The methodology followed the Indigenous research principles of relationship, respect, relevance, reciprocity, and responsibility. Interviews and a youth focus group were conducted with Indigenous community members and practitioners from industry, academia, non-governmental organizations (NGOs), and government. Analysis was conducted using an iterative process to develop codes and themes in the qualitative data analysis software NVivo. Results indicated that issues with scale, jurisdiction, the concept of source water protection, representation, funding, and capacity impact efforts to protect Indigenous source waters. Hopeful recent developments and upcoming opportunities were identified, and a water protection framework for First Nation communities in Ontario was developed in partnership with an Anishinaabe water protection committee. Recommendations are provided to multiple sectors for moving forward respectfully, and effectively, towards the protection of Indigenous waters.

Epidemiologic features of medical emergencies in remote First Nations in northern Ontario: a cross-sectional descriptive study using air ambulance transport data

For about 25 000 Ontarians living in remote northern First Nations communities, seeing a doctor in an emergency department requires flying in an airplane or helicopter. This study describes the demographic and epidemiologic characteristics of patients transported from these communities to access hospital-based emergency medical care. In this cross-sectional descriptive study, we examined primary medical data on patient transportation from Ornge, the provincial medical air ambulance service provider, for 26 remote Nishnawbe Aski Nation communities in northern Ontario from 2012 to 2016. We described these transports using univariate descriptive statistics. Over the 5-year study period, 10 538 patients (mean 2107.6 per year) were transported by Ornge from the 26 communities. Transport incidence ranged from 9.2 to 9.5 per 100 on-reserve population per year. Women aged 65 years or more had the highest transport incidence (25.9 per 100). Girls aged 5-9 years had the lowest mean incidence (2.1 per 100). Gastrointestinal issues accounted for 13.3% of transfers. Neurologic issues, respiratory issues and trauma each accounted for about 11% of transfers, and cardiac issues for 9.6%. Patients with obstetric issues accounted for 7.6% of transfers per year, and toxicologic emergencies for 7.5%. This study provides the epidemiologic foundation to improve emergency care and emergency transport from remote First Nation communities in Ontario.

Characterizing risk of type 2 diabetes in First Nations people living in First Nations communities in Ontario: a population-based analysis using cross-sectional survey data.

Population-based planning tools are important for informing diabetes-prevention efforts in First Nations communities. We used the Diabetes Population Risk Tool (DPoRT) to predict 10-year diabetes risk and describe the factors that contribute to diabetes risk in First Nations adults living in Ontario First Nations communities. We examined population data from adult (≥ 20 yr) respondents to the First Nations Regional Health Survey (RHS) phase 3, a representative cohort of First Nations people living in Ontario First Nations communities. We applied the DPoRT to risk factor information in the survey to predict the distribution of 10-year type 2 diabetes incidence and number of new diabetes cases from 2015/16 to 2025/26. There were 993 respondents to the RHS phase 3 adult survey, of whom 936 (708 without diabetes and 228 with a diagnosis of type 2 diabetes) were eligible for inclusion. The DPoRT predicted a type 2 diabetes risk of 9.6% (confidence interval [CI] 8.3-10.8) between 2015/16 and 2025/26, corresponding to 3501 (95% CI 2653-4348) new diabetes cases. Diabetes cases were predicted to occur disproportionately among those experiencing food insecurity, low income, overweight, obesity and physical inactivity. Reduced diabetes risk was predicted among those who reported connections to Indigenous culture, as measured by eating traditional vegetative foods a few times or often in the previous 12 months. Socioeconomic conditions and known risk factors for type 2 diabetes are important determinants of diabetes risk in First Nations communities. Culturally appropriate policies, programming and services that address socioeconomic disadvantage and other diabetes risk factors in First Nations communities likely have an important role for diabetes prevention in First Nations adults.

Reflections on Being a Learner: The Value of Relationship-based Community Evaluations in Indigenous Communities

Abstract: Drawing on Donna M. Mertens and Amy T. Willson’s work on transformative paradigms in program evaluations, together with the author’s experience working in partnership with First Nations communities in Ontario, this paper explores the lessons learned from the process of moving between assumptions and application using the transformative paradigm in First Nations evaluations; explores the relationships between power, discourse, and paradigms in the relationship between Western and Indigenous ways of knowing and being; and asks what steps an can evaluator take to ensure that local epistemological and ontological perspectives are respected and captured.

How integration of the federal Indian Register has enhanced First Nations-specific analysis of ICES data

IntroductionIn Ontario, First Nations are increasingly seeking population-level data about the health of their citizens. However, First Nations people are not readily identified in standard health administrative data and indirect strategies, such as the use of on-reserve addresses, are limited in scope and validity.
 Objectives and ApproachThe Chiefs of Ontario entered into a Data Governance Agreement with the Institute for Clinical Evaluative Sciences (ICES) that enabled the linkage of the federal Indian Register (IR) to data at ICES. This study examined the impact of the IR linkage on First Nations population estimates and location of residence, measured by postal code or residence code. Overall, and for each First Nation community in Ontario, we compared First Nations population estimates from the ICES data with and without the IR linkage to estimates available from Indigenous and Northern Affairs Canada (INAC).
 ResultsWithout the IR, using only Ontario residence codes or postal codes that were unique to a given community, 62,242 individuals were identified as living in First Nations communities. This is approximately 30% lower than the current INAC on-reserve population estimate of 92,234 for First Nations communities in Ontario. Adding the IR allowed the use of non-unique postal codes as well, resulting in the identification of an additional 15,183 First Nations individuals. It also allowed the identification of over 113,000 First Nations individuals who live outside of First Nations communities, especially in urban areas. Finally, the combination of residence information and the IR permits communities to identify their registered member living within and outside their communities.
 Conclusion/ImplicationsUsing the IR in combination with geographic residence information, made possible through the Data Governance Agreement signed between Chiefs of Ontario and ICES, will provide First Nations communities with more accurate and complete population estimates, which is key to the production of useful and relevant First Nations-specific health research.

Dietary Patterns and Type 2 Diabetes Mellitus in a First Nations Community.

Type 2 diabetes mellitus is a growing concern worldwide, particularly in Indigenous communities, which have undergone a marked nutrition transition characterized by reduced intakes of traditional foods and increased intakes of market foods. Few studies have assessed the relationships between differing dietary patterns and risk for type 2 diabetes in Indigenous communities in Canada. The objective of the study was to characterize dietary patterns using factor analysis (FA) and to relate these patterns to the incidence of type 2 diabetes after 10 years of follow up in a First Nations community in Ontario, Canada. We conducted a prospective analysis of 492 participants in the SLHDP who did not have diabetes at baseline (1993 to 1995) and were followed for 10 years. A food-frequency questionnaire was administered, and FA was used to identify patterns of food consumption. Multivariate logistic regression analyses determined associations of food patterns with incident type 2 diabetes, adjusting for sociodemographic and lifestyle confounders. At follow up, 86 participants had developed incident type 2 diabetes. FA revealed 3 prominent dietary patterns: Balanced Market Foods, Beef and Processed Foods and Traditional Foods. After adjustment for age, sex, waist circumference, interleukin-6 and adiponectin, the Beef and Processed Foods pattern was associated with increased risk for incident type 2 diabetes (OR=1.38; 95% CI 1.02, 1.86). In contrast, the Balanced Market Foods and Traditional Foods Patterns were not significantly associated with type 2 diabetes. Dietary interventions should encourage reduced consumption of unhealthful market foods, in combination with improvements in local food environments so as to increase access to healthful foods and reduce food insecurity in Indigenous communities.

Boiling over: A Descriptive Analysis of Drinking Water Advisories in First Nations Communities in Ontario, Canada

Access to safe and reliable drinking water is commonplace for most Canadians. However, the right to safe and reliable drinking water is denied to many First Nations peoples across the country, highlighting a priority public health and environmental justice issue in Canada. This paper describes trends and characteristics of drinking water advisories, used as a proxy for reliable access to safe drinking water, among First Nations communities in the province of Ontario. Visual and statistical tools were used to summarize the advisory data in general, temporal trends, and characteristics of the drinking water systems in which advisories were issued. Overall, 402 advisories were issued during the study period. The number of advisories increased from 25 in 2004 to 75 in 2013. The average advisory duration was 294 days. Most advisories were reported in summer months and equipment malfunction was the most commonly reported reason for issuing an advisory. Nearly half of all advisories occurred in drinking water systems where additional operator training was needed. These findings underscore that the prevalence of drinking water advisories in First Nations communities is a problem that must be addressed. Concerted and multi-faceted efforts are called for to improve the provision of safe and reliable drinking water First Nations communities.

Traditional foods and 25(OH)D concentrations in a subarctic First Nations community

BackgroundSub-optimal vitamin D status is common worldwide and the condition may be associated with increased risk for various chronic diseases. In particular, low vitamin D status is highly prevalent in indigenous communities in Canada, although limited data are available on the determinants of serum 25-hydroxyvitamin D (25(OH)D) concentrations in this population. The relationship between traditional food consumption and vitamin D status has not been well documented.ObjectiveTo investigate the determinants of serum 25(OH)D status in a First Nations community in Ontario, Canada, with a focus on the role of traditional food consumption and activities.MethodsA cross-sectional analysis was conducted within the Sandy Lake Health and Diabetes Project (2003–2005). A total of 445 participants (>12 years of age) were assessed for serum 25(OH)D status, anthropometric and lifestyle variables, including traditional and non-traditional dietary practices and activities. Diet patterns were identified using factor analysis, and multivariate linear regression analysis was used to analyse the determinants of 25(OH)D concentrations.ResultsMean serum 25(OH)D concentrations were 22.1 nmol/L (16.9, 29.9 nmol/L) in men and 20.5 nmol/L (16.0, 27.3 nmol/L) in women. Multivariate determinants of higher serum 25(OH)D included higher consumption of traditional and healthier market foods, higher wild fish consumption, male gender, spring/summer season of blood collection and more frequent physical activity. Significant negative determinants included hours of TV/day, higher BMI and higher consumption of unhealthy market foods.ConclusionsTraditional food consumption contributed independently to higher 25(OH)D concentrations in a First Nations community with a high prevalence of sub-optimal vitamin D status.

First Nations Own-Source Revenue: How Is the Money Spent?

The confluence of several factors – favourable Supreme Court of Canada decisions, the rise (until recently) in natural resource prices and the emergence of a cadre of well-educated on-reserve leaders – has encouraged the growth of First Nations commercial ventures over the past generation. This growth raises important questions: How significant is own-source revenue (much of it derived via First Nations-owned corporations) in financing First Nations governments? How are these governments spending incremental revenue that arises from market-based activities? Before the passage in 2013 of the First Nations Financial Transparency Act (FNFTA), relevant audited statements of First Nations were hard to obtain, if indeed they were publicly available. The FNFTA requires First Nations to publish online audited statements of revenues and expenditures, which enables hitherto unavailable insights into First Nations budgeting priorities. Our analysis of a sample of 72 FNFTA filings submitted by First Nations in Ontario, covering the fiscal years 2013 and 2014, finds that own-source revenue comprises, on average, nearly a third of total First Nations government revenues. First Nations with higher per capita own-source revenue increase economic development activities but only modestly increase education and health spending. They also undertake large increases in spending on general government and business management. Whether large increases in this last category are warranted is an important question for members of First Nations to address. Interpreting the audited statements of First Nations governments is difficult, however, because they do not apply standardized protocols to identify revenue and expenditure categories. Furthermore, some undetermined portion of their own-source revenue derives from impact and benefit agreements negotiated between First Nations councils and resource developers. These agreements are usually confidential and details about them in audited statements are scant. Finally, since our sample is derived from First Nations communities in Ontario, it might not be representative of pan-Canadian experience. Our results are an admittedly tentative look at the data derived from the audited statements, but two obvious policy conclusions emerge from the analysis. First, since the FNFTA is intended to help First Nations assess the budgeting activities of their respective councils, one simple policy recommendation would be to introduce more uniform and informative accounting protocols, which would considerably aid those interested in undertaking this task. Second, since many First Nations apparently do not consider it appropriate to use own-source revenue to finance basic education and health services, the onus for education funding will continue to fall squarely on the federal government. In the end, of course, it is up to First Nations people themselves to determine their financial priorities.

Implementation of a community greenhouse in a remote, sub-Arctic First Nations community in Ontario, Canada: a descriptive case study

Food insecurity is prevalent in northern communities in Canada and there is a movement to improve food security through both the re-vitalization of traditional harvesting practices as well as through sustainable agriculture initiatives. Gardening in northern communities can be difficult and may be aided by a community greenhouse. The objective of this project was to conduct a descriptive case study of the context and process surrounding the implementation of a community greenhouse in a remote, sub-Arctic First Nations community in Ontario, Canada. Data sources included semi-directed interviews with a purposive and snowball sample of key informants (n=14), direct observations (n=32 days), written documentation (n=107), and photo-documentation (n=621 total). Digital photographs were taken by both a university investigator during community visits and a community investigator throughout the entire project. The case study was carried out over 33 months; from early 2009 until October of 2011. Thematic data analyses were conducted and followed a categorical aggregation approach. Categories emerging from the data were appointed gardening-related themes: seasons, fertile ground, sustainability, gardeners, ownership, participant growth, and sunshine. Local champions were critical to project success. Uncertainty was expressed by several participants regarding ownership of the greenhouse; the local community members who championed the project had to emphasize, repeatedly, that it was community owned. Positive outcomes included the involvement of many community members, a host of related activities, and that the greenhouse has been a learning opportunity to gain knowledge about growing plants in a northern greenhouse setting. A strength of the project was that many children participated in greenhouse activities. Community and school greenhouse projects require local champions to be successful. It is important to establish guidelines around ownership of a greenhouse and suitable procedures for making the building accessible to everyone without compromising security. Implementing a greenhouse project can engage community members, including children, and provide a great learning opportunity for gardeners in a remote, northern community.

Admission to hospital for pneumonia and influenza attributable to 2009 pandemic A/H1N1 Influenza in First Nations communities in three provinces of Canada

BackgroundEarly reports of the 2009 A/H1N1 influenza pandemic (pH1N1) indicated that a disproportionate burden of illness fell on First Nations reserve communities. In addition, the impact of the pandemic on different communities may have been influenced by differing provincial policies. We compared hospitalization rates for pneumonia and influenza (P&I) attributable to pH1N1 influenza between residents of First Nations reserve communities and the general population in three Canadian provinces.MethodsHospital admissions were geocoded using administrative claims data from three Canadian provincial data centres to identify residents of First Nations communities. Hospitalizations for P&I during both waves of pH1N1 were compared to the same time periods for the four previous years to establish pH1N1-attributable rates.ResultsResidents of First Nations communities were more likely than other residents to have a pH1N1-attributable P&I hospitalization (rate ratio [RR] 2.8-9.1). Hospitalization rates for P&I were also elevated during the baseline period (RR 1.5-2.1) compared to the general population. There was an average increase of 45% over the baseline in P&I admissions for First Nations in all 3 provinces. In contrast, admissions overall increased by approximately 10% or less in British Columbia and Manitoba and by 33% in Ontario. Subgroup analysis showed no additional risk for remote or isolated First Nations compared to other First Nations communities in Ontario or Manitoba, with similar rates noted in Manitoba and a reduction in P&I admissions during the pandemic period in remote and isolated First Nations communities in Ontario.ConclusionsWe found an increased risk for pH1N1-related hospital admissions for First Nations communities in all 3 provinces. Interprovincial differences may be partly explained by differences in age structure and socioeconomic status. We were unable to confirm the assumption that remote communities were at higher risk for pH1N1-associated hospitalizations. The aggressive approach to influenza control in remote and isolated First Nations communities in Ontario may have played a role in limiting the impact of pH1N1 on residents of those communities.

Body Mass Index of First Nations youth in Ontario, Canada: influence of sleep and screen time

Prevalence rates of overweight and obesity in Canada have risen rapidly in the past 20 years. Concurrent with the obesity epidemic, sleep time and physical activity levels have decreased among youth. Aboriginal youth experience disproportionately high obesity prevalence but there is inadequate knowledge of contributing factors. This research aimed to examine sleep and screen time behavior and their relationship to Body Mass Index (BMI) in on-reserve First Nations youth from Ontario, Canada. This was an observational population-based study of cross-sectional design. Self-reported physical activity, screen time, and lifestyle information was collected from 348 youth aged 10-18 years residing in five northern, remote First Nations communities and one southern First Nations community in Ontario, Canada, from October 2004 to June 2010. Data were collected in the school setting using the Waterloo Web-based Eating Behaviour Questionnaire. Based on self-reported height and weight, youth were classified normal (including underweight), overweight and obese according to BMI. Descriptive cross-tabulations and Pearson's χ² tests were used to compare screen time, sleep habits, and physical activity across BMI categories. Participants demonstrated low levels of after-school physical activity, and screen time in excess of national guidelines. Overall, 75.5% reported being active in the evening three or less times per week. Approximately one-quarter of the surveyed youth watched more than 2 hours of television daily and 33.9% spent more than 2 hours on the internet or playing video games. For boys, time using the internet/video games (p=0.022) was positively associated with BMI category, with a greater than expected proportion of obese boys spending more than 2 hours using the internet or video games daily (56.7%). Also for boys, time spent outside after school (p=0.033) was negatively associated with BMI category, with a lesser than expected proportion spending 'most of the time' outside (presumably being active) after school. These relationships were not observed in girls. Adjusted standardized residuals suggest a greater than expected proportion of obese individuals had a television in their bedroom (66.7%) as compared with the rest of the population. The current study adds to the limited information about contributors to overweight and obesity in First Nations youth living on-reserve in Canada. Concerns about inadequate sleep, excess screen time, and inadequate physical activity mirror those of the general population. Further investigation is warranted to improve the understanding of how various lifestyle behaviors influence overweight, obesity, and the development of chronic disease among First Nations youth. Initiatives to reduce screen time, increase physical activity, and encourage adequate sleep among on-reserve First Nations youth are recommended.

An integrative assessment of water vulnerability in First Nation communities in Southern Ontario, Canada

Assessing vulnerability related to water is a global concern and especially important to populations experiencing multiple exposures and sensitivities. Approaches are required that span social and physical concerns, and that bridge multiple types and forms of knowledge. This research investigates the water vulnerability of three First Nation communities in Ontario, Canada. A collaborative process was used to build an integrative understanding of water vulnerability, develop an associated instrument, and undertake the community scale assessments. Results from the assessment provided communities with a comprehensive overview of water vulnerability, and pointed to gaps in knowledge and specific areas where attention was needed. Conducting assessments at a community scale following the methodology employed in this research responds to the need for integration and context sensitivity when engaging in water vulnerability assessments and introduces innovations to existing assessment tools. A holistic approach to water vulnerability assessment provided decision-makers with the context-specific details and empirical insights they require to prioritize issues and allocate resources.

Traditional knowledge management and preservation: Intersections with Library and Information Science

The African proverb “When an elder dies, a library burns down” clearly sums up the importance of traditional knowledge preservation and cultural continuity, which the study found to be a key need and concern amongst First Nations communities in Ontario, Canada. To follow-up on elders’ suggestions that libraries are potential custodians of traditional knowledge, this paper explores how traditional knowledge preservation intersects with Library and Information Science (LIS) practices of knowledge classification, organization, and dissemination and establishes the various challenges that this intersection poses to these LIS practices. The paper concludes that libraries and other information institutions need to re-examine and reconstruct themselves in ways that take into account non-western epistemologies and worldviews and develop much needed cultural competency in order to undertake traditional knowledge custodianship.

Traditional knowledge management and preservation: Intersections with Library and Information Science

The African proverb “When an elder dies, a library burns down” clearly sums up the importance of traditional knowledge preservation and cultural continuity, which the study found to be a key need and concern amongst First Nations communities in Ontario, Canada. To follow-up on elders’ suggestions that libraries are potential custodians of traditional knowledge, this paper explores how traditional knowledge preservation intersects with Library and Information Science (LIS) practices of knowledge classification, organization, and dissemination and establishes the various challenges that this intersection poses to these LIS practices. The paper concludes that libraries and other information institutions need to re-examine and reconstruct themselves in ways that take into account non-western epistemologies and worldviews and develop much needed cultural competency in order to undertake traditional knowledge custodianship.

Conformity and Rationality in Indigenous Schooling: The Education Situation on First Nations Reserves

A major problem of education in isolated, predominantly First Nations communities in Ontario’s far north is that prescriptive statements and ideological preferences assume discussions about the purposes of schooling in these communities. Frequent suggestions, sometimes implicit, and sometimes explicit, indicate that the ideal condition for effective schooling must reflect the social, political, and economic characteristics of Eurocentric societies. Very closely linked with such a notion of schooling is the suggestion that education represents a single, final state of affairs, namely, excellence, measured by a Eurocentric gauge and analyzed in the units of its standards, that everyone should try to emulate, and the most successful should reach. Certainly, many discussions of schooling in First Nations communities have not occurred at a genuinely conceptual or theoretical level but involve mere word juggling because they do not carry the viewpoints and voices of First Nations people. This study examines the viewpoints of First Nations and Euro–Canadian teachers on the nature and aims of schooling, its guiding principles, its practical functions, and its role in First Nations society. The findings suggest that the idea of schooling is to develop and implement a two–way education that encourages a cross–fertilization of insights, practices, and mental prototypes of both Eurocentric and First Nations traditions and cultures.

Conversations on telemental health: listening to remote and rural First Nations communities

Telemental health involves technologies such as videoconferencing to deliver mental health services and education, and to connect individuals and communities for healing and health. In remote and rural First Nations communities there are often challenges to obtaining mental healthcare in the community and to working with external mental health workers. Telemental health is a service approach and tool that can address some of these challenges and potentially support First Nations communities in their goal of improving mental health and wellbeing. Community members' perspectives on the usefulness and appropriateness of telemental health can greatly influence the level of engagement with the service. It appears that no research or literature exists on First Nations community members' perspectives on telemental health, or even on community perspectives on the broader area of technologies for mental health services. Therefore, this article explores the perspectives on telemental health of community members living in two rural and remote First Nations communities in Ontario, Canada. METHODS; This study was part of the VideoCom project, a collaborative research project exploring how remote and rural First Nations communities are using ICTs. This current exploration was conducted with the support of Keewaytinook Okimakanak (KO), our partner in Northwestern Ontario. With the full collaboration of the communities' leadership, a team involving KO staff and VideoCom researchers visited the two communities in the spring of 2010. Using a participatory research design, we interviewed 59 community members, asking about their experiences with and thoughts on using technologies and their attitudes toward telemental health, specifically. A thematic analysis of this qualitative data and a descriptive quantitative analysis of the information revealed the diversity of attitudes among community members. Finally, based on a discussion with the community telehealth staff, a 'ways forward' section was proposed as a way to begin addressing certain issues that were raised by community members. This article explores the continuum of community members' perspectives that range from interest and enthusiasm to hesitancy and concern. One participant reported personal experience with using telemental health and found the approach helpful in increasing her comfort in the therapeutic situation. In addition, concerns relating to appropriateness and safety were voiced. A variety of advantages (eg facilitation of disclosure, increased access to services, usefulness) and disadvantages or concerns (eg interference with capacity building, concerns about privacy) are reported and discussed. Following a coding procedure, a descriptive quantitative analysis demonstrated that 47% of the participants were categorized as having a positive response toward telemental health, 32% as having a negative response, and 21% as being neutral or undecided. Valuing Indigenous knowledge can help us understand community members' experiences of and concerns with telemental health and inform more successful and appropriate initiatives. With the invaluable support of the KO Telemedicine co-authors, we offer ways forward to address concerns identified by the community members. Most importantly, any ways forward for community telemental health initiatives need to be community driven and community led.

Injury in First Nations Communities in Ontario

Background: High and variable rates of injury have been reported in Aboriginal communities in Canada. This has not been well studied for specific injury types. We sought to compare the rate and categories of injuries leading to hospital admission among those in First Nations communities relative to those living in small northern and southern communities in Ontario. Methods: Administrative data were used to define the study populations. The incidence of all-cause injury and specific injury categories for residents living in Ontario’s Aboriginal communities (N=28,816) was determined for 2004 using hospital discharge data. Comparisons were made with residents of small communities in northern (N=211,834) and southern Ontario (N=650,002). Age- and sex-adjusted rates were calculated. Results: All-cause-injury age- and sex-adjusted rates were 2.5 times higher for those living in First Nations communities compared to those living in northern communities. Relative risks (RR) for specific injury types in First Nations compared with northern communities were: assault (RR=5.5 in females and 4.8 in males), intentional self-harm (RR=5.9 in females and 5.2 in males) and accidental poisoning (RR=4.9 in females and 3.7 in males). Differences were also seen between northern and southern communities: assault (RR=2.8 in females and 3.5 in males), intentional self-harm (RR=2.1 in females and 1.4 in males) and accidental poisoning (RR=2.2 in females and 1.7 in males). Discussion: Injuries severe enough to require a hospital admission were higher in First Nations communities in northern Ontario relative to those in northern and southern Ontario communities. Higher rates of certain injuries were also noted in northern compared with southern communities. This underscores the importance of using a geographic comparison group.