Urban Aboriginal People Research Articles

The Cedar Project: risk factors for transition to injection drug use among young, urban Aboriginal people

Studies suggest that Aboriginal people in Canada are over-represented among people using injection drugs. The factors associated with transitioning to the use of injection drugs among young Aboriginal people in Canada are not well understood. The Cedar Project is a prospective cohort study (2003-2007) involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants' venous blood samples were tested for antibodies to HIV and the hepatitis C virus, and drug use was confirmed using saliva screens. The primary outcomes were use of injection drugs at baseline and tranisition to injection drug use in the six months before each follow-up interview. Of 605 participants, 335 (55.4%) reported using injection drugs at baseline. Young people who used injection drugs tended to be older than those who did not, female and in a relationship. Participants who injected drugs were also more likely than those who did not to have been denied shelter because of their drug use, to have been incarcerated, to have a mental illness and to have been involved in sex work. Transition to injection drug use occurred among 39 (14.4%) participants, yielding a crude incidence rate of 19.8% and an incidence density of 11.5 participants per 100 person-years. In unadjusted analysis, transition to injection drug use was associated with being female (odds ratio [OR] 1.98, 95% confidence interval (CI) 1.06-3.72), involved in sex work (OR 3.35, 95% CI 1.75-6.40), having a history of sexually transmitted infection (OR 2.01, 95% CI 1.07-3.78) and using drugs with sex-work clients (OR 2.51, 95% CI 1.19-5.32). In adjusted analysis, transition to injection drug use remained associated with involvement in sex work (adjusted OR 3.94, 95% CI 1.45-10.71). The initiation rate for injection drug use of 11.5 participants per 100 person-years among participants in the Cedar Project is distressing. Young Aboriginal women in our study were twice as likely to inject drugs as men, and participants who injected drugs at baseline were more than twice as likely as those who did not to be involved in sex work.

Reflections on 'Aboriginalising' the Research Process

This article describes the way a multidisciplinary research team set about 'Aboriginalising' their research processes in the initial phase of a project that aimed to develop a culturally appropriate model of care for urban Aboriginal people with diabetes. Although academic conventions and protocols tended to dominate, the project incorporated the innovative approach that the Aboriginal researchers brought to the process of recruiting and facilitating focus groups, which they likened to 'hunting and gathering'. In developing and strengthening partnerships between research institutions and Aboriginal communities, it is important that Aboriginal and non-Aboriginal researchers challenge the conventional academic models of research in ways that are culturally appropriate and informed by Aboriginal scholarship. This article illustrates the difficulties and challenges on both sides of the partnership. It concludes by outlining the key principles learnt during the first phase of the project.

Finding Your Allies Where You Can: How Canadian Courts Drive Aboriginal Policy in Canada

While it has been valuable to Aboriginal peoples to have the courts as allies in their fight for state recognition, it is worth asking whether the slow, expensive, incremental process of achieving recognition through litigation is really the most efficient, let alone just, policy development process. Metis, Non-Status Indians, and Aboriginal women have all determined that litigation can be a useful strategy for achieving state recognition of their Aboriginality in the face of government intransigence. Yet the courts have proven to be imperfect, inconsistent, and not always reliable allies. This article reviews the cases in which Aboriginal women, Non-Status Indians, Metis, and urban Aboriginal people have sought to use litigation to drive the reform of rules for state recognition of Aboriginal peoples in Canada. These cases include not only successful litigation, but also occasions of which last resort to the courts has failed, revealing the difficulties and frustrations that Aboriginal peoples can face in having to rely on litigation to change government policy.

What Now? Future Federal Responsibilities Towards Aboriginal People Living in Cities

For decades, successive federal governments insisted that the federal fiduciary responsibility to Registered Indians ended at reserve boundaries, while not recognizing any responsibilities for Non-Status Indians, Metis, and Inuit. The recent growth of urban Aboriginal populations has changed this situation dramatically. Many federal programs for urban Aboriginal people are not delivered in a status-blind fashion, while other services are still entangled in or complicated by the provisions of the Indian Act. This paper explores the policy history underlying the current situation while identifying four issues for further discussion: (1) political self-determination in the cities; (2) problems arising from the cities' junior position in the Canadian federation; (3) the challenge of dealing with the diversity of circumstances and preferences of Aboriginal and non-Aboriginal urban dwellers; and (4) the legacy of differential programs based upon differentiations among sections of the Aboriginal population that no longer have constitutional salience. Long-term solutions, such as replacing the Indian Act, creating a cities charter and creating addenda to treaties or section 35 are discussed.

Not just bricks and mortar: planning hospital cancer services for Aboriginal people

BackgroundAboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals.Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted.FindingsRelationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i) being alone and lost in a big, alien and inflexible system; (ii) failure of open communication, delays and inefficiency in the system; (iii) practicalities: costs, transportation, community and family responsibilities; (iv) the need for Aboriginal support persons; and (v) connection to the community.ConclusionsDesign considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes.

The health of urban Aboriginal people: insufficient data to close the gap

The health of urban Aboriginal people: insufficient data to close the gap

Mortality of urban Aboriginal adults in Canada, 1991–2001

To compare mortality patterns for urban Aboriginal adults with those of urban non-Aboriginal adults. Using the 1991-2001 Canadian census mortality follow-up study, our study tracked mortality to December 31, 2001, among a 15% sample of adults, including 16 300 Aboriginal and 2 062 700 non-Aboriginal persons residing in urban areas on June 4, 1991. The Aboriginal population was defined by ethnic origin (ancestry), Registered Indian status and/or membership in an Indian band or First Nation, since the 1991 census did not collect information on Aboriginal identity. Compared to urban non-Aboriginal men and women, remaining life expectancy at age 25 years was 4.7 years and 6.5 years shorter for urban Aboriginal men and women, respectively. Mortality rate ratios for urban Aboriginal men and women were particularly elevated for alcohol-related deaths, motor vehicle accidents and infectious diseases, including HIV/AIDS. For most causes of death, urban Aboriginal adults had higher mortality rates compared to other urban residents. Socio-economic status played an important role in explaining these disparities. Results from this study help fill a data gap on mortality information of urban Aboriginal people of Canada.

The health of urban Aboriginal people: insufficient data to close the gap

The Australian Government has committed to reducing Indigenous disadvantage, including closing the life-expectancy gap within a generation, and to halving the gap in mortality rates for children under 5 years of age within a decade. Sixty per cent of the health gap between Indigenous and non-Indigenous Australians is attributable to the health of Indigenous people living in non-remote areas of Australia. We conducted a brief review of recent Australian original research publications on the health of the 53% of Indigenous people who live in urban areas, and found that data are sparse; there were only 63 studies in the past 5 years (11% of all articles about Indigenous health during this period). Although Indigenous Australians living in remote areas experience greater health disparity, the government will not achieve its aims without paying due attention to the non-remote-living population. More research is required, and particularly research that actually tests the impact of policies and programs.

A comparison of coronary heart disease event rates among urban Australian Aboriginal people and a matched non-Aboriginal population

BackgroundAge-specific death from cardiovascular disease among Australian Aboriginals is estimated to be four to seven times that of general population, and the major cause of premature death. There is little...

Measuring the gap: accuracy of the Western Australian hospital morbidity data in the identification of adult urban Aboriginal and Torres Strait Islander people

To assess the sensitivity of the recording of Aboriginality in the Western Australia Linked Data. This was a follow-up study using record linkage. Demographic data was obtained from 993 adult, urban-dwelling Aboriginal Australian participants in the Perth Aboriginal Atherosclerosis Risk study (PAARS). These were linked to the Western Australian Linked Data (State-wide hospital admissions and discharges, and deaths) to provide the number of admissions and Indigenous status coding from 1980 to 2006. There were 14,413 admissions for PAARS participants in the study period. The sensitivity of coding of Indigenous status in hospital admissions data significantly improved over time, exceeding 0.9 in every year since 2002. Prior to 2002 sensitivity was around 0.8, but poorer for males, with some anomalous years. The coding of Indigenous status in the Western Australia Hospital Morbidity Database since 2002 has improved. The data from earlier decades must be approached with more caution. The improved accuracy of identification of Indigenous status in the Western Australia Hospital Morbidity Database allows comparative studies of adult Aboriginal and non-Aboriginal population health outcomes to be undertaken with confidence.

多文化主義における「先住民文化」への都市アボリジニの対応:アデレードのガーナ文化学習の事例から

多文化主義における「先住民文化」への都市アボリジニの対応:アデレードのガーナ文化学習の事例から

Engaging with Aboriginal communities in an urban context: some practical suggestions for public health researchers

In this paper, one Indigenous and two non-Indigenous public health researchers reflect on our combined experience of over thirty years in Aboriginal health, in order to develop some practical guidelines, particularly for researchers working with urban Indigenous population groups. Public health research is important not only to address the health inequities experienced by Australia's Indigenous populations, but also to build knowledge and confidence and to inform practice in Aboriginal community-controlled health organisations. Ethical guidelines and previous research experience demonstrate that researchers need to engage with the communities that may be involved in or affected by the research they propose. Although more than half of Australia's Aboriginal and Torres Strait Islander population live in urban and regional centres, most research and commentaries address the health and social issues of remote communities. Researchers often do not know how to engage with urban Aboriginal communities and how to approach the particular research challenges within this context. The practical guidelines suggested in this paper may assist public health researchers to conduct ethical health research that is planned and carried out in a culturally appropriate way and that will benefit urban Aboriginal people. While not intended to be prescriptive, we believe that the lessons learned in Victoria will be applicable to other urban Indigenous contexts around Australia.

An overview of Aboriginal health research in the social sciences: current trends and future directions

OBJECTIVES: To examine if Aboriginal health research conducted within the field of social sciences reflects the population and geographic diversity of the Aboriginal population.STUDY DESIGN: Review.METHODS: We searched the Web of Science Social Science Citation Index, the Arts and Humanities Citation Index and Scholars Portal for the time period 1995–2005 using search terms to reflect different names used to refer to Canada’s Aboriginal peoples. Citations that did not focus on health or Canada were eliminated. Each paper was coded according to 7 broad categories: Aboriginal identity group; geography; age; health status; health determinants; health services; and methods.RESULTS: Based on the 96 papers reviewed, the results show an under-representation of Metis and urban Aboriginal peoples. Most of the papers are on health status and non-medical determinants of health, with a particular focus on chronic conditions and life-style behaviours. Only 6 papers examined traditional approaches to healing and/or access to traditional healers/medicines. A small number involved the use of community-based research methods.CONCLUSIONS: Further research is required to address gaps in the current body of literature. Community-based research studies are necessary to address gaps that are most relevant to Aboriginal peoples.

Estimated nutrient intake of urban Indigenous participants enrolled in a lifestyle intervention program

AbstractAim: The present study evaluates the reported nutrient intake of adult urban Aboriginal and Torres Strait Islander people who participated in a medically based lifestyle intervention program.Methods: The analysis was based on dietary records from all Indigenous participants (n = 100) enrolled in a 2003–2005 prospective lifestyle intervention study that followed a cohort of overweight (body mass index > 25) participants served by the Townsville Aboriginal and Islanders Health Service, Queensland, Australia. Standardised multiple‐pass 24‐hour dietary recalls were collected at baseline and 12‐month program completion. Changes in pre‐ and post‐program reported intake were evaluated using a paired‐sample t‐test. The Mann–Whitney test was used to compare baseline intake with an age and gender‐matched sample created from 1995 National Nutrition Survey data.Results: The cohort was 88% female with a mean age of 44.4 ± 1.3 standard error of the mean. Dietary intake improved between baseline and program completion. At baseline, there was a high prevalence of reported intakes below the Estimated Average Requirement for vitamin A, thiamine, riboflavin, niacin, folate, vitamin C, magnesium, calcium, phosphorus, iron and zinc. Compared with the median Australian intake, the Indigenous intake was significantly higher in protein and cholesterol; however, vitamin A, vitamin C, niacin, potassium, magnesium, iron and fibre were lower.Conclusions: The present study found the intake in a cohort of Indigenous people was significantly different than the previously measured Australian nutrient intake. The nutrient patterns observed in the present study may be associated with the excess chronic disease burden experienced by Australian Indigenous populations.

Challenges to Tuberculin Screening and Follow-up in an Urban Aboriginal Sample in Montreal, Canada

We sought to describe the prevalence and predictors of tuberculin skin test (TST) reactors in a high-risk sample of urban Aboriginal people, and to evaluate adherence to medical evaluation and latent tuberculosis infection (LTBI) treatment among those with TST reactivity. Of the 164 participants tested, 86% returned for TST reading. Positive TST reactions (>or=10 mm) were observed in 17.7% (25/141, 95% CI 11.4-24.0) of participants, and were associated with older age (OR per 10 year increase 1.8, 95% CI 1.2-2.7) and Inuit Aboriginal group (OR 2.8, 95% CI 1.1-7.3). Only four participants presented for evaluation, of whom one initiated and none completed LTBI treatment. Tuberculin screening in this population can be an effective strategy for identifying TST reactive individuals; however, screening efforts will have minimal impact without additional efforts in this high-risk group.

Knowledge and Perceptions of Tuberculosis Among a Sample of Urban Aboriginal People

Achieving a high level of tuberculosis (TB) awareness is crucial for the success of prevention and treatment efforts in high-risk groups, and thus represents a key challenge for public health initiatives. Research exploring knowledge and perceptions of TB in Aboriginal populations has been lacking to date. We sought to explore the knowledge and perception of TB in a sample of high-risk Aboriginal peoples in Montreal who were undergoing a tuberculin skin test (TST) as part of a larger study. We conducted standardized, face-to-face interviews using a structured interview guide. The interview explored participants' knowledge and perception of TB using a combination of both structured and open-ended questions. We also asked a series of open-ended questions that probed for participants' experiences with urban health services, whether TB is discussed in Aboriginal communities and participants' intentions should their TST result be positive. A total of 164 eligible Aboriginal persons volunteered to participate in our study. Close to one-third (54/164) reported knowing little about TB, and participant responses indicated that there were many prevalent misconceptions about the symptoms, transmission, cause and risk factors for the disease. The majority of respondents felt that TB was not openly discussed in their homes and communities, and approximately half (90/164) of respondents reported that they were not concerned about contracting TB. We conclude that there is a lack of knowledge and several misconceptions about TB among our sample of urban Aboriginal peoples.

Characteristics and outcome of type 2 diabetes in urban Aboriginal people

Characteristics and outcome of type 2 diabetes in urban Aboriginal people

Characteristics and outcome of type 2 diabetes in urban Aboriginal people: the Fremantle Diabetes Study

We analysed data from Aboriginal patients with type 2 diabetes recruited to the community-based Fremantle Diabetes Study and compared them with those from the Anglo-Celt participants. Diabetes prevalence among Aboriginal people in the Fremantle area was more than double that of Anglo-Celts and the average age at diagnosis was 14 years or younger. Glycaemic control, urinary albumin :creatinine and the proportion of smokers were all higher in the Aboriginal group and there was evidence of lower diabetes-related quality of life and high rates of disability at a young age. The Aboriginal patients died 18 years or younger than their Anglo-Celt counterparts. Specialized, culturally-sensitive and sustainable programmes are urgently needed to improve the management of diabetes in urban Aboriginal communities.

Urban Australian Aboriginal peoples’ experience of human services

English Urban Aboriginal communities were asked about their experiences of human services. The misuse of Aboriginal liaison staff, the attitudes of staff and policy-makers, the invisibility of Aboriginal clients, poor communication, lack of access to services, client rights and lack of integration were raised. Respect for Aboriginal persons’ social citizenship is discussed. French Il a été demandé aux communautés aborigènes urbaines de décrire leur expérience des services humains disponibles. Les dilemmes suivants ont été soulevés: une mauvaise utilisation des employés assurant la liaison, certaines attitudes d'employés et de développeurs de politiques, un manque de visibilité de la clientèle aborigène, des communications déficientes, des difficultés d'accès aux services, les droits des clients et un manque d'intégration. Une discussion sur le respect pour la citoyenneté sociale des personnes aborigènes est présentée dans l'article. Spanish Se pidió información a las comunidades aborígenes urbanas sobre sus experiencias como usuarios de los servicios humanos. Se trataron los siguientes temas: el mal uso de los empleados aborígenes en su función conectora, las actitudes de los empleados y políticos, la invisibilidad del cliente aborigen, la mala comunicación, la falta de acceso a los servicios, la falta de integración, y cuestiones de derechos del cliente. Se explora la cuestión de la ciudadanía social de los aborígenes.

Cardiovascular risk among urban Aboriginal people

Cardiovascular risk among urban Aboriginal people