Indigenous Health Research Monitoring, September 2021

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 New scientific publications and articles


Article Summaries

Psychoactive substance use

What’s love got to do with it? “Love” and alcohol use among U.S. Indigenous peoples: Aligning research with real-world experiences

McKinley, C. E., and Scarnato, J. M. (2021). What’s love got to do with it? “Love” and alcohol use among U.S. Indigenous peoples: Aligning research with real-world experiences. Journal of Ethnic & Cultural Diversity in Social Work, 30(1–2), 26–46.
Open access: PDF

Context

Love is a component of family resilience, defined as the capacity of a family to overcome challenges. The family can influence the adoption of behaviours that impact health, such as the use of psychoactive substances. However, the way in which love may be associated with health‑related behaviours among Indigenous peoples remains poorly understood and is the subject of few studies. In point of fact, researchers are more interested in intimate relations than family love. Focusing on the link between family love and alcohol use may contribute to research on protective factors for excessive alcohol use that can be promoted in prevention activities.

Objectives

Identify intergenerational changes in the expression of love and family resilience in two Indigenous nations in the American Southeast and determine the relationship between love and alcohol use.

Methodology and data

This exploratory research project used mixed methods.

Critical ethnography was the method selected for the qualitative phase, aimed at understanding how love and family resilience influence alcohol use and wellbeing. The various data collection methods (individual and family interviews as well as focus groups) brought together 436 participants, 228 from an inland tribe and 208 from a coastal tribe.

For the quantitative phase, an online survey was completed by 127 participants. Family resilience was measured using the Family Resilience Inventory. The authors analyzed the data for intergenerational changes in verbal and physical expressions of love, which is a component of family resilience. Statistical correlations between family resilience and alcohol use were tested.

What was learned?

A majority of participants mentioned the importance of family love as expressed, in part, through:

  • Verbal or physical affection;
  • Affection rituals;
  • The resilience of sticking together through hard times;
  • Combatting struggle with understanding and support.

Parents in the two study groups said they openly express their love to family members, especially children, which was uncommon among previous generations. For the inland tribe, the lack of affection expressed by parents is seen as a risk factor for the proper development of children.

Verbal affection is primarily associated with mothers and female caregivers. The lack of demonstrated affection between fathers and sons among the coastal tribe was mentioned. It would appear, however, that cultural and gendered norms around the expression of love are changing over time. The participants emphasized that fathers demonstrate affection to their children more today than was the case in previous generations.

The results of the survey supported those of the qualitative phase by indicating a change in affective behaviours over time. The analyses indicate that participants consider the level of family resilience during their upbringing to have been significantly lower than it is in their current family.

Furthermore, the quantitative analysis shows an association between family resilience and alcohol abuse. In the multivariate analysis, higher levels of family resilience in one’s current family and during one’s upbringing are negatively associated with excessive use of alcohol.

Limitations

The authors point out that convenience sampling limits the ability to generalize the results. Given the diversity among Indigenous peoples, the results should be tested in other contexts with larger samples. Another limitation to the results mentioned is that the participants self-assessed.


Social inequalities in health

Identification with ancestral culture is associated with fewer internalizing problems among older Naskapi adolescents

Blacklock, A., Schmidt, L. A., Fryberg, S. A., Klassen, G. H., Querengesser, J., Stewart, J., Campbell, C. A., Flores, H., Reynolds, A., Tootoosis, C., and Burack, J. A. (20 20). Identification with ancestral culture is associated with fewer internalizing problems among older Naskapi adolescents. Transcultural Psychiatry, 57(2), 321–331.

Context

Cultural identity is considered an important factor in the promotion of wellbeing among Indigenous peoples. Several studies show an association between a strong cultural identity and fewer externalizing and internalizing problems, including anxiety, depression, and aggressive and rule‑breaking behaviours. Given that cultural identity varies with age and gender, the authors proposed to examine whether the beneficial effects of a strong cultural identity also vary with those factors.

Objectives

Examine the roles of age and gender in moderating a) the cultural identity and internalizing and externalizing problems, and b) the interaction between cultural identity and externalizing problems among Naskapi adolescents in Québec.

Methodology and data

The participants consisted of 61 Naskapi students with an average age of 14.5, 32 of whom were female. The Naskapi Nation of Kawawachikamach is a community in the Nord-du-Québec region accessible only by plane or a 20-hour train ride. The participants, who were recruited at Jimmy Sandy Memorial School, completed a questionnaire in English about internalizing (anxious-depressed behaviour, withdrawn-depressed behaviour and somatic complaints) and externalizing (aggressive and rule‑breaking behaviours) problems, cultural identity and sociodemographic data. Hierarchical multiple linear regressions were conducted.

What was learned?

The relationship between Indigenous cultural identity and the presence of an internalizing disorder varies with the age of the participant. The results show that adolescents between the ages of 14 and 18 who present a strong cultural identity (significant involvement in Indigenous activities and comfortable with the Naskapi language) report less anxiety and depression, withdrawal, and somatic complaints than do those with a weaker cultural identity. This result was not observed in young people under the age of 14. According to the authors, this is because cultural identity tends to develop more in later adolescence.

No other effect or interaction was observed with respect to age, gender, cultural identity or internalizing or externalizing disorders.

Limitations

The authors report that using self-assessment to measure internalizing and externalizing disorders may have created a bias of memory and social desirability. In addition, the sample size may have influenced the statistical power and limited the observation of significant results. Finally, the results cannot be generalized to other Indigenous populations, although they may be useful in understanding the role of Indigenous cultural identity on wellbeing.


Violence at the intersections of women’s lives in an urban context: Indigenous women’s experiences of leaving and/or staying with an abusive partner

Smye, V., Varcoe, C., Browne, A. J., Dion Stout, M., Josewski, V., Ford-Gilboe, M., and Keith, B. (2021). Violence at the intersections of women’s lives in an urban context: Indigenous women’s experiences of leaving and/or staying with an abusive partnerViolence Against Women, 27(10), 1586–1607.

Context

Intimate partner violence encompasses a wide range of sexually, physically and psychologically violent behaviours. Indigenous women report higher levels of intimate partner violence than do non-Indigenous women, due, in part, to the intersection of sexism, racism, classism and colonialist policies to which they are subjected. The responsibility for leaving a violent relationship often lies with the woman. This solution is not always viable, however, since conjugal separation may be associated with economic and housing instability, loss of child custody and reduced access to care. It may also be associated with psychological distress and even, frequently, an intensification of the violence.

Objectives

  • Identify the characteristics of the social context of Indigenous women who are in the process of deciding whether to leave a violent relationship or stay.
  • Explore the benefits and harms of turning to social and health services during this process.
  • Examine what constitutes effective health and social services support for women.
  • Analyze how institutional and sociopolitical contexts influence their experience of leaving a violent relationship or staying.
  • Formulate recommendations concerning the role of policies and health institutions in delivering culturally safe services to Indigenous women.

Methodology and data

This article presents data from an ethnographic study that included individual and group interviews, photovoice and participant observation in a Canadian city. Participants were recruited through community organizations supporting victims of intimate partner violence. Twenty-five Indigenous women, five non-Indigenous women, ten Indigenous men and ten victims’ service and support workers participated in the study. The analyses were based on critical feminist approaches and Indigenous perspectives.

What was learned?

Four themes intersect in women’s decision making:

  • State–Indigenous Relations: Indigenous women are at greater risk than non-Indigenous women of losing custody of their children or being incarcerated. Women in the study reported taking those risks into consideration when deciding whether to leave a violent relationship or stay.
  • Complex trauma, stigma and discrimination: Indigenous peoples tend to suffer from various forms of violence, including a history of policies aimed at their assimilation (such as residential schools). Participants in the study reported having experienced discrimination at the hands of health and social services when asking for help in leaving an abusive relationship.
  • Relationships with family, the community and the land: An attachment to the place of origin and family is a core element in the decision to leave a relationship or stay. In reality, leaving a violent relationship is often synonymous with leaving the community, which may have negative consequences on social support, cultural connections, access to housing and income.
  • Health, healing and resistance: A majority of women in the study reported that finding a support group for Indigenous people was a kind of lifeline and a beginning to finding health and well-being, moving forward in their lives and engaging in the decision process of leaving a violent relationship.

The participants and the authors recommend that policies and health institutions focus more on the responsibility of men, hire female Indigenous support workers who have experienced intimate partner violence, and improve access to housing for Indigenous women.

Limitations

The authors did not address limitations to their study.


Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: A systematic scoping review

Kairuz, C. A., Casanelia, L. M., Bennett-Brook, K., Coombes, J., and Yadar, U. N. (2021). Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: A systematic scoping reviewBMC Public Health. 21, 1302.
Open access: PDF

Context

According to the authors, racism is the manifestation of beliefs, emotions, behaviours and practices that perpetuate and worsen social inequalities for members of an ethno-racial group. Racism is increasingly recognized as an important health determinant in combination with other determinants, such as access to housing, employment and education. It also contributes to social inequalities in health that disproportionately affect Aboriginal and Torres Strait Islander people living in Australia and elsewhere in the world. The failure of policies aimed at narrowing the social inequalities gap in health affecting this population lies with interventions that often target the individual, despite studies showing an association between structural determinants of health, such as racism, and health issues.

Objective

The purpose of this systematic scoping review was to identify and analyze literature that describes and associates racial discrimination with impacts on the physical and mental health of Aboriginal and Torres Strait Islander peoples of all ages living in Australia.

Methodology and data

The authors followed the PRISMA-ScR guidelines. A total of 335 articles were identified in five databases. Three other articles were located manually. The removal of duplicate articles left 218 articles for assessment. In the end, 20 studies were included in the review. After evaluating the full texts and quality of the studies, 12 articles were analyzed by considering 1) exposure to racism and 2) effects on mental, physical and behavioural health outcomes.

What was learned?

The studies included in the review underscore the association between racism and adverse impacts on the physical and mental health for people of all ages.

Racism has a greater negative impact on the mental health of Indigenous people than on their physical health. The association between racism and depression, behavioural problems in children and sleep disorders is consistently reported in three of the articles reviewed. Other studies looking at ethnic minorities (not including Indigenous people) confirm the association between racism and depression, post-traumatic stress and suicidal thoughts.

Racism is associated with a negative health perception overall. Few studies look at racism and physical health conditions, such as obesity, asthma, high blood pressure, diabetes and heart disease, and no significant association was observed. Only one study in the review showed an association between racism and the use of tobacco and alcohol.

Limitations

The authors point out that the period of exposure to racism considered by the studies in the review was often limited in time, which may lead to underestimating the phenomenon. Moreover, the results are not representative of the population as a whole because of sampling bias. Also, only quantitative studies were selected for inclusion. Finally, the articles reviewed distinguish between mental and physical health and do not take into consideration cultural and community dimensions of wellbeing. These limitations underscore the importance of including Indigenous perspectives and methodologies in research in order to obtain results that represent how Aboriginal and Torres Strait Islander people understand the concept of health.


Early childhood and child development

How do young aboriginal fathers in Australia “stay on track”? — Perspectives on the support networks of Aboriginal fathers

Faulkner, D., Hammond, C., Nisbet, L., and Fletcher, R. (2021). How do young aboriginal fathers in Australia ‘stay on track’? – Perspectives on the support networks of Aboriginal fathers. Journal of Family Studies, 27(1), 146–159.

Context

Few studies examine the role of Aboriginal and Torres Strait Islander fathers in Australia, and even fewer look at those fathers living in regional and urban areas. The role of contemporary fathers seems to be marked by a combination of physiological and social paternity. The latter ensures healthy relations between men and boys of different generations. Their role is also influenced by social norms of the dominant Western culture imposed through colonization.

Objective

Report the experiences of young Aboriginal fathers living in regional and urban New South Wales by analyzing their support network before and after the birth of their first child. The authors were interested in the Stayin’ on Track research program that offers online support and assistance to young Aboriginal fathers.

Methodology and data

Two series of semi-directed interviews, ranging in length from about ten minutes to one hour, were hosted by two Aboriginal mentors known to the participating fathers. The presence of the mentors was intended to ensure that the interviews were conducted in a culturally appropriate manner. The interviews were recorded, transcribed and coded, and the data was processed using thematic analysis.

What was learned?

The notion of responsibility was central in the participants’ perception of paternity, and the father’s awareness of this came soon after their paternity was announced. Several participants mentioned that the experience was akin to “learning how to be a man” or “manning up,” leading them to adopt new behaviours and assess their social network.

The participants also expressed a desire to perpetuate the tradition of being a good father, whether or not they had had a father present in their own life. For a majority of participants, just being there was a good starting point, which the authors understood as expressing the importance of being a father.

Moreover, when asked about their support network, some participants reported turning to their extended family when they need moral support or advice. Others, however, are less inclined to seek out family members.

Finally, participants expressed that becoming a father allows men to develop and reinforce their sense of belonging to the community and to maintain their Aboriginal identities. On the other hand, Aboriginal fathers feel pressured by negative stereotypes about them. Some said they would try to avoid making mistakes that would tarnish the image of Aboriginal fathers.

Limitations

The authors do not see their results as reflective of the experiences of Aboriginal and Torres Strait Islander fathers in other regional or urban settings in Australia. In addition, the research looked at a specific period of fatherhood that does not reflect the situation of fathers as their children get older and grow in number.


Wellbeing and mental health promotion

Land-based intervention: A qualitative study of the knowledge and practices associated with one approach to mental health in a Cree community

Walsh, R., Danto, D., and Sommerfeld, J. (2020). Land-based intervention: A qualitative study of the knowledge and practices associated with one approach to mental health in a Cree community. International Journal of Mental Health and Addiction, 18, 207–221.
Open access: PDF

Context

This project followed up a study comparing the resilience of one Cree community, which reported lower rates of suicide and use of mental health services, with that of five other Cree Nation communities. The distinctive characteristics of this community are: the importance of intergenerational cultural continuity, ethnocultural identity and a connection with the land. This final characteristic forms an integral part of the wellbeing of Indigenous populations. Mental health interventions focused on a connection with the land are more appropriate than Western approaches for Indigenous communities.

Objective

Understand the fundamental principles of interventions based on the land and their implementation in Indigenous communities.

Methodology

For this qualitative phenomenological study, interviews were conducted with three members of the community who practice or support land-based interventions. Project George is a land-based Ontario suicide prevention program for young people in Moose Factory and the Moosonee region. Volunteers and Elders accompany young people in the forest as they learn traditional Cree bush skills.

What was learned?

Researchers were able to identify the key components, benefits and challenges inherent in land-based interventions.

  • Key components include intergenerational knowledge transfer, teamwork, relationship building, involvement in decision making, the participation of Elders, and combining traditional practices with new outdoor activities.
  • Benefits include focusing on health rather than mental illness; connecting with Cree culture, nature, family and community, and one’s identity and spirituality; and developing pride and self‑esteem.
  • Challenges primarily concern costs, problems with ensuring sustainable funding, and provincial policies and regulations.

Land-based interventions reinforce cultural identity and intergenerational relationships, thereby ensuring cultural continuity and empowering participants. They also foster the creation of positive relationships among participants, which are critical to the healing process. An involvement in traditional activities on the land encourages young Indigenous participants to develop relations with their peers, elders, ancestors, culture, traditions, deceased family members, spirits and nature. In this way, land-based interventions can help heal the trauma experienced within communities.

It is increasingly clear that territorial dispossession played a role in the development of substance abuse and other mental health issues among Indigenous peoples. Despite the challenges identified, a variety of land-based interventions continue to be implemented.

Limitations

The authors did not address limitations to their study.


The inclusion of articles presented in this monitoring newsletter does not represent their endorsement by the Institut. Professional judgment remains essential in assessing the value of these articles for your work. You can also consult the Methodology for Indigenous Health Research Monitoring.