The Impact of Racial and Non-racial Discrimination on Health Behavior Change Among Visible Minority Adults During the COVID-19 Pandemic.

INTRODUCTION: Pre-pandemic health behavior has been put forward as a reason for excess COVID-19 infection and death in some racialized groups. At the same time, scholars have labeled racism the other pandemic and argued for its role in the adverse COVID-19 outcomes observed. The purpose of this study was to examine the impact of discrimination on health behavior change among racialized adults in the early stages of the pandemic. METHODS: Data were collected from 210 adults who identified as a visible minority in Alberta, Canada, in June 2020. The Everyday Discrimination Scale (Short Version) was adapted to examine past-month experiences. Four questions asked if alcohol/cannabis use and stress eating had significantly increased, and if sleep and exercise had significantly decreased in the past month. Logistic regression models examined associations between discrimination attributed to racial and non-racial causes and health behavior change adjusted for covariates. RESULTS: The majority of adults (56.2%) reported past-month discrimination including 26.7% who attributed it to their race. Asian adults reported more racial discrimination and discrimination due to people believing they had COVID-19 than other visible minorities. Racial discrimination during the pandemic was strongly associated with increased substance use (OR: 4.0, 95% CI 1.2, 13.4) and decreased sleep (OR: 7.0, 95% CI 2.7, 18.4), and weakly associated with decreased exercise (OR: 2.2, 95% CI 1.1, 4.5). Non-racial discrimination was strongly associated with decreased sleep (OR: 4.8, 95% CI 1.8, 12.5). CONCLUSION: Racial discrimination may have a particularly important effect on intensifying adverse health behavior changes among racialized adults during a time of global crisis.

Effectiveness of Live Health Professional-Led Group eHealth Interventions for Adult Mental Health: Systematic Review of Randomized Controlled Trials.

BACKGROUND: The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. OBJECTIVE: This systematic review aims to assess experimental evidence for the effectiveness of live health professional-led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. METHODS: Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. RESULTS: Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional-led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional-led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity. CONCLUSIONS: Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement. TRIAL REGISTRATION: PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13643-020-01479-3.

Socioeconomic Status Moderates the Impact of Emotional but not Physical Childhood Abuse on Women's Sleep.

A recent systematic review highlighted associations between childhood abuse and adult sleep quality, and the need for research focused specifically on women and the role of moderating variables. The objectives of the present study were (1) to assess the impact of frequent physical and emotional child abuse on adult sleep among women; and (2) to assess the role that childhood socioeconomic status (SES) could play in moderating these associations. In-person data were collected from women living in a mid-sized city in western Canada in 2019-2020 (N = 185; M age = 40 years). Sleep quality was measured using the Pittsburgh Sleep Quality Index. Physical and emotional abuse experienced often or very often in childhood were assessed using single items (yes or no). Childhood SES was assessed by a single item and dichotomized at the sample median. Linear regression models examined associations between each form of abuse and continuous adult sleep quality score adjusted for covariates. Statistically significant interactions were stratified and examined by child SES group. Frequent physical and emotional childhood abuse were each associated with clinically and statistically significant increases in past-month sleep problem scores among women in adjusted models. This association was moderated by childhood SES for emotional child abuse, but not physical child abuse. Findings suggest that growing up in an upper-middle to upper SES household may buffer the adverse impact of frequent emotional child abuse on later adult sleep, but may not promote resilience in the context of frequent physical child abuse.

Adult PTSD symptoms and substance use during Wave 1 of the COVID-19 pandemic.

INTRODUCTION: This study examined associations between pandemic-related PTSD symptoms and substance use among adults, the role of gender and socioeconomic status in these outcomes, and the supports that adults needed to address these problems during Wave 1 of the COVID-19 pandemic in Alberta, Canada. METHODS AND MEASURES: Data were collected from 933 community-based adults without a previous diagnosis of PTSD in June 2020. The Primary Care PTSD Screen was adapted to assess pandemic-related PTSD symptoms. Participants were asked if alcohol or cannabis use had increased in the past month. Adjusted logistic regression models examined associations between pandemic-related PTSD symptoms and substance use. RESULTS: More women (19%) than men (13%) met criteria for high pandemic-related PTSD symptomology, while a similar percentage (13.4% of women, 13.2% of men) reported significant increases in substance use during the pandemic. Adults 18-35 years; those who believed they would become infected with the virus; and those with low income, education, or pandemic-related job loss were more likely to report PTSD symptoms. High pandemic-related PTSD symptomology was associated with a significant substance use increase among both women (OR = 2.2) and men (OR = 2.3) in adjusted models. Many adults (50% of women, 40% of men) reported they needed help to address these problems. CONCLUSIONS: Pandemic-related PTSD symptoms were common among adults during Wave 1 of COVID-19. These symptoms were associated with a significant increase in substance use among women and men. Many adults voiced a need for help with these problems. Findings suggest substance use interventions that consider and address pandemic-related PTSD symptoms may be needed.

Adverse childhood experiences are associated with illicit drug use among pregnant women with middle to high socioeconomic status: findings from the All Our Families Cohort.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with illicit drug use among pregnant women who are socioeconomically vulnerable. While it is assumed that the impact of ACEs on illicit drug use in pregnancy is reduced among women with higher socioeconomic status (SES), this assumption is not well tested in the literature. The objective of this study was to examine the impact of maternal ACEs on illicit drug use in a community-based sample of pregnant women with middle to high SES. METHODS: This study is a secondary analysis of a prospective cohort study that collected data from 1660 women during and after pregnancy in Calgary, Canada between 2008 and 2011 using mailed surveys. Illicit drug use in pregnancy was self-reported by women at 34-36 weeks gestation. An established scale examined maternal ACEs before 18 years. Logistic regression models and 95% confidence intervals tested associations between maternal ACE scores and illicit drug use in pregnancy. RESULTS: Overall, 3.1% of women in this predominantly married, well-educated, middle and upper middle income sample reported illicit drug use in pregnancy. Women with 2-3 ACEs had more than a two-fold increase, and women with 4 or more ACEs had almost a four-fold increase in illicit drug use in pregnancy, relative to women with 0-1 ACEs after adjustment for confounders. Exposure to child abuse was more consistently associated with illicit drug use in pregnancy than exposure to household dysfunction in childhood. CONCLUSIONS: Maternal ACEs were common and associated with a moderate increase in the odds of illicit drug use in pregnancy among Canadian women with middle to high SES.

Physical Activity Buffers the Adverse Impacts of Racial Discrimination on Allostatic Load Among Indigenous Adults.

BACKGROUND: Racial discrimination has been associated with biological dysfunction among ethnic minorities. The extent to which regular physical activity (PA) may buffer this association is unknown. PURPOSE: To examine the association between past-year racial discrimination and allostatic load (AL) stratified by PA within a sample of Indigenous adults. METHODS: Data were collected from Indigenous adults attending university in a city in western Canada between 2015 and 2017. The Experiences of Discrimination Scale was used to assess discrimination and the Godin-Shephard Leisure-Time Physical Activity Questionnaire assessed PA. A composite of seven biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function measured AL. Linear regression models examined associations adjusted for confounders (N = 150). RESULTS: In the insufficiently active group, every 1 point increase in racial discrimination (up to a maximum of 9) resulted in approximately one third of a point increase in AL score. In the sufficiently active group, the association between racial discrimination and AL score was not statistically significant. CONCLUSIONS: A growing body of research suggests racial discrimination is associated with multisystem biological dysregulation and health risks. Increased action to address racism in society is a priority. As that work unfolds, there is a need to identify effective tools that racialized groups can use to buffer the effects of racism on their health. The present findings suggest that engagement in regular PA may attenuate the pernicious effects of discrimination on biological dysfunction.

The impact of eHealth group interventions on the mental, behavioral, and physical health of adults: a systematic review protocol.

BACKGROUND: COVID-19 has resulted in an increased demand for eHealth services globally. There is emerging evidence for the efficacy for group eHealth interventions that support population-based mental health and wellbeing, but a systematic review is lacking. The primary objective of this systematic review is to summarize the evidence for eHealth group counseling and coaching programs for adults. A second objective is to assess, within studies selected for our primary objective, the impact of programs that encourage PA on outcomes compared to those that do not. METHODS: Randomized controlled trials that assess the impact of eHealth group counseling or coaching programs on mental health, health behavior, or physical health activity among community-dwelling adults will be included. We will search the following electronic databases (from January 2005 onwards): MEDLINE, PsycINFO, CINHAL, and the Central Register of Controlled Trials. The primary outcomes will be changes in mental health conditions (e.g., depression, anxiety, stress, quality of life), behavioral health conditions (e.g., substance use, smoking, sexual behavior, eating behavior, medication adherence), and physical health conditions (e.g., coping with cancer, menopausal symptoms, arthritis pain). Secondary outcomes will be changes in physical activity. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion with a third reviewer. A narrative synthesis without meta-analysis will be conducted. The strength of the body of evidence will be assessed using GRADE. The risk of bias in individual studies will be appraised using the Cochrane Risk of Bias 2.0 tool. Potential sources of gender bias in included studies will be considered at all stages of the planned review. DISCUSSION: This review will contribute to the literature by providing evidence on the effectiveness of eHealth counseling and coaching programs delivered to adults in a group format. SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020187551 ).

The Impact of Racially Motivated Housing Discrimination on Allostatic Load among Indigenous University Students.

Allostatic load (AL) is an aggregate measure of wear and tear on the body due to the chronic activation of the stress response system. The goal of this study was to examine the association between racially motivated housing discrimination (HD) and AL score within a sample of Indigenous university students. Data for this cross-sectional study were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (N = 104; mean age = 27.8 years). An item adapted from the Experience of Discrimination Scale was to assess racially motivated HD in the past 12 months. AL was measured as a composite of 7 biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for age, income, parenthood, and other situations in which discrimination had been experienced. Indigenous university students who experienced racially motivated HD in the past year (16.8% of the sample) had an average AL score of approximately 4, which was almost double that of their peers who had not. In an adjusted model, racially motivated HD was associated with a 1.5 point increase in AL score. This model explained 35% of the adjusted variance in AL score, of which racially motivated HD explained 24%. These results suggest Indigenous adults who experienced racially motivated HD in the past year had early and more pronounced wear and tear on neuroendocrine, cardiovascular, metabolic, and immune system functioning in young and middle adulthood than Indigenous peers who did not. These findings combine with others to highlight the need for increased efforts to prevent racially motivated HD in urban centers.

Maternal adverse childhood experiences are associated with binge drinking during pregnancy in a dose-dependent pattern: Findings from the All Our Families cohort.

BACKGROUND: Binge drinking (BD) is a serious risk factor for fetal alcohol spectrum disorders (FASD) and associated with more severe forms of the disorder. Thus, special attention to specific risk factors for BD adjacent to and during pregnancy is warranted. OBJECTIVES: (1) To examine the role that maternal adverse childhood experiences (ACEs) may play in BD in the 12 months before pregnancy and during pregnancy in a sample of women with moderate to high socioeconomic status; and (2) to examine the sociodemographic correlates of BD before and during pregnancy within this sample. PARTICIPANTS AND SETTING: This secondary analysis (N = 1663) was derived from the All Our Families prospective cohort study collected in Alberta, Canada between 2008-2011. METHODS: Data were collected using three mailed surveys completed by women during and after pregnancy. An established scale examined maternal ACEs before 18 years. Adjusted logistic regression models tested associations between ACE score and BD before and during pregnancy. RESULTS: Approximately 5 in 10 (48.3 %) and 1 in 10 (10.0 %) women reported ≥1 BD episode before and during pregnancy; respectively. In adjusted models, a woman's ACE score was associated with BD pre-pregnancy in a weak, nonmonotonic fashion; and during pregnancy in a moderate, dose-response fashion. Overall, ACEs resulted in two to three-fold increase in the odds of BD during pregnancy. CONCLUSIONS: Maternal ACEs were common in this middle to upper-middle income, well-educated sample and impacted the next generation through BD in pregnancy. These findings combine with others to speak to the public health significance of maternal ACEs on alcohol-related behaviour among expectant mothers across the socioeconomic spectrum, and the need for targeted evidence-based interventions for this population.

Past-Year Racial Discrimination and Allostatic Load Among Indigenous Adults in Canada: The Role of Cultural Continuity.

OBJECTIVE: This study aimed to examine the association between racial discrimination and allostatic load (AL) and whether this association was moderated by cultural continuity among Indigenous adults. METHODS: Data were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (mean age = 27.8 years). The Experience of Discrimination Situation Score and the Vancouver Index Enculturation Subscale were used to assess racial discrimination and cultural continuity, respectively. AL was measured as a composite of seven biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for confounders (n = 104; 72.5% women). RESULTS: Across the full sample, racial discrimination was associated with a linear, dose-response increase in AL score after adjustment for confounders. Among adults with low cultural continuity, past-year discrimination was associated with increased AL and explained 22% (adjusted R) of the variance in AL score. Taken together, the full model including age, sex, and income explained 38% of the variance in AL score in this subgroup. Among adults with high cultural continuity, racial discrimination was not associated with AL, whereas age remained significant and explained 13% of the variance in AL score. CONCLUSIONS: Past-year racial discrimination was associated with early and more pronounced wear and tear on stress response systems among Indigenous adults relative to peers. Indigenous cultural continuity served as an important buffer that promoted biological resilience against the adverse effects of racial discrimination on physiologic regulation among Indigenous adults.

Trauma-informed interventions versus control for cancer-risk behaviours among adults: rationale and design for a randomized trial.

BACKGROUND: Tobacco use, alcohol use, and sugar-sweetened beverage consumption are each associated with increased cancer-risk. Psychological trauma is a common experience and a key driver of these behaviours among adults. The primary aim of this study is to evaluate the effect of trauma-informed yoga, drumming, and psychoeducation compared to control on tobacco use, alcohol use, and sugar-sweetened beverage consumption among community-based adults. Secondary aims are to evaluate the effect of these interventions compared to control on psychological and physiological stress symptomology, social connection, and coping behaviour. METHODS: Recruitment for this single-blinded randomized trial began in April 2019 in the Faculty of Health Sciences at the University of Lethbridge. Adults who consumed tobacco, alcohol, or sugar-sweetened beverages in the past month and live in Lethbridge, Alberta are being recruited using ads placed in public spaces. Participants are randomly allocated to a 12-session group yoga class, 12-session group drumming class, a 12-session psychoeducation class, or control. Participants attend an appointment in-person to fill out an online questionnaire package, provide a saliva sample, and complete physical measures pre-intervention, and 1-month and 6-months post-intervention. DISCUSSION: This study provides a unique opportunity to compare the impacts of two trauma-informed body-based interventions to psychoeducation and control for cancer-risk behaviour among community-based adults. The findings can be used to develop trauma-informed group interventions to reduce cancer-risk behaviour in general populations. Results are expected in 2022. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov ISRCTN15583681 on 22 August 2019 (retrospectively registered).

Childhood racial discrimination and adult allostatic load: The role of Indigenous cultural continuity in allostatic resiliency.

OBJECTIVE: To examine the association between racial discrimination experienced in childhood on allostatic load (AL) in adulthood, and whether this association differed by cultural continuity among Indigenous adults. METHOD: Data were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (N = 105). The frequency of childhood racial discrimination was measured using an item modified from the Experience of Discrimination Scale. AL was measured as a composite of 7 biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Cultural continuity was measured using the Vancouver Index Enculturation Scale. Bootstrapped linear regression models examined associations adjusted for confounders, with and without stratification by a dichotomized measure of Indigenous cultural continuity. RESULTS: Most Indigenous adults (72.3%) experienced racial discrimination some or most of the time in childhood. The frequency of child discrimination was significantly associated with AL, explaining 11% of the variance in adult AL score after adjustment for age and income. In the high cultural continuity group, there was no association between child discrimination and adult AL. In the low cultural continuity group, child discrimination was significantly associated with AL, explaining 21% of the variance in adult AL score. CONCLUSION: Childhood racial discrimination may have a biological toll on adult health through altered activation of the stress response system which could, over time, exacerbate health inequities in this population. High Indigenous cultural continuity served as a resilience factor that buffered the adverse impacts of childhood discrimination on adult AL score.

The biological impacts of Indigenous residential school attendance on the next generation.

We investigated the biological impacts of Indigenous residential school attendance on the adult children of survivors, operationalized through allostatic load (AL); and the extent to which intergenerational trauma, operationalized through adverse childhood experience (ACE) score, mediated this association. Data were collected in-person from a university-based sample of Indigenous adults (N = 90, mean age: 28 years) in a mid-sized city in western Canada between 2015 and 2016. Associations were analyzed in multinominal regression models, with terciled AL and ACE scores as outcomes. The cross-products of coefficients method was used to test mediation. Overall, 42.7% and 33.7% reported their mother and father had attended residential school; respectively. In an adjusted model, maternal, but not paternal, residential school attendance was a risk factor associated with a moderate increase in AL among her adult children. The strength of this association did not change when the analysis was limited to mothers who raised their children. Maternal and paternal residential school attendance were each associated with increased ACE score among adults raised by survivors. However, ACE score did not explain the association between maternal residential school attendance and offspring AL score in mediational analyses. The present findings suggest colonial residential school experiences may have become biologically embedded, passed to subsequent generations, and exhibited through the dysregulation of allostatic systems among the adult children of maternal residential school survivors. Maternal exposure to residential school influenced biological dysregulation among her adult children in ways that could not be further exacerbated by her children's exposure to ACEs. The Canadian Truth and Reconciliation Commission asked governments to acknowledge the impact of residential schools on the current state of Indigenous health. Our findings underline the importance of this call by demonstrating how the residential school experience may get under the skin to impact the health of the next generation.

Short-term changes in daily movement behaviour influence salivary C-reactive protein in healthy women.

This study assessed the effect of changing daily movement behaviour on C-reactive protein (CRP) measured in saliva. Two groups of women either reduced daily movement or increased physical activity for 10 days. Salivary CRP increased by 31% in the sedentary group (0.378 ± 0.596 to 0.487 ± 0.793 µg·L-1) and decreased by 22% in the active group (0.414 ± 0.640 to 0.259 ± 0.284 µg·L-1). These results suggest short-term changes in daily movement behaviour can affect salivary CRP, a marker of systemic inflammation.

Community belonging and sedentary behavior among First Nations adults in Canada: The moderating role of income.

This study examined how income and community belonging may interact to influence leisure sedentary behavior among Indigenous adults. Data were obtained from 1,304 First Nations adults who completed the Canadian Community Health Survey in 2012. Among average-income earners, a strong sense of belonging to local community was associated with less sedentary behavior, a finding also documented in the general population. Among low-income earners, a strong sense of belonging to local community was associated with more sedentary behavior, a finding that is novel in the literature. These associations remained significant after adjustment for sociodemographic covariates and mental and physical health, suggesting other factors are influencing this correlation.

Sedentary behavior among adults: The role of community belonging.

Sedentary behavior is a modifiable determinant of health. Little is known about the ways in which contextual factors may influence this behavior. The objectives of this study were to: (1) examine the association between community belonging and adult sedentary behavior during leisure; (2) determine if this association was explained by perceived health. Data were derived from the 2010 Canadian Community Health Survey (N = 11,494 adults). Multinomial regression models and 99% confidence intervals were used to examine associations between sense of community belonging and sedentary behavior, adjusting for sociodemographic variables and perceived health. On average, adults were sedentary for 20-24 h per week during leisure. More than a third of the sample reported low sedentary behavior (≤ 19 h a week). In a fully adjusted model participants who were female, in middle adulthood, married, and/or living in higher income households were less sedentary during leisure. Adults with a strong sense of community belonging were also significantly less sedentary during leisure; this association remained significant after adjustment for perceived mental and overall health. Most efforts to address sedentary behavior have focused on individual-level interventions. The present finding highlights the role that larger contextual factors may play in sedentary behavior. Sense of community belonging is a contextual determinant of health that may serve as a useful target for interventions designed to reduce adult sedentary behavior during leisure.

Looking further upstream to prevent fetal alcohol spectrum disorder in Canada.

Half of all pregnancies in Canada are unintended. Whether a pregnancy is intended or unintended has a bearing on the risk of prenatal alcohol exposure. Research indicates that women who experience an unintended pregnancy are significantly more likely to consume alcohol while pregnant. Most fetal alcohol spectrum disorder (FASD) prevention frameworks in Canada have adopted a mid-stream approach focused on preventing alcohol consumption among women who are already pregnant. Yet there is a second approach, further upstream, that is rarely discussed as an FASD prevention tool in this country - preventing unintended pregnancy itself. Improving access to long-acting reversible contraceptives for women and girls who are experiencing cost and access barriers to these methods could do much to stem the incidence of FASD and the prohibitive health and social costs associated with this disorder in Canada.

Illicit and prescription drug problems among urban Aboriginal adults in Canada: the role of traditional culture in protection and resilience.

Illicit and prescription drug use disorders are two to four times more prevalent among Aboriginal peoples in North America than the general population. Research suggests Aboriginal cultural participation may be protective against substance use problems in rural and remote Aboriginal communities. As Aboriginal peoples continue to urbanize rapidly around the globe, the role traditional Aboriginal beliefs and practices may play in reducing or even preventing substance use problems in cities is becoming increasingly relevant, and is the focus of the present study. Mainstream acculturation was also examined. Data were collected via in-person surveys with a community-based sample of Aboriginal adults living in a mid-sized city in western Canada (N = 381) in 2010. Associations were analysed using two sets of bootstrapped linear regression models adjusted for confounders with continuous illicit and prescription drug problem scores as outcomes. Psychological mechanisms that may explain why traditional culture is protective for Aboriginal peoples were examined using the cross-products of coefficients mediation method. The extent to which culture served as a resilience factor was examined via interaction testing. Results indicate Aboriginal enculturation was a protective factor associated with reduced 12-month illicit drug problems and 12-month prescription drug problems among Aboriginal adults in an urban setting. Increased self-esteem partially explained why cultural participation was protective. Cultural participation also promoted resilience by reducing the effects of high school incompletion on drug problems. In contrast, mainstream acculturation was not associated with illicit drug problems and served as a risk factor for prescription drug problems in this urban sample. Findings encourage the growth of programs and services that support Aboriginal peoples who strive to maintain their cultural traditions within cities, and further studies that examine how Aboriginal cultural practices and beliefs may promote and protect Aboriginal health in an urban environment.

Epidemiology of adolescent Salvia divinorum use in Canada.

BACKGROUND: Salvia divinorum is a potent, naturally occurring hallucinogen gaining popularity as a recreational drug in North America. To date, detailed epidemiologic information about the use of this substance among adolescents living outside the United States has been limited. This study provides information on the prevalence and correlates of Salvia divinorum use among adolesecents in Canada using a nationally representative sample. METHODS: Data were obtained from a representative sample of 42,179 Canadian adolescents aged 12-17 years living across all 10 provinces who completed the Youth Smoking Survey in 2008-09. RESULTS: Overall, 3.8% of adolescents reported using Salvia in the past year and 6.2% had used the substance in their lifetime. A conservative estimate suggests 23.2% of youth were repeat users. Salvia use was highest among youth in British Columbia and Quebec. Comparatively, the prevalence of 12-month Salvia use was higher than 12-month cocaine and amphetamine use but lower than 12-month ecstasy, cannabis, and other hallucinogen use. Correlates of Salvia use included older age, male gender, high available spending money, binge drinking, illicit drug use and smoking in fully adjusted models. Findings suggest low self-esteem may be an important correlate specific to the use of this substance among youth. CONCLUSIONS: Salvia divinorum use is prevalent among Canadian adolescents. Salvia may be a significant public health issue in Canada given it is readily available, under limited regulation, and little is known about the abuse liability of the substance, interactions with other substances, and potential complications from use.

Racial discrimination, post traumatic stress, and gambling problems among urban Aboriginal adults in Canada.

Little is known about risk factors for problem gambling (PG) within the rapidly growing urban Aboriginal population in North America. Racial discrimination may be an important risk factor for PG given documented associations between racism and other forms of addictive behaviour. This study examined associations between racial discrimination and problem gambling among urban Aboriginal adults, and the extent to which this link was mediated by post traumatic stress. Data were collected via in-person surveys with a community-based sample of Aboriginal adults living in a mid-sized city in western Canada (N = 381) in 2010. Results indicate more than 80 % of respondents experienced discrimination due to Aboriginal race in the past year, with the majority reporting high levels of racism in that time period. Past year racial discrimination was a risk factor for 12-month problem gambling, gambling to escape, and post traumatic stress disorder (PTSD) symptoms in bootstrapped regression models adjusted for confounders and other forms of social trauma. Elevated PTSD symptoms among those experiencing high levels of racism partially explained the association between racism and the use of gambling to escape in statistical models. These findings are the first to suggest racial discrimination may be an important social determinant of problem gambling for Aboriginal peoples. Gambling may be a coping response that some Aboriginal adults use to escape the negative emotions associated with racist experiences. Results support the development of policies to reduce racism directed at Aboriginal peoples in urban areas, and enhanced services to help Aboriginal peoples cope with racist events.