Housing as a determinant of Inuit mental health: associations between improved housing measures and decline in psychological distress after rehousing in Nunavut and Nunavik.

INTERVENTION: In 2014-2015, more than 400 public housing units were constructed in Nunavut and Nunavik, two of the four Inuit regions in Canada. This provided the opportunity to assess the impact of improved housing conditions from a population health perspective in 12 Inuit communities where housing needs were the most severe. The aim of the research is to examine the associations between changes in housing conditions and changes in psychological distress pre-post rehousing. METHODS: A pre-post uncontrolled study was conducted in collaboration with Nunavut- and Nunavik-based organizations. Applicants at the top of public housing waitlists were recruited by local housing officers; participants completed questionnaires 1-6 months before rehousing, and 15-18 months after. Change in psychological distress was measured with the Kessler 6-item scale. Changes in three housing measures were examined: number of adults per household, number of children per household, and sense of home score. For each housing measure, a categorical variable stratified participants into three categories. The reference category included participants reporting significant change in the concerned housing measure; the two other categories included participants reporting little or no change. Associations were tested with linear multilevel regression models for change. RESULTS: A total of 102 Inuit adults completed the study. A reduction in the number of adults per household (living with 2 adults or less after rehousing) and an increase in sense of home were associated with significant decline in psychological distress pre-post rehousing (p < 0.001). CONCLUSION: Increased investments leading to such improvements in housing circumstances are promising ways to promote mental health in Inuit regions.

RéSUMé: INTERVENTION: En 2014-2015, plus de 400 logements sociaux ont été construits au Nunavut et au Nunavik, deux des quatre régions inuites du Canada, permettant ainsi d'évaluer l'impact de l'amélioration des conditions de logement sur la santé. Cette étude vise à examiner les associations entre les changements dans les conditions de logement et les changements dans la détresse psychologique avant et après le déménagement, dans 12 communautés inuites où les besoins en logement étaient les plus criants. MéTHODES: Une étude pré-post non contrôlée a été menée en collaboration avec des organisations du Nunavut et du Nunavik. Les participants figurant en tête des listes d'attente pour le logement social ont rempli les questionnaires de recherche 1-6 mois avant le déménagement et 15-18 mois après. Les changements de la détresse psychologique ont été mesurés à l'aide de l'échelle Kessler 6-item. Les changements des trois conditions de logement suivantes ont été examinés : le nombre d'adultes par ménage, le nombre d'enfants par ménage et le sentiment d'avoir un chez-soi. Pour chaque condition de logement, une variable catégorielle a été créée pour stratifier les participants ayant rapporté des changements (référence) et les participants n'ayant rapporté que peu ou pas de changement. Les associations ont été testées avec des modèles de régression linéaire multiniveaux. RéSULTATS: Un total de 102 adultes Inuit ont complété l'étude. Une réduction du nombre d'adultes par ménage (vivre avec 2 adultes ou moins après le déménagement) et une augmentation du sentiment d'avoir un chez-soi étaient associées à une baisse significative de la détresse psychologique (p < 0,001). CONCLUSION: Des investissements accrus menant à de telles améliorations des conditions de logement représentent une avenue prometteuse pour promouvoir la santé mentale dans les régions inuites.

The psychosocial dimension of housing in Nunavik: does social support vary with household crowding?

OBJECTIVES: Studies show that living in overcrowded households can contribute to the erosion of social support, which is an important factor in health and well-being. In this study, we examine the relationship between household crowding and social support for Inuit living in Nunavik (hereafter referred to as Nunavimmiut), a region where housing shortages are considered a serious public health problem. We assess whether overcrowding is associated with lower levels of perceived social support and whether this association varies by gender and age group. METHODS: Cross-sectional data are from Qanuilirpitaa? the 2017 Nunavik Health Survey (N = 1306; aged 16 years and older). A perceived social support index was derived from answers to questions related to three different components of social support: positive interaction, emotional support, and love and affection. Associations between overcrowding (more than one person per room) and perceived social support were assessed using weighted linear and logistic regressions, adjusted for several factors. Sex- and age-stratified analyses were also conducted. RESULTS: Nunavimmiut report significantly lower levels of social support when living in overcrowded households, independently of other covariates. Analyses stratified by sex and age further show that the detrimental association between overcrowding and perceived social support is higher and stronger for men and older adults (both men and women 55 years and older). CONCLUSION: Overcrowding is associated with lower levels of perceived social support, which is a key component of health for the general population and for Nunavimmiut. Future research should examine the factors creating stronger associations between overcrowding and lower social support for men and older adults.

RéSUMé: OBJECTIFS: Des études montrent que le fait de vivre dans un ménage surpeuplé peut contribuer à l'érosion du soutien social, qui est un facteur important de santé et de bien-être. Dans cette étude, nous examinons la relation entre le surpeuplement des ménages et le soutien social chez les Inuits du Nunavik, une région où la pénurie de logements est considérée comme un grave problème de santé publique. Nous évaluons si le surpeuplement est associé à des niveaux plus faibles de soutien social perçu chez les Inuits vivant au Nunavik (ci-après appelés Nunavimmiut), et si cette association varie selon le sexe et le groupe d'âge. MéTHODES: Les données transversales proviennent de Qanuilirpitaa? l'enquête sur la santé au Nunavik de 2017 (N = 1 306; âgés de 16 ans et plus). Un indice de soutien social perçu a été dérivé des réponses aux questions relatives à trois composantes différentes du soutien social : interaction positive, soutien émotionnel, et amour et affection. Les associations entre le surpeuplement résidentiel (plus d'une personne par pièce) et le soutien social perçu ont été évaluées à l'aide de régressions linéaires et logistiques pondérées, ajustées pour plusieurs facteurs. Des analyses stratifiées par sexe et par âge ont également été réalisées. RéSULTATS: Les Nunavimmiut déclarent des niveaux de soutien social significativement plus faibles lorsqu'ils vivent dans des ménages surpeuplés, indépendamment d'autres covariables. Les analyses stratifiées par sexe et par âge montrent en outre que l'association néfaste entre le surpeuplement et le soutien social perçu est plus élevée et plus forte chez les hommes et les adultes plus âgés (hommes et femmes de 55 ans et plus). CONCLUSION: Le surpeuplement résidentiel est associé à des niveaux inférieurs de soutien social perçu, lequel est une composante clé de la santé pour la population générale et pour les Nunavimmiut. Les recherches futures devraient examiner les facteurs en cause derrière l'association entre le surpeuplement résidentiel et l'affaiblissement du soutien social chez les hommes et les adultes plus âgés.

"We're Home Now": How a Rehousing Intervention Shapes the Mental Well-Being of Inuit Adults in Nunavut, Canada.

This study explores the ways in which a rehousing intervention shapes the mental well-being of Inuit adults living in Nunavut, Canada, where the prevalence of core housing need is four times the national average. More specifically, it compares the housing experiences of participants who were rehoused in a newly built public housing unit, to the experiences of participants on the public housing waitlist. The study was developed in collaboration with organizations based in Nunavut and Nunavik. Semi-structured interviews were transcribed, and a deductive-inductive thematic analysis was performed based on Gidden's concept of ontological security, and Inuit-specific mental health conceptualization. Twenty-five Inuit adults participated (11 rehoused, 14 waitlist). Three themes were identified to describe how the subjective housing experiences of participants improved their mental well-being after rehousing: (1) refuge creation; (2) self-determination and increased control; (3) improved family dynamics and identity repair. Implicit to these themes are the contrasting housing experiences of participants on the waitlist. Construction initiatives that increase public housing stock and address gaps in the housing continuum across Inuit regions could promote well-being at a population level. However, larger socio-economic problems facing Inuit may hamper beneficial processes stemming from such interventions.

Relocating to a new or pre-existing social housing unit: significant health improvements for Inuit adults in Nunavik and Nunavut.

OBJECTIVES: In 2014-2015, over 400 social housing units were constructed in selected communities in Nunavik and Nunavut, two Inuit regions in northern Canada where housing shortages and poor quality housing are endemic and undermine population health. This paper presents results from a before-and-after study examining the effects of rehousing, i.e., relocating to a newly constructed or pre-existing social housing unit, on psychosocial health and asthma-related symptoms for Inuit adults. METHODS: Baseline data were collected 1-6 months before, and follow-up data 15-18 months after rehousing. Of the 289 participants at baseline, 186 were rehoused. Of the 169 participants eligible at follow-up, 102 completed the study. Self-reported health measures included psychological distress, perceived stress in daily life, perceived control over one's life, and asthma-related symptoms. Data are analyzed using multilevel models for longitudinal data. RESULTS: After adjusting for age, sex, and region of residence, participants reported significantly lower levels of psychological distress and perceived stress in daily life, and improved sense of control over their lives 15 to 18 months after rehousing. Participants were also significantly less likely to report asthma-related symptoms at follow-up. CONCLUSION: Significant positive health impacts are observed for adults who relocated to newly constructed or pre-existing social housing units. Increasing investments to redress the housing situation across Inuit Nunangat is required, not only to improve living conditions but also to improve the health and well-being of the population.

Effect of Resistance Training and Various Sources of Protein Supplementation on Body Fat Mass and Metabolic Profile in Sarcopenic Overweight Older Adult Men: A Pilot Study.

The decrease in resting energy expenditure (REE) and fat oxidation with aging is associated with an increase in fat mass (FM), and both could be prevented by exercise such as resistance training. Dairy consumption has also been shown to promote FM loss in different subpopulations and to be positively associated with fat oxidation. Therefore, we sought to determine whether resistance exercise combined with dairy supplementation could have an additive impact on FM and energy metabolism, especially in individuals with a deficit in muscle mass. Twenty-six older overweight sarcopenic men (65 ± 5 years old) were recruited for the study. They participated in 4 months of resistance exercise and were randomized into three groups for postexercise shakes (control, dairy, and nondairy isocaloric and isoprotein supplement with 375 ml and ~280 calories per shake). Body composition was measured by dual X-ray absorptiometry and REE by indirect calorimetry. Fasting glucose, insulin, leptin, inflammatory profile, and blood lipid profile were also measured. Significant decreases were observed with FM only in the dairy supplement group; no changes were observed for any other variables. To conclude, FM may decrease without changes in metabolic parameters during resistance training and dairy supplementation with no caloric restriction without having any impact on metabolic properties. More studies are warranted to explain this significant decrease in FM.

Effect of Resistance Training and Various Sources of Protein Supplementation on Body Fat Mass and Metabolic Profile in Sarcopenic Overweight Older Adult Men: A Pilot Study.

The decrease in resting energy expenditure (REE) and fat oxidation with aging is associated with an increase in fat mass (FM), and both could be prevented by exercise such as resistance training. Dairy consumption has also been shown to promote FM loss in different subpopulations and to be positively associated with fat oxidation. Therefore, we sought to determine whether resistance exercise combined with dairy supplementation could have an additive impact on FM and energy metabolism, especially in individuals with a deficit in muscle mass. Twenty-six older overweight sarcopenic men (65 ± 5 years old) were recruited for the study. They participated in 4 months of resistance exercise and were randomized into three groups for postexercise shakes (control, dairy, and nondairy isocaloric and isoprotein supplement with 375 ml and ~280 calories per shake). Body composition was measured by dual X-ray absorptiometry and REE by indirect calorimetry. Fasting glucose, insulin, leptin, inflammatory profile, and blood lipid profile were also measured. Significant decreases were observed with FM only in the dairy supplement group; no changes were observed for any other variables. To conclude, FM may decrease without changes in metabolic parameters during resistance training and dairy supplementation with no caloric restriction without having any impact on metabolic properties. More studies are warranted to explain this significant decrease in FM.

Identification of tasks performed by stroke patients using a mobility assistive device.

Many stroke patients are prescribed canes or other mobility assistive devices. Once taken home, these mobility assistive devices are often abandoned or misused. A means for assessing the use of the cane in the home and community settings is required to assist clinicians in the prescription of these devices. In this study, we propose the use of wearable sensors to identify tasks performed by stroke patients with a mobility assistive device. Subjects performed ten tasks with a three-axis accelerometer attached to their ankle and a neural network was trained to identify the task being performed. Results from 15 stroke patients indicated that these motor tasks can be reliably identified with a median sensitivity of 90 % at a median specificity of 95%. These results indicate that it is possible to use a single module with a three-axis accelerometer attached to the ankle to reliably identify motor tasks associated with the use of a cane. Therefore, we envision that the methodology presented in this paper could be used to evaluate the use of a cane in the context of the task being performed.