Reduced Association Between Aboriginal Cultural Status and Health Outcomes and Behaviours After Multivariate Adjustment Dr. Mark Lemstra Senior Epidemiologist Saskatoon Health Region

CCHS - Adult Health Survey Data set Canadian Community Health Survey conducted by Statistics Canada (cycles 2001/03/05) and identical Saskatoon health survey (2007) Sample size N = 5,948 Age 12 and above Results Aboriginal Cultural status has a more limited association with health outcomes or behaviours after multivariate adjustment Income status has a strong association with health outcomes and behaviours

Table 1: Crude and Adjusted Associations with Self-Rated Health Reference Categories: Age: Yrs; Family Income: > 75,000; Smoking: Occasional/Former/Never; Physical Activity: Active/Moderate; BMI: Normal/Under weight; Heart Disease: No Heart Disease; Self Rate Health: Good/Fair/Poor VariableCrude (OR) Adjusted (OR) 95% CI Age- Over 65 Age Family Income- 0-25,000 Family Income- 25,001-75, Smoker -Daily Physically Inactive BMI – Over Weight/Obese Has Heart Disease Aboriginal

Table 2: Crude and Adjusted Associations with Suicide Ideation Reference Categories- Age: 12 – 44 Yrs; Family Income: > 75,000; Neighbourhood Income Type: Rural; Smoking: Occasional/Former/Never Smoker; Life Stress: Not at all; Consulted a Doctor: Zero Visits; Suicide: Yes VariableCrude (OR)Adjusted (OR)95 % CI Age- Over 65 Age Family Income-0-25,000 Family Income-25,001-75, Low Income Neighbourhoods Smoker-Daily Life Stress-Quite a Bit/Extreme Doctor Visits- Over 20 Doctor Visits Aboriginal

Table 3: Crude and Adjusted Associations with Diabetes VariableCrude (OR)Adjusted (OR)95 % CI Age- Over 65 Age Low Income Neighbourhoods Has High Blood Pressure BMI – Over Weight/Obese High BP * Low Income High BP * Middle Income No High BP * Low Income No High BP * Middle Income Aboriginal Reference Categories: Age: Yrs; Neighbourhood Income Type: Rural; Blood Pressure: No; BMI: Normal/Under Wt; Income: > 75,000; Diabetes: Yes

Table 4: Crude and Adjusted Associations with Heart Disease Variable Crude (OR) Adjusted (OR) 95% CI Age – Over 65 Age Gender – Male Family Income – 0-25,000 Family Income-25,001-75, Has High Blood Pressure Aboriginal Reference Categories: Age: Yrs; Gender: Female; Income: > 75,000; Has High Blood Pressure: No; Heart Disease: Yes

Table 5: Crude and Adjusted Estimates for Daily Smoking VariablesCrude ORAdjusted OR 95% CI Age Age Family Income 0-25,000 Family Income 25,001-75, Low Income Neighbourhoods < Than Secondary Graduate Education Secondary Graduate Education Has Considered Suicide Life Stress – Quite a bit/Extreme Aboriginal Cultural Status Reference Categories - Age -> Than 65; Family Income -> 75,000; Neighbourhood Income Type- Rural; Education – University Graduate; Has not Considered Suicide; No Life Stress; Smoking-Daily smoker

Saskatoon School Health Survey Dataset Questions from National Longitudinal Survey of Children and Youth (NLSCY) were used to review health outcomes and behaviours Data collection 2007 February Sample Size N = 4,093 participants Age years Results Aboriginal cultural status a more has limited association with health outcomes or behaviours after multivariate adjustment

Table 1: Crude and Adjusted Estimates for Depressed Mood among Youth VariableCrude ORAdjusted OR95% CI Aboriginal Cultural Status Female Was Hungry - Sometimes/Most of the times Parents ’ Low Education Low Self Esteem Felt like an outsider at school Was Bullied at school Alcohol Use High Anxiety Suicide Ideation Reference Categories: Culture: Caucasian; Gender: Male; Hunger: Never/Rarely; Parents’ Education: University Graduate; Self-Esteem: High ; School-Outsider: Rarely/Never; Bullying: No; Alcohol: None; Anxiety: Low; Suicide: No;

Table 2: Stepwise Regression Model for Depressed Mood among Youth Independent Model 0 Model 1 Model 2 Model 3 Model 4 Variables Crude OR Adj OR Adj OR Adj OR Adj OR_____ Aboriginal _______ Female _______ Hungry Parent Low Education ______ Low Self-Esteem Felt like an Outsider Bullied ______ Alcohol Use High Anxiety Suicide Ideation

Table 3: Crude and Adjusted Estimates of Having Been Drunk among Youth VariablesCrude ORAdjusted OR95% CI Aboriginal cultural status Age Low income neighbourhoods Low self-esteem Skipped school 1-5 times or more Have been bullied Friends tried marijuana Reference categories - Caucasian cultural status; Age 9-12; Rest of Saskatoon; High self- esteem; Never skipped school 1-5 times or more; Not been bullied; None of my friends tried marijuana; Being drunk -Have not been drunk