1. Daniel (Beaulieu) McKennitt, BSc., MD Department of Medicine Division of Community Medicine Faculty of Medicine and Dentistry University of Alberta

2. Presentation Overview Background of issues Culturally appropriate tobacco use program in Edmonton Overview of culturally appropriate program Evaluation of culturally appropriate program Recommendations based on evaluation How Canadian Cancer Society can respond to behavioral health disparities.2

3. Family

4. Daniel

5. Objectives To introduce the problems of Aboriginal Health in Canada To demonstrate how standardized health prevention programs can be culturally modified To illustrate a participatory action research approach to developing and evaluating public health interventions 5

6. Aboriginal Health

7. First Nations/Inuit to Canadian Rate Ratio for Age-adjusted Chronic Disease Chronic diseases range from 1.5 to 5.3 times higher, compared to the Canadian population. Diabetes is the leading chronic condition, followed by cardiovascular problems. Diabetes is more prevalent among women. Chronic diseases tend to cluster in the same individuals. Source: Young et al. and the FNIRHS Steering Committee

8. Population Pyramid, 2000 Courtesy Larry Svenson, Alberta Health & Wellness

9. Aboriginal Health Aboriginal people have higher rates of substance abuse, infant mortality, chronic disease, blood- borne pathogens, infectious disease, and suicide than non-Aboriginal people Theories exist as to why this is, but basically stems back to colonization and the residential school system Aboriginal population is much younger than non Aboriginal population

13. So what does this all mean? Aboriginal people have always healed in all four areas, mental, emotional, physical and emotional This is not only true of the individual but of the community and the nation as a whole

14. Bridging the Gap? What is lacking is culturally appropriate healing methods and Aboriginal health care providers that can institute relevant programs and be sensitive to the needs of Aboriginal people

15. Aboriginal Health Group

16. One approach…. Monthly speaker series Cultural Appropriate Tobacco Use Aboriginal Health Awareness Week Leadership training

17. Background Approximately 60% of Aboriginal Canadians smoke daily, compared to 22% of all Canadians. Cigarette smoking occurring in more than half of all Aboriginal households This rate is roughly three time the Canadian national average.

18. Smoking Prevention Program in Edmonton Butt Out – a modified AADAC Teaming Up for Tobacco Free Kids program - did not resonate with Aboriginal youth. Stop smoking messages in the program focused on the harm of tobacco, which conflicted with messages of tobacco as a sacred plant in Aboriginal culture. Butt Out focused on health hazards, such as diseased lungs, and yellowed teeth. Aboriginal Elders use tobacco in important ceremonies and often do not have serious tobacco-related health issues. 18

19. Development of Culturally Appropriate Tobacco Use Program The Butt Out smoking prevention program was modified to make it more culturally appropriate Spearheaded by Aboriginal post- secondary students from different faculties and on-going consultation with Elders, Aboriginal community members, and Aboriginal youth themselves over a 6-month period. 19

21. Cultural Appropriate Tobacco Use Currently delivered in Aboriginal schools within the province including on and off reserve

22. How was the intervention modified? Spiritual Physical Emotional Mental Ingredients of cigarettes different from traditional tobacco Difference between traditional and recreational use Traditional role of tobacco in Aboriginal culture Peer pressure, Coping skills

23. Evaluation Purpose: To evaluate the effectiveness of a Culturally Appropriate Tobacco Use Program for Aboriginal Youth Study premise: Programs that do not recognize the significance of tobacco as a sacred plant in Aboriginal culture may confuse Aboriginal youth and be less effective.

24. Methods Two grade 4 classrooms from separate schools with high Aboriginal enrollment Random assignment control group (standard smoking prevention) experimental group (culturally appropriate tobacco program) Both classes received 60-90 minute intervention on the same day delivered by post-secondary Aboriginal students Pretest (one week before intervention) and posttest (one week after intervention)

25. Measures (Pre- & Post-test) Smoking Behaviour Smoking Update Continuum Self-Esteem Harris Children's Self-Concept Scale, Second Edition (Piers-Harris 2) Cultural knowledge CATUPAY Questionnaire Self-Efficacy Self-Efficacy Scale

26. Data Analysis Data entered into SPSS 17.0 Non-Aboriginal children removed from dataset Final sample: 11 students in treatment school, 6 students in control school Paired-sample t-tests were used to compare mean scores on each measure pre and post test at each school We were not expecting to find significant results given small sample size

27. Results: Similarities For Aboriginal children who received either program: Higher levels of self-esteem post-intervention. Children reported knowing less about what was inside a cigarette post-intervention. There were no significant changes in self-efficacy related to smoking post-intervention. Mean scores stayed relatively the same.

28. Results: Culturally appropriate Smoking behaviour Significant reduction in mean smoking behaviour for children receiving culturally appropriate intervention. No statistically significant changes in smoking behaviour for those who received the standard smoking prevention program. Smoking by friends - Significant reduction in reports of friends who smoked regularly post- intervention among those who received culturally appropriate intervention Slight increase in reports of friends who smoked regularly post- intervention in control school, but not significantly

29. Recommendations Aboriginal health is a serious issue and one that all Canadians need to be aware of Aboriginal people must heal together and through utilizing all the social determinants of health this is possible Must ‘bridge the gap’ by offering alternative means of developing health and health programming applicable to Aboriginal communities/ Aboriginal patients

30. Acknowledgements Elder Martha Campiou Dr. Cam Wild, Professor, School of Public Health, University of Alberta Ms. Cheryl Currie, Doctoral Student, School of Public Health, University of Alberta Edmonton Aboriginal community especially Elders and Youth

31. Contact 301-10827-85 Avenue, Edmonton, Alberta, T6E-2L2 Phone: (780) 952-9170 Fax: (780) 459-5742 Email:dwm4@ualberta.ca Website: http://www.aboriginalhealthgroup.org

32. Meegwetch!!