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

2. 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

3. Table 1: Crude and Adjusted Associations with Self-Rated Health Reference Categories: Age: 12-44 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- 45-64 2.44 1.52 1.72 1.37 1.37-2.16 1.16-1.61 Family Income- 0-25,000 Family Income- 25,001-75,000 2.14 1.45 1.39 1.16 1.12-1.72 0.96-1.40 Smoker -Daily1.401.261.06-1.50 Physically Inactive1.391.201.04-1.38 BMI – Over Weight/Obese 1.411.261.09-1.46 Has Heart Disease2.661.441.05-1.97 Aboriginal1.401.270.89-1.82

4. 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- 45-64 0.32 0.92 2.82 2.90 1.84-4.34 1.85-4.54 Family Income-0-25,000 Family Income-25,001-75,000 3.52 1.49 3.86 1.92 2.52-5.90 1.28-2.88 6 Low Income Neighbourhoods5.122.161.25-3.75 Smoker-Daily2.791.571.19-2.07 Life Stress-Quite a Bit/Extreme2.54 1.201.52-2.62 Doctor Visits- Over 20 Doctor Visits- 1-20 4.92 1.02 5.00 1.15 2.34-10.72 0.83-1.58 Aboriginal2.761.780.99-3.20

5. Table 3: Crude and Adjusted Associations with Diabetes VariableCrude (OR)Adjusted (OR)95 % CI Age- Over 65 Age -45-64 7.34 3.83 5.59 2.69 3.49-8.97 1.73-4.18 6 Low Income Neighbourhoods2.253.471.79-6.71 Has High Blood Pressure6.082.491.55-3.99 BMI – Over Weight/Obese3.392.601.79-3.77 High BP * Low Income High BP * Middle Income No High BP * Low Income No High BP * Middle Income 13.17 4.57 7.69 1.38 2.31 2.10 1.97 1.16 2.31-1.00 2.10-1.06 1.97-0.75 1.16-0.59 Aboriginal1.721.220.61-2.44 Reference Categories: Age: 12-44 Yrs; Neighbourhood Income Type: Rural; Blood Pressure: No; BMI: Normal/Under Wt; Income: > 75,000; Diabetes: Yes

6. Table 4: Crude and Adjusted Associations with Heart Disease Variable Crude (OR) Adjusted (OR) 95% CI Age – Over 65 Age - 44-65 51.35 12.28 32.53 8.90 17.07-62.02 4.64-17.10 Gender – Male 1.311.841.36-2.48 Family Income – 0-25,000 Family Income-25,001-75,000 3.94 2.15 2.14 1.20 1.28-3.55 0.74-1.97 Has High Blood Pressure5.852.141.59-2.88 Aboriginal0.841.050.47-2.35 Reference Categories: Age: 12-44 Yrs; Gender: Female; Income: > 75,000; Has High Blood Pressure: No; Heart Disease: Yes

7. Table 5: Crude and Adjusted Estimates for Daily Smoking VariablesCrude ORAdjusted OR 95% CI Age 12-44 Age 45-65 2.60 2.92 2.77 3.56 1.92-3.99 2.46-5.16 Family Income 0-25,000 Family Income 25,001-75,000 2.66 1.59 2.21 1.77 1.56-3.13 1.31-2.38 6 Low Income Neighbourhoods3.602.301.46-3.62 < Than Secondary Graduate Education Secondary Graduate Education 1.52 1.69 1.90 1.37 1.39-2.58 1.06-1.76 Has Considered Suicide2.791.521.13-2.03 Life Stress – Quite a bit/Extreme 1.301.321.03-1.69 Aboriginal Cultural Status3.431.591.17-2.17 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

8. 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 10-15 years Results Aboriginal cultural status a more has limited association with health outcomes or behaviours after multivariate adjustment

9. Table 1: Crude and Adjusted Estimates for Depressed Mood among Youth VariableCrude ORAdjusted OR95% CI Aboriginal Cultural Status 2.811.130.68-1.88 Female 1.84 1.671.18-2.35 Was Hungry - Sometimes/Most of the times 3.58 2.071.36-3.16 Parents ’ Low Education 1.96 1.501.07-2.12 Low Self Esteem11.03 3.192.08-4.87 Felt like an outsider at school 6.71 3.362.39-4.74 Was Bullied at school 4.06 1.881.28-2.76 Alcohol Use 3.74 2.521.73-3.67 High Anxiety53.3222.1714.17-34.69 Suicide Ideation12.88 3.732.50-5.57 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;

10. 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 2.81 2.81 2.09 1.66 1.13_______ Female 1.84 1.81 1.98 2.17 1.67_______ Hungry 3.58 3.40 2.26 2.07 Parent Low Education 1.96 1.67 1.41 1.50______ Low Self-Esteem 11.03 6.27 3.19 Felt like an Outsider 6.71 4.12 3.36 Bullied 4.06 2.86 1.88______ Alcohol Use 3.74 2.52 High Anxiety 53.32 22.17 Suicide Ideation 12.88 3.73

11. Table 3: Crude and Adjusted Estimates of Having Been Drunk among Youth VariablesCrude ORAdjusted OR95% CI Aboriginal cultural status3.530.780.47-1.31 Age 13-155.582.951.76-4.96 6 Low income neighbourhoods6.972.161.06-4.43 Low self-esteem4.672.081.34-3.22 Skipped school 1-5 times or more11.284.563.05-6.83 Have been bullied3.321.661.13-2.43 Friends tried marijuana18.028.055.58-11.63 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