Socioeconomic inequalities in health among Indigenous peoples living off-reserve in Canada: Trends and determinants

Using three nationally representative Aboriginal Peoples Surveys (2001, 2006 and 2012, n = 68,040), we examined income-related inequalities in self-perceived poor/fair general health status among Indigenous adults (18+) living off-reserve in Canada. We used the relative and absolute concentration indices (RC and AC, respectively) to quantify income-related inequalities in health for men and women, within the three Indigenous populations (First Nations, Métis, and Inuit), and in different geographic regions. Moreover, we performed decomposition analysis to determine factors that explain income-related inequality in health within the Indigenous peoples living off-reserve in Canada. The prevalence of poor/fair health status among the Indigenous population living off-reserve increased from 18% in 2001 to 22% in 2012. The extent of pro-rich relative (absolute) income-related inequalities in health increased by 23% (42%) from 2001 to 2012. Income-related inequalities in health increased statistically significantly within First Nations and Métis populations as well as in Atlantic provinces, Ontario, Alberta, British Columbia and Territories. Decomposition analyses indicated that, besides income itself, occupational status and educational attainment were the most important factors contributing to the pro-rich distribution of health among Indigenous peoples living off-reserve. Growing socioeconomic inequalities in health among Indigenous peoples should warrant more attention. Policies designed to address the broader array of social determinants of health may mitigate the continuing inequalities in health among Indigenous peoples living off-reserve in Canada.     

The Lifetime Effect of Residential School Attendance on Indigenous Health Status

Objectives. I examined the health impact of lifetime Indian Residential school (IRS) attendance and the mediating influences of socioeconomic status and community adversity on health outcomes in a national sample of Aboriginal peoples in Canada.Methods. In an analysis of data on 13 881 Inuit, Métis, and off-reserve First Nations or North American Indian adults responding to the postcensus 2006 Aboriginal Peoples Survey administered October 2006 to March 2007, I tested the direct effect of IRS attendance on health and indirect effects through socioeconomic and community factors using logistic regression procedures.Results. Negative health status was significantly more likely with IRS attendance than nonattendance. The direct effect of IRS attendance remained significant although it attenuated substantially when adjusting for demographic characteristics, socioeconomic status, and community-level adversities. Community adversity and socioeconomic factors, primarily income, employment status, and educational attainment mediated the effect of IRS on health.Conclusions. Residential school attendance is a significant health determinant in the Indigenous population and is adversely associated with subsequent health status both directly and through the effects of attendance on socioeconomic and community-level risks.The prevalence of poor general health in the Canadian population continues to be substantially higher among Aboriginal peoples than non-Aboriginal peoples.1–3 The disparity and greater burden of illness in the Indigenous population have been attributed in part to the enduring effects of colonization that destabilized Aboriginal cultural, economic, and community systems.3 Establishment of the Indian residential school (IRS) system and enforcement of compulsory enrollment for school-aged Aboriginal children constituted some of the most assertive means by which the Canadian government administered colonial policies. There are potential health risks associated with IRS attendance3–5; however, these effects, and factors explaining health outcomes were not assessed systematically in previous research. The etiology of negative health status among residential school attenders has been obscured partly because of the failure to expand the scope of Indigenous health determinants in empirical analysis to consider simultaneously the influences of early colonization-specific experiences and more proximal socioeconomic disadvantages and adverse psychosocial and community conditions.I examined the effect of lifetime residential school attendance on self-reported health status and the extent to which socioeconomic and community adversities were pathways linking IRS attendance histories to health outcomes in Inuit, Métis, and off-reserve First Nations or North American Indian adults surveyed across Canada for the 2006 Aboriginal Peoples Survey. Self-assessed general health is a strong predictor of morbidity independent of sociodemographic factors, is highly correlated with physician-assessed health status, predicts health care system spending,6,7 and is a culturally relevant, valid indicator of health in Indigenous populations.8 By using national data inclusive of multiple Indigenous groups, and comprehensive analytic procedures to test models incorporating an array of risk factors disproportionately affecting the Indigenous population, I was able to address some limitations of previous research on Indigenous health attributable to limited use of multivariate analysis for determining mechanisms mediating the impact of colonization-related experiences on health, lack of national data derived from culturally relevant indicators of health and measures in common across Aboriginal groups, and nonrepresentativeness owing to insufficient inclusion of urban and off-reserve populations and Indigenous peoples residing in isolated geographic areas.The results are relevant to locating critical points of intervention for reducing population health disparities and the greater burden of illness in vulnerable groups undergoing rapid population growth. As of the 2011 enumeration of the population, more than 1.4 million persons, or 4.3% of the population of Canada, were Aboriginal people reporting North American Indian (First Nations), Métis, Inuit, or other Aboriginal identities.9 Approximately three quarters, including status and nonstatus Indians and the Métis and Inuit, resided off reserve. By year 2031, the Aboriginal population is projected to increase to 1.7 to 2.2 million.10     

South Australian four-year-old Aboriginal children: residence and socioeconomic status influence weight

Objective: Obesity rates have increased in children in Australia in the past 15 years. However, there is little available population data describing rates of overweight and obesity in Aboriginal children. Methods: Anthropometric data of four‐year‐old children (n=11,859) were collected by trained nurses at routine statewide preschool health checks during 2009. Weight status (underweight, healthy weight, overweight and obese) was determined using age and gender specific International Obesity Task Force (IOTF) cut‐points. Results: There were 337 Aboriginal children (3%) in the study population. Aboriginal children had significantly higher rates of overweight and obesity compared to non‐Aboriginal children (28% compared to 18% respectively, χ²p=0.0001). A statistically significant association between BMIz score and identifying as Aboriginal remained after controlling for rural/urban residence and socioeconomic status using multiple regression analyses. Conclusions: Aboriginal children have higher rates of overweight and obesity compared to their non‐Aboriginal peers by the time they are four years of age. Aboriginal children have higher BMIz scores compared to non‐Aboriginal children after controlling for rural/urban residence and socioeconomic status. Implications: A significant investment is required to optimise the health of Aboriginal women before pregnancy and throughout pregnancy. A rethink may be necessary in the approach to dietary management and catch‐up growth of Aboriginal children of low birth weight or having growth failure in early childhood.     

Aboriginal Physician Use in Canada: Location,Orientation and Identity

The main objectives of this paper are to compare Aboriginal and Canadian health status and physician use and to identify the factors associated with the use of physician services. Data are drawn from the 1991 Aboriginal Peoples Survey (APS) and the 1991 General Social Survey (GSS), which are weighted random samples of the Aboriginal and total Canadian populations, respectively. The results demonstrate that Aboriginals were much less likely to use physician services, even though Aboriginals rank their health similarly to the total Canadian population. Location becomes an important aspect of both physician use and health status, with Aboriginals residing on-reserve generally having lower levels of self-assessed health and less likely to have seen a physician. While Aboriginals with the poorest health status were more likely to have seen a physician, other factors including education were found to be barriers to use of health care. Aboriginal identity and cultural orientation provided mixed results. © 1997 by John Wiley & Sons, Ltd.     

Residential mobility within England and urban-rural inequalities in mortality

This study is situated within the international literature on geographic health inequalities between urban and rural areas. Using data from the Office for National Statistics Longitudinal Study (ONS LS), this paper assesses the role of residential mobility within England between 1981 and 2001 in explaining geographic inequalities in all-cause mortality between urban and rural Local Authority Districts at the end of the period (deaths occurring between 2001 and 2005). First, the pattern of directly age-standardised death rates (2001-2005) in urban and rural areas of residence in 2001 is examined and compared with the pattern that would have been seen if the observed death/survival of individuals had occurred in their original place of residence in 1981, or in 1991. Secondly, logistic regression is applied to examine whether individuals' residential mobility between urban and rural areas predict the risk of mortality, adjusting for people's socio-demographic characteristics. Findings show that, for this sample, residential mobility 1981-2001 accounts for about 30% of the urban-rural inequalities in mortality observed at the end of the period. LS members who were residentially mobile between urban and rural areas were relatively healthier than long-term urban residents, with better mortality outcomes among rural in-migrants. In age-stratified analysis, LS members of working age (20-64 years) moving out of rural areas, and LS members of retirement age (65 years and older) moving into rural areas, were shown to be healthier. Processes of selective migration in and out of rural areas in England are complex and may partly explain urban-rural health inequalities. In terms of varying mortality risk, findings also highlight the possible marginalisation and disadvantage of sub-groups of the rural population.     

Access and utilization of health services by British Columbia's rural Aboriginal population

PURPOSE: To provide a picture of the access and use of health services by Aboriginal British Columbians living in both reserve and off-reserve communities. DESIGN/METHODOLOGY/APPROACH: This project represents a collaborative effort between the University of British Columbia and multiple Aboriginal community partners. Between June and November 2003, 267 face-to-face interviews were conducted with Aboriginal persons in seven rural community organizations across the province. FINDINGS: This paper reports on the results of a survey of 267 Aboriginal clients. It was found that a substantial number of survey respondents accessed health services provided by an Aboriginal person. Although most respondents felt that services were available, they also identified a number of concerns. These revolved around the need to travel for services, as well as a lack of access to more specialized services. A number of self-reported barriers to service were also identified. These findings have several policy implications and will be useful to service planners. RESEARCH LIMITATIONS/IMPLICATIONS: Several questions for additional research were identified including the need to establish an inventory of service problem areas and investigating service and benefit policy and community awareness issues. ORIGINALITY/VALUE: This paper provides policy makers with knowledge on the rural Aboriginal population, a population that has faced long standing problems in accessing appropriate health services.     

Aboriginal participation in the DOVE study

OBJECTIVE/BACKGROUND: Aboriginals constitute a substantial portion of the population of Northern Alberta. Determinants such as poverty and education can compound health-care accessibility barriers experienced by Aboriginals compared to non-Aboriginals. A diabetes care enhancement study involved the collection of baseline and follow-up data on Aboriginal and non-Aboriginal patients with known type 2 diabetes in two rural communities in Northern Alberta. Analyses were conducted to determine any demographic or clinical differences existing between Aboriginals and non-Aboriginals. METHODS: 394 diabetes patients were recruited from the Peace and Keeweetinok Lakes health regions. 354 self-reported whether or not they were Aboriginal; a total of 94 self-reported being Aboriginal. Baseline and follow-up data were collected through interviews, standardized physical assessments, laboratory testing and self-reporting questionnaires (RAND-12 and HUI3). RESULTS: Aboriginals were younger, with longer duration of diabetes, more likely to be female, and less likely to have completed high school. At baseline, self-reported health status was uniformly worse, but the differences disappeared with adjustments for sociodemographic confounders, except for perceived mental health status. Aboriginals considered their mental health status to be worse than non-Aboriginals at baseline. Some aspects of health utilization were also different. DISCUSSION: While demographics were different and some utilization differences existed, overall this analysis demonstrates that "Aboriginality" does not contribute to diabetes outcomes when adjusted for appropriate variables.     

Child overweight and undernutrition in Thailand: Is there an urban effect?

An urban advantage in terms of lower risk of child undernutrition has been observed in many developing countries, but child obesity is often more prevalent in urban than rural areas. This study aimed to assess whether urban-rural disparities in undernutrition and obesity were attributable to concentrations of socioeconomically advantaged children into urban communities or to specific aspects of the urban environment. A sample of 4610 children ages 2-10 years was derived from the 2004 Round of the Kanchanaburi Demographic Surveillance System, monitoring health and demographic change in the province of Kanchanaburi, Thailand. We used multi-level logistic regression to model the odds of short stature, underweight, and obesity for children in 102 communities. Models tested whether child socioeconomic conditions accounted for urban-rural disparities or if aspects of the social and physical environment accounted for disparities, adjusting for child characteristics. 27.8% of children were underweight, while 19.9% had short stature, and 8.3% were obese. Bivariate associations showed urban residence associated with lower risk of undernutrition and a greater risk of obesity. Urban-rural disparities in odds of short stature and underweight were accounted for by child socioeconomic characteristics. Urban residence persisted as a risk factor for obesity after adjusting for child characteristics. Community wealth concentration, television coverage, and sanitation coverage were independently associated with greater risk of obesity. Undernutrition was strongly associated with household poverty, while household affluence and characteristics of the urban environment were associated with odds of obesity. Further research is needed to characterize how urban environments contribute to children's risks of obesity in developing countries.     

重庆市居民超重与肥胖现状及影响因素分析

目的了解重庆市居民超重与肥胖现状及主要影响因素。方法运用分层整群随机抽样方法及面对面询问调查,获得18岁及以上居民个人基本情况,体检获取身高、体重数据。采用多因素Logistic回归分析方法筛选超重肥胖相关影响因素。结果共调查4 183人,重庆市18岁及以上居民超重、肥胖率分别为27.0%,8.2%,超重、肥胖率均城市高于农村,女性高于男性。多因素Logistic逐步回归分析显示,城乡、性别、年龄、家庭人均年收入和体力活动是超重和肥胖的相关影响因素。结论重庆市居民超重、肥胖率较高,必须采取平衡膳食、增加体力活动和开展健康教育等措施进行综合防治。     

2004年天津市农村15岁以上居民健康体检结果分析

目的2004年对天津市15岁及以上农村居民进行身体健康检查，及时了解农村居民的健康状况及影响因素，为改善农村居民健康及完善农村医疗保健服务提供科学依据。方法对天津市2643859名15岁及以上农村人口进行身体健康检查，内容包括：基本体征及危险因素情况，内、外、五官科各项体征及女性的妇科检查。结果15岁及以上人群肥胖率为13．62％，超重率为26．70％，高血压患病率为31．57％；18岁以上人群吸烟率为22．38％，饮酒率为11．21％；35岁以上人群的糖尿病患病率为8．67％；女性阴道炎检出率为6．84％，宫颈炎检出率为1．33％，宫颈糜烂5．95％，乳腺增生检出率为4．96％。15岁以上人群其他内科、外科、五官科异常检出率低于0．5％。结论超重肥胖、高血压、糖尿病和血糖异常已成为农村居民重要的健康问题，应在农村地区针对主要健康问题制定干预策略与目标，开展健康教育与健康促进，控制慢性病危险因素的进一步发展，尽快建立农村医疗保险体系。以保障广大农村居民的身体健康。     

Feeding the Hispanic hospital patient: cultural considerations

As service-oriented professionals in a multicultural society, dietitians must be aware of cultural influences on food consumption patterns, population demographics, and health care usage by ethnic groups. The United States has one of the largest Hispanic populations in the world. The major health problems in the Hispanic population are cardiovascular disease, diabetes mellitus, and obesity. The use of health care services by Hispanic subgroups is dependent upon their residence in a rural or an urban area. This article summarizes national trends in food consumption, health care usage, prevalent health problems, and eating habits of Mexicans and Puerto Ricans, the most populous of the Hispanic subgroups. We provide diet modifications for energy-, fat- and sodium-restricted diets, which are part of the treatment for problems prevalent in this ethnic population. Dietitians must consider cultural and demographic influences to help Hispanic hospital patients modify their diet in ways that are both healthful and culturally acceptable.     

北京酒仙桥地区中老年人群心血管病发病相关因素的调查和分析

目的　了解北京酒仙桥地区中老年人群心血管病发病的相关因素 ,以制定合理的预防措施。方法　于 1996年 6～ 12月对该地区 9个居委会抽样调查了 5 87名 5 0岁以上中老年人的健康状况 ,主要包括身高、体重、血压、空腹血糖和血脂、75 g葡萄糖耐量试验和心电图检查 ,并抽样检查了 30 4人的空腹胰岛素。结果　发现超重及肥胖在小学文化程度及文盲者中所占比例最大(P <0 .0 1) ,同时女性超重及肥胖所占比例高于男性 (P <0 .0 5 ) ,但不同年龄间超重及肥胖与非超重间构成比差异无显著性 (P >0 .0 5 )。在超重及肥胖者中高脂血症、高血压、冠心病、糖耐量低减和糖尿病的患病率明显高于非超重者 (P <0 .0 1) ,超重及肥胖者中空腹血糖、胰岛素、总胆固醇和甘油三酯水平明显高于非超重者 (P <0 .0 1)。结论　对中老年人群进行以预防肥胖为重点的健康教育 ,以降低心血管病的发病率是当前一件十分迫切和非常有益的事     

A socioecological framework to understand weight-related issues in Aboriginal children in Canada

Obesity prevention efforts in Aboriginal (First Nations, Métis, or Inuit) communities in Canada should focus predominantly on children given their demographic significance and the accelerated time course of occurrence of type 2 diabetes mellitus in the Aboriginal population. A socioecological model to address childhood obesity in Aboriginal populations would focus on the numerous environments at different times in childhood that influence weight status, including prenatal, sociocultural, family, and community environments. Importantly, for Aboriginal children, obesity interventions need to also be situated within the context of a history of colonization and inequities in the social determinants of health. This review therefore advocates for the inclusion of a historical perspective and a life-course approach to obesity prevention in Aboriginal children in addition to developing interventions around the socioecological framework. We emphasize that childhood obesity prevention efforts should focus on promoting maternal health behaviours before and during pregnancy, and on breastfeeding and good infant and child nutrition in the postpartum and early childhood development periods. Ameliorating food insecurity by focusing on improving the sociodemographic risk factors for it, such as increasing income and educational attainment, are essential. More research is required to understand and measure obesogenic Aboriginal environments, to examine how altering specific environments modifies the foods that children eat and the activities that they do, and to examine how restoring and rebuilding cultural continuity in Aboriginal communities modifies the many determinants of obesity. This research needs to be done with the full participation of Aboriginal communities as partners in the research.     

The effectiveness of community based physical activity interventions with Aboriginal peoples

Though historically rare, Aboriginal individuals continue to experience greater levels of cardiovascular disease than the general Canadian population. Increasing evidence indicates rising sedentary behaviors from the traditional healthy and active lifestyles of this population.

Objective

This investigation aimed to examine the health benefits of a community-based physical activity intervention for Aboriginal Canadians.

Methods

From 2007–2010, 273 participants from the province of British Columbia, Canada were recruited through 21 Aboriginal communities representing male and females of wide ranging ages and health statuses. Participants attended identical testing of body composition, blood pressure, total and high density lipoprotein cholesterols, and physical activity behavior pre-and post-training. Participants completed one of three self-selected 13 week interventions: walking (n = 149), walk/running (n = 86), or running (n = 27).

Results

Improvements in health measures were observed for both male and female participants of all age groups and all three training programs. Male and female participants' improvements included waist circumference: 2.7 cm and 2.2 cm, total cholesterol: 0.18 mmol/L and 0.12 mmol/L, and systolic blood pressure: 2.6 mm Hg and 1.5 mm Hg, respectively.

Conclusions

The self-selected intensities program was successful in improving health status and physical activity for Aboriginal adults of all ages, genders and activity programs.     

Cardiovascular Disease Risk Factors and Obesity of Rural and Urban Elementary School Children

Previous studies on the influence of a rural/urban setting on the prevalence of cardiovascular disease risk factors in children have not sufficiently controlled for socioeconomic status, race, gender, and perhaps, may not have included a representative sample of rural and urban children. This study compared the cardiovascular disease risk factors and rate of obesity of children living in rural and urban settings. It also determined the magnitude of the effect of the rural/urban setting on cardiovascular disease risk factors and obesity when controlling for race, socioeconomic status, and gender. The subjects were 2,113 third- and fourth-grade children; 962 from an urban setting and 1,151 from a rural setting. Height, weight, skinfolds, resting blood pressure, and total cholesterol levels were measured. Aerobic power (pVO2max) was estimated from cycle ergometry. Physical activity and smoking history were obtained from a questionnaire. Clustering analyses using adjustment for sample error indicated that total cholesterol, blood pressure, smoking, and physical activity levels of rural and urban children were not different (P > 0.10); however, body mass index and sum of skinfolds was greater for rural youth (P < 0.004). Logistic regression indicated that rural children had a 54.7 percent increased risk of obesity (P = 0.0001). This study's results indicate that, in children, a rural setting is associated with obesity, but not with the major risk factors associated with cardiovascular disease.     

Chronic cardiovascular disease mortality in mountaintop mining areas of central Appalachian states

Purpose: To determine if chronic cardiovascular disease (CVD) mortality rates are higher among residents of mountaintop mining (MTM) areas compared to mining and nonmining areas, and to examine the association between greater levels of MTM surface mining and CVD mortality. Methods: Age‐adjusted chronic CVD mortality rates from 1999 to 2006 for counties in 4 Appalachian states where MTM occurs (N = 404) were linked with county coal mining data. Three groups of counties were compared: MTM, coal mining but not MTM, and nonmining. Covariates included smoking rate, rural‐urban status, percent male population, primary care physician supply, obesity rate, diabetes rate, poverty rate, race/ethnicity rates, high school and college education rates, and Appalachian county. Linear regression analyses examined the association of mortality rates with mining in MTM areas and non‐MTM areas and the association of mortality with quantity of surface coal mined in MTM areas. Findings: Prior to covariate adjustment, chronic CVD mortality rates were significantly higher in both mining areas compared to nonmining areas and significantly highest in MTM areas. After adjustment, mortality rates in MTM areas remained significantly higher and increased as a function of greater levels of surface mining. Higher obesity and poverty rates and lower college education rates also significantly predicted CVD mortality overall and in rural counties. Conclusions: MTM activity is significantly associated with elevated chronic CVD mortality rates. Future research is necessary to examine the socioeconomic and environmental impacts of MTM on health to reduce health disparities in rural coal mining areas.     

中国居民2002年营养与健康状况调查

目的 了解中国国民的营养与健康现状。方法 调查目标总体为31个省、自治区、直辖市，采用多阶段分层整群随机抽样方法。调查于2002年开展，包括询问调查、医学体检、实验室检测和膳食调查4个部分。结果 城市居民能量食物来源构成中，谷类食物仅占48．5％，脂肪供能比高达35．0％；农村居民膳食结构趋于合理(61．4％ vs．27．5％)。5岁以下儿童生长迟缓率为14．3％，低体重率为7．8％。3～12岁儿童维生素A缺乏率为9．3％。人群贫血患病率为15．2％。人群超重率为17．6％，肥胖率为5．6％。≥18岁人群高血压患病率为18．8％；糖尿病患病率2．6％；高胆固醇血症、高甘油三酯血症、低高密度脂蛋白胆固醇血症患病率依次为2．9％、11．9％、7．4％。高血压知晓率、治疗率、治疗者控制率分别为30．2％、247％、25．0％。中国人群的营养与健康状况存在较明显的城乡差异以及年龄别差异。结论 中国人群的健康面临双重疾病负担。城乡个体营养与健康水平的差异加大了疾病预防控制工作的难度。     

Baseline cardiovascular risk factors and stroke mortality by municipality population size in a 19-year follow-up study-NIPPON DATA80

The urban-rural difference in cardiovascular risk factors and stroke mortality throughout Japan was examined in a cohort by using hierarchical data structure. The subjects were 9,309 men and women aged > or = 30 years who were residents of 294 areas in 211 municipalities of Japan in 1980; they were followed up until 1999. The population sizes of the municipalities in which the aforementioned areas were located were used to distinguish between urban and rural areas. We applied multilevel modeling to take into account the hierarchical data structure of individuals (subjects) (level 1) nested within areas (level 2). Statistically significant differences were observed in the case of medium (30,000-300,000) and small (<30,000) municipality populations compared with large (> or =300,000) municipality populations with regard to the following parameters: body mass index in men, serum total cholesterol in both men and women, and daily alcohol drinking in women. The values or frequencies of these cardiovascular risk factors were significantly higher in large populations. Meanwhile, age-adjusted odds ratios for stroke mortality in the areas in the medium and small municipalities compared with those in the areas in the large municipalities were 1.31 (95% confidence interval (CI) 0.81-2.13) and 1.40 (95% CI 0.87-2.24) in men, and 1.32 (95% CI 0.79-2.20) and 1.62 (95% CI 0.99-2.65) in women, respectively. The results of multivariate analyses adjusted for age, body mass index, total cholesterol, diabetes, hypertension, current smoking, and daily alcohol consumption did not change materially. In conclusion, stroke mortality tended to be higher in rural areas than in urban areas in Japan, especially among women.     

Changes in Health Insurance Coverage Within Rural and Urban Environments—1977 to 1987

This study examines changes in the health insurance coverage of the nonelderly population in rural and urban areas between 1977 and 1987, using data from the National Medical Care Expenditure Survey (NMCES) and the National Medical Expenditure Survey (NMES). It was designed to test the hypothesis that differences in the rates of health insurance coverage in rural and urban areas have diminished over time, and to explore the composition of changes in coverage within rural and urban environments. The data suggest that the proportions of the populations that are without health insurance in rural and urban areas have converged since 1977. Although both rural and urban settings witnessed increases in the proportion of their populations without health insurance from any source, urban regions experienced a greater increase than did rural areas. These changes occurred among most subgroups within the population. In no subgroup did the percentage of the population without insurance in urban areas exceed that found in rural areas in either 1977 or 1987.     

Alcohol consumption and injury among Canadian adolescents: variations by urban-rural geographic status.

CONTEXT: The impact of alcohol consumption on risks for injury among rural adolescents is an important and understudied public health issue. Little is known about whether relationships between alcohol consumption and injury vary between rural and urban adolescents. PURPOSE: To examine associations between alcohol and medically attended injuries by urban-rural geographic status using a representative national sample of Canadian adolescents. METHODS: The study involved a secondary analysis of a national sample of Canadian adolescents aged 11-15 years (n = 7,031) from the 2001-2002 Health Behavior in School-Aged Children Survey. Respondents were classified into 5 geographic categories of rural-urban status. Multiple logistic regression was used to examine the magnitude and homogeneity of associations between drinking patterns and adolescent injuries across these 5 geographic groupings. FINDINGS: Higher rates of alcohol consumption and adolescent injuries were observed in more rural areas. Alcohol consumption was significantly associated with higher risks for injury occurrence with evidence of a dose-related pattern of risk. Associations between alcohol consumption and injury were consistent by urban-rural geographic status. CONCLUSIONS: Misuse of alcohol is an important potential cause of injury. Adolescents whose lifestyle includes alcohol consumption experience higher risks for injury, and this association is observed consistently by urban-rural geographic status. Findings of this study emphasize a need to intervene with high-risk adolescents as a tertiary prevention strategy, irrespective of geographic background.