Risk and Protective Factors for Suicide Attempt Among Indigenous Māori Youth in New Zealand

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by Terryann C. Clark, Elizabeth Robinson, Sue Crengle, Theresa Fleming, Shanthi Ameratunga, Simon J. Denny, Linda H. Bearinger, Renee E. Sieving, and Elizabeth Saewyc


Indigenous youth around the world are at greater risk for suicide and suicide attempts compared to their peers. Among First Nations youth in Canada, suicide rates are five to six times higher than among non-Aboriginal youth. In New Zealand, suicide rates are about twice as high in Maori vs. non-Māori youth. There is limited information about indigenous- and youth-specific risk factors. This study explores the risk and protective factors associated with suicide attempts among Māori youth, as well as the potential for family connection to reduce suicide attempts.

Risk Factors for Suicide

The researchers randomly surveyed Māori students throughout New Zealand about their health and well-being. The results indicated that the strongest risk factor for suicide was symptoms of depression, with females being twice as likely as males to report significant depressive symptoms. Other significant risk factors were having a close friend or family member commit suicide, being in a younger age group, having anxiety, witnessing an adult hit another adult or child at home, and being uncomfortable in New Zealand European social surroundings.

Protective Factor for Suicide

When protective factors are present, an individual can “bounce back” when faced with adversity; this is called the resilience effect and is magnified in high risk situations. Family connection was found to be a protective factor, but did not act through the resilience effect. Rather, family connection acted as a compensatory mechanism to reduce the risk of suicide attempts across all levels of risk, not just at higher levels of risk.


Prevention efforts to prevent suicide should include programs for the whole population, not just those at immediate risk of suicide. These programs should prioritize positive mental health and support indigenous philosophies of family well-being and connection.

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What are the Odds? Community Readiness for Smoke-Free Bingos in First Nation Communities

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by Peter J. Hutchinson, Joan L. Bottorff, Natalie Chambers, Roberta Mowatt, Dennis Wardman, Debbie Sullivan, and Wanda Williams


First Nations communities are concerned about second-hand smoke exposure among young women and children. Tobacco control policies (TCPs) can significantly reduce second-hand smoke, but implementation varies from community to community. This research paper presents six communities’ experiences around establishing smoke-free policies, as well as three main factors that influence a community’s acceptance of TCPs. Also discussed is the community readiness model and how it can be refined for TCPs.

Factors affecting success of TCPs

After qualitatively analyzing participant interviews and observational data, the authors identified three main factors that influence the success of TCPs. These factors were most strongly illustrated in three different community halls used for bingo:

  • Economic drivers: Bingo generated valuable revenue for the community. There was no alternative source of revenue to support community activities and upkeep of the facility, so smoke-free policies were unsuccessful.
  • The Smoking majority: Bingos were held most days of the week and were well-attended by smokers. It became difficult to use the hall for other intended uses, e.g., children’s sports. However, smoking bans were not successful because bingo was considered to be more important than other activities.
  • Community and grassroots support: The band council consulted the community and decided to prohibit smoking during all events. Bingo attendance decreased initially but improved over time as community members became used to the smoke-free policy. However, since attendance did not reach previous levels, adapting the hall for other revenue-generating activities became a priority.

Community readiness model

The community readiness model is a useful tool for assessing a community’s overall stage of readiness for change, particularly those relating to health initiatives. For TCPs, the model needs to be refined to include socioeconomic factors, such as the three identified in the bingo halls. By refining the model to include these factors, First Nations communities can gain a better understanding of how to successfully implement TCPs in the future. In the authors’ words:

Using a comprehensive approach to assessing community readiness has the potential to increase success in implementing comprehensive TCPs and practices in First Nations communities in ways that are culturally relevant, address local conditions, and build on existing efforts.

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Strengthening Aboriginal Health through a Place-Based learning Community

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by John F. Anderson, Basia Pakula, Victoria Smye, Virginia Peters, and Leslie Schroeder


Mainstream models of health care have not been successful in meeting the needs of Aboriginal Peoples. Solutions are needed that value Indigenous knowledge and Western science equally, and focus on community strengths and successes rather than problems and failures.

The Health Integration Project Planning (HIPP) Committee is a partnership between the reserve community of Sts’ailes, Fraser Health Authority (FHA), and researchers at the University of Victoria and the University of British Columbia. Together, they look for ways to improve health services for the Sts’ailes people and other FHA clients. One of the Committee’s projects, the Sts’ailes Primary Health Care Project, was developed to examine how Indigenous and Western models of health care are used in the delivery of health and wellness services to Aboriginal communities.

Place-based learning communities (PbLCs)

PbLCs are dialogue-based networks that support a community’s ability to generate its own research projects and co-produce locally relevant knowledge with other researchers. The principles of PbLCs are being implemented in the Sts’ailes project, and include the following: • Protocols: Dialogues during HIPP forums are structured to ensure equality of power between the participants.

  • Iterative dialogue: Dialogue between the partners is multi-directional and usually narrative. Discussions are extensive and repeated to ensure that all parties understand one another.
  • Stakeholders and community participation: Participation and feedback from the community is highly encouraged to ensure that the research is applicable and meets with community approval.
  • Honouring traditional teachings: Community leaders strive to blend the best of the medical model with traditional, holistic approaches.

Partnership outcomes

An intimate, trusting partnership has emerged between the members of the HIPP Committee. This collaborative environment, which was developed during the Sts’ailes project, is in contrast to past initiatives in which academic researchers imposed their projects upon Aboriginal communities in a top-down fashion.

However, each PbLC partnership is unique and requires hard work and patience to develop. The HIPP Committee can serve as an example rather than a template for future initiatives in other Aboriginal communities.

Full article (PDF) >>

Alienation and Resilience: The Dynamics of Birth Outside Their Community for Rural First Nations Women

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by Jude Kornelsen, Andrew Kotaska, Pauline Waterfall, Louisa Willie, and Dawn Wilson


Women in rural First Nations communities are often evacuated to give birth due to lack of local maternity services. Studies suggest that these women face significant social, cultural, and financial stress as a result.

Bella Bella/Waglisla: Women’s birth experiences

In the small community of Bella Bella/Waglisla in British Columbia, maternity services began to decline in the year 2000. In 2001, it was mandated that all pregnant women had to leave the community to give birth at a larger hospital. The authors surveyed women about their birth experiences before and after the loss of maternity services, and included those who gave birth locally and those who were evacuated to referral centres. Data were gathered through written surveys (55 participants) and in-depth interviews (12 participants) and qualitatively analyzed to identify themes:

  • The decision-making process: Many women who chose to leave the community to give birth before the loss of services did so when local services began to decline. They described their decision in terms of safety and risk, and were usually strongly influenced by their physician and family, as well as their loss of confidence in local services as the number of health care providers declined.
  • Isolating experience of birth in a referral community: When traveling to give birth, many women had to make compromises on transportation method, quality of accommodation, and choosing accompanying family members. The women often gave birth while separated from their other children and without the usual sense of community celebration.
  • Travel concerns: The women expressed concerns about traveling during bad weather and being unable to return home. As a result, several chose less comfortable but more reliable methods of transportation (e.g., bus or boat vs. plane).
  • The importance of family: About half of the women were able to have accompanying family members at the referral centres, which helped to reduce the sense of isolation. However, there was also a profound sense of sadness for the family members left behind.
  • The desire to be home: Many of the women wanted to return home immediately after giving birth at the referral centre, despite the discomfort or need for continued medical attention. The desire for familiar routines and foods was strong.
  • Understanding the change in service: Many women did not understand why maternity services were no longer available locally, and felt that the loss of these long-standing services was irrational.

Alienation and resilience

Many of the women felt a sense of isolation, alienation, and powerlessness as a result of having to give birth at a referral centre. However, most of the women showed resilience by proactively seeking answers about the decline in services, or trying to mitigate their feelings of isolation and estrangement at the referral centres (e.g., by bringing along family members and returning home as soon as possible).

Due to limited maternity service in small rural communities, local births for Aboriginal women are not always possible. In order to reduce negative outcomes, solutions are needed to reduce the stress of evacuation for birthing mothers and involve the affected women and communities in the decision-making process.

Full article (PDF) >>

Further Reading: Book Review

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The Crisis of Chronic Disease among Aboriginal Peoples: A Challenge for
Public Health, Population Health and Social Policy
by J. Reading, PhD
University of Victoria, Centre for Aboriginal Health Research, 2009
ISBN 978-1-55058-407-3
185 pages

Aboriginal people in Canada face many challenges in terms of their health and well-being. The rates of diseases such as diabetes, heart disease, HIV/ AIDS, and tuberculosis are much higher in the Aboriginal population than in the Canadian population in general. The Crisis of Chronic Disease among Aboriginal
Peoples: A Challenge for Public Health, Population Health and Social Policy explores Aboriginal health and chronic diseases using a life course approach, from the prenatal stage of life to late adulthood. In addition to examining the risk factors for various chronic diseases across each of these life stages, the book discusses the burden of chronic disease for Aboriginal Peoples in Canada.

Health is determined by multiple and interrelated factors. In his section on chronic disease risk factors, Reading begins with a discussion of risk factors at the
community-level, such as poverty, housing, and access to health services, and their effects on health. Then, Reading conducts an extensive review of the literature to describe in detail the effects of risk factors throughout each stage of life. He argues that using a life course approach allows us to integrate scientific knowledge with cultural and sociological knowledge in a meaningful way.

The life course approach complements Aboriginal conceptions of health and well-being because it understands health in a holistic way. This approach allows us to follow risk factors throughout the lifespan in a logical way from the prenatal stage of life to late adulthood. In the section on the burden of chronic disease, Reading examines the impact of diseases such as diabetes, cardiovascular disease, cancer, and musculoskeletal
conditions on the Aboriginal population. He also examines the impact of chronic diseases on mental health. For example, Reading examines the relationship between diabetes and mental health by discussing diabetes-related depression and anxiety, and the impacts of this co-morbidity on an individual. Reading also indicates that there are gaps in the research in this area.

Each section uses specific indicators to describe the risk factors or the burden of disease. Statistics for the Aboriginal population in Canada are compared to general Canadian statistics whenever possible. In addition, population-specific statistics for First Nations, Inuit, and Métis are given whenever possible.

This book is a valuable resource for students, researchers, and policymakers, and an important addition to the chronic disease literature on Aboriginal Peoples. It identifies gaps in research and points to areas where interventions are needed or could be successful.

Jeff Reading is the Director of the Centre for Aboriginal Health Research at the University of Victoria.

Jennifer O’Neill, MSc
Research Officer
National Aboriginal Health Organization

Volume 6, Issue 1 – Traditional Medicine

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There is no uniform approach or generic label assigned to traditional medicine; rather, it is an acknowledgment of the geographic and cultural diversity within Indigenous knowledge. The papers in this journal offer a broad examination of traditional medicine, each sharing a unique Indigenous knowledge approach to understanding what traditional medicine is and its application in contemporary settings. The scope of the articles identified holism and interconnectivity as the core foundation of traditional medicine. In the spirit of diversity, each author frames traditional medicine differently and acknowledges the value of these practices.

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Editorial – Traditional Medicine

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Dawn Martin-Hill
Ph.D. Cultural Anthropology
Academic Director Indigenous Studies
McMaster University

There is no uniform approach or generic label assigned to traditional medicine; rather, it is an acknowledgment of the geographic and cultural diversity within Indigenous knowledge. The papers in this journal offer a broad examination of traditional medicine, each sharing a unique Indigenous knowledge approach to understanding what traditional medicine is and its application in contemporary settings. The scope of the articles identified holism and interconnectivity as the core foundation of traditional medicine. In the spirit of diversity, each author frames traditional medicine differently and acknowledges the value of these practices.

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Traditional Anishinabe Healing in a Clinical Setting: The Development of an Aboriginal Interdisciplinary Approach to Community-based Aboriginal Mental Health Care

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Marion A. Maar, Ph.D., Assistant Professor, Northern Ontario School of Medicine, Laurentian University

Marjory Shawande, Traditional Coordinator, Noojmowin Teg Health Access Centre, Aundek Omni Kaning, ON


Traditional medicine has been practiced by Aboriginal people for thousands of years at the community level. It is still practiced today outside of the mainstream health system by many Aboriginal people. However, providing this type of care in a clinical, health centre setting and in co-operation with western treatment methods is new, and requires a merging of traditional Aboriginal and western medical world views in order to develop protocols for service delivery that ensure the integrity of both systems. The groundwork required to ensure the safety of clients, providers, and organizations within the new integrated system is still largely undocumented.

To address this gap, we studied factors that support the successful integration of traditional Aboriginal healing and western mental health care approaches, and document the experiences of clients and providers. To accomplish this we contextualize 10 years of experience of traditional healing services development with in-depth interviews and focus groups with 17 community service providers and 23 clients.

We found that the development of traditional healing protocols, inter-professional education for providers and community members and a focus on client access to traditional Anishinabe health services provide the basis for the integration of western and traditional healing practices in the model under study. Our findings show integrated care resulted in positive experiences for clients and providers. We conclude that traditional healing approaches can be successfully integrated with clinical mental health services. Further research is necessary to improve our understanding of client experiences with this integrated approach and the impact on wholistic health and well-being.

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Contemporary Perceptions of Health from an Indigenous (Plains Cree) Perspective

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Holly Graham, RN, Ph.D.(c), University of Saskatchewan, Saskatoon,

Lynnette Leeseberg Stamler, RN, Ph.D., University of Saskatchewan, Saskatoon,


Currently, there is limited literature demonstrating awareness of how contemporary Aboriginal Peoples understand and define health, address their health concerns, and perceive barriers to obtaining optimal health. This knowledge is an important and essential first step in program planning for delivering effective health care for all aspects of health. An additional challenge is to effectively address and meet these needs in a timely manner which is critical to overall Indigenous wellness.

The primary researcher, who is Indigenous (Plains Cree), wondered whether the social determinants of health were reflective and an appropriate framework to address the existing health disparities between Aboriginal and non-Aboriginal Peoples of Canada, and more specifically, the Plains Cree people from Thunderchild First Nation.

This paper examines the results from a qualitative descriptive research study completed in Thunderchild First Nation, Saskatchewan. There were four predominant themes that were derived from the data: health was consistently described in relation to physical, mental (intellectual), emotional, and spiritual wellness; value of health; factors related to the environment; and factors related to economics. Collectively, there does appear to be a holistic perception of health, similar to the teachings from the Medicine Wheel. Pursuing and maintaining health included a combination of information and practices from both the western and Traditional Indigenous world. This data supports that the determinants of health may be an appropriate framework to address the health needs of Indigenous Peoples, and an appropriate frame for federal, provincial and local policy makers to implement structural changes necessary to decrease the health disparities between the Indigenous Peoples and the rest of Canada.

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Aboriginal Midwifery: A Model for Change

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Amber D. Skye, MHSc. Student, Department Public Health Sciences, Faculty of Medicine, University of Toronto

This paper will discuss indigenous knowledge and epistemologies of health and well-being as essential practices to improving the health status of Aboriginal communities. These methods will be illustrated through the practice of Aboriginal midwifery and birthing practices currently being revitalized in Aboriginal communities. Indigenous knowledge of health, well-being, medicine, and healing practices have historically sustained the health and well-being of Aboriginal communities for centuries pre-contact.However, these traditional epistemologies of health and healing have been eroded through centuries of colonial oppression and the imposition of western scientific methodologies and legislation.

Through decades of acculturation, much of the traditional knowledge of health, medicine and healing has been lost. However, a recent resurgence of traditional Aboriginal midwifery has occurred in an effort to retain, revive and restore the indigenous knowledge of Aboriginal communities. The revival of traditional Aboriginal midwifery has resulted in the development of Aboriginal birthing centres that blend traditional knowledge, medicine and healing practices with contemporary medical services, to provide culturally significant maternal care services for Aboriginal women and families.

Currently, there are Aboriginal birthing centres and services in, Nunavut, Quebec and Ontario. The high quality of community-based maternal care, access to culturally significant health services – utilizing traditional medicine and employing traditionally trained Aboriginal midwives has shown improved outcomes, impacting community healing, cultural revival, and community capacity building. The traditional methodologies employed by Aboriginal birthing centres will be detailed to exemplify the significance of indigenous knowledge and epistemologies of health in providing improved health care services to Aboriginal communities.

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