Suchergebnisse

IntroductionCanada has one of the highest rates of prescription opioid consumption globally. Little is known about the prevalence and determinants of opioid use among citizens of the Metis nation – one of three Aboriginal groups recognized by the Canadian constitution.
Objectives and ApproachOur objectives were to (i) identify trends in prescription opioid use among Metis citizens from 2006 to 2018 and (ii) identify whether replacing OxyContin with OxyNeo in February 2012 differentially impacted prevalence of opioid use among Metis when compared with all other Manitobans. The Manitoba Metis Federation and the University of Manitoba partnered on this research. We identified prescription opioid use using dispensation records from the province's drug database, which includes records for all prescription drugs dispensed in community. We defined acute prescription opioid use as ≤28 days prescription and chronic use as ≥ 29 days' prescription. We tested for differences in annual trends in acute and chronic prescription opioid use between Metis and all other Manitobans. We used an interrupted time series design to test whether replacing OxyContin differentially impacted prevalence of acute and chronic opioid use among Metis when compared with all other Manitobans. We used generalized linear models to test for trends and the impact of replacing OxyContin.
ResultsAcross all years (2006-2018) acute prescription and chronic opioid use was higher among Metis than all other Manitobans. Acute and chronic use decreased in both groups, non-differentially. Replacing OxyContin with OxyNeo was associated with decreased acute opioid use in both Metis and all other Manitobans and had a greater impact on chronic opioid use among Metis than among all other Manitobans. Conclusion / Implications: Findings highlight the differential experiences arising from the historic and ongoing colonial project in Canada, which need to be considered when working to prevent and treat inappropriate Opioid use among Metis.

AbstractWe examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID‐19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID‐19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID‐19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine‐safety test subjects before population‐wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non‐prioritization of the Métis during COVID‐19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign—though understandable—interpretations.

IntroductionThe Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. First Nation children and youth make up a substantial proportion of BGCW participants, but there are few empirical data available on how the programs influence health, social and education outcomes in this population.
Objectives and ApproachWe linked BGCW attendance records for all Manitoba children born 1987-2010 to the individual-level administrative health, social and education data in the population-based Data Repository at the Manitoba Centre for Health Policy in Winnipeg. The comparison group of non-participants was matched on age and neighbourhood of residence. We narrowed the cohort to First Nation participants by linking to datasets containing First Nation identifiers. Education outcomes were examined using a generalized additive model, and health and justice system outcomes with a time-to-event model, adjusted for socioeconomic status, mother's mental health and age at first birth, and involvement in the child welfare system.
Results3,754 First Nation children and youth participated in BGCW from 2005-2016. The comparison group comprised 23,593 First Nation children and youth. Greater BGCW participation was associated with higher likelihood of performing well in grade 3 numeracy, but not other education outcomes (grade 3 reading, grade 7 student engagement or mathematics, grade 7/8 reading/writing, or graduating high school). Greater BGCW participation was also associated with lower risk of becoming involved with the justice system among youth aged 12-17 (i.e., lower risk of being charged with a crime) and with lower risk of teen pregnancy.
Conclusion / ImplicationsParticipation in BGCW programs may contribute to improved health, justice and education outcomes for First Nation children and youth in Winnipeg.

ObjectiveManitoba has one of the highest incarceration rates among Canadian provinces, and because of Canada's racist and colonial policies, the number of Métis women in custody is disproportionately high. In this study, we examined birth outcomes among Métis and all other Manitoba women who were incarcerated while pregnant.
ApproachUsing linked administrative health and justice system data, we developed a 2004-2017 cohort of mother-infant dyads with a live birth (n= mothers; n= infants). We identified all Métis mother-infant dyads, and then divided them into 3 mutually exclusive groups: a) prenatal incarceration; b) post-natal incarceration; c) no incarceration. We developed matched comparison groups for each exposure based on Métis identity, maternal age, geography and income, and, after adjusting for other potentially confounding variables (e.g., maternal age, maternal mental health, and socioeconomic factors), we examined risk differences in birth outcomes among Métis women and infants between exposure groups.
ResultsThe cohort included n=534 mothers who were incarcerated while pregnant (a), n=1,677 mothers incarcerated postnatally (b), and n=14,084 mothers never incarcerated (c). When we compared prenatal vs postnatal incarceration (a vs b), we found that women incarcerated during the prenatal period were more likely to have a low birth weight infant (RD: 4.2, 95% CI: 3.0, 5.4), preterm birth (RD: 5.1, 95% CI: 3.7, 6.5) or Caesarean birth (RD: 5.5, 95% CI: 3.8, 7.1) and were less likely to have a large-for-gestational-age infant (RD: -3.8, 95% CI: -5.1, -2.5) or to initiate breast feeding (-3.4, 95% CI: -5.5, -1.3). In the prenatal vs no incarceration comparison (a vs c), the same outcomes were statistically significant as above; however, the risk differences were even more pronounced.
ConclusionPrenatal incarceration is associated with poor birth outcomes for all mothers and infants in Manitoba; however, Métis women and children are disproportionately affected, further perpetuating inequities they may already experience. Canadians must acknowledge the harms of racist policies and practices, and work to support the health and well-being of Métis people.

IntroductionEarly education outcomes influence children's educational trajectories with long-term effects extending into adulthood. Aboriginal peoples face numerous systemic barriers to academic success. It remains unknown if full-day kindergarten (FDK) is associated with improved academic outcomes among Metis children – a distinct Aboriginal people recognized by the Canadian Constitution.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to identify whether FDK was associated with improved short- and long-term outcomes among Metis children. We created a cohort of Metis children by linking several provincial databases held in the Manitoba Population Research Data Repository (1998-2011). Education data were used to identify all Metis children who attended FDK (n=247) vs half day kindergarten (HDK; n=547). FDK children were matched by age and sex to children in HDK. We used a step-wedged design and applied propensity scores to adjust for measured confounding. We tested for differences in grades 3, 7, 8 outcomes and high school graduation using generalized linear models.
ResultsFDK children were more likely to live in a low-income neighbourhood. 72% FDK and 74% HDK students met or approached numeracy expectations in grade 3; and 55% FDK and 48% HDK met or approached numeracy expectations in grade 7. For reading expectations, 77% FDK and 75% HDK met or approached grade 3 reading expectations; in grade 8, 62% in each group met or approached expectations for reading and writing. High school graduation rate for FDK children was 84% and for HDK children was 64%. After adjusting for confounding we found FDK children were more likely to graduate high school than HDK children; other outcomes were non-significant.
Conclusion / ImplicationsKindergarten programs may be insufficient to overcome structural barriers that Metis children face. Culturally appropriate education strategies are needed to support improved outcomes amongst this population.

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), a prenatal income supplement. Research has demonstrated positive outcomes associated with HBPB, but it remains unknown if Metis women and children – who are of mixed European and Aboriginal descent and one of the most marginalized populations in Canada -- benefit from the program.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to determine the impact of HBPB on Metis newborn and early childhood outcomes. We included all Metis women giving birth in Manitoba 2003-2011 who received income assistance during pregnancy (n=4,852), adjusting for differences between those receiving (n=3,681) and not receiving (n=1,171) HBPB with propensity score weighting. We used multi-variable regressions to compare outcomes between groups: breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, birth hospitalization length of stay (LOS), neonatal readmissions, infant hospitalizations, vaccinations at age 1 and 2, and child development scores at kindergarten.
ResultsHBPB receipt was associated with reductions in low birth weight (adjusted Relative Risk (aRR): 0.74 (95% CI: 0.58-0.94)) and preterm births (aRR: 0.78 (0.65-0.94)), and increases large-for-gestational age births (aRR: 1.21 (1.06-1.39)) and neonatal readmissions (aRR: 1.58 (1.05-2.37)). Birth hospitalization LOS was lower for newborns whose mothers received HBPB (Mean Difference 0.29 days). HBPB was associated with increases in vaccinations for children aged 1 (aRR: 1.08 (1.00-1.15)) and 2 (aRR: 1.12 (1.05-1.18)). No significant associations were found for small-for-gestational age births, Apgar scores, breastfeeding initiation, infant hospitalizations or child development scores.
Conclusion / ImplicationsA modest unconditional prenatal income supplement to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased neonatal readmissions warrants further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes.

This study, a partnership between <Organization 1> and <Organization 2>, investigated whether attending full-time kindergarten (FTK) was associated with better educational outcomes for Metis students in Manitoba, who may face unique barriers to academic success. We utilized linked administrative data from the Manitoba Population Research Data Repository. For each measured education outcome, there were no significant differences in how Metis students who attended FTK vs Metis students who attended half-time kindergarten (HTK) performed. FTK does not provide sufficient support to Metis students to overcome the structural barriers to academic success they may face. It is likely that an upstream approach to addressing the structural barriers is needed to support improved outcomes in this population.

ObjectivesIndigenous children in Canada, including Metis children, are taken into care by the child welfare system at a disproportionately high rate. The objective of this study was to explore factors related to having a child taken into care from Metis families in Manitoba, and specifically from Metis mothers experiencing incarceration.
ApproachThe cohort comprised all mother-child dyads in Manitoba, Canada with live births between Jan 1, 2004-Dec 31, 2014. The factors we examined included the mother experiencing incarceration after the birth of a child, having prior interaction with the legal system, socioeconomic status, maternal age, and mother's mental health disorder diagnoses. Using the Cox proportional hazards model, unadjusted and adjusted hazard ratios describing the risk of a child being taken into care by five years of age were generated for three exposure groups: no incarceration, prenatal incarceration, and postnatal incarceration.
ResultsBefore adjustment, mothers experiencing incarceration after the birth of a child had greater risk of having a child taken into care (HR 9.3; 95% CI 7.7-11.3) compared with women who did not experience incarceration; after adjusting for measured confounders, their elevated risk dropped to aHR 6.1 (5.0-7.4). After further adjustment for prior custody in the prenatal period, mothers experiencing incarceration had 3.8 times the risk (3.0-5.0), and after adjusting for maternal mental health disorders, this dropped to 2.6 times the risk (2.0-3.4). In fully adjusted models, other factors associated with having a child taken into care included receiving diagnoses for a substance use disorder (aHR 2.6; 2.1-3.2) and for psychosis (aHR 2.4; 1.4-4.1) during the five years prior to the child's birth.
ConclusionDue to colonialism, Metis women experience high levels of social and mental health complexity, placing their children at increased risk of being taken into care. Responding to the Truth and Reconciliation Commission's Calls to Action to redress the harms of colonialism is necessary to support Metis children's health and well-being.

ObjectivesRed River Métis are Indigenous people hailing from the Canadian Prairies who have historically experienced poor health outcomes due to colonial practices. Researchers from the Manitoba Métis Federation (MMF) partnered with health services researchers to test whether MMF-led COVID initiatives were associated with access to COVID-19 testing and vaccines.
ApproachWe linked the Métis Population Data-Base from the MMF (to identify Red River Métis) with whole-population COVID testing and vaccination data and health and social services administrative data (for information on sociodemographics and confounders) to complete this retrospective cohort study. We used restricted mean survival time models to test whether COVID-19 vaccination differed between Métis and all other Manitobans (AOM); models adjusted for demographics, comorbidities, and other characteristics (age, socioeconomic status, urbanicity, and mental health status). Data were stratified by sex and subsequent effect modification analyses tested whether associations differed by sex and physical health comorbidities.
ResultsCOVID testing rates were lower during the first year of the pandemic among Métis than among AOM. During the second year of the pandemic, this finding was reversed - Métis accessed tests at higher rates. There was no difference between Métis and AOM in accessing first vaccine doses before implementation of MMF-led initiatives. After initiatives were put in place, Métis received their second COVID vaccine, on average, 1.3 (95% CI 1.9-0.6) days sooner than AOM, after adjusting for confounders. Effect modification analyses showed this relationship was concentrated among females – female Métis received their second vaccine 1.7 (2.6-0.8) days sooner than female AOM; differences were non-significant for males. Métis with 2+ comorbidities received their vaccine second 2.9 (5.3-0.5) days sooner than AOM with 2+ comorbidities.
ConclusionPublic health initiatives prioritizing Métis for vaccines improved uptake. Initiatives led by Métis to improve COVID outcomes were critical to supporting Métis during the course of the pandemic. Public health response efforts need to operate from a standpoint that honours Indigenous sovereignty in their design and implementation.