title: Cultural continuity, traditional Indigenous language, and diabetes in Alberta First Nations: a mixed methods study.
abstract: BACKGROUND
  We used an exploratory sequential mixed methods approach to study the association between cultural continuity, self-determination, and diabetes prevalence in First Nations in Alberta, Canada.
  
  
  METHODS
  We conducted a qualitative description where we interviewed 10 Cree and Blackfoot leaders (members of Chief and Council) from across the province to understand cultural continuity, self-determination, and their relationship to health and diabetes, in the Alberta First Nations context. Based on the qualitative findings, we then conducted a cross-sectional analysis using provincial administrative data and publically available data for 31 First Nations communities to quantitatively examine any relationship between cultural continuity and diabetes prevalence.
  
  
  RESULTS
  Cultural continuity, or "being who we are", is foundational to health in successful First Nations. Self-determination, or "being a self-sufficient Nation", stems from cultural continuity and is seriously compromised in today's Alberta Cree and Blackfoot Nations. Unfortunately, First Nations are in a continuous struggle with government policy. The intergenerational effects of colonization continue to impact the culture, which undermines the sense of self-determination, and contributes to diabetes and ill health. Crude diabetes prevalence varied dramatically among First Nations with values as low as 1.2% and as high as 18.3%. Those First Nations that appeared to have more cultural continuity (measured by traditional Indigenous language knowledge) had significantly lower diabetes prevalence after adjustment for socio-economic factors (p =0.007).
  
  
  CONCLUSIONS
  First Nations that have been better able to preserve their culture may be relatively protected from diabetes.
authors.affiliation: Department of Medicine, University of Alberta, 4100 Research Transition Facility, 8308 114 Street, Edmonton T6G 2V2, AB, Canada. roster@ualberta.ca.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Oster
authors.forename: Angela
authors.initials: A
authors.lastname: Grier
authors.forename: Rick
authors.initials: R
authors.lastname: Lightning
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Mayan
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Toth
mesh_terms: D000328:Adult; D000416:Alberta / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003469:Culture; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007198:Indians, North American; D007802:Language; D008297:Male; D015995:Prevalence; D036301:Qualitative Research; D012649:Self Concept; D020377:Self Efficacy; D011795:Surveys and Questionnaires