title: Do discrimination, residential school attendance and cultural disruption add to individual-level diabetes risk among Aboriginal people in Canada?
abstract: BACKGROUND
  Aboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization. The purpose of this study was to investigate the possible role of discrimination, residential school attendance and cultural disruption on diabetes occurrence among First Nations adults.
  
  
  METHODS
  This 2012/13 cross sectional survey was conducted in two Saskatchewan First Nations communities comprising 580 households and 1570 adults. In addition to self-reported diabetes, interviewer-administered questionnaires collected information on possible diabetes determinants including widely recognized (e.g. age, sex, lifestyle, social determinants) and colonization-related factors. Clustering effect within households was adjusted using Generalized Estimating Equations.
  
  
  RESULTS
  Responses were obtained from 874 (55.7 %) men and women aged 18 and older living in 406 (70.0 %) households. Diabetes prevalence was 15.8 % among women and 9.7 % among men. In the final models, increasing age and adiposity were significant risk factors for diabetes (e.g. OR 8.72 [95 % CI 4.62; 16.46] for those 50+, and OR 8.97 [95 % CI 3.58; 22.52] for BMI 30+) as was spending most time on-reserve. Residential school attendance and cultural disruption were not predictive of diabetes at an individual level but those experiencing the most discrimination had a lower prevalence of diabetes compared to those who experienced little discrimination (2.4 % versus 13.6 %; OR 0.11 [95 % CI 0.02; 0.50]). Those experiencing the most discrimination were significantly more likely to be married and to have higher incomes.
  
  
  CONCLUSIONS
  Known diabetes risk factors were important determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not predictive of diabetes on an individual level. In contrast, those experiencing the highest levels of discrimination had a low prevalence of diabetes. Although the reasons underlying this latter finding are unclear, it appears to relate to increased engagement with society off-reserve which may lead to an improvement in the social determinants of health. While this may have physical health benefits for First Nations people due to improved socio-economic status and other undefined influences, our findings suggest that this comes at a high emotional price.
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. roland.dyck@usask.ca.|Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. roland.dyck@usask.ca.|Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. roland.dyck@usask.ca.
authors.forename: Roland F
authors.initials: RF
authors.lastname: Dyck
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. cpk646@mail.usask.ca.
authors.forename: Chandima
authors.initials: C
authors.lastname: Karunanayake
authors.affiliation: Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. bonnie.janzen@usask.ca.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Janzen
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. jal226@mail.usask.ca.
authors.forename: Josh
authors.initials: J
authors.lastname: Lawson
authors.affiliation: Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. viv.ramsden@usask.ca.
authors.forename: Vivian R
authors.initials: VR
authors.lastname: Ramsden
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. donna.rennie@usask.ca.
authors.forename: Donna C
authors.initials: DC
authors.lastname: Rennie
authors.affiliation: Willow Cree Health Centre, Duck Lake, Saskatchewan, Canada. director@willowcreehealth.com.
authors.forename: P Jenny
authors.initials: PJ
authors.lastname: Gardipy
authors.affiliation: William Charles Health Centre, Montreal Lake Cree Nation, Saskatchewan, Canada. lauralee_1430@hotmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: McCallum
authors.affiliation: Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. sya277@mail.usask.ca.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Abonyi
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. james.dosman@usask.ca.
authors.forename: James A
authors.initials: JA
authors.lastname: Dosman
authors.affiliation: Indigenous Peoples' Health Research Centre, University of Regina, Regina, Canada. jo-ann.episkenew@uregina.ca.
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Episkenew
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. pup165@mail.usask.ca.|Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. pup165@mail.usask.ca.
authors.forename: Punam
authors.initials: P
authors.lastname: Pahwa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003469:Culture; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000209:etiology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D063505:Racism; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012525:Saskatchewan; D012574:Schools; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D055815:Young Adult