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Despite the billions of dollars invested in improving Indigenous health and wellbeing outcomes in Australia, there is little evidence of program effectiveness to inform policy and practice. The deficiency of evaluations is problematic. Critical to this process is the effective engagement of commissioners with Indigenous peoples, which is not well documented. Currently, there is scant evidence on modes of commissioning practices used. This scoping review will aim to identify the spectrum of commissioning practices used when evaluating Indigenous health and wellbeing programs in Australia, codifying them into a model set. Documents (between 2008 and 2020) will be retrieved from Scopus, Proquest, Informit, Google Scholar and via a web-based search that refers to the commissioning of Indigenous health and wellbeing program evaluations in Australia, New Zealand, Canada or the United States. Importantly, the research team is Indigenous-led and the project’s governance, quality and translation framework will be informed by a project advisory group, including Indigenous associates. This will be the first scoping review globally to identify practices used to commission Indigenous health and wellbeing program evaluations. Results will be utilised to strengthen the commissioning practices of Indigenous health and wellbeing programs in Australia and overseas.

There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non‐Indigenous practitioners culturally adapted and applied the Tri‐Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness. Aboriginal community‐controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12‐month follow‐up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks. The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre‐defined issue, time and resource‐intensiveness of the process, and need to review appropriateness prior to implementation in other regions. The adapted CRT was valuable for evaluating the project and co‐designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns.

Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. Healthy Beginnings is a nurse‐led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6‐ and 12‐month survey data) and retention (survey completions), in the first year of life according to participants’ language spoken at home (English or other language). Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6‐month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%‐65%) compared to those speaking English (70%‐80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families.

A study examining the role of a teacher in the implementation of a health promotion programme is presented. The study is in reference to a locally governed Kanienke:haka (Mohawk) community-based diabetes prevention program.

The Active Kids voucher is a universal, state‐wide voucher program, provided by the New South Wales (NSW) Government, Office of Sport. All school‐aged children in NSW are eligible to receive a voucher to reduce registration costs of structured physical activity programs. This study explores reasons behind lower uptake among children who are overweight or obese, from cultural and linguistically diverse families and those living in low socio‐economic areas. Participants were recruited through a convenience sample of parent/carers who participated in the NSW Health Go4Fun program. Qualitative data were collected using focus groups. The Framework method was adapted for the analysis, taking an interpretive phenomenological approach. Study participants (n= 54) were all parents of children who were overweight or obese from both low and high socio‐economic status (SES). Most reported speaking a primary language other than English at home (65%). Parents were mostly aware of the Active Kids program (91%) and reported that the voucher had a positive impact on their children's participation in structured physical activity. A range of socio‐ecological factors, in addition to activity cost, influenced whether parents were able to use an Active Kids voucher and participate in structured physical activity. The Active Kids voucher does not alleviate all barriers, particularly for families living in low socio‐economic areas. Engagement of this population in structured physical activities using the Active Kids vouchers could be strengthened through the implementation of effective interventions which comprehensively address the remaining barriers, such as access and flexibility of programs with local stakeholders and activity providers.

To describe the need for high school sleep education from the perspective of undergraduate university students. Undergraduate students who completed an online course on sleep and circadian health were surveyed 6 months after course completion. Students were asked whether a similar course would have benefited them as high school students, and about the need for sleep education in high schools. Thematic analysis of this qualitative data was carried out. Eighty‐nine students who had attended 71 unique high schools provided responses. Eight‐one per cent thought they would have benefitted from a similar course during high school and identified domains of sleep knowledge particularly relevant to high school students. They cited environmental barriers to healthy sleep present during high school and believed that sleep education could improve students’ lifestyle, sleep and performance. Nineteen per cent of students said they would not have benefited, because they perceived sleeping patterns during high school to be nonmodifiable or believed that previous sleep education was sufficient. Of the respondents who did not think students would benefit, 53% would still tell their high school principal that there was a need for sleep education. The findings support the need for engaging sleep education for high school students. Future studies should examine the perspectives of students in high school directly, rather than undergraduate students who have already shown an interest in sleep health. Sleep health is missing from the Australian school curriculum. Online courses may be an engaging method of promoting sleep and circadian health to high school students.

Ethical values underpin the health promotion discipline and profession, and competencies required for professional practice. Understanding how ethical values are translated into professional practice is critical. The aim of this exploratory sequential mixed methods study was to explore Australian health promotion stakeholder perspectives about ethical health promotion practice. A face‐to‐face group‐based workshop (n = 15), online survey (n = 77) and in‐depth individual interviews (n = 15) collected qualitative and quantitative data from health promotion stakeholders. Descriptive statistics were used to analyse quantitative and thematic analysis to analyse qualitative data. Tensions emerged regarding the nomenclature of ethical health promotion practice, with ethics framed largely by participants as related to formal approval for research. A range of barriers and enablers to ethical practice were identified. Barriers related to obtaining ethical approvals and working with specific population groups and communities. Enablers included professional development opportunities, access to a specialised human research ethics committee and a better understanding of what is meant by ‘ethical practice’. Findings suggest the need for an ethical health promotion practice framework and resources for practitioners and organisations throughout Australia. We propose a framework comprising two pillars: (a) developing critical practice; and (b) building the evidence‐based for health promotion. This study recognises the need for increased dialogue about the ethical foundations of health promotion. The development of a health promotion ethics framework can better support the development of ethical practice in the Australian health promotion discipline and profession.

To evaluate population‐level implementation of Confident Body, Confident Child (CBCC); an evidence‐based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2‐6 years; with community child health nurses (CHNs). This study utilised an implementation‐effectiveness hybrid design, with dual focus on assessing: (a) CBCC implementation into Child Health Centres at a regional health service in Queensland, Australia (process evaluation); and (b) CBCC’s effect on CHNs’ knowledge and attitudes (outcomes evaluation). Process (CBCC reach, dose, fidelity) and outcome data (CHN knowledge of child body image; and attitudes towards higher body weights) were collected during implementation, and pre‐ and post‐intervention delivery to CHNs, respectively. Twenty‐six CHNs (all female; mean age 52.7 ± 9.5 years) participated in the study by attending a 1‐day CBCC training workshop and completing demographic and outcome surveys. Process evaluation found that CBCC was implemented as planned and reached 56% of CHNs across the health service. Outcome evaluation showed small but non‐significant improvements in CHN knowledge (P= .077) and attitudes towards overweight (using Anti‐Fat Attitudes scale; significant improvements on willpower sub‐scale only (P< .05)). This is the first study to evaluate population‐wide CBCC implementation in a real‐world health service setting with CHNs. Findings highlight the potential for using pragmatic, implementation‐focused methodologies to translate preventive eating disorder programs into community child health services.

Poor sleep quality is common among university students and can have negative implications for physical, emotional, cognitive and academic wellbeing. Previous research has identified that sleep beliefs and sleep behaviours are associated with poor sleep quality. However, few studies have examined these variables simultaneously. This study explored associations between dysfunctional beliefs about sleep, sleep hygiene and sleep quality in a sample of university students. Participants were recruited from a pool of undergraduate psychology students and included 120 male students and 145 female students with an average age of 20 years (SD = 5.10). Participants completed an online survey including the Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes About Sleep Scale, Sleep Hygiene Index and demographic items. Overall 60.4% of participants (59.4% of women, 40.6% of men) had poor sleep quality. Logistic regression indicated a significant positive association between sleep hygiene and sleep quality, OR= 1.16, P>.001, 95% CI (1.10, 1.23), and no significant relationship between dysfunctional beliefs about sleep and sleep quality, OR= 1.03, P> .79, 95% CI (0.84, 1.26), after adjusting for covariates. Sleep interventions for university students are needed and could focus on common hygiene components, such as using the bed for activities other than sleeping, engaging in arousing activities before bed and how to manage thinking and worrying before bed. So What? The results of the study demonstrate poor sleep quality is common among university students and indicates that sleep interventions are warranted. The positive association found between sleep hygiene and sleep quality highlights that interventions should focus on behavioural components of sleep.

This study aimed to analyse the relationship between peer‐delivered health promotion programmes and student well‐being and to expand the limited body of research examining peer‐to‐peer mental health promotion as experienced by student leaders. The study was cross‐sectional and focused on the experience of participants of a Sydney‐based University Mental Health Day event, including student leaders, student participants, university staff and industry partners. It adopted a mixed‐method approach to data collection, including a quantitative and a qualitative phase. Results from the quantitative phase demonstrate the benefits of peer‐delivered health promotion programmes to students who receive the event. Results from the qualitative phase of the study provide a deeper insight into the delivery of the event, from both a student leader perspective, and also from the perspective of other stakeholders, who worked closely with student leaders. Two main themes emerged from the qualitative material and are explored in detail: enabling leadership and creating a sense of purpose. The study concludes that, while there is mounting evidence of the benefits of student‐led mental health programmes for both leaders and their peers, more research needs to be carried out to better understand how to optimise these experiences and unlock their full potential with reference to student mental health. With the ongoing pressure on university student services to support student well‐being not being met with appropriate resourcing, peer‐to‐peer programmes, like the Mental Health and Well‐being Student Ambassador Programme, have a real opportunity to make strides in supporting and promoting student mental health.

The health benefits for children of regular physical activity (PA) are well documented. This study examined relationships between organised sport participation in multiple settings and child and household‐level characteristics. Using a general population survey of Queensland children's health and lifestyle characteristics, participation in organised sport was examined in (a) club settings, (b) club‐based team and individual organised sport settings and (c) school settings. The association between organised sport participation in these settings and meeting the Australian PA guidelines was also considered. Organised sport participation prevalence was 46% (both school and club settings), 16% (club sport only), 20% (school sport only) and 18% (neither setting). Multivariable logistic regression analysis indicated participation in one setting increased the odds of participation in other settings, exclusive participation in individual sport decreased the odds of school sport participation and organised sport participation was not associated with meeting recommended PA guidelines for children. The study highlights areas where the contribution of organised sport to PA more broadly could be strengthened. Organised sport participation, however, was not sufficient to meet the child PA guidelines. The home environment, availability of parents and guardians and PA opportunities in other settings, such as school, free time and active transport, are as important to increasing children's PA levels. While organised sport is an important component towards meeting PA guidelines, PA policy and program development should consider strategies to encourage PA in other settings to help children achieve health‐enhancing levels of PA that are sustained into adulthood.

Internationally, universities have recognised the benefits of Pet Support Programs (PSPs). However, existing literature has predominately focused on quantitatively measuring health outcomes associated with a PSP amongst student populations. This research aimed to explore the feasibility of a PSP within an Australian university, as there is a need to explore practical considerations involved in implementation. This research used a qualitative descriptive approach. Participants were recruited via purposive snowball sampling. The sample included 17 participants across eight administrative divisions within an Australian university. Semi‐structured individual interviews were used to collect data. Data were analysed using thematic analysis. Three main themes emerged from the data: Organisational Change, Program Management and Perceived Outcomes. Findings suggest several considerations from both an organisational and program level that need to be addressed prior to implementation, including the university's policies, the location and animal welfare. The main perceived outcomes were stress relief and social support. Ways to minimise risks to those who may have an aversion towards animals were also discussed. Participants believed implementing a PSP would be feasible in the university setting, provided all aforementioned considerations were adequately addressed. Considerations identified have the potential to act as a barrier or a facilitator depending on how they are managed. Where feasible and later implemented, a PSP could provide Australian university students and staff with an alternative means of improving mental health, providing stress relief and contributing towards the Health Promoting University framework.

The significant investment in health research has resulted in an increased focus to determine suitable approaches to measure health promotion research impact. This research was undertaken at the request of a nationally competitive research organisation that funds health promotion research, to explore how Chief Investigators (CIs) on their funded projects understood research impact, its measurement and associated challenges. Participants were required to be or have been a CI on an Australian competitive research (exploratory or intervention) grant focussed on health promotion. The qualitative study used thematic analysis from one‐on‐one interviews. Themes were created and descriptive quotes were selected to illustrate the main findings. The majority of participants were female (n = 13) working at a university (n = 13). Three themes emerged: a) defining health research impact; b) complexity and simplicity of measuring health research impact; c) challenges of measuring health research impact: i) differing language; ii) differing assessment; iii) attribution and timing; and iv) resourcing and skills. Researchers recognised that there are significant challenges in measuring the impact of health promotion research. The most significant factors identified by participants were the disciplinary background of the researchers undertaking the measurement, their skills and experience and the resources (including time) available to assess impact. Research impact assessment is complex, time consuming and requires specific skills to facilitate measurement of impact provision of funding for this activity in research grants and research impact training is required.

Published evaluations of population‐level social marketing campaigns predominantly focus on impact and outcome evaluation. Evaluation of complementary locally implemented activities and programs, despite being common and important components of social marketing campaigns are rarely published. This study sought to examine the drivers of engagement of local implementers in the Make Healthy Normalcampaign, implemented in New South Wales (NSW), Australia from 2015 to 2018, and to describe their engagement with the campaign as well as the scope and extent of complementary activities. We conducted 13 in‐depth semi‐structured qualitative interviews with health and nonhealth stakeholders from a range of urban, regional and rural settings across NSW. We analysed the interviews thematically, using an inductive and iterative approach. We found stakeholder engagement (ie decision to buy into and commit resources) to the campaign was underpinned by two main drivers: “understanding”, or how well they understood the campaign and their role in it, and “perceived fit”, or how appropriate it was to their context. A third factor, “communication” functioned to enhance both understanding and perceived fit. Our results suggest that stakeholders would engage with the campaign more where they had a sound understanding of the campaign objectives and content, and an appreciation of how the campaign fits their strategic and procedural context. Campaign managers should incorporate clear, regular and efficient communication with local implementers and work with these groups early in the campaign development process. Organisers should also support and promote a “community of practice” approach to capitalise on the innovations of those promoting campaign messages at the community level.

Osteoporosis presents a serious public health issue and physical activity is recognised as the most effective modifiable risk factor for the condition. The reasons behind physical activity participation, however, are complex. We therefore aimed to explore the experiences related to a bone‐targeted exercise intervention, determine enjoyment and acceptability of each exercise mode, and identify barriers and facilitators to osteogenic exercise for young adult women. The present study was conducted within the Osteoporosis Prevention Through Impact and Muscle‐loading Approaches to Exercise (OPTIMA‐Ex) trial, a three‐arm RCT comparing musculoskeletal outcomes from two supervised, high‐intensity, exercise programs (impact and resistance training) with an unsupervised low‐intensity exercise control. A mixed‐methods approach was used, including quality of life and physical activity enjoyment questionnaires and qualitative analysis of semi‐structured interviews. All groups had improvements in the 'mental health' domain of the quality of life measure; however, the two supervised exercise groups had greater levels of physical activity enjoyment. The qualitative analysis revealed that overall the trial activities were positively, yet the two supervised groups had 'richer' exercise experiences. Motivations for participation, barriers to physical activity and desired continuation of participation differed between all three groups. Findings suggest that bone‐targeted exercise interventions for young adult women must address perceived time demands and environmental barriers to participation in order to maximise compliance and adherence. As physical activity is the most effective lifestyle strategy to improve bone health and young adulthood an important window for its augmentation, increasing convenience, accessibility and understanding of osteoporosis preventative behaviours in this demographic is vital.

This study explores the experiences of adults aged 18 years and older who received an unintended sunburn while wearing sunscreen and examines why the application of sunscreen as a sun protection measure did not work as intended. Qualitative content analysis was conducted on 11 interviews with people living in Australia who had received an unintended sunburn. Data were collected from July 2017 to January 2018. Twelve participants took part in individual semi‐structured interviews either face‐to‐face or over the telephone, and 11 participants met the eligibility criteria and were included for analysis. The themes that emerged included experience of disbelief after sunburn; sunburn after water‐based activity; inaccurate sunscreen application; sunscreen acceptability and trust; discomfort in application, opportunistic sun exposure; aesthetically motivated behaviour; normative beliefs; and lack of awareness of recent sun safety campaigns. Participants perceived themselves as well protected from sun exposure and were surprised they received a sunburn. We found that participants did not reapply sunscreen often enough, especially before and during water activities and overestimated the amount of time they could be safely exposed to the sun. The findings of this study suggest a greater need for sun protection education on how to effectively use and apply sunscreen to avoid sunburn and skin cancer. This study explores the experiences of adults aged 18 years and older who received an unintended sunburn while wearing sunscreen and examines why the application of sunscreen as a sun protection measure did not work as intended. Qualitative content analysis was conducted on 11 interviews with people living in Australia who had received an unintended sunburn.

The context of community-based childhood obesity prevention programs can influence the effects of these intervention programs. Leadership readiness for community mobilisation for childhood obesity prevention is one such contextual factor. This study assessed perceived community leadership readiness (PCLR) at two time points in a state-wide, multisite community-based childhood obesity prevention program. PCLR was assessed across 168 suburbs of 20 intervention communities participating in South Australia's Obesity Prevention and Lifestyle (OPAL) program. Using a validated online PCLR tool, four key respondents from each community rated each suburb within their respective community on a nine-point scale for baseline and 2015. Average PCLR and change scores were calculated using the general linear model with suburbs nested in communities. Relationships between demographic variables and change in PCLR were evaluated using multiple regression. Ease of survey use was also assessed. Average PCLR increased between baseline (3.51, s.d. = 0.82) and 2015 (5.23, s.d. = 0.89). PCLR rose in 18 of 20 intervention communities. PCLR was inversely associated with suburb population size (r2 = 0.03, P = 0.03, b = -0.25) and positively associated with intervention duration (r2 change = 0.08, P = 0.00, b = 0.29). Only 8% of survey respondents considered the online assessment tool difficult to use. PCLR increased over the course of the OPAL intervention. PCLR varied between and within communities. Online assessment of PCLR has utility for multisite program evaluations. Use of a novel, resource-efficient online tool to measure the key contextual factors of PCLR has enabled a better understanding of the success and generalisability of the OPAL program. Community leadership is important to the success of community-based health promotion programs. This study assessed perceived community-level leadership readiness for childhood obesity prevention, at two time-points, in 168 suburbs engaged in South Australia's Obesity Prevention and Lifestyle initiative. The study found greater increases in readiness associated with longer intervention exposure and smaller populations. The use of an online tool holds promise for illuminating the role of readiness in large-scale intervention trials.

Objective: The Inuit population in Canada's North has suffered from high rates of death by suicide. We report on the first large-scale, controlled, epidemiologically representative study of deaths by suicide in an Indigenous population, which investigates risk factors for suicide among all Inuit across Nunavut who died by suicide during a 4-year period.Methods: We identified all suicides by Inuit (n= 120) that occurred between January 1, 2003, and December 31, 2006, in Nunavut. For each subject, we selected a community-matched control subject. We used proxy-based procedures and conducted structured interviews with informants to obtain life histories, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II diagnoses, and measures of impulsive and (or) aggressive traits.Results: Compared with control subjects, subjects who died by suicide were more likely to have experienced childhood abuse (OR 2.38; 95% CI 1.39 to 4.08), have family histories of major depressive disorder (P= 0.002) and suicide completion (P= 0.02), and have been affected by major depressive disorder (OR 13.00; 95% CI 6.20 to 27.25), alcohol dependence (OR 2.90; 95% CI 1.59 to 5.24), or cannabis dependence (OR 3.96; 95% CI 2.29 to 6.8) in the last 6 months. In addition, subjects who died by suicide were more likely to have been affected with cluster B personality disorders (OR 10.18; 95% CI 3.34 to 30.80) and had higher scores of impulsive and aggressive traits (P< 0.001).Conclusions: At the individual level, clinical risk factors for suicide among Inuit are similar to those observed in studies with the general population, and indicate a need for improved access to mental health services. The high rate of mental health problems among control subjects suggests the need for population-level mental health promotion.

Purpose. To assess the evolution of perceived ownership of a university-Aboriginal community partnership across three project stages.Design. Survey administration to project partners during project formalization (1996—T1), mobilization (1999—T2), and maintenance (2004—T3).Setting. Aboriginal community of Kahnawake, outside Montreal, Quebec, Canada.Participants. Partners involved in influencing decision making in the Kahnawake Schools Diabetes Prevention Project (KSDPP).Measure and Analysis. A measure of perceived primary ownership subjected to linear trend analysis.Results. KSDPP staff were perceived as primary owner at T1 and shared ownership with Community Advisory Board (CAB) members at T2 and T3. Trend tests indicated greater perceived ownership between T1 and T3 for CAB (χ21= 12.3, p < .0001) and declining KSDPP staff (χ21= 10.5, p < .001) ownership over time. Academic partners were never perceived as primary owners.Conclusion. This project was community driven from the beginning. It was not dependent on an external academic change agent to activate the community and develop the community's capacity to plan and implement a solution. It still took several years for the grassroots CAB to take responsibility from KSDPP staff, thus indicating the need for sustained funding to build grassroots community capacity.

Active School Travel (AST) programs, such as Safe Routes to School (SR2S), have been predominantly evaluated using self-reported methods that are susceptible to bias (e.g., social desirability). Objective methods, such as observational route counts, are underutilised in AST program evaluations, and existing studies have not assessed instrument inter-rater reliability. This study aimed to strengthen the evidence base supporting the use of objective measurements to estimate school children's AST behaviour by adapting an existing observational route counting instrument to align with the route-level aims of SR2S programs and assessing its inter-rater reliability.

The prevalence of smoking is high in many Aboriginal Canadian communities; rates of 50% are not uncommon. Aboriginal Canadians suffer a severe burden of smoking-related disease. Research in other populations has linked depression and smoking. It is not known whether mental health or affective measures are related to smoking for any of Canada’s First Nations, and this study sought to answer this question. Understanding relations between affect and smoking behaviour is requisite to mounting anti-smoking interventions. Smoking status and psychosocial measures including depression, mastery, affect balance and social support were obtained in a community-based chronic disease survey for a rural Interior Salishan First Nation in British Columbia (Plateau area). Persons surveyed were on-reserve residents (n=187), overweight (body mass index ≥25 kg/m2), with mean age of 44.1 years (standard deviation 15.0). The prevalence of smoking was 48.1%. Adjusted for age, sex and body mass index, smokers relative to nonsmokers had higher (p<0.010) depression (mean 21.3 [CI 95%, 19.1–23.4] vs. 16.1 [14.1–18.0]) and negative affect (18.6 [14.9–22.3] vs. 11.0 [7.6–14.4]), and lower mastery (36.4 [35.5–37.3] vs. 38.1 [37.2–38.9]). A positive relationship between mastery and social support was greater for nonsmokers (p=0.046). Depression and negative affect are associated with smoking among overweight persons in a rural First Nation in British Columbia. Furthermore, smoking is inversely related to mastery, and this relation varies with social support. Longitudinal study is required to determine whether smoking influences mental health and mastery, or the reverse. Le tabagisme est très répandu dans de nombreuses communautés autochtones du Canada; des taux de 50% ne sont pas rares, et les Autochtones du Canada souffrent beaucoup de maladies liées au tabagisme. Les recherches menées auprès d’autres populations ont établi un lien entre la dépression et le tabagisme. Par ailleurs, on ne sait pas si le tabagisme a une incidence sur la santé mentale ou émotionnelle des Autochtones du Canada. La compréhension des liens entre l’affect et le statut de fumeur est un important préalable à l’élaboration d’interventions visant la réduction du tabagisme. Une enquête au niveau communautaire sur les maladies chroniques d’une population rurale autochtone de la Colombie-Britannique a fourni des données sur le statut de fumeur/nonfumeur et sur des caractéristiques psychosociales incluant la dépression, la maîtrise de sa situation, l’équilibre émotif et le soutien social. Les participants de l’étude étaient des Indiens inscrits vivant dans une réserve (n=187), 67% étant des femmes, et l’âge moyen était de 44,1 ans (écart-type de 15,0). Le taux de tabagisme était de 48,1%. Compte tenu de l’âge, du sexe et de l’indice de masse corporelle, les fumeurs, comparativement aux non-fumeurs présentaient des taux plus élevés (p<0,010) de dépression (21,3 [19,1–23,4] c. 16,1 [14,1–18,0]) et d’affect négatif (18,6 [14,9–22,3] c. 11,0 [7,6–14,4]), et un taux moins élevé de maîtrise de sa situation (36,4 [35,5–37,3] c. 38,1 [37,2-38,9]). Une relation positive entre la maîtrise de sa situation et des niveaux supérieurs de soutien social prévalait chez les non-fumeurs (p=0,046). Il existe une corrélation entre la dépression ou un affect négatif et le tabagisme chez les personnes faisant de l’embonpoint dans une population rurale autochtone de la Colombie- Britannique. De plus, le tabagisme est inversement proportionnel à la maîtrise de sa situation, et cette relation varie selon le degré de soutien social. Les efforts pour réduire le tabagisme dans la population autochtone du Canada devraient porter sur les aspects de la santé mentale, du soutien social et de la maîtrise de sa situation, en tenant compte des contextes socioculturel et historique plus larges d’où émergent les formes actuelles de style de vie.

Purpose. To apply Karasek's Job Content Model to an analysis of the relationships between job type and perceived stress and stress behaviors in a large company during a period of reorganization and downsizing.Design. Cross-sectional mail-out, mail-back survey.Setting. A large Canadian telephone/telecommunications company.Subjects. Stratified random sample (stratified by job category) of 2200 out of 13,000 employees with a response rate of 48.8%.Measures. Responses to 25 of Karasek's core questions were utilized to define four job types: low demand and high control = “relaxed”; high demand and high control = “active”; low demand and low control = “passive”, and high demand with low control = “high strain.” These job types were compared against self-reported stress levels, perceived general level of health, absenteeism, alcohol use, exercise level, and use of medications and drugs. Similar analyses were performed to assess the influence of shift work.Results. Employees with “passive” or “high strain” job types reported higher levels of stress (trend test p <.0001); poorer health (trend test p = .006); and higher levels of absenteeism (trend test p >.0001). More shift workers reported themselves in poor or fair health (chi-square p = .018) and reported high levels of stress at home (chi-square p = .002) than nonshift workers. The relationships between job type and levels of stress, health, and absenteeism, however, held for nonshift workers as well.Conclusions. Job types with high demand and low control were associated with increased stress, increased absenteeism, and poorer self-concept of health. The demand/control model of Karasek and Theorell was validated in this setting with respect to stress and some stress-associated attitudes and behaviors.

This paper reports exploratory research to predict smoking initiation prospectively as a function of both personal (peer and family) and more macro (school and community) social environment. At the macro level, older peer smoking by school system and school board by school system were significant predictors of smoking onset. At the personal level, the effect of gender varied with time. Males began to smoke earlier than females, but females had higher onset rates in the period from the end of Grade 7 to the end of Grade 9. Significant sibling and peer influences replicate the consistent findings in the smoking initiation area. Implications for the longitudinal study of the smoking onset process are given. [Translations are provided in the International Abstracts Section of this issue.]

IntroductionThe increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country.ObjectiveThis article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik(Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method.MethodA retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed.ResultsThe psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations.