Search

Background: The Indigenous people of Canada include First Nations, Inuit and Metis. This research focused on four diverse First Nations communities located in Ontario and Manitoba. First Nations communities have well-established culturally-based social processes for supporting their community members experiencing dying, loss, grief and bereavement. However, communities do not have formalized local palliative care (PC) programs and have limited access to medical services, especially pain and symptom management. Methods: Researchers conducted participatory action research (PAR) in partnership with four First Nations communities to create local PC programs. A conceptual framework for community capacity development (Kelley model) and an integrative framework for PC research with First Nations communities guided the research over 6 years. Based on a community assessment, Elders and Knowledge Carriers, community leaders and First Nations health care providers created PC programs grounded in the unique social, spiritual and cultural practices of each community, and integrated them into local health services. Maintaining local control, community members engaged external health care organizations to address gaps in health services. Strategies such as journey mapping clarified roles and strengthened partnerships between community and external health care providers. Finally, community members advocated for needed funding, medication and equipment to provide palliative home care. The research team provided mentorship, facilitation, support, education and resources to the community leaders and documented and evaluated their capacity development process. Results: Our findings contribute to PC practice, policy and research. Four unique PC programs were created that offered First Nations people the choice to receive PC at home, supported by family, community and culture. A workbook of culturally relevant resources was developed for use by interested First Nations communities across Canada, including resources for program development, direct care, education, and engaging external partners. Policy recommendations and a policy framework to guide PC program development in First Nations communities were created. All research outcomes were published on a website and disseminated nationally and internationally. Our work also contributes to furthering discussions of research methods that can advance public health and PC initiatives. We demonstrated the achievements of PAR methods in strengthening community action, developing the personal skills of community health care providers and creating more supportive environments for First Nations people who wish to die at home. The Kelley model was adapted for use by First Nations communities. We also identified keys to success for capacity development. Conclusions: This research provides a Canadian example of implementing a public health approach to PC in an Indigenous context using PAR. It provides evidence of the effectiveness of a community capacity development as a strategy and illustrates how to implement it. This approach, fully grounded in local culture and context, has potential to be adapted to Indigenous communities elsewhere in Canada and internationally.

This article explores the application of two-eyed seeing in the first year of a three-year study about the effectiveness of cultural interventions in First Nations alcohol and drug treatment in Canada. Two-eyed seeing is recognized by Canada’s major health research funder as a starting point for bringing together the strengths of Indigenous and Western ways of knowing. With the aim of developing a culture-based measurement tool, our team carried out an Indigenous-centred research process with our interpretation of two-eyed seeing as a guiding principle. This enabled us to engage in a decolonizing project that prioritized Indigenous methodologies and ways of knowing and knowledge alongside those of Western science. By concentrating on Indigenous governance in the research process, our project supported efforts at Indigenous cultural renewal. Two illustrations are offered, our team’s reconceptualization of Western derived understandings of data collection through Indigenous storytelling and our research grant timeframe with Indigenous knowledge gardening. This article contributes to the Indigenous research and policy literature which is lacking documentation about how Indigenous communities and research teams are benefitting from two-eyed seeing.

Providing palliative care in Indigenous communities is of growing international interest. This study describes and analyzes a unique journey mapping process undertaken in a First Nations community in rural Canada. The goal of this participatory action research was to improve quality and access to palliative care at home by better integrating First Nations’ health services and urban non-Indigenous health services. Four journey mapping workshops were conducted to create a care pathway which was implemented with 6 clients. Workshop data were analyzed for learnings and promising practices. A follow-up focus group, workshop, and health care provider surveys identified the perceived benefits as improved service integration, improved palliative care, relationship building, communication, and partnerships. It is concluded that journey mapping improves service integration and is a promising practice for other First Nations communities. The implications for creating new policy to support developing culturally appropriate palliative care programs and cross-jurisdictional integration between the federal and provincial health services are discussed. Future research is required using an Indigenous paradigm.

Objective To systematically describe when and how brief alcohol interventions delivered to adolescents in primary care settings reduce alcohol use and alcohol-related consequences among adolescents, using realist review methodology. Study design Eleven electronic databases, gray literature, and reference screening were searched up to June 2016; 11 brief interventions published in 13 studies met inclusion criteria. Intervention design components (delivery context and intervention mechanisms) underlying brief alcohol interventions for adolescents were extracted and linked to alcohol use and related consequences. Results Brief interventions had either an indicated context of delivery (provided to adolescent patients with low-to-moderate risk for alcohol problems) or universal context of delivery (provided to general adolescent patient population). Interventions that used motivational interviewing in an indicated delivery context had 2 potential mechanisms—eliciting and strengthening motivation to change and providing direction through interpretation. These interventions resulted in clinically significant reductions in alcohol use and associated consequences. Peer risk also was identified among universal and indicated brief interventions as a potential mechanism for changing alcohol-related outcomes among adolescents who received the intervention. None of the studies tested the processes by which interventions were expected to work. Conclusions The current evidence base suggests that both indicated and universal delivery of brief alcohol interventions to adolescents in primary care settings can result in clinically important changes in alcohol-related outcomes. Studies that test brief intervention processes are now necessary to better understand how brief interventions work with adolescents in primary care settings.

OBJECTIVES: Motor vehicle crashes (MVCs) are a leading cause of death for Canadian Aboriginal peoples; developing effective interventions should be a public health priority. While intervention research has been conducted outside of Canada, few formal program evaluations have been conducted in Canada. We reviewed Canadian and non-Canadian Indigenous road safety initiatives to inform future program development in Canada. METHODS: A systematic review of the published and grey literature examining MVC intervention programs in Indigenous communities was performed. Studies published after 1980 reporting pre-post comparisons of MVC interventions in Indigenous communities were included in the review. These studies were assessed using a modified Participatory Action Research quality assessment tool. Haddon’s Matrix of injury epidemiology and prevention was used to categorize crash-related risk factors targeted in the MVC interventions. SYNTHESIS: A total of 11 studies met inclusion criteria, including 1 Canadian study and 10 non-Canadian studies. Successful intervention components included focus groups, training community members, educational activities, distribution of safety devices, collaboration with local law officials to enhance enforcement, driver-licensing courses, and incentive programs. Potential barriers to successful implementation and evaluation involved lack of incorporation of cultural and contextual factors, enforcement factors, and methodological limitations. CONCLUSION: Several effective strategies to reduce MVCs can be adapted and implemented at the community and national levels. Future directions might include using multiple intervention components and incorporating a collaborative, culturally and contextually appropriate approach, while promoting evaluation initiatives and widespread dissemination of findings.

Background Heavy episodic (binge) drinking is common in and problematic for undergraduates. Researchers often assume that an individual's heavy episodic drinking is stable and trait-like. However, this fails to consider fluctuating, state-like variation in heavy episodic drinking. This study proposes and tests a novel conceptualization of heavy episodic drinking as a trait-state wherein the contribution of both trait-like stability and state-like fluctuations are quantified. It was hypothesized that heavy episodic drinking is a trait-state such that individuals have trait-like tendencies to engage in heavy episodic drinking, and state-like differences in the expression of this tendency over time. Methods A sample of 114 first-year undergraduates from a Canadian university completed self-report measures of heavy episodic drinking at 3 time points across 130 days. Hypotheses were tested with repeated-measures analysis of variance (ANOVA), test-retest correlations, and generalizability theory analyses. Results A substantial proportion of the variance in heavy episodic drinking is attributable to trait-like stability, with a smaller proportion attributable to state-like fluctuations. Conclusions The heavy episodic drinker seems characterized by a stable, trait-like tendency to drink in a risky manner, and this trait-like tendency seems to fluctuate in degree of expression over time. Findings complement research suggesting that people have trait-like predispositions that increase their risk for heavy episodic drinking. However, despite this stable tendency to drink heavily, the frequency of heavy episodic drinking appears to be at least partly sporadic or situation dependent. These findings serve as a caution to alcohol researchers and clinicians who often assume that a single assessment of heavy episodic drinking captures a person's usual drinking behavior.

Binge eating is exceedingly common in nonclinical samples of young adults, with epidemiological evidence that 49.1% and 30.0% of university-aged women and men, respectively, engage in episodic binge eating. Thus, there is impetus to identify dispositional factors contributing to the emergence and maintenance of binge eating. Impulsivity is well cited as an important vulnerability factor, as longitudinal studies have indicated impulsivity prospectively predicts future binge eating (i.e., a predisposing model). However, no studies to date have examined whether binge eating reciprocally influences future impulsivity (i.e., a complication model). In addition, no prior longitudinal studies have included men, despite evidence that a significant proportion engage in binge eating. To address these gaps in the literature, we conducted a short-term 3-week, 3-wave cross-lagged longitudinal design with 241 undergraduate students (186 women; 53 men). Consistent with our hypotheses, we found both impulsivity and binge eating exhibited strong stability over time, and impulsivity predicted future binge eating across all three waves of the study. Contrary to the complication model, binge eating did not predict future impulsivity. The findings from the current study suggest that personality-targeted prevention and intervention approaches targeting impulsivity may demonstrate clinical utility in attenuating binge eating symptomatology.

This study tested the association between personality traits (i.e., anxiety sensitivity, sensation seeking, impulsivity, and hopelessness; as measured by the Substance Use Risk Profile Scale (Woicik et al. in Addictive Behaviors 34:1042–1055, 2009)), drinking motives (i.e., enhancement, social, coping, and conformity; as measured by the Drinking Motives Questionnaire—Revised (Cooper in Psychological Assessment 6:117–128, 1994)), and problematic patterns of alcohol use in 191 Canadian Aboriginal youth. Confirmatory factor analyses provided support for a three-factor model of drinking motives. Hierarchical regression analyses demonstrated that personality traits independently predicted motives for alcohol use: anxiety sensitivity predicted conformity motivated drinking; sensation seeking and impulsivity predicted enhancement motivated drinking; and hopelessness predicted coping motivated drinking. In addition, personality traits and drinking motives predicted problematic patterns of alcohol misuse: sensation seeking, hopelessness, and enhancement motives predicted heavy episodic drinking, while all personality traits and all drinking motives (save conformity) predicted alcohol-related problems. These findings suggest that specific personality traits in Canadian Aboriginal youth can explain specific reasons for drinking and may represent appropriate targets for intervention.

Indigenous communities and federal funding agencies in Canada have developed policy for ethical research with Indigenous Peoples. Indigenous scholars and communities have begun to expand the body of research regarding their peoples, and novel and innovative methods have begun to appear in the published literature. This review attempts to catalogue the wide array of Indigenous research methods in the peer-reviewed literature and describe commonalities among methods in order to guide researchers and communities in future method development. A total of 64 articles met inclusionary criteria and five themes emerged: General Indigenous Frameworks, Western Methods in an Indigenous Context, Community-Based Participatory Research, Storytelling, and Culture-Specific Methods.

In order to meet the need for accessible interventions and support for families affected by fetal alcohol spectrum disorder (FASD), we have developed an Internet-based, distance intervention for caregivers of children with FASD between the ages of four and twelve, called Strongest Families™ FASD.To evaluate the usability of the Strongest Families FASD program content and website in terms of learnability, efficiency and acceptability.A remote usability testing approach was conducted in two iterative cycles of participants. Synchronous online usability testing sessions were conducted, followed by asynchronous testing. A total of 18 participants were included, comprised of both health care professionals with expertise in FASD and caregivers of children with FASD. The data collected in each cycle was examined for commonalities and results were used to inform changes to the website and content after each cycle.Participants rated the website as appealing and relatively easy and fast to use. Nevertheless, several usability problems were identified such as difficulty navigating between sections of content on the website, displaying too much content per page, and the relevance and appropriateness of the content as it related to FASD.The identification of usability problems was an important step in refining the Strongest Families FASD program before its effectiveness is evaluated in a randomized controlled trial.

Globally, Indigenous mental health research has increasingly focused on strengths-based theory to understand how positive factors influence wellness. However, few studies have examined how social support buffers the effects of trauma and stress on the mental health of Indigenous people. Using survey data from 207 males and 279 females in 2 Ontario First Nations we examined whether social support diminished the negative effects of perceived racism, historical trauma and loss on depression and/or anxiety. Among females, having more social supports was significantly related to a lower likelihood of depression/anxiety, whereas greater perceived racism and historical losses were associated with a greater likelihood of depression/anxiety. For both males and females, childhood adversity was significantly related to a greater likelihood of depression/anxiety. Among females, a significant interaction was found between social support and childhood adversities. For females with low social support, depression/anxiety was significantly higher among those who had experienced childhood adversities versus those with none; however, for those with high level of social support, the association was not significant. The same relationships were not found for males. Possible reasons are that males and females might experience depression/anxiety differently, or the social support measure might not adequately capture social support for First Nations males.

This paper details a four-stage methodology for developing early alcohol interventions for at-risk Aboriginal youth. Stage 1 was an integrative approach to Aboriginal education that upholds Aboriginal traditional wisdom supporting respectful relationships to the Creator, to the land and to each other. Stage 2 used quantitative methods to investigate associations between personality risk factors and risky drinking motives. Stage 3 used qualitative interviews to further understand the contexts and circumstances surrounding drinking behaviour within a larger cultural context. Stage 3 involved tailoring personality- matched, motive-specific brief interventions to meet at-risk adolescents’ needs. Stage 4 involved an efficacy test of the interventions. This novel methodology has significance for future program development to meet diverse social, cultural and health needs of at-risk adolescents.

Important to the assessment of adolescent alcohol misuse is examination of alcohol-related problems. However, most measurement tools have only been validated among Euro-American cultures. The present study assessed the ability of the Rutgers Alcohol Problem Index (RAPI) to identify problem drinkers among groups of First Nations Mi'kmaq and non-Aboriginal adolescents from rural Nova Scotia and compared cut-point scores across cultural groups. Receiver Operating Characteristic (ROC) curve analyses revealed that the RAPI adequately distinguished between problem and non-problem drinkers in both groups with similar levels of precision. Cut-points were lower for First Nations Mi'kmaq as compared to non-Aboriginal adolescents. Results support the use of the RAPI with First Nations Mi'kmaq and non-Aboriginal adolescents and suggest that cut- points may need to be lowered for use with First Nations Mi'kmaq adolescents. Findings highlight the need for empirical examination of the cross-cultural psychometric applicability of alcohol assessment tools and cut-points among First Nations adolescents.

Background: Single-session counseling is being implemented across Canada to increase the accessibility and availability of mental health services. Despite increasing use, existing research on single-session counseling is sparse and has methodological limitations. In addition, some stakeholders are skeptical that this model of care can support meaningful change for clients. Objective: The aim of this study is to evaluate a new single-session counseling program (called Same-Day Counseling) offered in an outpatient community mental health clinic in Northwestern Ontario, Canada. Methods: Clients who attend Same-Day Counseling services will be given the opportunity to participate in the program evaluation. Those who consent will complete measures before their session, after their session, and at 1-month follow-up. Data will provide information on who accesses Same-Day Counseling (eg, typical presenting problems, symptom severity), client satisfaction with services, and whether clients benefit from the services (eg, improved functioning and reduced symptom severity). Results: Data collection is underway with 80 participants having completed baseline measures and 55 participants having completed follow-up measures. Data collection is expected to conclude in December 2015. Conclusions: This study is designed to contribute to the literature regarding the integration of single-session counseling into ongoing mental health services, with additional attention to methodological rigour. Our approach will help to address ongoing concerns regarding the implementation of single-session counseling, and inform health care providers and policy makers regarding the utility of this model for addressing the mental health care need of the community. [JMIR Res Protoc 2016;5(1):e22]

The identification and reduction of measurement errors is a major challenge in psychological testing. Most investigators rely solely on classical test theory for assessing reliability, whereas most experts have long recommended using generalizability theory instead. One reason for the common neglect of generalizability theory is the absence of analytic facilities for this purpose in popular statistical software packages. This article provides a brief introduction to generalizability theory, describes easy to use SPSS, SAS, and MATLAB programs for conducting the recommended analyses, and provides an illustrative example, using data (N = 329) for the Rosenberg Self-Esteem Scale. Program output includes variance components, relative and absolute errors and generalizability coefficients, coefficients for D studies, and graphs of D study results.

We sought to evaluate a translation of anxiety-focused cognitive behavioral therapy (CBT) to a First Nations children's mental health provider in rural Ontario and to enhance our understanding of CBT challenges and adaptations unique to the First Nations context.The study was conceptualized as a mixed methods sequential explanatory approach using a quasi-experimental (before and after) design with quantitative and qualitative components. Data were produced in two ways: questionnaires completed by therapists, parents and clients pre- and post-training, and through a focus group with therapists working with First Nations clients. Participants of this study were a subset of a larger knowledge translation study involving ten agencies, and comprised nine therapists (two males and seven females), and seven children (six males and one female) from a single First Nations agency. The mean age of children was 11.8 years (±2.71), comparable to children in other agencies.First Nations therapists' scores on a child CBT knowledge questionnaire post-training did not differ from those of therapists in other agencies when controlling for initial values, suggesting comparable training benefit. Children did not differ between groups on any key measures, and all key measures showed improvement from pre- to post-training. Four key themes emerged from therapist focus groups: client challenges, value of supervision, practice challenges, and Northern/rural/remote challenges.The study highlights the importance of delivering a culturally appropriate CBT program to First Nations populations in Northern Ontario, and provides preliminary evidence of its effectiveness.Nous avons cherché à évaluer une adaptation de la thérapie cognitivo-comportementale (TCC) axée sur l’anxiété pour un prestataire de soins de santé mentale aux enfants des Premières nations en région rurale de l’Ontario, et à accroître notre compréhension des problèmes et des adaptations de la TCC propres au contexte des Premières nations.L’étude a été conceptualisée comme une approche de méthodes mixtes séquentielles explicatives à l’aide d’un devis quasi-expérimental (avant et après) avec des composantes quantitatives et qualitatives. Les données ont été produites de deux manières: des questionnaires remplis par les thérapeutes, les parents et les clients avant et après la formation, et à l’aide d’un groupe de discussion formé des thérapeutes travaillant avec les clients des Première nations. Les participants à cette étude étaient un sous-ensemble d’une étude plus vaste du transfert des connaissances comportant dix organismes et composée de neuf thérapeutes (deux masculins et sept féminins), et sept enfants (six garçons et une fille) d’un seul organisme des Premières nations. L’âge moyen des enfants était de 11,8 ans (±2,71), comparable aux enfants d’autres organismes.Les scores des thérapeutes des Premières nations à un questionnaire sur les connaissances de la TCC après la formation ne différaient pas de ceux des thérapeutes d’autres organismes, après contrôle des valeurs initiales, ce qui suggère des avantages comparables de la formation. Les enfants ne différaient pas entre les groupes à aucune des mesures clés, et toutes les mesures clés montraient une amélioration entre avant et après la formation. Quatre thèmes principaux se sont dégagés des groupes de discussion des thérapeutes: les problèmes des clients, la valeur de la supervision, les problèmes organisationnels, et les problèmes des régions nordiques/rurales/ éloignées.L’étude souligne l’importance d’exécuter un programme de TCC culturellement adapté aux populations des Premières nations du nord de l’Ontario, et fournit des données probantes préliminaires de son efficacité.

Aboriginal people are substantially more likely to be injured or die in motor vehicle crashes (MVCs) than the general population. However, research examining MVCs among Canadian Aboriginal populations is limited. We examine trends and gaps in the Canadian literature and suggest priorities for future research.We conducted a systematic review of the published and grey literature on MVCs involving Canadian Aboriginal people. We used the Haddon matrix of injury epidemiology and prevention to identify trends in crash-related risk factors.We reviewed 20 studies, which consisted of research at both national and provincial levels. We identified various risk factors related to human (e.g., male sex, substance use), vehicle and equipment (e.g., driving an older vehicle, driving a car [v. other types of vehicles]), and physical environment (e.g., occurring on-reserve, muddy and loose-gravel road conditions) variables. However, we did not find research that examined risk factors related to the social environment, such as perspectives related to MVCs.This review indicates that rates of death, hospital admission and injury related to MVCs are twice as high among Aboriginal populations than the general Canadian population, which highlights a major public health concern. Priorities for future research should include examination of the social environment, more rigorous methods and collaborative research in partnership with Aboriginal communities.

The relationship between male sex and employment as barriers to accessing mental health care is unclear. The aim of this research was to examine (1) whether the clinical features of men referred to a shared mental health care (SMHC) service through primary care differed when symptoms were affecting them in the work domain; and (2) empirically re-evaluate the effectiveness of a SMHC model for work-related disability using a pre-post chart review of N = 3960 referrals to SMHC. ANOVA and logistic regression were performed to examine symptoms (Patient Health Questionnaire, PHQ) and disability (World Health Organization Disability Assessment Schedule, WHODAS 2) at entry and discharge. Men were RR (relative risk) = 1.8 (95% C.I.: 1.60–2.05) times more likely to be referred to SMHC with work problems than women. Having greater disability and more severe somatic symptoms increased the likelihood of a work-related referral. There were no significant differences after treatment. Problems in the work domain may play an important role in men’s treatment seeking and clinicians’ recognition of a mental health care need. This study is relevant because men are underrepresented in mental health (MH) treatment and primary care is the main gateway to accessing MH care. Asking men about functioning in the work domain may increase access to helpful psychiatric services.

article i nfo Heavy episodic drinking is increasingly common among undergraduate women. Cross-sectional research suggests that depressive symptoms and heavy episodic drinking are related. Nonetheless, surprisingly little is known about whether depressive symptoms are an antecedent of heavy episodic drinking, a consequence of heavy episodic drinking, or both. Such knowledge is essential to the accurate conceptualization of heavy episodic drinking, depressive symptoms, and their interrelations. In the present short-term longitudinal study, depressive symptoms and heavy episodic drinking were proposed to reciprocally influence each other over time, with depressive symptoms predicting changes in heavy episodic drinking over 1 week and vice versa. This reciprocal relations model was tested in 200 undergraduate women using a 4-wave, 4-week longitudinal design. Structural equation modeling was used to conduct cross-lagged analyses testing reciprocal relations between depressive symptoms and heavy episodic drinking. Consistent with hypotheses, both depressive symptoms and heavy episodic drinking were temporally stable, and depressive symptoms predicted changes in heavy episodic drinking over 1 week. Contrary to hypotheses, heavy episodic drinking did not predict changes in depressive symptoms over 1 week. Results are consistent with a vulnerability model suggesting depressive symptoms leave undergraduate women vulnerable to heavy episodic drinking. For undergraduate women who are struggling with feelings of sadness, worthlessness, and hopelessness, heavy episodic drinking may provide a temporary yet maladaptive means of avoiding or alleviating depres- sive symptoms.

Canadian Aboriginal youth show high rates of excessive drinking, hopelessness, and depressive symptoms. We propose that Aboriginal adolescents with higher levels of hopelessness are more susceptible to depressive symptoms, which in turn predispose them to drinking to cope—which ultimately puts them at risk for excessive drinking. Adolescent drinkers (n=551; 52% boys; mean age=15.9years) from 10 Canadian schools completed a survey consisting of the substance use risk profile scale (hopelessness), the brief symptom inventory (depressive symptoms), the drinking motives questionnaire—revised (drinking to cope), and quantity, frequency, and binge measures of excessive drinking. Structural equation modeling demonstrated the excellent fit of a model linking hopelessness to excessive drinking indirectly via depressive symptoms and drinking to cope. Bootstrapping indicated that this indirect effect was significant. Both depressive symptoms and drinking to cope should be intervention targets to prevent/decrease excessive drinking among Aboriginal youth high in hopelessness.

Regarding: Thorell LH, Wolfersdorf M, Straub R, Steyer J, Hodgkinson S, Kaschka WP, et al. Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression. J Psychiatric Res. 2013;47:1925–1931 Language: en

OBJECTIVE: The factor structure of the Drinking Motives Questionnaire - Revised (DMQ-R; Cooper, 1994) was examined in a sample of First Nations (i.e., Mi'kmaq) adolescents. RESULTS: Exploratory principal components analysis indicated a three-factor structure (conformity, coping, and positive reinforcement motives), with the positive reinforcement motives of enhancement and social motives not separating into the expected two distinct factors. Moreover, community informants (e.g., school personnel) anecdotally indicated possible wording problems with some of the social motive items for the cultural group. A qualitative methodology - focus group interviews with Mi'kmaq adolescents - was used to explore potential reasons for these observed differences in the structure of drinking motives from previous findings in the majority culture (i.e., a measurement problem vs. a real difference in the structure of drinking motives in the Mi'kmaq culture). CONCLUSIONS: Qualitative findings support the interpretation that a true social motive for alcohol use does not exist in this cultural/age group and that drinking in social contexts for this group seems less motivated by social affiliation than by enhancement motives (e.g., drinking to party). Language: en

Background: Fetal alcohol spectrum disorder (FASD) is a term used to encompass the full range of neurobehavioral and cognitive dysfunction that may occur as a consequence of prenatal alcohol exposure. There is relatively little research on intervention strategies that specifically target the behavioral problems of children with FASD. Availability and access to services are barriers to timely and effective care for families. The Strongest Families FASD intervention was recently adapted from the Strongest Families “Parenting the Active Child” program to include FASD-specific content delivered via an Internet-based application in conjunction with 11 telephone coaching sessions. Objective: Our objectives are to (1) evaluate the effectiveness of Strongest Families FASD in reducing externalizing problems (primary outcome), internalizing problems, and parent distress (secondary outcomes) in children aged between 4 and 12 years diagnosed with FASD when compared to a control group with access to a static resource Web page; (2) evaluate the effectiveness of Strongest Families FASD in improving social competence (secondary outcome) in school-aged children aged between 6 and 12 diagnosed with FASD when compared with an online psychoeducation control; and (3) explore parental satisfaction with the Strongest Families FASD online parenting program. Methods: Parents and caregivers (N=200) of children diagnosed with FASD who have significant behavioral challenges, ages 4-12, are being recruited into a 2-arm randomized trial. The trial is designed to evaluate the effectiveness of the Web-based Strongest Families FASD parenting intervention on child behavior and caregiver distress, compared to a control group receiving access to a static resource Web page (ie, a list of FASD-specific websites, readings, videos, and organizations). Results: The primary outcome will be externalizing problems measured by the Child Behavior Checklist (CBCL). Secondary outcomes include (1) internalizing problems and (2) social competence, both measured by the CBCL; and (3) parental distress measured by the Depression Anxiety Stress Scale-21. The Client Satisfaction Questionnaire-8 (CSQ-8) and the Satisfaction Survey are completed by the intervention group at the end of session 11. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials (CONSORT) Statement. Conclusions: It is hypothesized that the Strongest Families FASD intervention group will improve child behavior and parental distress. Caregiver satisfaction is anticipated to be positive. Advancing evidence on the effectiveness and acceptance of distance services can inform policy and adoption of eHealth programs. ClinicalTrial: ClinicalTrials.gov NCT02210455; https://clinicaltrials.gov/ct2/show/NCT02210455 (Archived by WebCite at http://www.webcitation.org/6bbW5BSsT) [JMIR Res Protoc 2015;4(4):e112]

This article briefly outlines a program of research aimed at creating culturally and contextually relevant alcohol use early interventions for First Nations adolescents. We created a collaborative relationship with communities aimed at adapting established intervention approaches for use with First Nations adolescents. Employing a 4-stage method (see Mushquash, Comeau, McLeod, and Stewart, 2010), we tested Cooper's (1994) motivational model of alcohol use (see Mushquash, Stewart, Comeau, & McGrath, 2008), personality-motive relationships (see Mushquash, Stewart, Mushquash, Comeau, & McGrath, 2013), and delivered a tailored, matched intervention (see Mushquash, Comeau, & Stewart, 2007). We found that this approach resulted in reductions in frequency of drinking, heavy episodic (i.e., binge) drinking, and negative alcohol-related consequences. This approach is one way in which researchers might collaborate with First Nation communities to develop interventions to address community-based priorities.Keywords: First Nation, brief intervention, personality, alcohol use motivesResumeCet article presente sommairement un programme de recherche dont l'objectif est d'etablir des interventions pour enrayer la consommation precoce d'alcool, qui sont adaptees a la culture et au contexte des adolescents des Premieres Nations. Les auteurs ont etabli une relation de collaboration avec les communautes afin d'adapter des approches d'intervention existantes destinees aux adolescents de Premieres Nations. Ils ont utilise une methode en quatre temps (voir Mushquash, Comeau, McLeod & Stewart, 2010) pour tester le modele motivationnel de consommation d'alcool de Cooper (1994; voir Mushquash, Stewart, Comeau & McGrath, 2008) et les relations personnalite - motivation ( voir Mushquash, Stewart, Mushquash, Comeau & McGrath, 2013), pour ensuite concevoir des interventions sur mesure correspondantes (voir Mushquash, Comeau & Stewart, 2007). Selon les auteurs, cette approche a permis de reduire la frequence de la consommation, des beuveries express et des consequences negatives associees a l'alcool. Elle constitue une facon dont les chercheurs pourraient collaborer avec les communautes des Premieres Nations en vue d'etablir des interventions qui correspondent aux priorites de ces dernieres.Mots-cles : Premiere Nation, breve intervention, personnalite, con- sommation d'alcool, motifs.Research suggests there are high levels of mental health problems (Kirmayer, Brass, & Tait, 2000) and substance use (Chansonneuve, 2007) among Aboriginal peoples in Canada. Our understandings of mental health and substance use among First Nations people must recognise diversity and resist pressures to conceptualise all First Nations people as a homogenous group. While many First Nations may share similar histories (e.g., colo- nialism) and current contexts (e.g., poverty), recognising and hon- ouring diversity is of great importance. To understand mental health and substance use among First Nations peoples, mixed- methods approaches that are collaborative and emphasise respect for community-based knowledge and the importance of relation- ships are needed.Throughout this research, it was my goal to identify promising theoretical models on which to build early intervention frame- works for First Nations peoples using a four-stage method de- scribed in Mushquash et al. (2010), which emphasizes collabora- tive knowledge sharing and respect for community-based understandings. However, before applying models to guide inter- vention development, it is important to evaluate whether the pro- posed models are appropriate to use with First Nations peoples. In order to illustrate this approach, I will describe an example of how we implemented our four-stage method through the design and delivery of an alcohol use early intervention for First Nation adolescents. I will then describe how this approach may contribute to improvements in policy, practice, and research. …

The role of social factors in gamblers' over-reporting of wins was explored using a survey administered via the Internet. One hundred and fifteen gamblers (average age 36.9) completed the survey. The majority of gamblers reported that they do not over-report wins, and would not do so for social reasons. However, they believe that other gamblers do mislead people about their losses for a variety of social reasons, such as a desire to appear skilled or to be popular. As well, the majority of gamblers report not feeling urges to gamble when hearing about wins, although younger people, males, and those with gambling problems were significantly more likely to report feeling and/or acting on urges to gamble when hearing about others' wins. The discrepancy between their views of themselves and of other gamblers may be due to cognitive distortions specific to gamblers, or may reflect a general self-presentation bias.

The authors regret that in our comment on Thorell et al. (2013), Mushquash et al., (2014), the confidence intervals (CIs) for sensitivity, specificity, PVþ and PV were computed incorrectly. In each case, the sample size used in computing theWilson score CIwas the overallN for the 2 2 table rather than the appropriate rowor column total. As a result, the CIs for those test properties were too narrow.We report here a revised version of our Table 2 (Table 2R) with corrected CIs for those test properties. The point estimates for all test properties and the CIs for overall accuracy were not affected by the error, and remain unchanged. The authors would like to apologise for any inconvenience caused.

Background This paper describes the methods, strategies and insights gained from a scoping study using a “Two-Eyed Seeing” approach. An evolving technique, Two-Eyed Seeing respects and integrates the strengths of Indigenous knowledge and Western sciences, often “weaving back and forth” between the two worldviews. The scoping study was used to inform a tool for measuring the impact of culturally based addictions treatment services on wellness in Indigenous populations. It formed part of a three-year study, Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment. The scoping study identified and mapped literature on cultural interventions in addictions treatment, and described the nature, extent and gaps in literature. Methods Using a Two-Eyed Seeing approach, we adapted, applied and enhanced a common framework of scoping studies. In the end stage of the scoping review process, an Ad Hoc Review Group, led by our project Elder, reviewed and interpreted Indigenous and Western understandings within the mapped information. Elements of the scoping study were joined with results from community focus groups with staff at treatment centres. Results Two-Eyed Seeing contributed differently at each stage of the scoping study. In early stages, it clarified team expertise and potential contributions. At the mid-point, it influenced our shift from a systematic to a scoping review. Near the end, it incorporated Western and Indigenous knowledge to interpret and synthesize evidence from multiple sources. Conclusions This paper adds to the collective work on augmenting the methodology of scoping studies. Despite the challenges of a Two-Eyed Seeing approach, it enables researchers using scoping studies to develop knowledge that is better able to translate into meaningful findings for Indigenous communities.

In April of 2006, a team of researchers consisting of both university and community partners from a Mi’kmaq reserve in Nova Scotia began the data-collection phase of a high school-based research study that had been two years in planning. The study examines the possible relationships between youth-reported childhood maltreatment, posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, alcohol misuse, and resiliency factors. The aim of the research study is to provide information about adolescent alcohol misuse that is of practical benefit to community-based service providers, and capable of making a scholarly contribution to the scientific study of the relations of anxiety/mood symptoms and addictive behaviours. The primary aim of this paper is to present both the context from which the project grew, and the steps involved in conducting research with our school partners and the community service providers. A secondary aim is to present some of the preliminary data from the study, with a specific focus on resiliency.

This paper describes the development of and pilot results for an alcohol abuse early intervention program targeting at-risk Mi’kmaq youth conducted in partnership with the communities in which these youth live and the schools which they attend. This intervention was based on a previously-established, successful psychoeducational and cognitive-behavioral approach for at-risk adolescent drinkers from the majority culture that focuses on differentpersonality pathways to alcohol abuse in youth (Conrod, Stewart, Comeau, & MacLean, 2006). Through partnership and collaboration with two Mi’kmaq communities, the original intervention was adapted to be culturally appropriate for Mi’kmaq youth. The culturally-adapted intervention included traditional Mi’kmaq knowledge and teachings in order to make the program as meaningful and relevant as possible in the partner communities (Comeau et al., 2005). The pilot results were encouraging. Compared to pre-intervention, students who participated in the intervention drank less, engaged in less binge-drinking episodes (i.e., 5 drinks or more/occasion), had fewer alcoholrelated problems, and were more likely to abstain from alcohol use. Moreover, students who participated in the intervention also reduced their marijuana use at four-month post-intervention, even though the intervention was specifically designed to target alcohol misuse. No such significant changes were observed in a non-random control group of eligible students who did not participate in the intervention. Future research should determine if this intervention is effective for at-risk youth in other First Nations communities across Canada, and whether the promising, but preliminary results with marijuana mean that the benefits of the intervention might extend to adolescents’ use of substances other than alcohol.

Introduction Prescription opioid (PO) misuse and related harms are high in Canada, and a major public health challenge. In Canada, 1.4 million individuals (4.3% of the total population) self-identify as Aboriginal, among whom substance use and related harms are elevated. While there are reports of PO use and associated problems among Aboriginal groups, no comprehensive data review currently exists. Methods A review of available data sources (ie journal publications, public reports and 'grey' literature) was conducted following principles of a scoping review. Information and data were identified, extracted, and organized into major indicator categories: PO prescribing/dispensing, use/abuse, morbidity/mortality harms and treatment, and narratively reported. Results Data suggest that PO dispensing, use and misuse levels among Aboriginal populations are high and/or rising in select settings when compared to the general Canadian population. High levels of PO-related dependence and pregnancy harms exist (mainly in Northern Ontario); there is some indication of elevated opioid mortality among Aboriginals. Vast discrepancies in availability and access to interventions exist; some recent pilot studies suggest improved care. Conclusions Data regarding PO use and harms among Aboriginal people are limited, even though elevated problem levels are indicated; improved monitoring, and more effective yet culturally and contextually appropriate interventions for this acute problem are needed.

Background: Cultural interventions offer the hope and promise of healing from addictions for Indigenous people. a However, there are few published studies specifically examining the type and impact of these interventions. Positioned within the Honouring Our Strengths: Culture as Intervention project, a scoping study was conducted to describe what is known about the characteristics of culture-based programs and to examine the outcomes collected and effects of these interventions on wellness. Methods: This review followed established methods for scoping studies, including a final stage of consultation with stakeholders. The data search and extraction were also guided by the “PICO” (Patient/population, Intervention, Comparison, and Outcome) method, for which we defined each element, but did not require direct comparisons between treatment and control groups. Twelve databases from the scientific literature and 13 databases from the grey literature were searched up to October 26, 2012. Results: The search strategy yielded 4,518 articles. Nineteen studies were included from the United States (58%) and Canada (42%), that involved residential programs (58%), and all (100%) integrated Western and culture-based treatment services. Seventeen types of cultural interventions were found, with sweat lodge ceremonies the most commonly (68%) enacted. Study samples ranged from 11 to 2,685 clients. Just over half of studies involved quasi-experimental designs (53%). Most articles (90%) measured physical wellness, with fewer (37%) examining spiritual health. Results show benefits in all areas of wellness, particularly by reducing or eliminating substance use problems in 74% of studies. Conclusions: Evidence from this scoping study suggests that the culture-based interventions used in addictions treatment for Indigenous people are beneficial to help improve client functioning in all areas of wellness. There is a need for well-designed studies to address the question of best relational or contextual fit of cultural practices given a particular place, time, and population group. Addiction researchers and treatment providers are encouraged to work together to make further inroads into expanding the study of culture-based interventions from multiple perspectives and locations.