Abstract
Objectives: 1) To examine associations between racial discrimination and drug problems among urban-based Aboriginal adults; and 2) to determine whether these associations are best explained by symptoms of psychological stress, distress or post-traumatic stress disorder (PTSD).
Methods: Data were collected through in-person surveys with a community-based sample of Aboriginal adults (N = 372) living in a mid-sized city in western Canada in 2010. Associations were examined using bootstrapped linear regression models adjusted for confounders, with continuous prescription and illicit drug problem scores as outcomes. Mediation was examined using the cross-products of coefficients method.
RESULTS: More than 80% of Aboriginal adults had experienced racial discrimination in the past year, with the majority reporting high levels in that period. Past-year discrimination was a risk factor for PTSD symptoms and prescription drug problems in models adjusted for confounders and other forms of psychological trauma. In mediation models, PTSD symptoms explained the association between discrimination and prescription drug problems; psychological stress and distress did not. PTSD symptoms also explained this association when the covariance between mediators was controlled. The results also indicate that participation in Aboriginal cultural traditions was associated with increased discrimination.
CONCLUSIONS: Most efforts to address Aboriginal health inequities in Canada have focused on the role Aboriginal people play in these disparities. The current findings combine with others to call for an expanded focus. Non-Aboriginal Canadians may also play a role in the health inequities observed. The findings of this study suggest efforts to reduce discrimination experienced by Aboriginal adults in cities may reduce PTSD symptomology and prescription drug problems in these populations.
Key words: Aboriginal, racial discrimination, prescription drugs, posttraumatic stress, Canada
Mots Clés: Indiens d’Amérique nord, discrimination raciale, médicaments sur ordonnance, stress post-traumatique, Canada
Résumé
OBJECTIFS: 1) Examiner les associations entre la discrimination raciale et les problèmes de toxicomanie chez les adultes autochtones en milieu urbain; et 2) déterminer si ces associations s’expliquent mieux par les symptômes du stress psychologique, de la détresse ou de l’état de stress post-traumatique (ESPT).
MÉthode: Les données ont été recueillies au moyen de questionnaires administrés en personne auprès d’un échantillon communautaire d’adultes autochtones (N = 371) vivant dans une ville de taille moyenne de l’Ouest canadien en 2010. Les associations ont été examinées à l’aide de modèles de régression linéaire avec rééchantillonnage (bootstrap) ajustés en fonction de facteurs confusionnels, les résultats étant les notes obtenues par rapport aux ordonnances continues de médicaments et aux abus de drogues illicites. Nous avons examiné la médiation à l’aide des produits croisés de la méthode des coefficients.
RÉsultats: Plus de 80 % des adultes autochtones avaient subi de la discrimination raciale au cours de l’année antérieure, la majorité indiquant des niveaux élevés de discrimination durant cette période. La discrimination au cours de l’année antérieure était un facteur de risque pour les symptômes d’ESPT et les abus de médicaments sur ordonnance dans les modèles ajustés en fonction des facteurs confusionnels et d’autres formes de traumatisme psychologique. Dans les modèles de médiation, les symptômes d’ESPT expliquaient l’association entre la discrimination et l’abus de médicaments sur ordonnance; le stress psychologique et la détresse ne l’expliquaient pas. Les symptômes d’ESPT expliquaient aussi cette association après ajustement pour tenir compte de la covariance entre les médiateurs. Les résultats montrent également que la participation aux traditions culturelles autochtones était associée à une discrimination accrue.
CONCLUSION: La plupart des efforts pour aborder les iniquités en santé chez les Autochtones du Canada portent sur le rôle joué par les Autochtones dans ces disparités. Nos constatations, combinées à celles d’autres chercheurs, justifient un élargissement de cette perspective. Les Canadiens non autochtones pourraient aussi jouer un rôle dans les iniquités en santé observées. Les constatations de notre étude indiquent que des efforts pour réduire la discrimination vécue par les adultes autochtones dans les villes pourraient réduire les symptômes d’ESPT et les abus de médicaments sur ordonnance dans ces populations.
Footnotes
Funding sources: This study was funded by the Alberta Gambling Research Institute and the Alberta Centre for Child, Family & Community Research (ACCFCR). C. Currie was salary-supported by awards from Alberta Innovates: Health Solutions and ACCFCR during the course of this research. Conflict of Interest: None to declare.
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