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Modifiable Risk Factors for Cancer in First Nations

Key findings 

  • First Nations peoples in Ontario have a higher prevalence of cancer risk factors including cigarette smoking, binge drinking, obesity and physical inactivity.
  • Understanding the prevalence of cancer risk factors may be the best way to determine where to direct cancer prevention resources most effectively to reduce the future burden of cancer and other chronic diseases.

See Modifiable Risk Factors for Cancer in First Nations Methodology for technical information.

Report date: March 2018
Data source: First Nations Regional Health Survey Phase 2, 2008/10 (First Nations Information Governance Centre); Canadian Community Health Survey, 2007–2014 (Statistics Canada).
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Indigenous Cancer Care Unit)
Notes:
1. Lines on the bars represent 95% confidence intervals.
2. † indicates high sampling variability in data for off-reserve First Nations adolescents. Interpret with caution.

 

Report date: March 2018
Data source: First Nations Regional Health Survey Phase 2, 2008/10 (First Nations Information Governance Centre); Canadian Community Health Survey, 2007–2014 (Statistics Canada).
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Indigenous Cancer Care Unit)
Notes:
1. Age-standardized to the 2006 Ontario Aboriginal identity population.
2. º represents estimate for on-reserve First Nations (RHS).

 

Report date: March 2018
Data source: Canadian Community Health Survey (CCHS), 2007-2012 (Statistics Canada) and First Nations Regional Health Survey (RHS) Phase 2, 2008/10 (First Nations Information Governance Centre)
Prepared by: Cancer Care Ontario, Indigenous Cancer Care Unit and Chiefs of Ontario

 

Report date: March 2018
Data source: First Nations Regional Health Survey Phase 2, 2008/10 (First Nations Information Governance Centre); Canadian Community Health Survey, 2007–2014 (Statistics Canada).
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Indigenous Cancer Control Unit)
Notes:
1. Age-standardized to the 2006 Ontario Aboriginal identity population.
2. Lines on the bars represent 95% confidence intervals.

 

Report date: March 2016
Data source: Canadian Community Health Survey (CCHS), 2007–2013 (Statistics Canada) and First Nations Regional Health Survey (RHS) Phase 2 (2008/10) (First Nations Information Governance Centre)
Prepared by: Cancer Care Ontario, Indigenous Cancer Control Unit and the Chiefs of Ontario, Health Research Sector
Notes:
1. Adult estimates are adjusted to the age distribution of the 2006 Ontario Aboriginal identity population (from the 2006 Census).
2. Lines on the bars represent 95% confidence intervals.
3. † indicates high sampling variability for off-reserve First Nations adolescents. Interpret with caution.
4. Obese adults ages 18 and older: BMI 30 or greater. Body Mass Index (BMI) equals weight in kilograms divided by (height in metres) squared. Excludes pregnant women.
5. Obese adolescents ages 12 to 17: using categories of BMI as specified by the Cole Classification System (Cole et. al., BMJ. 2000;210:1240-1243)

 

Report date: March 2016
Data source: Canadian Community Health Survey (CCHS), 2007-2012 (Statistics Canada) and First Nations Regional Health Survey (RHS) Phase 2, 2008/10 (First Nations Information Governance Centre)
Prepared by: Cancer Care Ontario, Indigenous Cancer Care Unit and Chiefs of Ontario

Data Table 1: Percentage of on-reserve and off-reserve First Nations and non-Aboriginal adolescents (ages 12 to 17) and adults (ages 20 and older) who smoked daily or occasionally, Ontario
  On-reserve First Nations (RHS) On-reserve First Nations (RHS) On-reserve First Nations (RHS)
Adolescents 30.3 24.8 36.4
Adults 49.8 46.6 53

Report date: March 2018
Data source: First Nations Regional Health Survey Phase 2, 2008/10 (First Nations Information Governance Centre); Canadian Community Health Survey, 2007–2014 (Statistics Canada).
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Indigenous Cancer Control Unit)
Notes: High sampling variability in data for off-reserve First Nations adolescents. Interpret with caution.

 

Data Table 2: Percentage of First Nations and non-Aboriginal adults (ages 20 and older) who smoked daily or occasionally, by year, Ontario, 2007 to 2013
  On-reserve First Nations (RHS) Off-reserve First Nations (CCHS) Non-Aboriginal (CCHS)
2007   50.7 23.5
2008   45.3 22.4
2009   45.3 22.4
2010 49.8 44.5 21.6
2011   39.6 21.9
2012   42.6 21.4
2013   38.7 20.5

Report date: March 2018
Data source: First Nations Regional Health Survey Phase 2, 2008/10 (First Nations Information Governance Centre); Canadian Community Health Survey, 2007–2014 (Statistics Canada).
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Indigenous Cancer Care Unit)
Notes:
1. Age-standardized to the 2006 Ontario Aboriginal identity population.
2. º represents estimate for on-reserve First Nations (RHS).

 

Data Table 3: Percentage of First Nations and non-Aboriginal men and women (ages 19 and older) who had 5 or more alcoholic drinks on one occasion at least 2 to 3 times a month in the past year, Ontario
  On-reserve First Nations (RHS) On-reserve First Nations (RHS) On-reserve First Nations (RHS) Off-reserve First Nations (CCHS) Off-reserve First Nations (CCHS) Off-reserve First Nations (CCHS) Non-Aboriginals (CCHS) Non-Aboriginals (CCHS) Non-Aboriginals (CCHS)
Men 25 20 29 28 23 32 19 18 20
Women 14 11 17 11 8 14 6 6 7

Report date: March 2018
Data source: Canadian Community Health Survey (CCHS), 2007-2012 (Statistics Canada) and First Nations Regional Health Survey (RHS) Phase 2, 2008/10 (First Nations Information Governance Centre)
Prepared by: Cancer Care Ontario, Indigenous Cancer Care Unit and Chiefs of Ontario

 

Data Table 4: Percentage of First Nations and non-Aboriginal men and women (ages 18 and older) who consumed at least 2 vegetables and 2 fruits a day, Ontario
  On-reserve First Nations (RHS) On-reserve First Nations (RHS) On-reserve First Nations (RHS) Off-reserve First Nations (CCHS) Off-reserve First Nations (CCHS) Off-reserve First Nations (CCHS) Non-Aboriginal Non-Aboriginal Non-Aboriginal
Male 12 9.2 14.8 21.9 17.7 26.1 22.8 22.2 23.4
Female 19.9 16.8 23 27.7 23.2 32.2 37 36.3 37.7

Report date: March 2018
Data source: First Nations Regional Health Survey Phase 2, 2008/10 (First Nations Information Governance Centre); Canadian Community Health Survey, 2007–2014 (Statistics Canada).
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Indigenous Cancer Control Unit)
Notes:
1. Age-standardized to the 2006 Ontario Aboriginal identity population.
2. Lines on the bars represent 95% confidence intervals.

 

Data Table 5: Percentage of First Nations and non-Aboriginal adolescents (ages 12 to 17) and adults (ages 18 and older) who were obese, Ontario
  On-reserve First Nations On-reserve First Nations On-reserve First Nations Off-reserve First Nations Off-reserve First Nations Off-reserve First Nations Non-Aboriginal Non-Aboriginal Non-Aboriginal
Adolescents 15.9 13.3 18.9 7.5 3.9 11.0 4.8 4.2 5.4
Adults 48.8 45.6 52.0 30.4 27.0 33.8 17.5 17.1 17.9

Report date: March 2018
Data source: Canadian Community Health Survey (CCHS), 2007–2013 (Statistics Canada) and First Nations Regional Health Survey (RHS) Phase 2 (2008/10) (First Nations Information Governance Centre)
Prepared by: Cancer Care Ontario, Indigenous Cancer Control Unit and the Chiefs of Ontario, Health Research Sector
Notes:
1. Adult estimates are adjusted to the age distribution of the 2006 Ontario Aboriginal identity population (from the 2006 Census).
2. Lines on the bars represent 95% confidence intervals.
3. † indicates high sampling variability for off-reserve First Nations adolescents. Interpret with caution.
4. Obese adults ages 18 and older: BMI 30 or greater. Body Mass Index (BMI) equals weight in kilograms divided by (height in metres) squared. Excludes pregnant women.
5. Obese adolescents ages 12 to 17: using categories of BMI as specified by the Cole Classification System (Cole et. al., BMJ. 2000;210:1240-1243)

 

Data Table 6: Percentage of First Nations and non-Aboriginal men and women (ages 18 and older) who were physically active, Ontario
  On-reserve First Nations (RHS) On-reserve First Nations (RHS) On-reserve First Nations (RHS) Off-reserve First Nations (CCHS) Off-reserve First Nations (CCHS) Off-reserve First Nations (CCHS) Non-Aboriginals (CCHS) Non-Aboriginals (CCHS) Non-Aboriginals (CCHS)
Men 44 39 49 60 54 65 53 53 54
Women 27 23 30 50 45 54 48 47 49

Report date: March 2016
Data source: Canadian Community Health Survey (CCHS), 2007-2012 (Statistics Canada) and First Nations Regional Health Survey (RHS) Phase 2, 2008/10 (First Nations Information Governance Centre)
Prepared by: Cancer Care Ontario, Indigenous Cancer Care Unit and Chiefs of Ontario

Results

Cigarette smoking

  • Cigarette smoking is associated with various cancers, including lung and colorectal cancers.
  • First Nations adults and adolescents living on-reserve reported a high prevalence of cigarette smoking (50% and 30%, respectively), followed closely by First Nations adults and adolescents living off-reserve (43% and 14%, respectively). These numbers are significantly greater than among their non-Aboriginal counterparts (22% in adults and 4.2% in adolescents).
  • The prevalence of cigarette smoking significantly declined from 2007 to 2013 for off-reserve First Nations and non-Aboriginal adults.
  • Similar proportions of on-reserve and off-reserve First Nations adults were cigarette smokers in 2010 (the only year for which on-reserve data is available).

 

Alcohol consumption

  • Drinking alcohol increases risk for many cancers, including colorectal and breast cancers.
  • First Nations adults (on-reserve and off-reserve) are more likely to binge drink than non-Aboriginal adults.

 

Vegetable and fruit consumption

  • Consuming a diet high in vegetables, fruit and dietary fibre lowers the risk of several cancers, including colorectal cancer. Conversely, a diet high in red meats and processed foods increases the risk of colorectal cancer.
  • On-reserve First Nations men (12%) and women (20%) were significantly less likely to consume at least 2 vegetables and 2 fruits per day, compared with those living off-reserve (27% and 40%, respectively). Values for both groups are significantly lower than for non-Aboriginal men (35%) and women (52%).

 

Obesity

  • Increased body fatness is associated with many cancers, including colorectal and post-menopausal breast cancers.
  • Almost half of First Nations adults (ages 18 and older) living on reserve were classified as obese (49%), a significantly greater proportion than in those living off-reserve (30%). Both on-reserve and off-reserve First Nations adults were significantly more likely to be obese than non-Aboriginal adults (17%).
  • First Nations adolescents living on-reserve were more than 3 times as likely to be obese as their non-Aboriginal counterparts (18% compared with 4.8%). The prevalence of obesity among First Nations adolescents living off-reserve and non-Aboriginal adolescents was also high (7.5% and 4.8%, respectively).

 

Physical activity

  • Regular physical activity has been associated with reduced risk for cancer, including colorectal cancer.
  • On-reserve First Nations adults were less likely to be physically active than off-reserve First Nations and non-Aboriginal adults. On-reserve First Nations women were the least likely to be physically active (27%) — about half as likely as off-reserve First Nations women (50%) and non-Aboriginal women (48%). On-reserve First Nations men (44%) were also significantly less likely to be physically active than off-reserve First Nation men (60%) and non-Aboriginal men (53%).

 

Opportunities

  • First Nations peoples in Ontario have higher incidence and mortality rates for certain cancers, including lung and colorectal cancers.
  • With their current high rates of cigarette smoking, First Nations peoples are expected to experience a substantial future burden of tobacco-related chronic disease. Strategies, policies and programs to reduce tobacco use should therefore be a priority.
  • The Indigenous Tobacco Program at Cancer Care Ontario aims to reduce non-traditional tobacco use and second-hand smoke exposure in First Nations, Inuit and Métis communities. The program develops and delivers culturally appropriate awareness and education initiatives. These activities help communities to build capacity to prevent commercial tobacco use, help people quit and protect people from second-hand exposure.
  • Geography is an important issue for First Nations peoples, especially for those living on-reserve in remote or rural areas, where there are challenges in getting prevention and treatment support. Improving access to resources and services is critical to system-level interventions designed to reduce cancer risk and improve First Nations health outcomes.
  • The Chiefs of Ontario and Cancer Care Ontario produced Cancer in the First Nations in Ontario: Risk Factors and Screening. The report provides essential evidence that First Nations can use to support cancer prevention and screening.
  • CCO’s Path to Prevention: Recommendations for Addressing Chronic Disease in First Nation, Inuit and Métis outlines evidence-based policy recommendations to guide decision-making about chronic disease prevention policy for First Nations, Inuit and Métis groups. The report focuses on the 4 major risk or protective factors for chronic disease: commercial tobacco use, alcohol consumption, physical activity and healthy eating. While the recommendations are aimed at the Government of Ontario, their implementation will involve full participation by First Nations, Inuit and Métis partners, as well as collaboration with relevant organizations.