Risk communication and perceptions about lead ammunition and Inuit health in Nunavik, Canada

ABSTRACT

Lead ammunition is commonly used to hunt waterfowl and other wildlife in the Arctic. Hunting with lead is problematic because the toxicant can be transferred to the consumer. Therefore, it is critical to evaluate perceptions and awareness of the risks associated with using lead ammunition among Arctic populations. Results of the Nunavik Child Development Study (a longitudinal health study gathering information on health and well-being among Inuit in Nunavik, Canada) included advice to eliminate the use of lead ammunition in hunting practices. We surveyed 112 Nunavik residents (93 women; 18 men) about their awareness of lead related messages, use of lead ammunition and risk perceptions about contaminants. Sixty-seven participants (59.8%) reported there was an active hunter in their household. We found that only 27% of participants had heard or seen the messages about reducing lead ammunition. After participants viewed the Nunavik Child Development Study messages about lead, 44% stated they would stop using lead ammunition. However, 28% indicated that they would continue using lead ammunition. We conclude that, while messages had an overall positive effect, further study is required to understand why people continue to use lead ammunition.

KEYWORDS:

• Contaminants
• risk perceptions
• Indigenous
• education
• health communication
• lead
• ammunition

Introduction

Country foods, including local fish and wildlife, are important for Arctic Indigenous populations [1]. Country foods contain healthy proteins, nutrients, and fats [2]. There are also economic realities and food security issues that create challenges to purchasing store-bought foods in Northern Canada [3]. Furthermore, harvesting local foods can engender social and cultural well-being, as well as promote physical activity [4].

While there are numerous benefits to harvesting activities, human health can be negatively affected if a hunter uses lead ammunition to harvest wildlife and waterfowl [5]. Furthermore, there can be other sources of lead exposure through hunting practices including fumes released when shooting and residues from firearm maintenance [6]. Lead can negatively affect multiple organs and body systems if it is consumed [7]. Numerous studies have examined the effects of lead on human health, including the Nunavik Child Development Study (NCDS) [8]. The NCDS was initiated in 1996 by researchers and northern health authorities in Nunavik (a northern region in Arctic Canada) to examine the effects of numerous activities on foetal and childhood development including the benefits of consuming country foods, and the potential harms of consuming contaminated food sources [9]. As a result, a communication campaign was developed to provide messaging to increase the consumption of healthy country foods (particularly those high in Omega-3 fatty acids), disseminate messages about country foods that may be high in contaminants such as mercury, as well as produce information about the need to eliminate the use of lead ammunition [10]

While studies in the North have examined communication about long-range contaminants such as mercury (see for example [11; 12], significantly less attention has been given to the issue of local hunting and lead use practices that put individuals at risk of contaminant exposure. In addition, a systematic literature review on communication about environmental health with Indigenous populations found that few studies have examined risk perceptions, message receptions, and awareness of contaminants [13]. We address this knowledge gap by using surveys administered to interviewers to examine health communication about lead and country foods. The primary objectives of our study were to assess awareness of the NCDS messages aimed to reduce the use of lead ammunition, and self-reported impact of the messages on health behaviour. We also assessed risk perceptions of contaminants to understand if these views influenced the use of lead ammunition. Our results provide insight into implications for communication practices and recommendations for improving health-risk messaging in Nunavik.

Background

Lead and public health

Lead shot is commonly used to hunt waterfowl and other wildlife in the North and elsewhere [14], even though under the Migratory Birds Convention Act, it is prohibited to hunt waterfowl with lead ammunition in Canada and the United States [15]. The lead can be transferred to the consumer if the meat is not cleaned thoroughly [16] or through other lead exposure through hunting contexts (e.g. fumes when shooting or firearm maintenance) [6]. There is no known exposure level to lead that is considered safe [7].

Lead exposure is particularly harmful to young children as it can cause permanent adverse health effects to the brain and nervous system [17]. Exposure of pregnant women to low levels of lead can be harmful for the developing foetus. Lead exposure to the developing foetus can cause miscarriage, stillbirth, premature birth, and low birth weight [7]. Due to the health effects associated with lead contamination, a ban on the sale of lead ammunition was adopted by major Nunavik organisations in 1998. Despite this, a recent study of Nunavik stores has shown that lead ammunition is still available and continues to be used in the region [18].

Lead shot is continuously used in Nunavik for numerous reasons including limited ammunition options in the North [19]. A case study in Nunavik also found that some hunters believe that lead ammunition has better ballistic properties than other types of ammunition such as steel shot [19]. While Inuit men are more often hunters than women [20], women are responsible for many tasks that help to ensure a productive hunt, including supplying hunting garments, preparing meals while on the land, and caring for children [21]. A study in Inukjuak by Kafarowski [21] found that there are a multitude of decisions about purchasing or using lead shot, deciding whether lead shot in harvested meat should be removed, or choosing to eat local or store-bought foods. Our study builds on previous studies and provides insight into the perceptions of contaminants among men and women, and message reception about lead ammunition.

The Nunavik child development study and communication strategy

Researchers from the NCDS examined a range of factors that influence child development in Nunavik, including the benefits of consuming country foods and the effects of toxicants, such as lead, on pre- and post-natal health and development (Nasivvik, 2017). The results of the study indicate that prenatal exposure to lead was associated with reduced body and head size and poorer intellectual function at school age [9]. The lead exposure was associated to more hyperactivity and rule-breaking behaviours as reported by the children’s teachers. In this manuscript we evaluate risk perceptions and lead message awareness arising from the communication campaign of the NCDS to Inuk in Nunavik.

A NCDS Communications Group was created to help determine what messages should be developed and how the information would be disseminated. The group consisted of university researchers from the NCDS, and representatives from the Nunavik Regional Board of Health and Social Services and the Nunavik Nutrition and Health Committee. It included people from Kativik Regional Government, the Nasivvik Centre for Inuit Health and Changing Environments, Inuit Tapiriit Kanatami, Makivik Corporation, a hunter representative, among others. The communication strategy created by the NCDS Communications Group aimed to reach numerous regional audience members including the NCDS study participants, the general Nunavik population, midwives, and staff of the regional health and social services network (for more information on the membership of the NCDS Communications Group, as well as the communication design process and messaging see Boyd and Furgal, 2022). The communication campaign began in October 2011. A multi-approach strategy was developed to disseminate information to the target audience. This included the creation of a YouTube video to inform people about the risks of lead contamination, particularly through the use of lead ammunition. Posters were developed to encourage Nunavik residents to watch the YouTube videos. A phone-in radio show was also available to all Nunavik communities on October 7^th, 2011. To be representative of the area and languages, the information was made available in Inuttitut, French and English.

Risk communication in the Canadian Arctic

There are numerous challenges to communicating about contaminants. Public health officials have attempted to deliver messages associated with contaminants to northern populations many times in the past. However, sometimes these health messages have been met with confusion or disbelief (McAuley & Knopper 2011). Challenges to risk communication can also include language capabilities in English, French and in local dialects, as these capabilities vary among northern residents and among scientists and public health officials [22]. Traditionally science about contaminants was transmitted primarily in English, using predominantly scientific terminology. To complicate matters, there is no traditional term for “chemical contaminant”.

Furthermore, there is a lack of studies that have examined reception and perception of risk messages about contaminants in the north, and even fewer have examined if people have taken (or plan to take) risk mitigation action after hearing messaging. Our research aimed to examine the reception and effectiveness of the lead ammunition advisories. Therefore, we pose our first two research questions: Were Inuit residing in Nunavik aware of the messages to stop using lead ammunition (RQ1)?

Risk perceptions

A critical component of developing effective risk communication strategies is understanding risk perceptions (Lundgren & McMakin, 2013). “Risk perception” can be defined as the subjective judgements people make about the characteristic and severity of a risk [23]. Subsequently, risk perception studies examine how people characterise and evaluate hazards [24]. This includes determining if people perceive that a hazard will affect them. If people do not think that a hazard affects them, then they may be less likely to take risk mitigation actions [23]. Risk perception information can provide a basis for understanding and anticipating public responses to hazards and can be used to improve the communication of risk information among the public, technical experts, and policy makers [25]. In this study, we seek to understand if risk perceptions about contaminants are related to risk mitigation behaviours [26]. Therefore, we pose our third research question: Did Nunavimiut plan to reduce lead ammunition use after viewing messages about lead (RQ2)?

Additionally, gender, age, and socioeconomic status are all reported to influence how people view risks (Slovic, 2000). Indeed, researchers have demonstrated that gender may influence perceptions of contaminants in the North, with women being particularly concerned about community level impacts and mitigating actions [27]. To determine if certain demographic groups may have different responses to using lead ammunition, we pose a fourth research question: Do demographic or socio-economic variables (age, gender, job status, household income or education) relate to intended behaviour change (RQ3)?

Methods

Community background: Kuujjuaq, Nunavik

This study was held in the community of Kuujjuaq, Nunavik. Nunavik encompasses the northern third of the province of Quebec, Canada. Within this region are 14 communities along the Hudson Bay, Hudson Strait and Ungava Bay ([28]; see Figure 1). There are approximately 12,055 residents in Nunavik and approximately 90% of the population is Inuit (Statistics Canada, 2013). Kuujjuaq is the administrative capital of Nunavik and lies on the western shore of the Koksoak River. It is the largest community in the region with 2,754 residents (Statistics Canada, 2017). Languages in the region consist of English, Inuttitut and French.

Figure 1. Map of Nunavik.

Questionnaire development, recruitment and study process

During 2009, focus groups were held in Kuujjuaq to pre-test questions and assess the best methods to achieve the study research goals. It was determined that surveys that were administered by interviewers were the most feasible and ideal methods for the study, rather than focus groups. This approach has consistently and successfully been used with past studies that have evaluated health risk perceptions and communications in northern regions (see [11]. The final surveys were conducted over a 15-day period between the dates of July 19 and 2 August 2013 .

A combination of convenience and snowball sampling was used to select study participants. Convenience sampling provided a means to access populations at their workplace, through phone listings and at local businesses. Snowball sampling is an often-complimentary method where participants in the study recommend additional participants (Biernacki & Waldorf, 1981). Efforts were made to ensure a variety of participants in terms of demographics including age and gender; however, respondent availability and willingness to participate ultimately factored into the sample composition of the study. The inclusion criteria for study were Inuk who were 18 years and older.

Three Kuujjuaq residents who could speak both Inuttitut and English were hired to work with researchers to survey participants and provide guidance to the study. All surveys were conducted face-to-face to ensure clarity and understanding of concepts between participants and interviewers. Participants were encouraged to ask for clarifying information if they thought a question was confusing. The study protocol was translated and offered in both English and Inuttitut languages to be representative of the population. Participants had the choice to be surveyed in either language. While French is also an official language in Nunavik, most Nunivimiut are not French speakers. The participant was provided with a $30 coupon to a local store to honour their time. Ethics approval to conduct this research was obtained by Trent University Research Ethics Board.

Measures

In this study we examine participants’ awareness of messages regarding lead ammunition, perceptions about contaminants and intended use of lead ammunition after hearing messages (i.e. exposure to health messaging). Surveys that were administered by interviewers aimed to captured quantitative measures through multiple-choice questions.

To assess if people heard the messages about lead ammunition (RQ1), participants were shown the YouTube video message about lead ammunition on an iPad. Participants were asked if they had heard or seen information about the health effects of using lead ammunition. The purpose of showing the YouTube video was to: (1) serve as a reminder of the information for those who had previously heard the information, (2) provide the message to those who had not heard the information, and (3) provide background for the other questions in this study.

To assess the effectiveness of the message (i.e. halting the use of lead ammunition) (RQ2), participants were first asked “is there an active hunter in your household”. Those who had an active hunter in their household were asked “Now that you have just heard the messages on the YouTube videos from the Nunavik Child Development Study, do you plan to stop using lead shot or tell the active hunter in your household to stop using lead shot?”

To understand if risk perceptions may influence the use of lead shot (RQ2), two questions were asked. First, participants were asked what they thought their current risk was of being negatively harmed by contaminants in country foods. Level of concern was measured on a four-point scale from “(1) very low” to “(4) very high”. Second, participants were asked to state the extent to which they agreed or disagreed with the statement: “I think there will be more risks to people’s health from contaminants in country foods here or around the world in the future than in the past”. Agreement with the statement was measured on a five-point scale from “(1) disagree” to “(5) agree”.

To assess if different socio-demographic groups may have varying responses to using lead ammunition (RQ3), participants were also asked a series of demographic-related questions. To ascertain age participants were asked “how old are you?” Participants were also asked “what is your gender?” They were also asked “what is the highest level of schooling you have completed?” Response categories included “no formal schooling”, “some years of elementary (i.e. grade 6 and lower)”, “some years of secondary (i.e. greater than 6, but did not graduate)”, “graduate high school”, “post graduate training”. To ascertain annual household income participants were asked, “what is your best estimate of your total annual household income (i.e. total sum of income from all adults living in household)”. Response categories included “less than $20,0000”, “$20,000 to less than $40,000”, “$40,000 to less than $60,000”, and “$60,000 or more”.

Data analysis

Survey data was tabulated, cleaned and analysed using SPSS statistical package version 24. Descriptive statistics were calculated for all variables to identify trends in the data. To measure the relationship between demographic groups and awareness of lead ammunition advisories, a series of chi-square and Fisher’s exact tests with the Bonferroni correction was calculated. Participants were segmented into 10-year age groups. Each age group was then compared to all other age groups. Pearson, Kendall’s tau-b, and point-biserial correlations were computed to measure relationships between perceptions of contaminants, intentions to stop using lead ammunition, and demographic variables.

Results

A total of 112 people completed the survey including 93 women and 18 men. This sample represents approximately 4.1% of the total population in Kuujjuaq and further represents 6.0% of the eligible participants in the population (i.e. 18 years and older). See Table 1 for a summary of participant socio-demographics.

Table 1. Summary of demographics for participants and residents of kuujjuaq.

	Number of Participants	Total Number of Kuujjuaq Residents
Age
18–29	20	740
30–39	35	430
40–49	29	325
50–59	17	310
60–69	9	165
Gender
Men	18	920
Women	93	960
Education
No formal schooling	1	745
Some years of elementary	9	-
Some years of secondary	53	-
High school graduate	24	255
Post graduate training	24	685
Household Income
Less than $20,000	8	35
$20,000 to less than $40,000	16	85
$40,000 to less than $60,000	14	95
$60,000 or more	47	570

Education level is provided for residents aged 15 and older. Gender and income is provided for residents aged 18 and older..

Those who stated that there was an active hunter in their household (n = 67; 59.8%).

Awareness of lead ammunition messages

Participants were shown the NCDS messages and asked if they had heard the information in the past. Twenty-seven percent (n = 30) of participants (95% CI: .186–.350) recalled hearing information about lead shot. Participants aged 30 or older were significantly more likely to have heard about lead ammunition than those between the ages of 18 and 29 (χ² (1) = 8.75, p < .05). In fact, no participants between the ages of 18 and 29 recalled hearing the information. However, there was no significant association between the other age groups, when compared to one another, and message awareness.

All participants who had an annual household income between $40,000 and $60,000 (n = 14) stated that they did not recall hearing or seeing the messages about lead ammunition. Participants with an annual income between $40,000 and $60,000 (n = 14) were less likely to have heard about lead ammunition use than those in all other income groups (p < .05, Fisher’s exact test). There was no significant association between income for all other income groups and message awareness. See Table 2 for summary of message recall by demographics.

Table 2. NCDS lead message recall By demographics.

	n	Percentage
Age
18–29	0	0%
30–39	10	28.6
40–49	11	37.9
50–59	4	23.5
60–69	4	44.4
Gender
Men	5	27.8
Women	24	25.8
Education
No formal schooling	0	0
Some years of elementary	2	22.2
Some years of secondary	11	20.8
High school graduate	7	29.2
Post graduate training	10	41.7
Household Income
Less than $20,000	2	25.0
$20,000 to less than $40,000	7	43.8
$40,000 to less than $60,000	0	0
$60,000 or more	16	34.0
Pregnancy in Past 2 Years
Yes	3	17.6
No	22	28.6

Perceptions of contaminants

Two items measured level of concern about contaminants. The majority, 67.9% (n = 72), of participants perceived their current risk from contaminants as being low or very low. When asked to indicate agreement with the statement, “I think there will be more risks to people’s health from contaminants here or around the world in the future than in the past”, 66.1% (n = 74), of the participants agreed and 14.3% (n = 16) somewhat agreed. See Table 3 for summary of risk perceptions by demographics.

Table 3. Risk perceptions by demographics.

	Perceived Current Risk		Perceived Future Risk
	Mean	SD	Mean	SD
Age
18–29 (n = 20)	2.2	0.6	4.2	1.3
30–39 (n = 35)	2.4	0.7	4.1	1.4
40–49 (n = 29)	2.2	0.8	4.3	1.3
50–59 (n = 17)	2.0	0.7	4.4	1.0
60–69 (n = 9)	2.0	0.5	4.4	1.3
Gender
Men (n = 18)	2.3	0.7	4.5	1.2
Women (n = 93)	2.2	0.7	4.3	1.2
Education
No formal schooling (n = 1)	2.0	-	5.0	-
Some years of elementary (n = 9)	2.3	0.8	4.3	0.7
Some years of secondary (n = 53)	2.2	0.6	4.1	1.3
High school graduate (n = 24)	2.2	0.9	4.1	1.6
Post graduate training (n = 24)	2.4	0.6	4.6	0.8
Household Income
Less than $20,000 (n = 8)	1.8	0.5	4.0	1.6
$20,000 to less than $40,000 (n = 16)	2.3	0.6	3.8	1.5
$40,000 to less than $60,000 (n = 14)	2.4	0.8	4.6	0.8
$60,000 or more (n = 47)	2.3	0.7	4.6	1.0
Pregnancy in Past 2 Years
Yes (n = 17)	2.4	0.7	3.7	1.7
No (n = 77)	2.2	0.7	4.3	1.1

Perceived current risk is measured on a four-point scale from “(1) very low” to “(4) very high”. Perceived future risk is measured on a five-point scale from “(1) disagree” to “(5) agree”.

Perceived current risk was not significantly correlated with population by age (r = −.14, p = .17), gender (r = .03, p = .79), education (τ_b = .05, p = .59), income (τ_b = .16, p = .11), or pregnancy in the past two years (r_pb = .14, p = .20). Perceived future risk was not significantly correlated with age (r = .07, p = .46), gender (r = .08, p = .42), or education (τ_b = .12, p = .16). However, perceived future risk was significantly correlated with income (τ_b = .22, p < .05) and recent pregnancy (r_pb = −.21, p < .05). Individuals with higher household income tended to perceive more risks from contaminants in the future, while women who had been pregnant in the previous two years tended to perceive less future risks.

Changes in lead ammunition use

There was no significant correlation between perceived current risk from contaminants (r_pb = .11, p = .51), or perceived future risks (r_pb = .11, p = .51), and intended lead ammunition use. There was a positive, but non-significant correlation between education attainment and intention to stop using lead bullets (τ_b = .19, p = .20). High school graduates (n = 10, 70.0%) and those with post graduate training (n = 8, 72.7%) were the most likely to intend to stop using lead ammunition after hearing the messages. Other socio-economic and demographic characteristics: age (r_pb = −.03, p = .84), gender (p = 1.0, Fisher’s exact test), income (τ_b = .04, p = .83) and having been pregnant in the past two years (p = .65, Fisher’s exact test) were not significantly related with intended behaviour change following hearing NCDS information. See Table 4 for summary of behaviour change responses by population.

Table 4. Risk perception summary.

Variable and Response Options	n (%) of total sample
Perceived Current Risk
Very low	13 (12.3%)
Low	59 (55.7%)
High	31 (29.2%)
Very high	3 (2.8%)
Perceived Future Risk
Disagree	8 (7.1%)
Somewhat disagree	7 (6.3%)
Neither agree nor disagree	7 (6.3%)
Somewhat agree	16 (14.3%)
Agree	74 (66.1%)

Participants were shown the NCDS message about lead before being asked about their intentions to continue using lead ammunition in the future. Those who stated that there was an active hunter in their household (n = 67; 59.8%) were then asked if they planned to stop using lead ammunition or tell the active hunter in their household to stop. Thirteen (19.4%; 95% CI: .099–.289) stated that they did not use lead ammunition. Fifteen of the 67 participants (22.4%; 95% CI: .124–.324) said that they did not intend to stop using the lead ammunition while 24 participants (35.8%; 95% CI: .243–.473) reported that they planned to stop using lead ammunition or tell the hunter in their household to stop. Fifteen (22.4%; 95% CI: .124–.324) stated that they did not know if they would stop. See Table 5 for summary of behavior change by demographic.

Table 5. Hunters stopped using lead ammunition after hearing the advisory.

		n	Percentage
Age
18–29		4	66.7%
30–39		9	60.0
40–49		8	61.5
50–59		1	33.3
60–69		2	100
Gender
Men		5	62.5
Women		19	63.3
Education
Some years of elementary		1	50.0
Some years of secondary		8	50.0
High school graduate		7	70.0
Post graduate training		8	72.7
Household Income
Less than $20,000		0	0
$20,000 to less than $40,000		6	75.0
$40,000 to less than $60,000		3	75.0
$60,000 or more		9	60.0
Pregnancy in Past 2 Years
Yes		3	50.0
No		16	64.0

Discussion and conclusion

Our study results provide insight into the awareness of NCDS messages about lead ammunition, perceptions of lead ammunition and use of lead ammunition for hunting. The majority of participants (73%) were not aware of the information (RQ1). It is particularly important to note that none of the 20 participants aged 18 to 29 had heard the messages. Since the messages resulting from the NCDS study focus on pre- and post-natal health, this is an age group that particularly warrants effective messaging about contaminants. These results are consistent with other studies that show the importance of and need for targeting messages to specific sub-groups [29]. In the future, communication campaigns about lead may need to also be targeted to a younger age group. This may require additional research to understand the best methods to communicate to Nunavimmiut aged 18 to 29. Additional research could also focus on different information sources and messaging about contaminants and environmental health. For example, is possible that messaging could be better received through different information channels. Future studies could examine if different messaging and materials result in higher knowledge of contaminants and more aligned risk perceptions.

Numerous researchers have indicated a need to examine risk perceptions about a hazard [24,30,31]. Risk perceptions can inform communication campaigns and help understand how people may react to a hazard [30]. Our results indicate that the majority (67.9%) of participants perceived their risk from contaminants as being low or very low. However, the majority (80.4%) believed that there will be more risks to people’s health from contaminants in the future. Of particular note, women who had been pregnant in the previous two years tended to perceive less future risks than those who were not pregnant within the past 2 years. Future research could examine the perceptions of this sub-group further. Numerous studies have pointed to the challenges in developing communication strategies for women of childbearing-age [11,32,33]. The differences in risk perceptions for this group confirm the need to better examine the communication needs and opinions of this population sub-group. This information could provide insight into more effective messaging strategies.

Finally, a primary objective of this research was to examine if messages may influence lead ammunition use in the future. There was a variation in responses to whether people would tell the active hunter in the household to stop using lead ammunition, or they would themselves stop using lead shot. There were more people who indicated they would stop than those who stated they did not intend to stop. However, approximately 30% still stated they did not intend to stop using lead ammunition. This shows that while the NCDS messages did have a positive response among many, there still needs to be an understanding why people would not stop or do not know if they would stop. This information may provide an insight into reasons for behaviours and could inform health communication strategies [34]. Creating communication strategies that provide targeted, relevant risk information to a target audience can contribute to the adoption of risk mitigation behaviours [35].

The results of this study have illuminated numerous avenues for future research. This research identified perceptions of contaminants and awareness of information about health effects of using lead ammunition. However, future studies could examine longitudinal perceptions, behaviour, and communication awareness. There is a lack of studies that examine longitudinal risk perceptions [36]. Examining risk perceptions of Arctic residents over time may identify underlying factors that affect views of contaminants or communication strategies that have been successful in increasing awareness about the risks associated with lead ammunition. In addition, examining perceptions and awareness of hazards, pre- and post-communication campaign may provide a better understanding of how a communication campaign was (or was not) successful. This research illuminates whether or not people changed their behaviours in regard to using lead ammunition. However, future research could examine the underlying factors for why people changed (or did not change) their behaviours. Future research should also focus on evaluating messaging towards active hunters. This could include examining contaminant knowledge and intentions following a campaign to reduce the use of lead ammunition.

There are limitations to the study. We are limited in understanding the perceptions and awareness of using lead ammunition among men because the large majority (90%) of the participants were women. A Statistics Canada (2001) study of Inuit Adults in the Canadian Arctic found that 80% of men harvested country food compared to 63% of women. Therefore, the lower percentage of men in this study likely further limits the understanding of behaviours and intentions among hunters. While women were a primary target audience for the NCDS messages, it is equally important to understand the perceptions and awareness of men because their use of lead ammunition as harvesters of food could have an impact not only on their health [37], but also on the health of any woman who may consume these foods with lead ammunition contaminants. However, there needs to be further understanding of messaging directed to hunters. We are unable to distinguish between participants who are active hunters and those with a hunter in the household. This sample is also limited to one community in Nunavik and while the sample represents 6.0% of the eligible participants in Kuujjuaq, the sample size is still relatively small. In the future, additional research should also examine message awareness and perceptions in other communities in Nunavik and among more participants. In addition, two years had passed between data collection and the release of the NCDS messages. This time lag could influence recollection and memory of the messages. Finally, we acknowledge the limitations associated with working with translators for this project. While it was necessary, and ultimately, beneficial to work with translators, there may be potential inconsistencies that may be present when working between Inuttitut and English language-based survey instruments (Squires, 2009). While we worked with community members to determine appropriate translations, we acknowledge challenges in interpreting answers when words like “contaminant” may be understood differently between languages.

Communication evaluations are critical for understanding message reception and behavioural change (or lack of behavioural change) [38]. This information can provide public health organisations and health communicators with the information needed to determine if more communication strategies are required, need alterations or are effective [39]. In the case of the NCDS health messages about lead ammunition, the communication strategy seemed to have moderate success in awareness [40]. However, further study is needed to understand why people would continue to use lead ammunition, as the study showed that there were some with a low level of cooperation to directional health messaging. This influence on cooperation may be complex and involve multiple factors. It is well established that Indigenous groups that maintain strong relationships with the land and animals around them are often at greater risk for exposure to environmental contaminants than other populations [41]. Therefore, it is imperative that effective messaging strategies continue to be researched and developed to adequately address this disparity.

Acknowledgments

Studies such as these could not be done without the participation of the people of Kuujjuaq, and we are grateful to them for sharing their time and views. We would like to thank the research assistants for their invaluable help: Mina Gordon, Darlene Kauke, Lizzie Epo, Kristeen McTavish and Nicole Bilodeau. Thank you to the Nunavik Nutrition and Health Committee with their partnership, support, and review of this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research reported in this publication was supported by the Canadian Institutes of Health Research under award number MOP102623 and the National Institute on Aging of the National Institutes of Health under award number K01AG066063. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Canadian Institutes of Health Research or the National Institutes of Health.