Running head: TB among Aboriginal Populations in Canada: The Role of Health Care
Professionals
1
Use either TUBERCULOSES FOR HEADER or
TUBERCULOSES AMONG ABORIGINAL PEOPLES
[APA Tip #1 & 2 Brief Header in CAPS]
[Move down to middle of the page]
TB [Tip 14-write out acronym] among Aboriginal Populations in Canada: The role of Health
Care Professionals
Submitted by Mary Jones
Student ID # 12345678
[APA Tip #3 –double space only]
Submitted in partial fulfilment of:
NURS 814.3 Aboriginal Health Issues (centre on page)
College of Nursing, University of Saskatchewan
[APA Tip #3 –double space only]
Submitted to
Arlene Kent-Wilkinson RN, PhD
May 1, 2015
(centre all content above)
PAPER #2
APA Example Paper TB-2 with APA Errors HIGHLIGHTED
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
2
Abstract [See APA Tip #5 – Center, but do not bold, flush first sentence to the left]
The persistent presence of infectious and increasingly non-infectious diseases is a major
concern among Aboriginal people of Canada. This in part can be attributed to the impact of
Aboriginal peoples’ contact with the Europeans (Houston & Houston, 2000). Tuberculosis (TB)
is an infectious disease which is far more common in the Aboriginal population than the
Canadian born non Aboriginal Canadians. Poverty and overcrowding in Aboriginal communities
are major factors accounting for higher prevalence rates of TB (Clark, Riben & Nowegesic,
2002; Waldram, Herring & Young, 2006; Levy, 2012). [See APA Tip #9 – Alpha order of first
author, not by year] [better to have no references in the abstract] The sub groups most affected
include children, youth and the elderly (Health Canada, 2012). Control programs in the past such
as the quarantine of infected Aboriginal people to sanatoriums left them with traumatic
experiences that even up to this day contributes to the reluctance in seeking treatment (Levy,
2012). In the current efforts to combat this disease in the community, health care professionals
play a crucial role. The paper concludes with a discussion of barriers still existing.
Keywords: TB, Aboriginal people, First Nations, Inuit, social determinants
[Indent and italic Keywords, do not bold]
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
3
TB Among Aboriginal Populations in Canada: The Role of Public Health Professionals
[See Tip #6 do not bold the Title above]
Introduction [Tip #7 do not use Introduction as a heading]
Tuberculosis (TB) has existed among humans for thousands of years. For example, the
detection of tuberculosis from fragments of the spinal column from Egyptian mummies dates
back to 2400 BCE. TB [APA Tip #14] is an infectious disease caused by a bacterium
Mycobacterium tuberculosis (M Tuberculosis) that is spreads by contact with contaminated air
droplets from infected persons (World Health Organization [WHO], 2011; New Jersey Medical
School: Global Tuberculosis Institute, 2011). [Tip # 9 alpha order of authors] TB usually affects
the lungs but can affect other organs such as the brain, intestines, and kidneys. Symptoms are
dependent on the infected site. Pulmonary TB symptoms usually manifest as chronic cough that
be associated with chest pain, haemoptysis, fatigue, weight loss, fever, and night-sweats.
(Zaman, 2010).
The widely used diagnostic test for TB is the sputum smear microscopy. It is estimated that
about one third of the world’s population is infected with M. tuberculosis. About, 8.5-9.2 million
new cases and 1.2-1.5 million deaths are reported each year. Most affected by this are the most
productive ages of the world’s population (World Health Organization, 2011). (WHO, 2011). Al
though the evidence shows a declining trend nationally, there is still a disproportionate
distribution between the general non-Aboriginal population and the Aboriginal populations. [Tip
#9] (Levy, 2012). This paper discusses the risk factors associated with the spread of TB among
Aboriginal people, particularly the social determinants of health. Moreover, it examines
strategies that have been implemented to control its spread in this population with specific focus
on the role of the health care professional (Health Canada, 2003a or b). [See APA Tip #22]
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
4
The paper concludes [Anthropomorphism] with a discussion of barriers still existing. [do not end
a sentence with ing]
[APA Tip #3]
Prevalence rates [See APA Tip #4 Font Times Roman onlySee APA Tip #12, capitalize all words in 3rd level of heading]
High TB rates in Canada have been associated with Aboriginal and foreign-born
populations (Phypers, Behr, Scholten, & Ellis, 2007) [Tip #16 one Author missing] compared to
case incidence rates of TB at 30-150 times that for the Canadian-born non-aboriginal [Tip #18]
population (King, 2012). Studies show that in 2004 there where [sp] 21% cases of TB in
Aboriginal people aged 15years [Tip #10 space needed] compared to only 6% for the nonAboriginal Canadian. In Aboriginal Canadians aged 15-64 years, the rate was 71% as against
52% for non-Aboriginals. For ages 65 years and older, there were 42% versus 8% for Aboriginal
versus non-Aboriginal populations respectively (Phypers, Behr, Scholten, & Ellis, 2007). [See
APA Tip #11 use et al., the subsequent time cited] [old statistics – 6 years old]
Remove
[See Tip # 8, avoid including any maps, graphs or conceptual models without authors written
permission]
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
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[Indent] Canadian National Statistics [Period] [See APA Tip #13 – 3rd level heading, indent, no
capitalization except first word]
Even though, the risk of developing active TB is very low, about 1,600 cases are
identified and reported nationally each year (Health Canada, 2012). Although there has been a
decline since 1924, in 2010 Statistics Canada reported 1,577 cases (new and re-treatment) with
an incidence rate of 4.6 per 100,000. The Public Health Agency of Canada’s (PHAC, 2009)
report, showed the highest rate of TB among Aboriginal Canadians with a rate of 27.8 per
100,000 in aboriginal [Tip #18] compared to 1.0 per 100,000 in non-Aboriginal people. These
rates have been increasing since 2002 (PHAC, 2002; PHAC, 2010).[same author, only year
needed]
[Indent] Provincial Statistics [Period] [See APA Tip #13]
[See APA Tip #3 re double space only between paragraphs]
Provincial trends are quite similar to national trends but case incidence among Aboriginal
populations increase with remote and northern locations. For example Nunavut had a
disproportionately higher incidence rate of TB in 2010. This was partly explained by a TB
outbreak which reported 101 active cases with an incidence rate of 304.0 per 100,000
populations (Canadian Institute of Health, 2012; [Tip #16 not in Reference page] Health Canada,
2012). Differences also exist in the incidence rates in other segments [of] vulnerable TB
populations. For example, while foreign-born Canadians accounted for most cases in Ontario,
British Columbia, Ontario and Quebec, in Manitoba, Saskatchewan and the North (Yukon, North
West Territories and Nunavut) Aboriginal peoples were most affected. In the Atlantic Provinces
cases were distributed equally between Aboriginal people and non-Aboriginal populations.
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
Furthermore, in Newfoundland and Labrador there were no reported cases among Aboriginal
peoples (Heath Canada, 2012).
[See APA Tip #8]
Segment of the Population Most Affected
[Tip #14 never start a sentence with an acronym]
TB is more common in adolescents and youth, a subgroup that under normal
circumstances can overcome the disease if they were healthy (Levy, 2012). In 2010 individuals
aged 25years to 34 years were most affected accounting for 18% of the total population with an
incidence rate of 6.0 per 100,000. For people aged 75year and over the incidence rate was 9.6
per 100,000 (Health Canada, 2012). For cases reported for ages 25 to 44years the provincial
trends tend to follow national trends. However, Saskatchewan and British Columbia had most
cases from ages 0 to 24yrs and ages 75 and over respectively (Health Canada, 2012).
[APA Tip #3]
6
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
7
Literature Review [See APA Tip #4 Font; APA Tip #12 centre 1st level heading]
TB among Aboriginal people has been studied extensively. Research has addressed the
historical factors (pre-contact, initial contact and post contact) and the risk factors particularly
the social determinants of TB. This brief review synthesizes the history of TB and risk factors
including the social determinants of TB among Aboriginal people.
Historical Context
[Indent paragraph Tip#8]
History has an important role in the spread of TB among Aboriginal communities and has been
studied from pre-contact, initial contact and post-contact eras. [See APA Tip #3 one double space
only] [See APA Tip #8 avoid one sentence paragraphs]
Pre contact. [See Tip #13]
Extensive eras and prevalent health issues present in those eras influenced the health of
aboriginal people. The Pre-contact era (early 1700s), was mainly characterized by parasitic
infections and environmental hazards. Houston and Houston (2000) have argued that the
persistent presence of infectious and increasingly non-infectious disease among Aboriginal
people can be attributed in part, to impacts of Aboriginal peoples’ contact with the Europeans.
Initial Contact. [See Tip #13]
According to Waldram, Herrings and Young (2006) [See Tip #11 use et al.] tuberculosis
was identified from AD 100 to AD 1650 and socio-demographic changes exacerbated the
outbreak of infections in the fifteen century. The expansion of trade by the Hudson Bay
Company opened the sea ports and enhanced the movement of the missionaries who were
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
8
already exposed to epidemics (Waldram, et al. 2006). [See Tip #11] The initial Aboriginal
contact with fur traders and explorers led to acute infections such as colds, influenza and
smallpox (Early 1700s to 1820) (Hackett, 2005). Pepperrell et al.(year) studied the evolution of
TB using historical data and genetic studies of modern TB bacteria. They found that TB lineage
between Aboriginal and French communities was explained by the bacterial lineage DS6Quebec.
This bacterial linage was also present in Aboriginal populations in Saskatchewan, Ontario and
Alberta. The authors [Reference] attributed this to contact between these populations during the
fur trade era of 1710-1870.
[See APA Tip #3 one double space only]
Post Contact. [See Tip #13]
The era between 1870s to present has been characterized by chronic infections (i.e., tuberculosis)
and disease of lifestyle (i.e., obesity, diabetes, cancer etc.) (Hackett, 2005). It is also reported that
First Nations and Inuit communities in the 1900 were affected by smallpox and tuberculosis and
the ineffective coordination at the national level did not help address the situation (Health
Canada 2003). [2003a or 2003b See Tip #22]
Risk Factors associated with the spread of TB [Tip#13, 2nd level heading, capitalize all words]
The depletion of bison in the 1879 caused starvation among Aboriginal people whose
health implication included a weakened immune system therefore succumbing to TB. Also, the
reserve system changed the natural dwellings of Aboriginal people leading to overcrowding and
unventilated housing hence serving as a catalyst for the spread of TB (Levy, 2012). Clark et al.
(2002) attributed the high incidence of TB in Aboriginal populations to inadequate housing (i.e.
high density per unit area, degree of isolation and income levels).
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
9
Many TB patients belong to socially vulnerable groups or people at higher risk of
exposure to the disease. In Canada, risk factors for latent and active TB include: people who
have come in contact with people known or suspected with active TB disease (i.e. Family
members sharing a living space), people with a history of active TB or an X-ray indicating active
TB with inadequate treatment, Aboriginal communities with high rates of latent and active TB
disease (Health Canada, 2012). It also includes poor urban homeless people, residents of long
term and correctional facilities, health care workers and staff of long term facilities and of
correctional facilities. Active TB is associated with a weakened immune system and can be a
major risk factor or consequence from other diseases. People susceptible to active TB include:
people living with HIV and AIDs, people receiving an organ transplant (due to the use immune
suppressing drugs), people with silicosis, chronic kidney disease requiring dialysis, cancer of the
neck and head. It also includes people infected with TB for the past two years with a chest X-ray
showing sign of old TB, treatment with glucocorticoids, treatment with necrosis factor (TNF)alpha inhibitors (for rheumatoid arthritis), all types of diabetes, people with a body mass index
less than 20, under five year olds first infected with TB and people who smoke one or more
packs of cigarette a day (Health Canada, 2012).
It is worth mentioning that a history of BCG vaccination may result in a false-positive
reaction to the tuberculosis screening test (TST), which may complicate decisions about
prescribing treatment. The presence or size of a TST reaction in persons who have been
vaccinated with BCG does not predict whether BCG will provide any protection against TB
disease (CDC, 2011). [Write out acronym in full first time cited] In Canada, BGC vaccination
varies from province to province. For example, in Saskatchewan clinical use of BGC began in
1933 and was discontinued in 1987. However, they continued to be used in some Aboriginal
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
10
communities until was discontinued in most communities in September 2011. In Ontario, the
vaccine is currently given to infants in Sioux and Lookout Zone (Health Canada, 2012). There is
still currently, a lot of controversy regarding the use of BCG and since it is proven to be more
effective in children. Children born in Aboriginal communities where the risk is high could still
benefit from the BCG vaccine.
Government Report
The government of Canada has over the years worked with Aboriginal people in the fight
against TB. Two of such reports are discussed in this section.
Joint Committee on Communicable Disease Control
The Joint Committee on Communicable Disease Control was established in 1990 and
drafted a TB control strategy in 1993. Recommendations included: centrally organized programs
to develop, monitor, coordinate and evaluate TB control and TB treatment. The strategy also
involved the availability of resources, partnerships between TB control programs, community
health agencies and Aboriginal communities (Hoeppner and [Tip 9f] Marciniuk, 2000; PHAC,
2002).
First Nations Health Branch (FNIHB) and the Assembly of First Nations TB Elimination
Strategy
Another important document is the TB elimination strategy which was developed in 1992
through a partnership between the First Nations Health Branch (FNIHB) and the Assembly of
First Nations. This strategy set out to ultimately eliminate TB beginning with reducing incidence
rate to 1 per 100,000 people (Health Canada, 2002). [More recent reports on TB?]
[APA Tip #3]
Strategies in Aboriginal Communities
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
11
The process of detecting and adequately treating TB in vulnerable populations is
particularly challenging. However, effective strategies have been adopted to curb the spread of
TB (Ahamed, 2004). Effective TB control involves case finding of infectious people,
investigation of contact with TB and treatment (Hershfield, 1999).
The implementation of directly-observed therapy short course (DOTS) has been a
‘breakthrough’ in the control of tuberculosis (Zaman, 2010). This standard treatment has been
adopted in Canada for the treatment of TB. Current treatment involves the use of isoniazid
(INH), rifampin (RMP), pyrazinamide (PZA) and ethambutol (EMB) (Hoeppner, Ward &
Elwood, 2007). DOT [Tip #14] has a number of benefits (including reduced drug resistance and
relapse). At the same time, DOT might not be possible in every geographical location due to
resource constraints. In such situations, priority has to be given to for instance, in cases of drug
resistance. In Canada, “DOT is recommended when self administered treatment fail to meet the
required standards” (Hoeppner, Ward & Elwood, 2007, p. 122). [See APA Tip #11]
[APA Tip #3]
Implications for Healthcare and Research
Lower rates of TB from the 20th century have been attributed to improved living
conditions, public health interventions (some of which have been discussed in the control
strategy section) and effective drug treatment (PHAC, 2002). [See APA Tip #8 avoid one
sentence paragraphs]
Treatment has been one of the most effective ways to control the spread of TB but at the
same time involves some cost to governments. Estimates of TB related health care expenditure in
Canada in 2004 amounted to $74 million estimated at about $ 47,290 per active TB case per
year. Research expenditure on TB accounted for $4.5 million (6% of the total) and non-research
expenditure accounted for 6.3 million (22% of the total) (Menzies & Oxlade, 2006). [See APA
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
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Tip #16 incomplete- Author missing] Provincial and Territorial expenditure were the highest
estimated at roughly 53 million. The Northern Territories accounted for the highest expenditure
and Atlantic provinces for the lowest (Menzies, D., & Oxlade, O., 2006). [See APA Tip #9d, 11,
et al]
TB among Aboriginal peoples has been well researched, much of this has been due to
collaborative research between non-Aboriginal researchers and Aboriginal organizations and
communities. A strength of this kind of research is the increased organizational and community
support (Boffa, King, McMullin, & Long, 2011).
Research has been crucial in the crusade against TB. Hoeppner and Marciniuk (2000)
discussed the important role of research in improving methods of diagnosis, prevention, vaccine
efficacy, and treatment of the disease (p. 145). [APA Tip #10 – Quotation marks?]
Role of the Health Care Professional
The [See Tip #8 need to indent] public professional’s roles in the prevention of TB include the
identification of suspected and confirmed cases as well as diagnoses and treat to protect public
safety. Additionally, through the collaboration with other specialist, they are involved with
prompt and complete reporting, effective case management, contact tracing, continuous medical
education and outreach programs to groups more susceptible to the disease. Another important
role is the provision of cultural appropriate treatment for TB patients especially marginalized
groups to remove the psychological barriers and increase adherence to treatment. According to
Stirling & Enarson [Tip #9f Use “and” outside the parenthesis; use “&” inside the parenthesis]
other roles include the coordination with HIV/AIDs programs for contact screening, planning
evaluation and implementation, community partnerships as well as analysis and dissemination of
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
13
surveillance data for local and regional scrutiny and comparison (2007). [Tip # 9c, put year with
the author – never by itself]
[Could give definition here of cultural competence and references like CNA, 2010]
Discussion
TB has proven to be a very difficult disease to eradicate in the world and complicated
even more with the advent of HIV and AIDs. There is continues ongoing research effort
especially for more efficacious vaccines and better treatments. Equally, important are policies
that address the social determinants and risk factors that fuel the spread of the disease.
Future Considerations
From the above discussion, it is clear that TB can be combated if policies address socioeconomic status and community involvement in disease management. Health research in this
area is crucial in affecting policy decisions.
Educational interventions have proven above all to empower people on health issues. The
role of the public health professional is crucial in educational campaigns including the provision
of reading materials on facts about TB in various aboriginal [Tip #18]languages. Voluntary
screening should be encouraged by the public health professional. Additionally, a tobacco
cessation program should be designed and implemented in Aboriginal communities to help
people quit smoking since it’s one of the risk factors. Funds should also be sourced externally to
implement programs that provide supplementary nutrition to the vulnerable in Aboriginal
communities. Another crucial role is the provision of culturally competent care, [references for
this and more detail should have been given in role of the health care professional] continuous
health education to remove psychological barriers. Equally important is advocating for better
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
14
policies that address the social determinants of health and other risk factors of TB. Priority
should still be given to research in vaccine development and continuous funding from
government to support TB programs.
[APA Tip #3]
Conclusion
[Tip #3]
TB has existed with mankind for decades but the recent HIV/AIDs pandemic creates an
urgent need for measures to curtail this infectious disease. This paper has focused on the social
determinants and other risk factors that make Aboriginal people more susceptible to TB such as
historical factors, poverty, poor housing conditions and access to health care. It looked at
strategies already implemented such as continuous treatment with DOT and more effective drugs
for those resistant to DOT regimens. Ongoing roles of the public health professional include
advocating for policies that reduce the risk factors as well as educational interventions to reach
out to all Aboriginal people in all geographical locations.
[See APA Tip #20]
References [APA Tip #6]
Ahamed, N., Yurasova, Y., Zaleskis, R., Grzemka, M., Reichman, L. B., & Mangura, B. T.
(2004). Brief guide on tuberculosis control for primary health care providers: For
countries in the WHO European Region with a high and intermediate burden of
tuberculosis. Retrieved
from, http://www.umdnj.edu/globaltb/downloads/products/briefguide%20%28rus%29.pd
f
[See APA Tip #23, Italic the title, 29 no comma after from]
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
15
Boffa, J., King, M., McMullin, K., Long, R (2011). A process for the inclusion of Aboriginal
People in health research: Lessons from the Determinants of TB Transmission project.
Social Science & Medicine. 72: 733-738
[period]
[See APA Tip #27, 23, 28, 24]
Canadian Institute for Health Information (2012). [Reference on p. 5 – not included here]
Centre for Disease Control (2011). Slide Set-Self Study Modules 1: Transmission and
Pathogenesis of TB. Retrieved from
http://www.cdc.gov/tb/publication/slidesheet/selfstudymodules/modules1/pathogenesis
[See APA Tip #24, 23, 29]
Clark, M., Riben, P. & Nowgesic, E. (2002). The association of housing density, isolation and
tuberculosis in Canadian First Nations communities. International Journal of
Epidemiology, 31, 940-945.
[See APA Tip #25, 28]
Hackett, P. (2005). From Past to Present: Understanding First Nations Health Patterns in a
Historical Context. Canadian Journal of Public Health, 2005 (96), 17-21.
[See APA Tip #29, 23, 28]
Health Canada. (2003a). Closing the Gaps in Aboriginal Health: Strengthening the Policy
Research Connection. Health Policy Research Bulletin, (5). Retrieved May 13, 2015,
from
http://www.hc-sc.gc.ca/sr-sr/pubs/hpr-rpms/bull/2003-5-aboriginal-autochtone/index-eng.php
[See APA Tip #21, 23, 29, 30]
Health Canada. (2003b). Tuberculosis in First Nations Communities. FNIHB & CIDPC. Ottawa:
Canada: Author.
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
[See APA Tip #23, 29] Write acronyms out in full – Old references! Need updating
Health Canada. (2012). Tuberculosis. Retrieved from
http://www.hc-sc.gc.ca/hl-vs/alt_formats/pacrb-dgapcr/pdf/iyh-vsv/diseasesmaladies/tuberculosis-eng.pdf
[See APA Tip #23]
Hershfield, E. (1999). Tuberculosis. 9 Treatment. Canadian Medical Association Journal,
161, 405-11.
[See APA Tip #23, 28]
Hoeppner, V. H., Marciniuk, D. D. (2000). Tuberculosis in aboriginal Canadian. Canadian
Respiratory Journal. 7(2), 141-146.
[See APA Tip #27, 29, 23, 28]
Hoeppner, V.H., Ward., H. & Elwood, K. (2007). Treatment of Tuberculosis Disease and
Infection. In Long, R. & Ellis, E. (eds.) Canadian Tuberculosis
Standards (6th ed.). Public Health Agency of Canada [period]
[See APA Tip #26, 25, 28, 23]
Houston, C., & Houston, S. (2000). The first smallpox epidemic on the Canadian plains: In the
fur-traders' words. Canadian Journal of Infectious Diseases, 11(2), 112–115.
King, M. (2012). Tuberculosis and the CIHR Pathway Initiative. Canadian Institute for Health
Research. Aboriginal Research New. Retrieved from
http://www.cihrirsc.gc.ca/e/documents/iaph_newsletter_august_2012.pdf
[See APA Tip #23, 29]
Levy, S. (2012). The Evolution of Tuberculosis. Bioscience, 62 (7), 625-629.
[See APA Tip #23, 26, 29, 28]
16
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
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Menzies, D., Oxlade, O., & Lewis, M. (2006). Cost of Tuberculosis in Canada. A Report
Prepared for the Public Health Agency of Canada. Retrieved from
http://www.phac-aspc.gc.ca/tbpc-latb/costtb/index-eng.php
[See APA Tip #23, 29, 30] Tip # 30 do not underline url]
New Jersey Medical School: Global Tuberculosis Institute, (2011). A history of tuberculosis.
Retrieved from http://www.umdnj.edu/ntbc/aboutus.htm
[See APA Tip #24, 23]
Ontario Lung Association. (2009). Tuberculosis: Information for Health Care Providers. (4thEd.).
Retrieved
from http://www.lung.healthdiary.ca/Guest/Product.aspx?IDS=yaQAZ%2f8w5Dph%2fs
SJ8eILtw%3d%3d
[See APA Tip #23, 29] Not found in body of paper – therefore delete here
Pepperell, C., Granka, J., Alexander, D., Behr, M., Chui, L., Gordon, J., Guthrie, J., Jamieson, F.,
Langlois-Klassen, D., Long, R., Nguyen, D., Wobeser, W. & Feldman, M. (2011).
Dispersal of Mycobacterium tuberculosis via the Canadian fur trade. Proceedings of the
National Academy of Sciences, 108(16), 6526-6531.
[See APA Tip #25, 11a, 23, 28]
•
When a reference has up to seven authors, spell out all authors names in the Reference List.
If there are more than eight authors, list the first six, then three ellipses, then the last author
(APA, 2010 p. 184, 198-199).
Public Health Agency of Canada. (2002). Tuberculosis in Canadian-born Aboriginal peoples.
Retrieved from http://www.phac-aspc.gc.ca/publicat/tbcbap-tbpac/special_report-eng.php
Public Health Agency of Canada. (2010). Tuberculosis in Canada 2009-Press Release. Retrieved
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
18
from http://www.publichealth.gc.ca/tuberculosis
[See APA Tip #23]
Public Health Agency of Canada. (2012a). BCG Usage in Canada-Current and Historical.
Retrieved from http://www.phac-aspc.gc.ca/tbpc-latb/bcgvac_1206-eng.php
[See APA Tip #23, 29]
Public Health Agency of Canada. (2012b). Tuberculosis in Canada 2010, Press Release.
Retrieved from http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tbcan10pre/index-eng.php
[See APA Tip #23]
Phypers, M., Kunimoto, D., Behr, M., Scholten, D. & Ellis, E. (2007). Epidemiology of
Tuberculosis in Canada. In Long, R. & Ellis, E. (Eds.) Canadian Tuberculosis
Standards (6th ed.). Public Health Agency of Canada [period]
[See APA Tip #22, 25, 23] This reference is out of Alpha order
Stirling, R., & Enarson, D. (2007). The Role of Public Health in Tuberculosis Control. In Long
R., & Ellis, E. (Eds.), Canadian Tuberculosis Standards (6th ed.). Public Health Agency of
Canada.
[See APA Tip #29, 23]
Waldram, Herring & Young (1995). Not included here [Tip #16]
Waldram, J.B., Herring, D.A., & Young, T.K. (2006). Aboriginal health in Canada: Historical,
cultural and epidemiological perspectives. (2nd Ed.). Toronto: University of Toronto
Press.
[See APA Tip #26]
World Health Organization. (2011). Tuberculosis Control 2011. WHO HTM/TB/2011.16
[See APA Tip #23- Include url]
TB among Aboriginal Populations in Canada: The Role of Health Care Professionals
Zaman, K. (2010). Tuberculosis: A Global Health Problem. Journal of Health, Population and
Nutrition, 28(2), 111-3.
[See APA Tip #29, 23, 28]
19