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Upon completion of community data analyses, draft reports were submitted to each First Nation partner for the initial review. Verification meetings were undertaken in each community, and feedback was incorporated into the local reports, which were only released to the First Nation. Each First Nation would have the discretion to determine whether or not to share their community-level results. Data training workshops were held where community representatives were trained on how to read and interpret their data, perform basic data analyses, write draft proposals and discuss current funding opportunities available to them. Data training workshops created an environment for representatives to work together, brainstorm, and share success stories and experiences. At the regional level, both the AFN Regional Chief and the regional health authority were consulted on the interpretation of the results before the release of a Regional Report at a regional event, such as an all-Chiefs meeting, with opportunities for the exchange of ideas on the pertinence of the results to First Nations, health implications and policy development. The timeline for data collection, community reporting, data training workshops and release of regional reports in the eight AFN regions is presented in Fig. 2. Fig. 2 figure 2 The timeline for data collection, community reporting, data training workshops and release of regional reports in the eight AFN regions Full size image Results A summary of the First Nations approached, selected and having participated in the FNFNES in each AFN region is presented in Table 1. Out of the 117 First Nations invited, 22 communities declined to participate after the initial consultation. Eighteen alternate communities were approached, and 17 agreed to participate. Two First Nations selected with certainty did not have an alternate (one community did not have an ecozone alternate, and one community did not have an alternate because of its population size). One purposely selected community chose not to participate. Three First Nations withdrew partway through data collection and were therefore dropped from the analyses for the region. One First Nation in the Saskatchewan AFN region had occupied reserves in two ecozones (Boreal Plains and Boreal Shield); a decision was made to split the First Nation into two sites by an ecozone boundary. A total of 92 First Nations located in 11 ecozones completed the five general study components of FNFNES. The location of First Nations by AFN region and ecozone is presented in Fig. 3. Most ecozones extend over two or more regions, such as the Boreal Plains and Boreal Shield. On the other hand, the AFN BC region includes three ecozones (Pacific Maritime, Boreal Cordillera and Montane Cordillera). Table 1 A summary of the First Nations approached, selected and having participated in the FNFNES in each AFN region Full size table Fig. 3 figure 3 Map of participating communities, AFN regions and ecozones Full size image Table 2 presents the participation rate and the characteristics of participants, including household information (age, gender, household size) by region. Overall, a total of 6487 or 78% of adults contacted for this Study completed the household questionnaire component of FNFNES. Although the randomization process ensured that there would be an equal chance of either gender being selected to participate, a higher percentage of females (66%) participated than males (34%). The average age of males and females was similar (44 and 45 years, respectively). Sixty-nine percent of households contained dependents under the age of 18 years, and the average household size across the regions was five people. At the regional level, the average number of people living in households ranged between four and six while the percentages of households with children were 58% in British Columbia, 68% in Alberta, 69% in Saskatchewan, 74% in Manitoba, 48% in Ontario, 55% in Quebec-Labrador, and 48% in the Atlantic region. Table 2 Participation rate and the characteristics of participants, including household information Full size table Traditional food systems remain foundational to First Nations. The average daily intake of traditional food was 61 grams, while some adults reported eating more than 1000 grams (Batal et al. 2021a). On days when traditional food was eaten, the intake of almost all nutrients was significantly higher while the intake of saturated fat was lower (Batal et al. 2021a, 2021b). The diet of First Nations adults does not meet nutrition recommendations; intake of vitamins A, D and C, folate, calcium and magnesium are inadequate (Batal et al. 2021c). First Nations living on-reserve experience extremely high rates of food insecurity: an average of 48% (range between 24% and 60%) of households are food insecure, and the rate is 3 to 5 times higher than the food insecurity rate reported for the general Canadian population (12%) (Batal et al. 2021d). Fish harvest and consumption were found to be important contributors to nutritional health and food security among First Nations (Marushka et al. 2021a). Traditional food is safe for consumption, with two primary exceptions. The use of lead-based ammunition resulted in very high levels of lead in many harvested mammal and bird samples. As a result, there is an elevated risk of exposure to lead for some adults and for women of childbearing age (Chan et al. 2021). Large predatory fish (such as walleye and northern pike) in some areas have higher levels of mercury, and some women of childbearing age have elevated levels of exposure, particularly in the northern parts of Saskatchewan, Manitoba, Ontario and Quebec (Chan et al. 2021). This is corroborated by the hair mercury monitoring results. While most (95.5%) of the 3404 participants who provided hair samples had mercury levels below the Health Canada mercury guideline of 2 μg/g, women of childbearing age (19–50) and older individuals (51+) living in northern ecozones and Quebec tend to have a higher hair mercury exposure (Tikhonov et al. 2021). Taste and colour of water are two common reasons that limit the use of drinking water. A total of 453 (30%) of the 1516 households that had drinking water tested showed exceedances for metals that affect taste and colour. Observed exceedances that might pose human health concerns were as follows: 128 or 8.4% for lead, 4.0% for manganese, 1.6% for uranium, 1.3% for aluminum and 0.2% for copper (Schwartz et al. 2021a). Regular maintenance and improvement of the water treatment and/or delivery system needs to be implemented to improve the drinking water supply quality. Pharmaceuticals such as caffeine and 17α-ethinylestradiol were detected in surface waters of some First Nations communities, suggesting potential sewage contamination, but the levels would not pose a threat to human health (Schwartz et al. 2021b). The health of many First Nations adults is compromised with very high rates of smoking and obesity (i.e., double the obesity rate among Canadians) and with one fifth of the adult population suffering from diabetes (Batal et al. 2021e). Dietary exposure to persistent organic pollutants was found to be associated with rates of type 2 diabetes among First Nations (Marushka et al. 2021b).