Birgit Niclasen

Psychometric Validation of the Revised Family Affluence Scale: a Latent Variable Approach

The aim was to develop and test a brief revised version of the family affluence scale. A total of 7120 students from Denmark, Greenland, Italy, Norway, Poland, Romania, Scotland and Slovakia reported on a list of 16 potential indicators of affluence. Responses were subject to item screening and test of dimensionality. Bifactor analysis revealed a strong general factor of affluence in all countries, but with additional specific factors in all countries. The specific factors mainly reflected overlapping item content. Item screening was conducted to eliminate items with low discrimination and local dependence, reducing the number of items from sixteen to six: Number of computers, number of cars, own bedroom, holidays abroad, dishwasher, and bathroom. The six-item version was estimated with Samejima’s graded response model, and tested for differential item functioning by country. Three of the six items were invariant across countries, thus anchoring the scale to a common metric across countries. The six-item scale correlated with parental reported income groups in six out of eight countries. Findings support a revision to six items in the family affluence scale.

Changes since 1980 in body mass index and the prevalence of overweight among inschooling children in Nuuk, Greenland

Abstract Objective. The aim of the study was to examine the trends which have occurred during the past generation in body mass index (BMI) and in the prevalence of overweight and obesity among children in public schools in Nuuk, Greenland. Study design. The study is a retrospective cohort study of BMI among inschooling children (age 6 or 7 years old). A database was created on the basis of files from school-nurses containing information on height and weight among children having attended school in Nuuk since 1970. The database contained 10,121 measurements in total, whereas 2,801 were on inschooling children. Measurements from these children form the basis of this study. Mean and quartiles of BMI among the inschooling children in 5-year intervals were used to determine the development in BMI since 1980. On the basis of international cut-points (1) for use among children and adolescents, the proportion of overweight and obese children and the trends since 1980 were determined. Results. The mean BMI has risen by a total of a bit more than 6% since 1980, corresponding to a rise of 1.2–3.8% for every 5-year period. Increases are also observed when assessing the proportion of overweight and obese, which were 6.6% and 0.9%, respectively, among the inschooling children during the period 1980-1984. These proportions increased to 16.5% and 5.2%, respectively, in 2000-2004. Conclusion. This study has provided evidence that during the past two decades, children in Nuuk have undergone a development towards a higher prevalence of overweight and obesity. (Int J Circumpolar Health 2005; 64(2):157–162)

Health care and health care delivery in Greenland

Objectives. To describe the health care system and health care delivery in Greenland. Study design and method. This was a literature study that included literature and articles searched in PubMed published from 1989 to 2009 about health care in Greenland. Results. The health care system is a publicly financed governmental responsibility. Its major challenges are limited economic resources, Greenland’s demographic structure, rapid epidemiological changes, increased public demand for specialized treatment, difficulty in recruiting professionals and the economic burden imposed by around-the-clock maintenance of specialized staff in sparsely populated areas. To meet these challenges, a public health program focusing on health promotion and prevention, educational initiatives to improve recruitment and a system reorientation moving towards larger health care regions is proposed to be gradually implemented from 2010. One fundamental component of this plan is tying the system together with a telemedicine system and in the future also with a joint electronic patient file system. The importance of better surveillance and monitoring of health has been recognized, while securing best clinical practice and implementing better steering instruments on resource allocation and quality are areas needing focus in the future. Conclusion. Many of the challenges for the Greenlandic health care system are being addressed with promising strategies, but only the future will show whether they are successful.

Child health in Greenland.

Aim: To review the knowledge on child health and child health problems in Greenland. Method: The review was based on theses, national statistics, national and international reports, and a search in Pub Med, PsycINFO, Web of Science, and WHOLIB databases from 1985 to 2005. The resulting articles were sorted by topic, type, quality of study, and relevance for child health today, providing 47 articles. Results: Children in Greenland have become taller and have improved their general health. The morbidity found in Greenlandic children is similar to that found elsewhere even though the magnitude of problems might differ. The child mortality is relatively high and unevenly distributed. The acute disease pattern is dominated by infections, mostly airway infections. Otitis and its sequelae is a problem. An increase in chronic conditions such as atopy, asthma, obesity, and disabilities has taken place. Overweight and obesity have tripled in 20 years and are a health threat as well as constituting negative health behaviour. Social ill health, socioeconomic inequity, and sociocultural changes also influence health but their consequences are not well investigated in children. Conclusions: A relatively high child mortality but the same morbidity pattern as in other Western societies was found. Negative health behaviour is frequent in schoolchildren. The influence of rapid cultural changes, and familial and societal factors related to social ill health, together with socioeconomic inequity, are of major importance to the health of children in Greenland. More accurate data on child health are necessary in the future to secure better prioritization. It is suggested to construct a set of reliable indicators of child health in Greenland to monitor the health of children on a national and regional basis.

Trends from 2002 to 2010 in Daily Breakfast Consumption and its Socio-Demographic Correlates in Adolescents across 31 Countries Participating in the HBSC Study.

Breakfast is often considered the most important meal of the day and children and adolescents can benefit from breakfast consumption in several ways. The purpose of the present study was to describe trends in daily breakfast consumption (DBC) among adolescents across 31 countries participating in the HBSC survey between 2002 to 2010 and to identify socio-demographic (gender, family affluence and family structure) correlates of DBC. Cross-sectional surveys including nationally representative samples of 11–15 year olds (n = 455,391). Multilevel logistic regression analyses modeled DBC over time after adjusting for family affluence, family structure and year of survey. In all countries, children in two-parent families were more likely to report DBC compared to single parent families. In most countries (n = 19), DBC was associated with family affluence. Six countries showed an increase in DBC (Canada, Netherland, Macedonia, Scotland, Wales, England) from 2002. A significant decrease in DBC from 2002 was found in 11 countries (Belgium Fr, France, Germany, Croatia, Spain, Poland, Russian Federation, Ukraine, Latvia, Lithuania and Norway), while in 5 countries (Portugal, Denmark, Finland, Ireland, Sweden) no significant changes were seen. Frequency of DBC among adolescents in European countries and North America showed a more uniform pattern in 2010 as compared to patterns in 2002. DBC increased significantly in only six out of 19 countries from 2002 to 2010. There is need for continued education and campaigns to motivate adolescents to consume DBC. Comparing patterns across HBSC countries can make an important contribution to understanding regional /global trends and to monitoring strategies and development of health promotion programs.

Low birthweight as an indicator of child health in Greenland—use, knowledge and implications

Objectives. The aim of this study was to analyse if low birthweight is a valuable indicator of child health in Greenland. Study Design. A case study focusing on “low birthweight as an indicator in Greenland” with 3 units and 5 subunits of analyses. Methods. Literature reviews, interviews with health care professionals and an analysis of the National Birth Register. Results. Low birthweight was a well-known and yearly surveyed indicator, but not used by clinicians or by policymakers. Research was sparse, but the major risk factor observed was smoking. The rate of low birthweight in 1997–2005 was on average 5.0%. Of the low birthweight cases, 67.0% infants were born prematurely but only 44.8% of these births had a low birthweight. The known risk factors for a low birthweight in Greenland included abnormal delivery, low Apgar score at 5 minutes, female gender, multiple birth, being a single mother and less than complete prenatal care by a midwife. For preterm birth, associations were found with a not normal delivery, perinatal mortality, low Apgar score at 5 minutes, multiple birth, single mothers, mothers born in Greenland, young mothers, mothers living in a village and in nulliparae. Conclusions. Low birthweight is as valuable an indicator of child health at the national level in Greenland as it is in other developed countries. If interventions are to be aimed at known, quantitatively important, modifiable determinants of low birthweight, the results suggest that cigarette smoking and antenatal care are the most important to address.

National indicators of child health and well-being in Greenland

Aims: The aim of the study was to identify core indicators of childrens health and well-being at the national level, adapt them to the needs of children in Greenland, and present empirical data about them. Methods: The indicators were based on the actual knowledge about the health of children in Greenland, on the goals identified in the National Public Health Strategy and in the UN Convention on the Rights of the Child, as well as on experiences from international studies. Criteria to determine quality and relevance were identified. Results: It is proposed that the 28 core indicators of child health that fulfilled the selected criteria be implemented immediately and that another 25 indicators be implemented later. Data showed that large subgroups of children are vulnerable because of their socioeconomic and demographic conditions, that morbidity associated with health behaviour and mortality was high, and that at-risk health behaviour was frequent compared to children in the other Nordic countries. Conclusions: The carefully selected indicators could be powerful tools in monitoring core issues in childrens health and the factors influencing it. They are also a necessary starting point for determining the outcomes of the countrys health and welfare policies. Although relevant indicators were identified, a lack of both validated data sources and routine data collections was obvious. Data on the proposed indicators showed many affected children in Greenland.

Onset of Overweight in Nuuk, Greenland: A Retrospective Cohort Study of Children From 1973 to 1992

The purpose of the study was to examine the age at onset of overweight and obesity of 2–15‐year‐old children in Nuuk, Greenland, born between 1973 and 1992. The study was a retrospective cohort study. The data were retrieved from the childrens individual health files containing information on height and weight, and the database contained a total of 12,002 measurements of BMI in 3,094 children (1,522 boys and 1,572 girls). The main outcome measure was age at onset of overweight—the age at which BMI was above an internationally recommended cutoff point for overweight. The study showed that an increasing proportion of children reached the overweight state and did so at an earlier age for later cohorts. This was seen for both boys and girls. Overweight was less prevalent among boys in all cohorts. For the 1973–1992 cohorts of children from Nuuk, Greenland, the age at onset of overweight was significantly decreased.

Conceptualizing and contextualizing food insecurity among Greenlandic children

Objective To review the context of food insecurity in Greenlandic children, to review and compare the outcomes related to food insecurity in Greenlandic children, in other Arctic child populations and in other western societies, and to explore the measure used by the Health Behaviour in School-aged Children (HBSC) study. Design The study includes literature reviews, focus group interviews with children and analyses of data from the HBSC study. HBSC is an international cross-national school-based survey on child and adolescent health and health behaviour in the age groups 11, 13 and 15 years and performed in more than 40 countries. The item on food insecurity is “Some young people go to school or to bed hungry because there is not enough food in the home. How often does this happen to you?” (with the response options: “Always”, “Often”, “Sometimes”, or “Never”). Results The context to food security among Inuit in Arctic regions was found to be very similar and connected to a westernization of the diet and contamination of the traditional diet. The major challenges are contamination, economic access to healthy food and socio-demographic differences in having a healthy diet. The literature on outcomes related to food insecurity in children in Western societies was reviewed and grouped based on 8 domains. Using data from the Greenlandic HBSC data from 2010, the item on food security showed negative associations on central items in all these domains. Focus group interviews with children revealed face and content validity of the HBSC item. Conclusion Triangulation of the above-mentioned findings indicates that the HBSC measure of food shortage is a reliable indicator of food insecurity in Greenlandic schoolchildren. However, more research is needed, especially on explanatory and mediating factors.

Adverse health effects of experiencing food insecurity among Greenlandic school children

Background In vulnerable populations, food security in children has been found to be associated with negative health effects. Still, little is known about whether the negative health effects can be retrieved in children at the population level. Objective To examine food insecurity reported by Greenlandic school children as a predictor for perceived health, physical symptoms and medicine use. Design The study is based on the Greenlandic part of the Health Behaviour in School-aged Children survey. The 2010 survey included 2,254 students corresponding to 40% of all Greenlandic school children in Grade 5 through 10. The participation rate in the participating schools was 65%. Food insecurity was measured as going to bed or to school hungry because there was no food at home. Results Boys, the youngest children (11–12 year-olds), and children from low affluence homes were at increased risk for food insecurity. Poor or fair self-rated health, medicine use last month and physical symptoms during the last 6 months were all more frequent in children reporting food insecurity. Controlling for age, gender and family affluence odds ratio (OR) for self-rated health was 1.60 (95% confidence interval (CI 1.23–2.06) (p<0.001), for reporting physical symptoms 1.34 (95% CI 1.06–1.68) (p=0.01) and for medicine use 1.79 (95% CI 1.42–2.26) (p<0.001). Stratification on age groups suggested that children in different age groups experience different health consequences of food insecurity. The oldest children reported food insecurity less often and experienced less negative health effects compared to the younger children. Conclusions All 3 measures of health were negatively associated to the occurrence of food insecurity in Greenlandic school children aged 11–17. Food security must be seen as a public health issue of concern, and policies should be enforced to prevent food poverty particularly among boys, younger school children and children from low affluence homes.