Ketil Lenert Hansen

Population based study of health and living conditions in areas with both Sami and Norwegian populations--the SAMINOR study

Objectives. The overall aim of the SAMINOR project was to study health and diseases in relation to living conditions among the Sami population and to compare these with the Norwegian population in the same area. This article provides an overview of the background of the study and a description of the methods employed for the data collection. We give sample characteristics and elaborate on different definitions of ethnicity. Study Design. Cross-sectional, population-based study, including questionnaires, a clinical examination and analyses of blood samples. Methods. All individuals 30 or 36 to 79 years of age who were living in defined municipalities or specified local areas with a known Sami population were invited to a cardiovascular screening program. The data were collected during 2003–2004. The questionnaires focused on living conditions, health, Sami traditions and ethnicity. The eligible population consisted of 27,987 individuals and 16,865 (60.6%) participated by answering at least one questionnaire. Analyses were restricted to the 36 to 79 year-old age group which had 16,538 participants. The screening program comprised a blood sample, measurements of blood pressure, height, weight, and waist and hip ratio. Different definitions of Sami ethnicity were explored. Results. Of the sample, 35.6% reported Sami background, and 13.2% reported that they, their parents and their grandparents had Sami as their domestic language. This stringent definition of Sami produced clearer differences between Sami and Norwegians, as shown for some measures of socioeconomic status. Conclusions. The findings that are related to more strict definitions of Sami ethnicity have important implications for the interpretation of earlier works and for future studies.

Ethnic discrimination and bullying in the Sami and non-Sami populations in Norway: the SAMINOR study

OBJECTIVES: To investigate the prevalence of self-reported experiences of ethnic discrimination and bullying among Sami and non-Sami adults. STUDY DESIGN: Cross-sectional, questionnaire-based survey. METHODS: SAMINOR is a population-based study of health and living conditions that was administered in 2003–2004 in 24 different Norwegian and Sami populated municipalities within central and northern Norway. This analysis was based on 12,265 men and women aged 36-79 years. Ethnic distribution was Sami (33.1%), Kvens (7.8%) and the ethnic Norwegian majority (59.1%). RESULTS: Overall, Sami and Kven respondents reported more ethnic discrimination and bullying in general than ethnic Norwegians (p > 0.001). The reporting was highest among the younger participants (p > 0.001). Men reported more ethnic discrimination than women, while women reported more bullying. Respondents with the strongest Sami affiliation reported higher levels of ethnic discrimination outside the Sami Language Act’s district, while respondents with weak Sami affiliation, Kvens and ethnic Norwegians, reported higher levels inside this district. Among the respondents that reported bullying previously, the most common type was discriminating remarks and the most common location was public schools. For those who reported bullying in the past year, the most common types were gossiping and discriminating remarks, and the most common locations were at work and in the local community. Two out of three of those reporting ethnic discrimination, independent of ethnicity, also reported bullying. CONCLUSIONS: The findings from this study show that the Sami and Kven population more often experience bullying and ethnic discrimination than ethnic Norwegians. These results are consistent with experiences from other minority and marginalized groups that experienced colonization. More research is needed to understand the role bullying and ethnic discrimination play in the wellbeing and health of the Sami and Kven population.

Ethnic discrimination and psychological distress: a study of Sami and non-Sami populations in Norway

The prevalence of psychological distress and its association with ethnic discrimination was examined among 13,703 participants (36 to 79 years of age) in a population-based study of health and living conditions in areas with indigenous Sami, Kven (descendants of Finnish immigrants), and Ethnic Norwegian populations (the SAMINOR study). Sami and Kven males reported greater levels of stress than Ethnic Norwegians. Ethnic discrimination was strongly associated with elevated levels of psychological distress. Results suggest that ethnic discrimination is a major potential risk factor for poor mental health, and may contribute to ethnicity-related differences in mental health between Sami and non-Sami populations.

Ethnicity, self-reported health, discrimination and socio-economic status: a study of Sami and non-Sami Norwegian populations

Objectives. Investigate the association between ethnicity, social factors and self-reported health conditions of Sami and non-Sami Norwegian populations. Study design. Cross-sectional questionnaire. Methods. SAMINOR is a population-based study of health and living conditions that was conducted in 24 municipalities in northern Norway during 2003 and 2004. The present study included 12,265 individuals aged between 36 and 79, whose ethnicity was categorized as Sami (33.1%), Kven (7.8%) and Norwegian majority population (59.1%). Results. Sami respondents reported inferior health conditions in comparison to the Norwegian majority population. The most unsatisfactory conditions were reported by Sami females living outside the defined Sami area (with greater integration and assimilation) (p&0.05). Females typically reported less favourable health conditions than did males. Health inequalities varied by age and were more apparent in persons aged in their mid-50s or above. Across ethnic groups, respondents with the highest education and household income were healthier than others. Furthermore, those reporting to have been frequently discriminated against were more likely to report poorer health than those who did not; the odds ratios (95% CI) was found to be 2.88 (1.92–4.32) for women and 1.61 (1.08-2.42) for men. When discrimination was included in the logistical model, the increased risk of poor self-reported health decreased to non-significance for Sami respondents. The estimated risk decreased further when the socio-economic status was taken into account. Conclusions. The findings of this study suggest that self-reported ethnic discrimination combined with low socio-economic status contributes to inequalities in self-reported health when Sami and Norwegian majority population are compared.

Ethnic discrimination and health: the relationship between experienced ethnic discrimination and multiple health domains in Norway's rural Sami population

Objective Self-reported ethnic discrimination has been associated with a range of health outcomes. This study builds on previous efforts to investigate the prevalence of self-reported ethnic discrimination in the indigenous (Sami) population, and how such discrimination may be associated with key health indicators. Study design The study relies on data from the 2003/2004 (n=4,389) population-based study of adults (aged 36–79 years) in 24 rural municipalities of Central and North Norway (the SAMINOR study). Self-reported ethnic discrimination was measured using the question: “Have you ever experienced discrimination due to your ethnic background?” Health indicators included questions regarding cardiovascular disease, diabetes, chronic muscle pain, metabolic syndrome and obesity. Logistic regression was applied to examine the relationship between self-reported ethnic discrimination and health outcomes. Results The study finds that for Sami people living in minority areas, self-reported ethnic discrimination is associated with all the negative health indicators included in the study. Conclusion We conclude that ethnic discrimination affects a wide range of health outcomes. Our findings highlight the importance of ensuring freedom from discrimination for the Sami people of Norway.

Emotional, physical and sexual violence among Sami and non-Sami populations in Norway: The SAMINOR 2 questionnaire study.

Aims: To assess the prevalence and investigate ethnic differences of emotional, physical and sexual violence among a population of both Sami and non-Sami in Norway. Methods: Our study was based on the SAMINOR 2 study, a population-based survey on health and living conditions in multiethnic areas with both Sami and non-Sami populations in Central and Northern Norway. Our study includes a total of 11,296 participants: 2197 (19.4%) Sami respondents and 9099 (80.6 %) non-Sami respondents. Results: Almost half of the Sami female respondents and one-third of the non-Sami female respondents reported any violence (any lifetime experience of violence). Sami women were more likely to report emotional, physical and sexual violence than non-Sami women. More than one-third of the Sami men compared with less than a quarter of non-Sami men reported having experienced any violence in their life. Sami men were more likely to report emotional and physical violence than non-Sami men. However, ethnicity was not significantly different regarding sexual violence experienced among men. Violence was typically reported to have occurred in childhood. Sami participants were more likely to report having experienced violence in the past 12 months. For all types of violence, the perpetrator was typically known to the victim. Conclusions: Regardless of gender, Sami respondents were more likely to report interpersonal violence. The prevalence of any violence was substantial in both ethnic groups and for both genders; it was highest among Sami women.

Approaching Etuaptmumk – introducing a consensus-based mixed method for health services research

With the recognized need for health systems’ improvements in the circumpolar and indigenous context, there has been a call to expand the research agenda across all sectors influencing wellness and to recognize academic and indigenous knowledge through the research process. Despite being recognized as a distinct body of knowledge in international forums and across indigenous groups, examples of methods and theories based on indigenous knowledge are not well documented in academic texts or peer-reviewed literature on health systems. This paper describes the use of a consensus-based, mixed method with indigenous knowledge by an experienced group of researchers and indigenous knowledge holders who collaborated on a study that explored indigenous values underlying health systems stewardship. The method is built on the principles of Etuaptmumk or two-eyed seeing, which aim to respond to and resolve the inherent conflicts between indigenous ways of knowing and the scientific inquiry that informs the evidence base in health care. Mixed methods’ frameworks appear to provide a framing suitable for research questions that require data from indigenous knowledge sources and western knowledge. The nominal consensus method, as a western paradigm, was found to be responsive to embedding of indigenous knowledge and allowed space to express multiple perspectives and reach consensus on the question at hand. Further utilization and critical evaluation of this mixed methodology with indigenous knowledge are required.

A population-based study on health and living conditions in areas with mixed Sami and Norwegian settlements - the SAMINOR 2 questionnaire study.

Objectives To describe the method, data collection procedure and participation in The Population-based Study on Health and Living Conditions in Areas with both Sami and Norwegian Settlements – the SAMINOR 2 questionnaire study. Study design Cross-sectional and semi-longitudinal. Methods In 2012, all inhabitants aged 18–69 and living in selected municipalities with both Sami and Norwegian settlements in Mid and Northern Norway were posted an invitation to participate in a questionnaire survey covering several topics related to health and living conditions. The geographical area was similar to the area where the SAMINOR 1 study was conducted in 2003/2004 with the exception of one additional municipality. Participants could alternatively use a web-based questionnaire with identical question and answer categories as the posted paper version. Results In total, 11,600 (27%) participated (16% used the web-based questionnaire), with a higher participation rate among those over 50 (37% for women and 32% for men). Some geographical variation in participation rates was found. In addition, for those invited who also participated in the SAMINOR 1 study, we found that the participation rates increased with the level of education and income, while there was little difference in participation rates across ethnic groups. Conclusion The knowledge generated from future theme-specific research utilizing the SAMINOR 2 database has the potential to benefit the general population in this geographical area of Norway, and the Sami people in particular, by providing knowledge-based insight into the health and living conditions of the multi-ethnic population in these parts of Norway.

Marginalisation and cardiovascular disease among rural Sami in Northern Norway: a population-based cross-sectional study

BackgroundLike other indigenous peoples, the Sami have been exposed to the huge pressures of colonisation, rapid modernisation and subsequent marginalisation. Previous studies among indigenous peoples show that colonialism, rapid modernisation and marginalisation is accompanied by increased stress, an unhealthy cardiovascular risk factor profile and disease burden. Updated data on the general burden of cardiovascular disease among the Sami is lacking. The primary objective of this study was to assess the relationship between marginalisation and self-reported lifetime cardiovascular disease (CVD) by minority/majority status in the rural Sami population of Norway.MethodsA cross-sectional population-based study (the SAMINOR study) was carried out in 2003-2004. The overall participation rate was 60.9% and a total of 4027 Sami individuals aged 36-79 years were included in the analyses. Data was collected by self-administrated questionnaires and a clinical examination.ResultsThe logistic regression showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely to report CVD as non-marginalised Sami living in Sami majority areas (OR 2.10, 95% CI: 1.40-3.14). No sex difference was found in the effects of marginalisation on self-reported life-time cardiovascular disease. Moderate to no intermediate effects were seen after including established CVD risk factors.ConclusionsThis study showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely as non-marginalised Sami from Sami majority areas to report lifetime cardiovascular disease (CVD). Moderate to no intermediate effects were seen after including established CVD risk factors, which suggest little difference in lifestyle related factors. Chronic stress exposure following marginalisation may however be a plausible explanation for some of the observed excess of CVD.

Acculturation and self-rated health among Arctic indigenous peoples: a population-based cross-sectional study

BackgroundAcculturation is for indigenous peoples related to the process of colonisation over centuries as well as the on-going social transition experienced in the Arctic today. Changing living conditions and lifestyle affect health in numerous ways in Arctic indigenous populations. Self-rated health (SRH) is a relevant variable in primary health care and in general public health assessments and monitoring. Exploring the relationship between acculturation and SRH in indigenous populations having experienced great societal and cultural change is thus of great importance.MethodsThe principal method in the Survey of Living Conditions in the Arctic (SLiCA) was standardised face-to-face interviews using a questionnaire. Very high overall participation rates of 83% were obtained in Greenland and Alaska, whilst a more conventional rate of 57% was achieved in Norway. Acculturation was conceptualised as certain traditional subsistence activities being of lesser importance for people’s ethnic identity, and poorer spoken indigenous language ability (SILA). Acculturation was included in six separate gender- and country-specific ordinal logistic regressions to assess qualitative effects on SRH.ResultsMultivariable analyses showed that acculturation significantly predicted poorer SRH in Greenland. An increased subsistence score gave an OR of 2.32 (P<0.001) for reporting poorer SRH among Greenlandic men, while an increased score for Greenlandic women generated an OR of 1.71 (P=0.01). Poorer SILA generated an OR of 1.59 in men (p=0.03). In Alaska, no evidence of acculturation effects was detected among Iñupiaq men. Among Iñupiaq women, an increased subsistence score represented an increased odds of 73% (p=0.026) for reporting poorer SRH. No significant effects of acculturation on SRH were detected in Norway.ConclusionsThis study shows that aggregate acculturation is a strong risk factor for poorer SRH among the Kalaallit of Greenland and female Iñupiat of Alaska, but our cross-sectional study design does not allow any conclusion with regard to causality. Limitations with regard to wording, categorisations, assumed cultural differences in the conceptualisation of SRH, and confounding effects of health care use, SES and discrimination, make it difficult to appropriately assess how strong this effect is though.