Tine Curtis

Cultural change and mental health in Greenland: the association of childhood conditions, language, and urbanization with mental health and suicidal thoughts among the Inuit of Greenland.

In Greenland, the rapid sociocultural change of the last 50 years has been paralleled by an epidemiological transition characterized by a reduction in infectious diseases, an increase in cancer and cardiovascular diseases, and an increased prevalence of mental health problems. During 1993-94 and 1997-98, two health interview surveys were conducted among Inuit in Greenland and Inuit migrants in Denmark. The response rates were 71 and 55%. Information on mental health was obtained from 1388 and 1769 adults. As indicators of mental health, the prevalence of potential psychiatric cases according to the General Health Questionnaire (GHQ-12) and the prevalence of suicidal thoughts were studied in relation to childhood residence and fathers occupation, current residence, and language. The statistical methods included logistic regression and graphical independence models. The results indicated a U-shaped association in Greenland of GHQ-cases with age and a high prevalence of suicidal thoughts among young people; a low prevalence of GHQ-cases among those who were bilingual or spoke only Danish; and a high prevalence of suicidal thoughts among migrants who grew up in Denmark and among residents of the capital of Greenland. In Greenland, women were more often GHQ-cases and had suicidal thoughts more often than men. The association between language and GHQ-cases is presumed to operate through socioeconomic factors. It is necessary to modify the common notion that rapid societal development is in itself a cause of poor mental health: as a result of successful integration into the modern Greenlandic society, some population groups have better mental health compared to other groups.

Changing living conditions, life style and health

Abstract Human health is the result of the interaction of genetic, nutritional, socio-cultural, economic, physical infrastructure and ecosystem factors. All of the individual, social, cultural and socioeconomic factors are influenced by the environment they are embedded in and by changes in this environment. The aim of the paper is to illustrate the influence of environmental change on living conditions and life style and some of the mechanisms through which such changes affect physical and mental health. The interrelationship between environmental and societal change is illustrated by an example from a small community in Greenland, where changing environmental conditions have influenced fishing and employment opportunities to the extent that the size of the population has changed dramatically. The link between social change and health is shown with reference to studies on education, housing and occupation as well as life style changes. The paper further illustrates the relationship between the rapid socio-cultural and economic change and the health of the population. Psychosocial stress is reflected in problems such as alcohol abuse, violence and suicide, and these factors have been shown in studies on migration and transitions in health to be connected to changes in lifestyle and living conditions. (Int J Circumpolar Health 2005; 64(5):442–450)

Climate change and human health: infrastructure impacts to small remote communities in the north

Abstract In northern regions, climate change can include changes in precipitation magnitude and frequency, reductions in sea ice extent and thickness, and climate warming and cooling. These changes can increase the frequency and severity of storms, flooding, or erosion; other changes may include drought or degradation of permafrost. Climate change can result in damage to sanitation infrastructure resulting in the spread of disease or threatening a community’s ability to maintain its economy, geographic location and cultural tradition, leading to mental stress. Through monitoring of some basic indicators communities can begin to develop a response to climate change. With this information, planners, engineers, health care professionals and governments can begin to develop approaches to address the challenges related to climate change. (Int J Circumpolar Health 2005; 64(5):487–497)

Violence, sexual abuse and health in Greenland

The purposes of the study were to analyse the lifetime prevalence of violence and sexual abuse among the Inuit in Greenland and to study the associations between health and having been the victim of violence or sexual abuse. Associations were studied with specific attention to possible differences between women and men. Further, response rates were analysed specifically in order to understand consequences of including questions on violence and sexual abuse in the questionnaire survey. The analyses were based on material from a cross-sectional health interview survey conducted during 1993–94 with participation from a random sample of the Inuit population in Greenland (N = 1393). The prevalence of ever having been a victim of violence was 47% among women and 48% among men. Women had more often than men been sexually abused (25% and 6%) (p < 0,001) and had more often been sexually abused in childhood (8% and 3%) (p = 0.001). Having been the victim of violence or sexual abuse was significantly associated with a number of health problems: chronic disease, recent illness, poor self-rated health, and mental health problems. The associations between having been the victim of violence or sexual abuse and health was stronger for women than for men. It is possible to secure a reasonably high response rate in a general health survey that includes questions on violence and sexual abuse.

The Danish Youth Survey 2002: asking young people about sensitive issues

Objectives. To explore ethical, legal and practical issues related to conducting a youth survey in Denmark on sexual experiences before the age of 15 and thereby achieve reliable data on child sexual abuse. Study design and methods. The relevant authorities were consulted on possible legal and ethical objections. By a pilot study based on conventional self-administered questionnaires, information was obtained about the reactions of school boards, teachers and 9th grade students. Results. The necessary conditions were present for the implementation of a nationwide anonymous youth survey without obtaining parental consent. The Central Scientific Ethical Committee had no objections. In a number of fields, Danish legislation accords 15-to-18-year-olds the competence to make independent decisions regarding their personal circumstances, and the UN Convention of Children’s Rights states that a child’s viewpoints must be accorded appropriate significance in relation to that child’s age and maturity. In the pilot study, no negative reactions were observed among the students and school authorities. About 25% of the students had difficulties in filling the questionnaire. No student made use of the accompanying offer of counselling. Conclusion. An anonymous youth survey based on computer-assisted self-interview (CASI) would increase the validity of youth surveys on child sexual abuse to which no ethical or legal objections were found.

Can we compare violence data across countries

Objectives. The paper aims to explore what knowledge can be obtained about violence through population-based data and additionally, through inter-country comparisons of violence data. Study design and methods. Data on lifetime and 12-month experiences of violence and/or severe threats of violence were obtained from self-administered questionnaires supplementary to nationwide, cross-sectional health interview surveys conducted in Greenland in 1993–94 (N=2,425) and in Denmark in 2000 (N=16,684). The overall response rate achieved for the self-administered questionnaire was 63 % (N=1,393) in Greenland and 63 % (N=10,458) in Denmark. Results. A comparison of violence data shows that overall, the violence prevalence was significantly higher in Greenland than Denmark. Experienced violence and/or severe threats amongst Greenlandic women was almost as prevalent as amongst Greenlandic men — especially so for severe lifetime violence. This was not the case for the Danish sample. Significantly more Danish men than Danish women reported experienced violence and/or severe threats for all age groups. Conclusion. Comparing violence data across countries enables us to describe actual differences in violence prevalence, as well as to highlight potential methodological discrepancies and cultural and gender differences in understanding and, thus, reporting of violence. This knowledge can be implemented in the development and improvement of existing and new prevention strategies.

Harmful alcohol use and frequent use of marijuana among lifetime problem gamblers and the prevalence of cross-addictive behaviour among Greenland Inuit: evidence from the cross-sectional Inuit health in transition Greenland survey 2006-2010

Background and objectives . Public health research has pointed to alcohol and substance abuse as the most significant public health challenges in Greenland with the negative impact on families and communities that entail, but few studies have investigated the role of problem gambling as addictive behaviour among Inuit. The objectives of the present study were to investigate (a) the association between lifetime problem gambling and harmful alcohol use as well as frequent use of marijuana and (b) the prevalence of cross-addictive behaviour among Greenland Inuit. Design . A representative cross-sectional study among Greenland Inuit (n=2,189). Data was collected among adults (18+) in 8 towns and 13 villages in Greenland from 2006–2010. Lifetime problem gambling, harmful alcohol use and frequent use of marijuana were measured through a self-administered questionnaire. Results . The odds ratio for harmful alcohol use and frequent use of marijuana was significantly higher among lifetime problem gamblers compared to non-problem gamblers/non-gamblers. One or more addictive behaviours were present among more than half of the men (53%) and one third of the women (37%), and the co-occurrence of lifetime problem gambling with either harmful alcohol use, frequent use of marijuana or both was found among 12.2% of men and 3.7% of women. The prevalence of one or more addictive behaviours was 44% in households with children. Conclusions . For lifetime problem gamblers, the gambling problems were more often than not combined with harmful alcohol use, frequent use of marijuana or both – especially among men. The high prevalence of addictive behaviours in households with children indicates that many families are presently affected negatively by alcohol, gambling and marijuana. This suggests that pathological gambling should be included systematically in future public health strategies, treatment programs and interventions in Greenland.

Impact of public health research in Greenland

In 1992, the Greenland Home Rule Government took over the responsibility for health care. There has since been a growing cooperation between the Directorate of Health and researchers in Denmark and Greenland, for instance by the Directorate supporting workshops and funding a chair in health research. Two health surveys have been carried out in Greenland by the National Institute of Public Health, and a follow-up is being planned together with the Directorate of Health. The results have been widely used by politicians, administrators, and health care professionals.

12th International Congress on Circumpolar Health in Nuuk

The scientific meeting of the IUCH was held in Nuuk in September 2003. The outcome of this meeting was positive, especially with respect to the health of Arctic Indigenous people. As part of the meeting program, the new IUCH council was elected, which, in turn, nominated Neil Murphy from Alaska as the new president of the IUCH. We welcome both Neil Murphy and the new IUCH council.