Intimate partner violence and its association with mental health problems: The importance of childhood violence - The SAMINOR 2 Questionnaire Survey.

AIMS: This study aims to estimate the prevalence of intimate partner violence (IPV) and its association with psychological distress and symptoms of post-traumatic stress (PTS) among Sami and non-Sami and to explore whether the association between IPV and mental health is modified by exposure to childhood violence (CV). These issues are scarcely studied among the Sami. METHODS: This study was based on the cross-sectional SAMINOR 2 Questionnaire Survey, a part of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations (SAMINOR). Chi-square tests and two-sample t-tests were used to test differences between groups. Multiple linear regression analysis was applied to explore the association between IPV/CV and continuous scores of psychological distress and symptoms of post-traumatic stress. RESULTS: Experiences of IPV (emotional, physical, and/or sexual) were reported by 12.8% of women and 2.0% of men. A significantly higher proportion of Sami women reported exposure to emotional (12.4 v. 9.5%, p = 0.003), physical (11.6 v. 6.9%, p < 0.001), and any IPV (17.2 v. 11.8%, p < 0.001) compared to non-Sami women. There were no ethnic differences in sexual IPV among women (2%). Exposure to IPV was associated with a higher score of psychological distress and PTS and was highest among those exposed to both IPV and CV. CONCLUSIONS: Sami women reported the highest prevalence of IPV. The association between IPV/CV and mental health problems did not differ by ethnicity or gender. The most severe mental health problems were observed for those who were exposed to both IPV and CV.

Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study.

BACKGROUND: The mortality of metabolic-obesity phenotypes has been thoroughly studied, but it is not known if or how the association between mortality and body mass index (BMI), waist circumference or a body shape index (ABSI) differ in strata of cardiometabolic health status. METHODS: We linked data on 12,815 men and women aged 36-79 years from the SAMINOR 1 Survey with mortality data from the Norwegian Cause of Death Registry. We defined metabolically healthy and unhealthy as having zero and ≥ 1, respectively, of the following: MetS, pre-existing diabetes or cardiovascular disease (CVD), or prescribed drugs for high blood pressure, hyperglycaemia or dyslipidaemia. We defined general and abdominal obesity as BMI ≥ 30 kg/m2 and waist circumference ≥ 88 cm (women) or 102 cm (men), respectively, and cross-classified these categories with metabolic status to create metabolically healthy non-obese and obese (MHNO and MHO) and metabolically unhealthy non-obese and obese (MUNO and MUO) phenotypes. We used Cox regression to estimate the hazard ratio (HR) for all-cause and CVD mortality for 1) the four phenotypes and 2) BMI, waist circumference and ABSI fitted with restricted cubic splines. We adjusted for age and lifestyle, and tested for interactions with sex and metabolic status (only continuous measures). RESULTS: The MHO phenotype was present in 7.8% of women and 5.8% of men. During a median follow-up of 15.3/15.2 years, 596/938 women/men had died, respectively. The MUNO and MUO groups had higher mortality than the MHNO group. Sex and phenotypes interacted with respect to CVD mortality: relative to the MHNO group, the MHO group had an adjusted HR (95% confidence interval) for CVD mortality of 1.05 (0.38-2.88) in women and 2.92 (1.71-5.01) in men. We found curvilinear associations between BMI/waist circumference and all-cause mortality irrespective of metabolic status. Corresponding relationships with CVD mortality were linear and the slope differed by sex and metabolic status. ABSI was linearly and positively associated with all-cause and CVD mortality in men. CONCLUSION: The relationships between BMI, waist circumference or ABSI and mortality differed by sex, metabolic status and cause of death. Poor metabolic health substantially increases mortality regardless of obesity status.

Physical activity in Sami and non-Sami populations in rural Northern Norway, the SAMINOR 2 Clinical Survey.

BACKGROUND: The Sami people is an indigenous minority population living in the northern parts of Norway and mainly in rural areas. We lack data of contemporary levels of physical activity (PA) in rural regions of Northern Norway and in the Sami population in particular. We aimed to describe the PA levels and investigate whether PA levels differs between Sami and non-Sami and between coastal and inland areas. METHODS: We used data from the second survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations - the SAMINOR 2 Clinical Survey (2012-2014) that includes the adult population in 10 municipalities in the counties Troms, Finnmark and Nordland. Participants self-reported on PA, ethnicity and modifiable lifestyle factors. Twelve thousand four hundred fifty-five individuals were invited with a response rate of 48.2% (n = 6004 participants). We tested differences using chi-square tests, two sample t-tests and linear regression models. RESULTS: Among 5628 participants, 41.1 and 40.9% of men and women, respectively, were defined as Sami. We found no ethnic differences in PA in men overall. However, Sami men living in Tana, and Nesseby reported higher PA compared to non-Sami men in the same area. For Sami women there was overall lower PA levels compared to non-Sami women, especially pronounced in Kautokeino/ Karasjok. CONCLUSION: This study showed small differences in PA levels between Sami and non-Sami men. Sami women had lower PA levels compared to their non-Sami counterparts. It is important to identify whether there are differences in various ethnic populations, together with other predictors for PA in future planning of public health interventions.

Vitamin D status in a multi-ethnic population of northern Norway: the SAMINOR 2 Clinical Survey.

OBJECTIVE: To investigate serum 25-hydroxyvitamin D (S-25(OH)D) concentration in a multi-ethnic population of northern Norway and determine predictors of S-25(OH)D, including Sami ethnicity. DESIGN: Cross-sectional data from the second survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations (the SAMINOR 2 Clinical Survey, 2012-2014). S-25(OH)D was measured by the IDS-iSYS 25-Hydroxy Vitamin DË¢ assay. Daily dietary intake was assessed using an FFQ. BMI was calculated using weight and height measurements. SETTING: Ten municipalities of northern Norway (latitude 68°-70°N). PARTICIPANTS: Males (n 2041) and females (n 2424) aged 40-69 years. RESULTS: Mean S-25(OH)D in the study sample was 64·0 nmol/l and median vitamin D intake was 10·3 µg/d. The prevalence of S-25(OH)D<30 nmol/l was 1·9 % and <50 nmol/l was 24·7 %. In sex-specific multivariable linear regression models, older age, blood sample collection in September-October, solarium use, sunbathing holiday, higher alcohol intake (in females), use of cod-liver oil/fish oil supplements, use of vitamin/mineral supplements and higher intakes of vitamin D were significantly associated with higher S-25(OH)D, whereas being a current smoker and obesity were associated with lower S-25(OH)D. These factors explained 21-23 % of the variation in S-25(OH)D. CONCLUSIONS: There were many modifiable risk factors related to S-25(OH)D, however no clear ethnic differences were found. Even in winter, the low prevalence of vitamin D deficiency found among participants with non-Sami, multi-ethnic Sami and Sami self-perceived ethnicity was likely due to adequate vitamin D intake.

The second clinical survey of the population-based study on health and living conditions in regions with Sami and Norwegian populations - the SAMINOR 2 Clinical Survey: Performing indigenous health research in a multiethnic landscape.

Background Globally, there is a huge lack of relevant research about widespread lifestyle diseases and living conditions in indigenous communities. Northern and Middle Norway have a history of multiple ethnic groups and the Sami has been acknowledged as the indigenous people of Norway by the Norwegian State. The SAMINOR 2 Clinical Survey, a part of the SAMINOR Study, was carried out to provide health information about the Sami population in Norway. Methods The cross-sectional population-based SAMINOR 2 Clinical Survey consists of both questionnaires and a clinical examination performed in 10 municipalities during 2012-2014. Results In total, 6004 men and women (participation rate 48%) aged 40-79 years took part in this study. In inland Finnmark, the Sami are in the majority (80-90%) as opposed to the coastline of Troms and Nordland, where the Sami population form a minority (20%). More women than men participated (54% versus 43%, respectively). Obesity was prevalent in this sample and a high mean glycated haemoglobin was observed. Conclusions: This article describes the methods and data collection of the SAMINOR 2 Clinical Survey and presents some characteristics of the sample. The definition of ethnic groups is a core question in the survey and includes several criteria. To ensure that indigenous values and priorities are reflected in the research themes, we recommend that future research projects be directed in close collaboration with the Sami Parliament and the local communities.

Estimated 8-year cumulative incidence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - The SAMINOR Study.

BACKGROUND: The aim of the study was to estimate and compare the 8-year cumulative incidence of diabetes mellitus (DM) among Sami and non-Sami inhabitants of rural districts in Northern Norway. METHODS: Longitudinal study based on linkage of two cross-sectional surveys, the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014). Ten municipalities in rural Northern Norway were included in the study. DM-free participants aged 30 and 36-71 years in SAMINOR 1 were followed from 2 years after SAMINOR 1 to attendance in SAMINOR 2. The average follow-up time was 8.1 years. Of 5875 subjects who had participated in SAMINOR 1 and could potentially be followed to SAMINOR 2, 3303 were included in the final analysis. Self-reported DM and/or HbA1c ≥ 6.5% were used to identify incident cases of DM. RESULTS: At baseline, body mass index (BMI) and waist-to-height ratio (WHtR) were higher among Sami than among their non-Sami counterparts. After 8 years of follow-up, 201 incident cases of DM were identified (6.1% both Sami and non-Sami subjects). No statistically significant difference was observed in the cumulative incidence of DM between the Sami and non-Sami. CONCLUSIONS: No statistically significant difference in the 8-year cumulative incidence of DM among Sami and non-Sami was observed, although Sami men and women had higher baseline BMI and WHtR.

Food in rural northern Norway in relation to Sami ethnicity: the SAMINOR 2 Clinical Survey.

OBJECTIVE: To estimate current food intake in the population of northern Norway and to investigate the impact of self-perceived Sami ethnicity and region of residence on food intake. DESIGN: The data are part of the second cross-sectional survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations (the SAMINOR 2 Clinical Survey, 2012-2014). Food intake was assessed by an FFQ. Ethnic and regional differences in food intake were studied by sex-specific, multivariable-adjusted quantile regression models. SETTING: Ten municipalities (rural northern Norway). SUBJECTS: Males (n 2054) and females (n 2450) aged 40-69 years (2743 non-Sami, 622 multi-ethnic Sami, 1139 Sami). RESULTS: The diet of Sami participants contained more reindeer meat, moose meat, food made with animal blood and freshwater fish; and contained less lean fish and vegetables. In the inland region, the consumption of reindeer meat was greatest in Sami participants, followed by multi-ethnic Sami participants and non-Sami participants, who had the lowest consumption (median 25, 12 and 8 g/d, respectively). Compared with the inland region, fish roe/liver intake was higher in the coastal region and lean fish intake was twice as high (41 and 32 g/d in males and females, respectively). CONCLUSIONS: When compared with non-Sami participants, those with solely self-perceived Sami ethnicity reported a significantly different intake of several foods, especially reindeer meat in the inland region. Multi-ethnic Sami tended to have similar diets to non-Sami. Residence in the coastal region predicted higher fish and roe/liver intake.

Disordered eating in Sami and non-Sami Norwegian populations: the SAMINOR 2 Clinical Survey.

OBJECTIVE: The present study aimed to investigate disordered eating (DE) among Sami compared with non-Sami residing in northern Norway. DESIGN: In a cross-sectional design, stratified by sex and ethnicity, associations were tested between DE (Eating Disturbance Scale; EDS-5) and age, education level, BMI category, anxiety and depression, physical activity and consumption of snacks. SETTING: The SAMINOR 2 Clinical Survey (2012-2014) based on the population of ten municipalities in northern Norway. SUBJECTS: Adults aged 40-69 years; 1811 Sami (844 male, 967 female) compared with 2578 non-Sami (1180 male, 1398 female) individuals. RESULTS: No overall significant ethnic difference in DE was identified, although comfort eating was reported more often by Sami individuals (P=0·01). Regardless of ethnicity and sex, symptoms of anxiety and depression were associated with DE (P<0·001). Furthermore, DE was more common at lower age and higher BMI values. Education levels were protectively associated with DE among Sami men (P=0·01). DE was associated (OR, 95% CI) with low physical activity in men in general and in non-Sami women (Sami men: 2·4, 1·4, 4·0; non-Sami men: 2·2, 1·4, 3·6; non-Sami women: 1·8, 1·2, 2·9) and so was the consumption of snacks (Sami men: 2·6, 1·3, 5·0; non-Sami men: 1·9, 1·1, 3·1; non-Sami women: 2·1, 1·3, 3·4). CONCLUSIONS: There were no significant differences regarding overall DE comparing Sami with non-Sami, although Sami more often reported comfort eating. There were significant sex and ethnic differences related to DE and physical activity, snacking and education level.

Distribution of risk factors for cardiovascular disease and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations: The SAMINOR 2 Clinical Survey.

OBJECTIVE: This study aimed to assess and compare the distribution of cardiovascular risk factors and the estimated 10-year risk of fatal or non-fatal acute myocardial infarction (AMI) or cerebral stroke (CS) among the Sami and non-Sami populations of Northern Norway. METHODS: The SAMINOR 2 Clinical Survey is a cross-sectional survey conducted in 10 municipalities in the counties of Finnmark, Troms and Nordland in rural Northern Norway in 2012-2014. All inhabitants aged 40-79 years were invited to participate, and 6004 (48.2%) accepted. The NORRISK 2 model was used to estimate the 10-year risk of fatal or non-fatal AMI or CS. Sex and age were included in the model, as well as the following risk factors for cardiovascular disease (CVD): serum total cholesterol, serum high-density lipoprotein cholesterol, systolic blood pressure, smoking habits and anti-hypertensive treatment. RESULTS: Only minor ethnic differences were observed between Sami and non-Sami populations in a number of individual risk factors for CVDs. Overall, the NORRISK 2 model revealed no ethnic differences in the 10-year risk of AMI or CS. CONCLUSIONS: There were no differences in 10-year risk of AMI or CS between the Sami and non-Sami populations in 10 selected municipalities in Northern Norway.

The prevalence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014).

INTRODUCTION: This study aimed to compare the prevalence of diabetes mellitus (DM) between Sami and non-Sami inhabitants of Northern Norway participating in the SAMINOR 1 Survey and the SAMINOR 2 Clinical Survey, and to track DM prevalence over time. METHODS: SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014) are cross-sectional, population-based studies that each recruited Sami and non-Sami inhabitants. The data used in this article were restricted to participants aged 40-79 years in 10 municipalities in Northern Norway. Participants completed self-administered questionnaires and underwent clinical examination and blood sampling. Both questionnaire information and non-fasting/random plasma glucose levels were used to ascertain DM. The study included 6288 and 5765 participants with complete data on DM and outcomes, ie 54.6% and 46.3% of the invited samples, respectively. RESULTS: No difference in the prevalence of DM between Sami and non-Sami participants was observed, in either survey. Women had a statistically significantly lower DM prevalence than men in SAMINOR 2. Mean waist-to-height ratio and waist circumference increased substantially in both sexes; mean body mass index increased only slightly in men and remained unchanged in women. The total, age-standardized DM prevalence in SAMINOR 1 and 2 was 10.0% (95% confidence interval (CI) 9.2-10.7) and 11.2% (95%CI 10.4-12.0), respectively, and the proportion of self-reported (ie known) DM increased from 49.2% to 73.0%. In almost the same time span (2004-2015), the use of oral glucose-lowering agents increased. CONCLUSION: Overall, no ethnic difference was observed in DM prevalence. Overall DM prevalence was high, but did not change significantly from SAMINOR 1 to SAMINOR 2. The percentage of known versus unknown cases of DM increased, as did the prescription of medication for DM between 2004 and 2015.

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUND: International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS: Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS: Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION: We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING: The Lowitja Institute.

Prevalence and associations for use of a traditional medicine provider in the SAMINOR 1 Survey: a population-based study on Health and Living Conditions in Regions with Sami and Norwegian Populations.

BACKGROUND: In Northern Norway, traditional medicine (TM) is shaped by both Christianity and traditional Sami nature worship. The healing rituals may include prayer and the use of tools such as moss, water, stones, wool and soil. Examples of TM modalities offered is cupping, blood-stemming, laying on of hands, healing prayers, and rituals. The purpose of this study was to investigate the prevalence of the use of TM in areas with predominantly Sami and Norwegian populations, and the influence of ethnicity, geography, gender, age, education, household income, religiosity and self-reported health on such use. METHODS: The study is based on data collected in the first SAMINOR Survey (SAMINOR 1) conducted in 2003/2004, including three self-administered questionnaires, clinical measures, and blood analyses. Data was collected in 24 municipalities in Norway known to have a substantial population of Sami. All residents aged 30 and 36-78/79 years in the predefined regions were invited regardless of ethnic background (N = 27,987). Of these, 16,865 (60.3%) accepted to participate and gave their consent to medical research. RESULTS: Of the 16,544 people responding to the question about TM use, 2276 (13.8%) reported to have used TM once or more during their lifetime. The most outstanding characteristic of the TM users was the affiliation to the Laestadian church, where 34.3% (n = 273) reported such use, followed by an inner Finnmark residence (31.1%, n = 481) and a Sami ethnicity (25.7%, n = 1014). Women were slightly more likely to use TM compared to men (15.9% and 11.5% accordingly, p < 0.001), and the TM users were slightly younger than the non-TM users (mean age 52.3 versus 54.3 years, p < 0.001). The TM users also had lower income (p < 0.001) than the non-TM users. We found no significant differences between the TM users and the non-TM users concerning years of education, and whether the participants were living with a spouse/partner or not. CONCLUSION: Further studies are necessary to examine the development of TM use in Norway over time, and use in areas with mainly Norwegian inhabitants. There is also a lack of studies quantifying TM use among Sami people in Sweden, Finland and Russia.

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

BACKGROUND: Like 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS: This 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.

Opioid prescriptions among Sami and non-Sami with chronic pain: The SAMINOR 2 Questionnaire Survey and the Norwegian Prescription Database.

This study is the first to investigate the prevalence of filled opioid prescriptions among indigenous Sami people with self-reported chronic musculoskeletal pain (CMSP) and compare it with that of non-Sami living in the same area. Baseline data from the SAMINOR 2 Questionnaire Survey (2012) was linked prospectively to the Norwegian Prescription Database. Information on filled opioid prescriptions during 2012-2019 was collected for 4767 persons who reported CMSP in SAMINOR 2. Gender-stratified chi-square tests, two-sample t-tests, Kruskal - Wallis tests, and multinomial logistic regression was applied. Two out of three CMSP respondents received no or only one prescription of opioids during 2012-2019. In each year, 80% of women received no opioids, 7-10% received one prescription of ≤ 180 defined daily doses (DDD), 8-9% received in total ≤ 180 DDD in two or more prescriptions, and 2-3% received > 180 DDD of opioids. Among men, 81-83% received no opioids, 8-11% received one prescription with ≤ 180 DDD, 5-9% received ≤ 180 DDD in two or more prescriptions, and 1-2% received > 180 DDD of opioids in a single year. There were no overall ethnic differences, which indicates a similar prescription policy for opioids for Sami and non-Sami with CMSP.

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

BACKGROUND: Acculturation 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. METHODS: The 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. RESULTS: Multivariable 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. CONCLUSIONS: This 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.

Iron stores in relation to dietary patterns in a multiethnic population: the SAMINOR study.

OBJECTIVE: We evaluated the association between serum ferritin (s-ferritin), transferrin saturation and dietary patterns, in connection with ethnicity, geographical settlement and lifestyle factors. DESIGN: In 2003-2004, a cross-sectional study of health and living conditions was carried out in northern Norway. SETTING: A questionnaire explored, among other factors, ethnicity and food consumption habits. Principal component analysis was used to assess the association between variables. Seven principal components were then used as input to a cluster analysis. To characterise food consumptions, five dietary patterns were identified and used to assess the effect of food consumption habits on Fe stores. SUBJECTS: A total of 16 323 men and women between the ages of 36 and 79 years participated. RESULTS: Participants who frequently consumed reindeer meat had higher levels of s-ferritin (P < 0.0001) than did individuals with other dietary patterns. This pattern was highly represented by subjects with three generations of Sami language (Sami I). Further, mean transferrin saturation in the reindeer group was higher compared with the other dietary clusters for men (P < 0.04) and women (P < 0.02). However, the reindeer pattern individuals also had the highest proportion of subjects with overweight and obesity. Obesity was positively associated with s-ferritin in both men and women (P < 0.0001). CONCLUSIONS: The differences in Fe status described earlier between inland Sami and non-Sami can be explained by several factors such as food habits, age and obesity. High level of s-ferritin may reflect high intake of reindeer meat. Being overweight and obese is also associated with s-ferritin levels.

Use of health care in the main area of Sami habitation in Norway - catching up with national expenditure rates.

INTRODUCTION: For many years political and professional concerns have centred on the health service access of Norway's modern Indigenous Sami people. Thirty years ago, a study determined that a low rate of health expenditure on Sami patients had lead to inferior health services for the Sami people, with their average consultation rate 6 times lower than the Norwegian national average. Since 1980, there have been few studies of differences in the utilization of medical services between the Sami people and the rest of the Norwegian population. There are few official statistics relating to the ethnic category Sami. This study explored the present utilization of healthcare services among the Sami people by investigating Sami municipalities' current expenditure on somatic hospital and specialist service. METHODS: To assess the use of health care in Sami municipalities, data on expenditure of somatic hospitals and specialist services were retrieved from the Norwegian Patient Registry, and age- and sex-adjusted expenditure rates were calculated. Predominantly Sami and non-Sami municipalities were compared, as well as a comparison with the national average. Factors considered to be explanatory variables for expenditure rates were distance to care, the supply and characteristics of the healthcare system, and the stability of GPs. RESULTS: The overall public hospital expenditure in Sami municipalities was above the national average and equivalent to corresponding municipalities in the same geographical area. However, there was considerable variation among the Sami municipalities. The age groups 35-49 and 50-64 years in all Sami municipalities had higher expenditure rates than the national average regarding out-patient contacts and hospitalizations, while the expenditure on the elderly (&#8805;80 years) was below the national average in most Sami municipalities. In addition to the public sector, there was a considerable volume of private practice specialist health care, mostly public funded and in urban parts of Norway. If the use of specialists in private practice is included, there is less variation in total out-patient expenditure rates in the Sami municipalities, with one exception. The municipalities with the lowest rate of public expenditure have the highest rate of private expenditure. CONCLUSION: No marked differences in healthcare expenditure was observed between the Sami and other municipalities. Overall healthcare use in Sami municipalities is above the national average and similar to corresponding municipalities in the same geographic area. However, a considerable variation in expenditure was observed among the Sami municipalities. These results do not indicate that ethnic barriers prevent Sami inhabitants from utilization of somatic hospital and specialist services. Disregarding the magnitude of expenditure, however, it is not possible to exclude that Sami patients experience a patient-physician relationship of lower quality.

The influence of religious factors on drinking behavior among young indigenous Sami and non-Sami peers in northern Norway.

It has been hypothesized that Laestadianism has contributed to the less drinking observed among indigenous Sami. This paper further investigates the bivariate protective influence of Sami ethnicity on youth drinking behavior using logistic regressions. We simultaneously controlled for the influence of religious revival movements (Laestadianism or evangelic) and religious importance (being personally Christian), in addition to socio-demographics and parental factors. Cross-sectional data from the 1994/95 North Norwegian Youth Study including 2,950 (675 Sami) 15-19 year-old high school students (RR: 85%) was used. Sami ethnicity was statistically significant for two out of six alcohol outcome measures, after adjustment for religiosity and other covariates, indicating less current drinking and party drinking. Religiousness was associated with higher youth and parental abstinence across ethnicities. Generally, stronger protective influences on drinking behavior were found for religious importance (being personally Christian) than religious affiliation (Laestadianism). The non-significance between Sami and non-Sami drinking may partly be explained by ethnic differences in religiosity, but also socio-demographics (e.g., residing in the Sami Highland) and parental factors (e.g., abstinence) contributed to such a result. Laestadianism`s profound impact on Sami culture, and its strong anti-alcohol norms may have contributed to a religious-socio-cultural context of abstinence.

The effect of coffee consumption on serum total cholesterol in the Sami and Norwegian populations.

OBJECTIVE: To assess coffee consumption in the Sami and Norwegian populations and to investigate the impact of unfiltered boiled coffee consumption on serum cholesterol concentrations. DESIGN: A cross-sectional study. Information was collected by self-administrated questionnaires and total serum cholesterol was analysed. Participants were divided into three ethnic groups: Sami I (Sami used as home language in the last three generations), Sami II (at least one Sami identity marker) and Norwegian. SETTING: In an area with Sami, Kven/Finnish and Norwegian populations, the SAMINOR study, 2003-2004. SUBJECTS: A total of 5647 men and 6347 women aged 36-79 years. RESULTS: More than 90 % of the study populations were coffee drinkers. Only 22 % were unfiltered coffee consumers. Sami I had the highest proportion of participants who consumed nine or more cups of unfiltered coffee per day, although the number of participants was limited. Total coffee consumption was associated with increased total cholesterol for men (P < 0·01) and women (P < 0·0001). For those who drank only unfiltered coffee, a significant association was found only in Norwegian men, adjusted for physical activity in leisure time, BMI and smoking habits (P < 0·001). From the lowest (less than five cups) to the highest (nine or more cups) unfiltered coffee consumption category, the mean total cholesterol levels increased by 0·29 mmol/l in Norwegian men. CONCLUSIONS: Unfiltered coffee consumption was lower in the present study compared to previous reports. In general, total coffee consumption was positively associated with total cholesterol levels. However, for unfiltered coffee consumption, an association was found only in Norwegian men.

Ethnic differences in the prevalence of general and central obesity among the Sami and Norwegian populations: the SAMINOR study.

AIMS: To estimate the prevalence of general (body mass index) and central (waist circumference and waist/hip ratio) obesity in an area with a mixed Sami and Norwegian population. METHODS: A cross-sectional population-based study carried out in 2003- 2004, the SAMINOR study. The attendance rate was 60.6%. A total of 7,301 men and 7,841 women, aged 36-79, were included in the analyses. Height, weight, waist and hip circumference were measured, body mass index (BMI) calculated and information concerning lifestyle was collected by questionnaire. RESULTS: The prevalence of general obesity (BMI > or = 30 kg/m(2)) in participants who had Sami as their home language for three generations (Sami I) and Norwegian participants was 38.7% and 24.3% for women respectively; and for men 26.9% and 23.4% respectively. More than 40% of the women had central obesity (waist circumference > or = 88 cm), and the highest prevalence was found in Sami I women (45%). The highest prevalence of central obesity (waist circumference > or = 102 cm) was found in Norwegian men (24.2%). The ethnic differences persisted after adjustment for age, education, physical activity in leisure time, and smoking habits. CONCLUSIONS: The prevalence of obesity was high in this population and central obesity was most pronounced in women, particularly in Sami women. Sami men were less obese than Norwegian men. Further studies are necessary to examine a possible explanation for these findings, especially to elaborate on the impact of diet.