A quality assurance study of the development of quality of care in outpatient clinics for treatment of addiction in Greenland.

INTRODUCTION: In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits. METHODOLOGY: This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0-4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots. RESULTS: The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001). CONCLUSION: For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers.

Excess mortality among individuals who have undergone addiction treatment: a study from Greenland.

In Greenland, where addiction-related concerns significantly affect well-being, research has explored alcohol's impact on health and mortality. However, no studies have focused on mortality among those who received addiction treatment. This study investigates whether individuals treated for addiction in Greenland experience elevated mortality rates compared to the general population. The study encompassed individuals receiving addiction treatment through the national system between 2012 and December 31, 2022. Data on treatment were sourced from the National Addiction Database, and Statistics Greenland. Person-years at risk were calculated and used to estimate crude mortality rates (CMRs). Adjusted standardized mortality rates (SMRs), accounting for age, sex, and calendar year, were estimated using an indirect method based on observed and expected deaths. Of the 3286 in treatment, 53.9% were women, with a median age of 37. About a third had undergone multiple treatment episodes, and 60.1% received treatment in 2019 or later. The cohort was followed for a median of 2.89 years, yielding 12,068 person-years. The overall CMR was 7.79 deaths per 1000 person-years, with a SMR of 1.42 (95% confidence interval: 1.15; 1.74). Significantly, SMRs differed by age at treatment entry, with younger groups exhibiting higher SMRs (p value = .021). This study found that individuals seeking treatment for addiction problems in Greenland had a higher mortality rate than the general population. Importantly, these SMRs were substantially lower than those observed in clinical populations in other countries.

Measurement of hearing impairment among Greenlandic school-children: association between self-reported data and clinical examinations.

BACKGROUND: Multiple ear infections is causing hearing impairment among children all over the world and the health and social consequences track into early adolescence and later in life, if not treated. The monitoring of prevalence in a population is important to assess the need for interventions in a population. METHODS: One hundred eighty  five children from 5 to 10th grade from Sisimiut town and the nearby settlements participated in a clinical examination to have ear-examination and pure tone audiometry. Participants filled out a questionnaire at home with their parents before the clinical examination, and hearing impairment was collected as individual self-reports and as audiometric measurements. RESULTS: A total of 185 children between 9 and 15 years of age (median: 11 years, IQR: 10-13) were included, 60% (n = 111) were girls. 247 (70%) of the 355 available otoscopies were clinically assessed as normal. Cohen's Kappa coefficient was 0.31. Eighteen children (10%) were found to have hearing impairment. None of the children had hearing aids. Test performance for self-reports were that sensitivity was 56% and specificity was 87%. The predictive value of a positive test was 31%, and the predictive value of a negative test was 95%. 32 children (17%) reported hearing impairment to the extent that they were not able to keep up in school, of which half reported that it had lasted for more than one year. 7 of the 32 children reporting hearing impairment (22%) reported that the extent of their hearing impairment was affecting their classroom experience so they were not able to follow. CONCLUSION: Self-reported and clinically screening for hearing impairment are two different concepts. Even though the two concepts are statistically correlated, the correlation coefficients are low. The test performance indicated that self-reported data might be measuring hearing as an experience in a social environment and not directly comparable to pure tone audiometry which examines hearing in controlled testing conditions. Since both measure hearing impairment, they supplement each other in research on impaired hearing, and the choice of measure should relate to the purpose and method of the investigation.

Implementation of AUDIT in the treatment planning process for alcohol use disorder in Greenland.

INTRODUCTION: The aim was to describe the treatment-seeking population with alcohol use disorder by means of data from the AUDIT questionnaire at referral and to evaluate and discuss if this information can be of use in treatment and service planning. METHODS: Data from 2016 to 2018 were extracted from the National Database on Substance Abuse Treatment. The sample included 1281 individual treatment seekers from all over Greenland. RESULTS: Mean age was 38.2 years (SD 12.1 years). Only 60.1% had a total AUDIT score suggesting dependency, and 15.5% had a harmful use. While most only drank 2-4 times a month, about 95% binge drank. Half reported loss of control at least weekly, and one of three had been unable to do what was expected of them, or needed a drink first thing in the morning weekly or more often. In two-third others had been concerned about the drinking. Users of cannabis had a higher AUDIT score, while gambling was unassociated to alcohol use. Substantial gender and regional differences were seen. DISCUSSION: The AUDIT screening was found useful in individual and national treatment planning. Data suggested that particular focus should be given to women in treatment, and the service offered to the East Greenlandic population.

Association between negative life events and morbidity in homeless seeking treatment for substance abuse in Greenland.

INTRODUCTION: The aim of the investigation was to describe the association between negative life events on morbidity in homeless seeking treatment for substance abuse in Greenland. METHODS: Cross sectional study on register data comparing homeless and individuals in secure housing initiating alcohol or substance abuse treatment in Greenland between 1 January 2017 and 14 December 2019, (N = 950). Results: Homeless were socio-economically disadvantaged compared to treatment seekers in secure housing. They had a heavier burden of psychiatric morbidity and suffered more negative life experiences. Controlled for having experienced abuse, most morbidity measures' predictive value was slightly less pronounced with psychiatric morbidity as an exception. CONCLUSION: The results indicate that both the morbidity and most analyzed negative life events are associated with being homeless and are mutually linked.

Does establishing local treatment institutions lead to different populations seeking treatment among Greenlandic Inuit?

Introduction: In 2016, a new addiction treatment service was established in Greenland to tackle the addiction problems with alcohol, cannabis and gambling among the population. The new service has established a treatment center in each of the five municipalities and works in partnership with a central private provider of treatment for those who reside in areas without a local treatment center.Methods: The national addiction database provided us with data from the Alcohol Use Disorder Identification Test, Alcohol Severity Index and questions on cannabis use and gambling behavior received at referral to, and at initiation of treatment. The data were analyzed for differences between the population in local or central treatment using SPSS version 25 (SPSS Inc., Chicago, IL).Results: Significant differences between the individuals in local and central treatment were revealed. Individuals in local treatment are more often women with minor children and a job, and their alcohol use is concentrated on weekends/holidays. Individuals in central treatment are more equal in both genders, few have minor children living at home, heavy drinking is more pronounced, and cannabis is used more frequently as well.Discussion: The findings support our expectations of local treatment being more attractive to individuals with obligations at home. The differences in the populations are worth considering when planning the treatment service, as the needs of the populations might differ. The findings are limited by many missing in the analyses, which we believe is caused by the establishing process of the new service.

Trends in toothbrushing in 20 countries/regions from 1994 to 2010.

BACKGROUND: For maintaining good oral health, twice-a-day toothbrushing routine is recommended world-wide. As an association between oral diseases and the main non-communicable diseases is confirmed, the importance of brushing is rising. The aim of this article is to describe trends in more-than-once-a-day toothbrushing frequency in 20 countries/regions participating in five consecutive HBSC Surveys between 1994 and 2010. METHODS: Eleven-, 13-, and 15-year-old children, who replied to the questionnaire in any of the five surveys, were included (N = 474 760). Trends were analysed by logistic regression and multilevel logistic regression modelling. RESULTS: Prevalence of recommended toothbrushing behaviour increased in all countries except in Scandinavia, which had already attained a very high level in 1994. The highest increase (more than + 16%) was observed in Estonia, Russia, Latvia, Finland and in Flemish Belgium. Girls had higher prevalence of toothbrushing than boys (OR = 2.06, 99% CI 2.03-2.10). However, the increasing trend was stronger among boys (OR(2010 vs. 1994) for boys 1.60; for girls 1.48), and among the younger adolescents (OR(2010 vs. 1994) for 11-year-olds 1.64; for 15-year-olds 1.45). CONCLUSION: Recommended toothbrushing frequency increased in most of the studied countries/regions and differences between the countries diminished during 2004-2010.

A qualitative study of the implementation and organization of the national Greenlandic addiction treatment service.

Background: Alcohol and cannabis use constitutes the major public health problems in Greenland. Thus, it is important to assess if Allorfik, a new national outpatient addiction treatment service introduced in 2016, was implemented successfully and how it is perceived. Allorfik introduced local treatment centers offering a treatment methodology (motivational interviewing and cognitive therapy) new to addiction treatment in Greenland with limited evidence from Indigenous populations such as the Greenlandic. The present study investigates the implementation of Allorfik from the perspective of those engaged in the process and the field. Methods: Data consisted of transcribed interviews with 23 individuals from both Allorfik and organizations collaborating with or supposed to collaborate with Allorfik. The theme of the interviews was their perspectives on the implementation process, enablers, and obstacles in the process and how Allorfik was performing at the time of the interview. The interview guide was informed by implementation theory. The transcribed material was analyzed using a general inductive approach. Results: The analysis resulted in three overall and interconnected themes, namely, implementation, collaborations, and challenges. The implementation was overall considered a success by the interviewees as all components were implemented as planned with a few adaptions, e.g., a treatment guideline update. The collaborations are considered challenging but important to all interviewees. Collaborations seem to rely on personal commitment as opposed to well-defined structures, making it unstable and vulnerable to changes in staff. One of the main challenges highlighted by the interviewees is the number of problems other than addiction among people in treatment, which makes addiction treatment and recovery difficult to achieve. Nevertheless, the high levels of other problems being treated in Allorfik highlights the need for easily accessible therapy as many find that Allorfik is the only place to turn to in times of crisis. Conclusion: Allorfik seems to have been implemented in accordance with original intentions and plans for addiction treatment service but has also become more than just a service for addiction treatment with easy access in a country with vast distances and limited resources.

Violence- and alcohol-related acute healthcare visits in Greenland.

AIMS: The aim of this study was to describe emergency admissions in Greenland's healthcare system, and the extent to which admissions were associated with alcohol abuse or violence. Furthermore, we aimed to test whether data on emergencies in Greenland could be registered in a reliable way by simple means. METHODS: Registration of all emergencies presented in 15 out of 17 of Greenland's health districts in the period 21 May to 7 June 2010. RESULTS: In the 17-day registration period, 2403 emergencies were registered. In 10% of cases the patients were clinically alcohol intoxicated. When reason for presentation were mental or social problems, attempted suicide, accidents, or violence, 24, 50, 15, and 59% respectively were intoxicated. Alcohol intoxication was statistically significantly more often associated with advanced treatment (e.g. evacuation, hospitalisation, or follow up by doctor or nurse). CONCLUSIONS: This study confirms that violence- and alcohol-related emergencies put a considerable strain on Greenland's healthcare system. Due to the short observation period, we have not been able to describe the actual extent of the problem in detail, nor was it possible to estimate whether this problem is more pronounced in Greenland than in other countries, for example Denmark.

Probably the most active population in the world: accelerometer measurements of 72 school-children in Greenland.

Physical activity is the most important lifestyle factor to contribute to a healthy early life. International recommendations are that children should be vigorously physically active for at least 1 h per day, and in Greenland, authorities have claimed a goal of being the world's most active population. Since 1994, the Health Behaviour in School-aged Children (HBSC) has measured physical activity among school-children in Greenland by questionnaire data, but the measurement properties of self-reported data in comparison to more objectively measured accelerometer data are unknown. The present paper describes the first study using clinical measures of physical activity among Greenlandic youth. Seventy-two school-children (56% girls) with a mean age of 12 years (range 25%; 75% was 11.5; 12.25) wore accelerometers for seven consecutive days, and data produced significant and informative findings for both practice and future research. Fifty-two per cent of the school-children met the international recommendations of being physically active >1 h per day, when measured by accelerometers, but self-reported data reported a prevalence of 10% meeting the recommendations. A majority of this sample of Greenlandic school-children lives up to international recommendations, which indicates that the goal of being the world's most active population is within reach.

The association between high recreational physical activity and physical activity as a part of daily living in adolescents and availability of local indoor sports facilities and sports clubs.

AIM: The aim of this study was to examine how vigorous physical activity (recreational physical activity) (VPA) and moderate to vigorous physical activity as a part of daily life (MVPA) is associated with structural characteristics (availability of sports facilities and sports clubs with child members) in Greenlandic adolescents. MATERIAL AND METHODS: Data from the 2006 Health Behaviour in School-aged Children survey including 2,430 children aged 11-17 years was used. Logistic regression models were developed with dichotomous measures on VPA and MVPA as outcomes, number of indoor sports facilities and of sports clubs with child members as independent variables, and adjusted for age, gender, family affluence (FAS), and type of habitation (capital, town or village). RESULTS: High VPA increased with access to indoor facilities, while high MVPA was less likely (odds ratio (OR) 0.54 (0.42-0.70)) if indoor sports facilities were present, both unadjusted and adjusted. Access to a local sports club increased OR for high VPA both unadjusted and adjusted to about 2.3 for five or more clubs, while access to sports clubs was not associated with unadjusted MVPA, negatively associated if adjusted for age, gender and FAS but positively associated if also adjusted for indoor sports facilities. CONCLUSIONS: Access to indoor sports facilities itself had a positive association with high VPA, but was persistently negatively associated with high MVPA. Presence of sports clubs with child members was positively associated with high VPA while the association with high MVPA was more complex. The findings have implications for public health planning.

Growth measures among preschool-age Inuit children living in Canada and Greenland.

AIM: The present study reports findings from a study of preschool-age Inuit children living in the Arctic regions of Canada and Greenland. METHODS: We compare stature and obesity measures using cutoffs from the Centers for Disease Control and the International Obesity Task Force references. The sample is comprised of 1121 Inuit children (554 boys and 567 girls) aged 3-5 years living in Nunavut (n=376) and Nunavik (n=87), Canada, in the capital city of Nuuk, Greenland (n=86), and in Greenland's remaining towns and villages (n=572). RESULTS: Greenland Inuit children were significantly taller than their Canadian counterparts, with greatest height and weight observed among children from Nuuk. Overall prevalence of stunting was low with the three cutoffs yielding similar values for height-for-age z-scores. Obesity prevalence was higher among Canadian Inuit children than their Greenland counterparts. CONCLUSIONS: Inuit children have stature values consistent with those of the Centers for Disease Control reference and low prevalence of stunting, though geographic variability in mean stature values between Canadian and Greenlandic samples likely reflects differences in both socioeconomic status and genetic admixture. Obesity prevalence is high among both Canadian and Greenland Inuit preschoolers, with children living in the city of Nuuk exhibiting lower obesity prevalence than children living in either Nunavut or Nunavik, Canada or Greenland's towns and villages. Varying obesity prevalence may reflect varying degrees of food security in remote locations as well as the influence of stature and sitting height which have not been well studied in young Inuit children.

Polysubstance abuse among sexually abused in alcohol, drug, and gambling addiction treatment in Greenland: a cross sectional study.

This study aims to investigate the association between earlier sexual abuse and polysubstance abuse among persons in alcohol, drug and gambling addiction treatment in Greenland. The study included 431 individuals treated in 2017-2019. Data on exposure (sexual abuse), outcome (polysubstance abuse), and potential confounders (age, sex, school education, further education, labour market affiliation, physical abuse and emotional abuse) were extracted from The National Database on Substance Abuse Treatment. Polysubstance abuse was defined as both smoking cannabis more than once a week and having an AUDIT score >15. Logistic regression was used to estimate odds ratios (ORs). In total, 61% reported having been sexually abused. Women were more often sexually abused and had more often been physically and emotionally abused when compared to men. Polysubstance abuse (OR 2.06, 95% CI: 1.22; 3.48) and cannabis abuse (OR 1.89, 95% CI: 1.20; 2.98), but not alcohol abuse, were more frequent in sexually abused when compared to non-victims of sexual abuse. This study found polysubstance abuse to be more frequent in sexually abused treatment seekers. It is recommended that the findings are taken into account in the planning of treatment services and in training of counsellors.

Greenlandic schoolchildren's compliance with national dietary guidelines.

OBJECTIVE: The aim of the present study was to examine to what extent children and adolescents in Greenland comply with the national dietary guidelines, and to analyse the influence of habitation and family affluence on the compliance with dietary guidelines. DESIGN: Data were from the Health Behaviour in School-aged Children (HBSC) survey in Greenland. The 2006 survey included 2462 students aged 11 to 17 years. RESULTS: The proportion of students complying with the national dietary guidelines varied from 14 % to 87 % depending on the food item. Sweets and soft drinks had the lowest compliance. The oldest children had the following characteristics compared with the younger children: fewer ate traditional Greenlandic foods, fewer ate fruit, fewer ate breakfast daily on school days and more drank soft drinks frequently. More boys than girls ate traditional Greenlandic foods often, while more girls ate vegetables daily. The least favourable eating habits in general were found among children from low affluent families and children in villages. CONCLUSIONS: Many Greenlandic schoolchildren did not comply with the national dietary guidelines. Despite a higher intake of traditional foods as a whole, children in villages and less affluent children were less likely to comply with guidelines. A strong relationship between diet, family affluence and availability was found. The study findings indicate that factors such as availability, cost and seasonal variation are important to the intake of both imported and traditional Greenlandic foods. The findings should be taken into consideration when promoting the national guidelines.

The effect of structural and functional social relations on smoking among adolescents - data from HBSC Greenland 2018.

The prevalence of adolescent smoking in Greenland is relatively high and remains an important topic to study. The present study reports the prevalence of smoking among Greenlandic adolescents in 2018 and the association between smoking and social relations. The study was based on HBSC Greenland 2018, using a theoretical framework proposed by Due and colleagues, which divides social relations into structural and functional relations. The study showed a statistically significant gender difference in smoking, as 11.4% of the girls reported to smoke compared to 7.9% of the boys. The smoking prevalence increased significantly with age, and differences were also found for a place of residence, as the smoking prevalence was higher in towns and settlements compared to Nuuk. The adolescent smoking prevalence was higher when living in a home with one adult or in a foster family, school home or orphanage, versus living in home with at least two adults. No significant associations were found between adolescent smoking and functional relations. The results are beneficial to consider when applying new interventions to prevent adolescent smoking initiation in Greenland.

Prevalence of problems with alcohol, marijuana and gambling among patients in a Regional Hospital in Northern Greenland: investigating the potential for brief interventions in a hospital setting.

Problems with alcohol, marijuana and gambling are major public health challenges in Greenland but their prevalence in a hospital setting has not been explored. Healthcare facilities play a significant role in Greenland. One important aspect is their provision of both primary and secondary healthcare services to a small and scattered population while their potential as settings for screening for problems with alcohol, substances and gambling is an unexplored area with large public health potential. This study explored the prevalences of problems with alcohol, marijuana and gambling in a hospital and the potential for the use of a hospital as a setting for screening for alcohol, substance and gambling problems. Patients from the Northern Ilulissat Hospital filled in a self-administered questionnaire regarding their behaviour related to alcohol, marijuana and gambling. Data were weighted and compared to the nationally representative 2018 Health Survey. In the Ilulissat Survey, a large proportion were abstainers but there were still problems related to alcohol, marijuana and gambling indicating a potential for screening in a hospital setting. The results based on data from 2,554 respondents showed that prevalences of problems with alcohol, marijuana and gambling are lower in the Ilulissat Survey compared to the 2018 Health Survey.

Trends in physical activity in Greenlandic schoolchildren, 1994-2006.

OBJECTIVES: To describe trends in self-reported physical activity among Greenlandic schoolchildren from 1994 to 2006, and to analyse associations between physical activity and quality of life, health, academic achievement, school satisfaction and substance use. STUDY DESIGN: Trend analysis of the Greenlandic data reported in the Health Behaviour in School-Aged Children (HBSC) survey on 11, 13, and 15 years olds in 1994, 1998, 2002 and 2006. METHODS: Analyses of associations data on all participating children in Greenland who were 11 to 17 years old in 2006 were used. RESULTS: Only about 30% of all children aged 11, 13 and 15 years fulfilled the national recommendations of being moderately physically active for 60 minutes a day. A higher proportion of children were highly physically active in 2006 compared with earlier years while no trend was seen in the proportion of inactive children. Fewer children were moderately active as they aged, but at the same time more children seemed to become more physically active with increasing age. Fewer children in the settlements were highly physically active compared with children living in the towns and the capital. Physically active children had good academic achievement, good self-rated health and smoked less on a daily basis when compared with inactive children. CONCLUSIONS: The results indicate that an increase in the level of physical activity among schoolchildren instead of a general decrease has taken place from 1994 to 2006. A high level of physical activity was associated with a positive rating of health, good quality of life and good academic achievement. The low number of highly physically active children living in the settlements is of concern.

Gambling in Greenlandic adolescents.

Gambling has never been investigated in Greenlandic adolescents. High prevalence of gambling problems and a relation to other addictive behaviours has been found in adult Greenlanders. Greenlandic adolescents are daily exposed to gambling, for example, by selling lottery tickets, through advertises and electronic devices. The aim of this study is to investigate how Greenlandic adolescents perceive gambling, and to pilot test the Lie/Bet screening-instrument.Ten semi-structured focus group interviews were conducted for 31 adolescents, aged 12-16, from 3 schools in Nuuk, Greenland.The 31 adolescents have experiences with gambling. Whether they define a game as gambling depends on: 1) Whether the game is about playing with or about money, 2) whether the game is about earning items, 3) the gain/loss, 4) who they lose money to, and 5) the purpose. If the purpose is to have fun, it is not necessarily seen as gambling. None mentioned bingo as gambling, arguing that bingo is about having fun. Two recent trends were found to have reached Greenland: The close link between sports and gambling, and skin-betting. Additionally, the Lie/Bet screen was, with slight modifications, found to be useful as a screening-instrument among Greenlandic adolescents and it is proposed to be used in future studies.

Self-reported hearing impairment among Greenlandic adolescents: Item development and findings from the Health Behaviour in School-aged Children study 2018.

OBJECTIVES: Ear infections are the leading cause of hearing impairment among children worldwide and a major public health problem in many indigenous populations, yet representative studies of self-reported hearing impairment are currently scarce. The purpose of the present study was therefore two-sided; first to develop an item bank for the collection of data on hearing impairment among Greenlandic adolescents, and second to report data on the child reports on hearing impairment from a national questionnaire-based survey. METHODS: The study describes the process of developing items measuring hearing impairment among schoolchildren, and reports data for their inclusion into a national questionnaire survey. The data formed part of the Health Behaviour in School-aged Children (HBSC Greenland) 2018 survey including 2,273 students, corresponding to 47.6% of all Greenlandic schoolchildren in the age range from 10 to 16 years. Data analyses performed describe the data characteristics and the frequency of self-reported hearing impairment among Greenlandic schoolchildren. Binary logistic regression examined the associations of hearing impairment on school-related (risk) factors and self-rated health. RESULTS: An average of 4% reported experiencing ear pain almost daily, and almost 10% reported ear pain at least weekly. Moreover, 3% reported having inflammation in the ear at least weekly, and 5% reported to have such impaired hearing that they were not at all able to follow what happened in school. Logistic regression showed that girls had significantly higher odds of low self-rated health, poor school environment and academic achievement below average when they had experienced impaired hearing. All ORs were statistically significant, varying from 1.85 (95% CI: 1.16-2.94) for low self-rated health, to 3.05 (95% CI 1.83-5.11) for feeling pressured by schoolwork. For boys the only significant association with impaired hearing was an academic achievement below average of 1.73 (95% CI 1.08-2.77). CONCLUSIONS: The study confirms clinical knowledge and case studies that there are a significant proportion of Greenlandic adolescents who have experienced impaired hearing. Future studies may use questionnaire data to follow up on children with hearing impairment to be able to report changes over time and associations to school-related and social factors.

Has the curve been broken? Trends between 1994 and 2006 in smoking and alcohol use among Greenlandic school children.

OBJECTIVES: To examine the development of smoking and alcohol use among Greenlandic schoolchildren and propose future preventive strategies. STUDY DESIGN: National survey in schoolchildren grade 6-11. METHODS: Analysis of data from the 1994, 1998, 2002 and 2006 Health Behaviour in SchoolAged Children (HBSC) surveys in Greenland. Trends in the prevalence of the categories never having smoked, non-smoking, daily smoking, never tried alcohol, never been drunk and been drunk 4 times or more were calculated for children and youth aged 11, 13 and 15. In the data from 2006, the age trends for daily smoking and getting drunk 4 or more times, the assessment of risks attributed to substance use and the perception of how easy it was to access cigarettes and alcohol were analysed. RESULTS: A decrease in daily smokers and in children having been drunk 4 or more times and an increase in non-smokers and in children that had never been drunk was found in both genders among children and youth aged 13 and 15. Among youth aged 15 to 17 years, both cigarettes and alcohol were reported as easy to access. Risk assessment was different for alcohol and cigarettes, as well as between genders. CONCLUSIONS: A decline in the use of tobacco and alcohol among Greenlandic school children was ascertained. Due to the children's evaluation of easy access and risk regarding smoking and alcohol use, some general recommendations regarding future focus areas of prevention were proposed.