Talk to Me, Not at Me: An Ethnographic Study on Health-Related Help-Seeking Behavior Among Socially Marginalized Danish Men.

Research shows that men tend to have delayed health-related help-seeking behavior. In this ethnographic study, we explored influential factors related to health-related help-seeking behavior among socially marginalized men who seem not to benefit from existing municipal health care services in a large Danish municipality. The study included 200 hours of participant observations and 25 ethnographic interviews with men between 45 and 65 years of age in their own homes and in public parks among their peers. In this study, we found that the men had several complex and interacting social- and health-related conditions, which seemed to affect their health-related help-seeking behavior. We conclude that collaborative initiatives between the outreach team who occasionally visits bench sites in the public parks and the municipal health care services in the local areas could lay the groundwork for encouraging men's health-related help-seeking behavior and aid men in supporting each other.

Health is not all about salads: An ethnographic study on health perceptions and health behavior among socially marginalized Danish men.

BACKGROUND: The effects of social marginalization and health are well-documented, revealing a complex association between health perceptions and health behavior. This is especially evident among socially marginalized men. OBJECTIVE: This study aims to explore health perceptions and health behaviors influencing overall health among socially marginalized men who seem to not benefit from existing municipal health care in a large Danish municipality. These men have varying health challenges and engage in risky health behaviors, such as alcohol drinking, tobacco smoking, and lack of physical activity. DESIGN AND SAMPLE: This was an ethnographic study including 200 hr of participant observations and 25 interviews with socially marginalized men aged 45-65. RESULTS: Health was perceived as related to the ability to participate in daily life activities, such as getting around effortlessly and the ability to work. Alcohol drinking appeared to be part of a complex approach in managing everyday life, including various personal physical and mental health challenges and admission to social networks. CONCLUSION: Overall, the results provide important insight into how health perceptions and health behaviors are embedded in the men's everyday lives. This knowledge may be used by public health nurses and other health professionals in providing and developing health services.

Improving posthospital medication management in a Danish municipality: A process evaluation.

AIMS AND OBJECTIVES: To evaluate an intervention developed to improve patient safety in posthospital medication management carried out by visiting nurses working in a municipality in Denmark. The intervention consisted of three elements: an initial interdisciplinary home visit by nurses, two subsequent scheduled visits and the use of an organising tool. BACKGROUND: As a consequence of specialised treatment plans and new treatment possibilities, patients with complex care needs can now be discharged from hospital more rapidly-and in greater numbers-than previously. Medication management is identified as the most challenging component of a discharge from the hospital to the home, in which discrepancies have been found in up to 94% of medication lists. DESIGN: A process evaluation inspired by the UK Medical Research Council's guidance. METHODS: The process evaluation was conducted for three months in a visiting nurses' department. Data consisted of visiting nurses' self-reports of performance of the intervention and group interviews (n = 4) with visiting nurses (n = 14). Self-reports were analysed to evaluate implementation performance and elaborated with interview data to illuminate mechanisms of impact and contextual factors. RESULTS: The implementation of the intervention highlighted the importance of the nurse-patient relationship, nursing assessment and logistics, and professional values in posthospital medication management. Complex care needs were a mediator in the high implementation rate, which involved 31 of the 38 patients in the target group. CONCLUSION: For patients with complex care needs, posthospital medication management may be improved by a reconsideration of the activity-based funding of home health care, a recognition of the importance of organising work and a critical consideration of standard systems. RELEVANCE TO CLINICAL PRACTICE: An increase in the number of patients with complex care needs in home health care is an international issue that affects many healthcare systems. This study points at contextual challenges and possible methods for facilitating the future development of posthospital care for these patients.

Visiting nurses' posthospital medication management in home health care: an ethnographic study.

BACKGROUND: Medication management is the most challenging component of a successful transition from hospital to home, a challenge of growing complexity as the number of older persons living with chronic conditions grows, along with increasingly specialised and accelerated hospital treatment plans. Thus, many patients are discharged with complex medication regimen instructions, accentuating the risk of medication errors that may cause readmission, adverse drug events and a need for further health care. AIM: The aim of this study was to explore visiting nurses' medication management in home health care after hospital discharge and to identify key elements in patient medication for improved patient safety. METHOD: Inspired by the ethnographic research cycle, participant observations and informal interviews were conducted at 12 initial visits by a nurse in a patient's home after hospital discharge. Data consisted of field notes and photographs from the patients' homes, medication lists and medical records. Field notes were analysed in four steps. FINDINGS: The analysis showed 12 stages in medication management in which nurses strove to adjust medication management to the patients' actual health status by mediating on knowledge of the patient, information to the patient and on rules and regulations and by establishing order in medication lists and medications in the home. CONCLUSION: The nurse-patient relationship, the integration of care and the context of care challenged patient safety in visiting nurses' medication management in patients' homes after hospital discharge. The implications for practice were the following: to ensure nurses' opportunities to continuously evolve their observation skills and skills in making sound clinical judgements; to establish interprofessional working processes which support the continuous assessment of patients' needs and the adjustment of care and treatment; to clarify expectations to nurses' responsibility and patients' privacy.

The association between physical activity, cardiorespiratory fitness and self-rated health.

OBJECTIVE: To investigate the joint association between self-reported physical activity as well as cardiorespiratory fitness and self-rated health among healthy women and men. METHOD: Data from 10,416 participants in The Danish Health Examination Survey 2007-2008 which took part in 13 Danish municipalities were analyzed. Leisure time physical activity level and self-rated health were based on self-reported questionnaire data. Optimal self-rated health was defined as "very good" or "good" self-rated health. Cardiorespiratory fitness (mL O2·min(-1)·kg(-1)) was estimated from maximal power output in a maximal cycle exercise test. RESULTS: A strong dose-response relation between cardiorespiratory fitness and self-rated health as well as between physical activity level and self-rated health among both women and men was found. Within categories of physical activity, odds ratios for optimal self-rated health increased with increasing categories of cardiorespiratory fitness, and vice versa. Hence, participants who were moderately/vigorously physically active and had a high cardiorespiratory fitness had the highest odds ratio for optimal self-rated health compared with sedentary participants with low cardiorespiratory fitness (odds ratio=12.2, 95% confidence interval: 9.3-16.1). CONCLUSION: Although reluctant to conclude on causality, this study suggests that an active lifestyle as well as good cardiorespiratory fitness probably increase self-rated health.

Drinking contexts and the legitimacy of alcohol use: findings from a focus group study on alcohol use in Denmark.

AIM: To examine the perceptions and meanings of alcohol use in Denmark with specific focus on drinking contexts. METHODS: A qualitative study using focus group interviews. The sample consisted of five focus groups of adults with one group for each of the following age groups: 16-20; 21-34; 35-44; 45-64; and 65-82 years. The groups consisted of both men and women with five to six participants in each group (27 in total). RESULTS: Alcohol use is perceived as legitimate in many social contexts with few being defined as inappropriate. Drinking alone is mostly associated with having alcohol-related problems, but considered legitimate if it is characterized by activity. Drinking socially plays an important role in people's considerations of legitimate use and seems to overrule the actual alcohol amount consumed. Different contexts influence different meanings of drinking with context and purpose changing with age and life stages. CONCLUSIONS: The social drinking context is pivotal in people's perception of the legitimacy of their alcohol use, leaving the alcohol amount less important. This calls for the need to focus on and incorporate the drinking context within public health initiatives aimed at reducing high risk drinking, just as the focus on the actual amount of alcohol people consume or their frequency of use.

Gambling behavior and problem gambling reflecting social transition and traumatic childhood events among Greenland Inuit: a cross-sectional study in a large indigenous population undergoing rapid change.

An increase in social pathologies is a key feature in indigenous populations undergoing transition. The Greenland Inuit are a large indigenous population constituting a majority in their own country, which makes it possible to investigate differences within the population. This led us to study gambling behavior and problem gambling among Greenland Inuit in relation to the ongoing social transition and traumatic events during childhood. A large representative cross-sectional study was conducted among Greenland Inuit (n = 2,189). Data was collected among adults (18+) in 9 towns and 13 villages in Greenland from 2005 to 2010. Problem gambling, gambling behavior and traumatic childhood events were measured through a self-administered questionnaire. The lie/bet screen was used to identify past year and lifetime problem gambling. Social transition was measured as place of residence and a combination of residence, education and occupation. The lifetime prevalence of problem gambling was 16 % among men and 10 % among women (p < 0.0001); and higher in towns (19 %) compared to the capital of Nuuk (11 %) and in villages (12 %) (men only, p = 0.020). Lifetime problem gambling was associated with social transition (p = 0.023), alcohol problems in childhood home (p = 0.001/p = 0.002) and sexual abuse in childhood (women only, p = 0.030). A comparably high prevalence of lifetime problem gambling among Greenland Inuit adds problem gambling to the list of social pathologies in Greenland. A significant association between lifetime problem gambling, social transition and traumatic childhood events suggests people caught between tradition and modern ways of life are more vulnerable to gambling problems.

A population-based randomized controlled trial of the effect of combining a pedometer with an intervention toolkit on physical activity among individuals with low levels of physical activity or fitness.

OBJECTIVES: To examine if receiving a pedometer along with an intervention toolkit is associated with increased physical activity, aerobic fitness and better self-rated health among individuals with low levels of physical activity or fitness. METHODS: The intervention was nested in the Danish Health Examination Survey (DANHES) and carried out in 2008. Participants were randomly assigned to either a pedometer group (n=326) or a control group (n=329). Physical activity, aerobic fitness, and self-rated health were measured at baseline and at 3-month follow-up, and differences were tested by Wilcoxons signed rank tests and Chi-squared tests. RESULTS: At follow-up, no significant differences in physical activity, aerobic fitness and self-rated health were found between the groups. However, the oldest participants in the pedometer group reported significantly more walking time compared to the controls (controls=368 min/week, pedometer group=680 min/week, P=0.05). Among participants who completed the intervention, a significant effect on total walking time was observed (median difference=225 min/week, P=0.04). CONCLUSIONS: The results suggest that receiving a pedometer and along with an intervention toolkit can increase walking time in older individuals, but not in younger individuals. Thus, this type of intervention offers great potential for promoting physical activity in older individuals. TRIAL REGISTRATION NUMBER: NCT01071811.

Associations between deprived life circumstances, wellbeing and self-rated health in a socially marginalized population.

BACKGROUND: Previous studies of self-rated health among socially marginalized people provide insufficient understandings of what influences their self-rated health. This study aimed to examine how disadvantaged life circumstances (homelessness, substance abuse, poverty) and general well-being were associated with poor self-rated health among the socially marginalized. METHODS: In a nationwide survey in Denmark, 1348 users of shelters, drop-in centres, treatment centres and social psychiatric centres answered a self-administered questionnaire. We analysed data using logistic regression. RESULTS: Disadvantaged life circumstances and well-being were associated with self-rated health, also when controlling for illness, mental disorder and age. Male respondents exposed to two or more disadvantaged life circumstances had higher odds of poor self-rated health [odds ratio (OR): 2.96; 95% confidence interval (CI): 1.80-4.87] than males exposed to fewer disadvantages. A low sense of personal well-being implied higher odds of poor self-rated health among both men and women. Among men, not showering regularly (OR: 1.81; 95% CI: 1.17-2.79), and among women, not eating varied food (OR: 2.24; 95% CI: 1.20-4.20) and exposure to physical violence (borderline significant) implied higher odds of poor self-rated health. Male and female respondents reporting lack of sleep and loneliness (borderline significant among women) had higher odds of poor self-rated health. CONCLUSIONS: The poor self-rated health among socially marginalized is strongly associated with massive social problems, poor living conditions and poor well-being. This study elucidates the need for more broadly based and holistic initiatives by both the health sector and the social services, incorporating health promotion initiatives into social work.

Effect of a Web-based intervention to promote physical activity and improve health among physically inactive adults: a population-based randomized controlled trial.

BACKGROUND: Many people in Western countries do not follow public health physical activity (PA) recommendations. Web-based interventions provide cost- and time-efficient means of delivering individually targeted lifestyle modification at a population level. OBJECTIVE: To examine whether access to a website with individually tailored feedback and suggestions on how to increase PA led to improved PA, anthropometrics, and health measurements. METHODS: Physically inactive adults (n = 12,287) participating in a nationwide eHealth survey and health examination in Denmark were randomly assigned to either an intervention (website) (n = 6055) or a no-intervention control group (n = 6232) in 2008. The intervention website was founded on the theories of stages of change and of planned behavior and, apart from a forum page where a physiotherapist answered questions about PA and training, was fully automated. After 3 and again after 6 months we emailed participants invitations to answer a Web-based follow-up questionnaire, which included the long version of the International Physical Activity Questionnaire. A subgroup of participants (n = 1190) were invited to a follow-up health examination at 3 months. RESULTS: Less than 22.0% (694/3156) of the participants logged on to the website once and only 7.0% (222/3159) logged on frequently. We found no difference in PA level between the website and control groups at 3- and 6-month follow-ups. By dividing participants into three groups according to use of the intervention website, we found a significant difference in total and leisure-time PA in the website group. The follow-up health examination showed no significant reductions in body mass index, waist circumference, body fat percentage, and blood pressure, or improvements in arm strength and aerobic fitness in the website group. CONCLUSIONS: Based on our findings, we suggest that active users of a Web-based PA intervention can improve their level of PA. However, for unmotivated users, single-tailored feedback may be too brief. Future research should focus on developing more sophisticated interventions with the potential to reach both motivated and unmotivated sedentary individuals. TRIAL REGISTRATION: Clinicaltrials.gov NCT01295203; http://clinicaltrials.gov/ct2/show/NCT01295203 (Archived by WebCite at http://www.webcitation.org/6B7HDMqiQ).

Recruiting residents from disadvantaged neighbourhoods for community-based health promotion and disease prevention services in Denmark-How, why and under what circumstances does an active door-to-door recruitment approach work?

Residents living in disadvantaged neighbourhoods have higher mortality and morbidity and participate less in health services than people living in more prosperous areas. Studies on how and why different approaches work for recruiting residents from disadvantaged neighbourhoods to health services are needed. Conducting face-to-face meetings with obliging health professionals (HPs) as part of an active recruitment strategy increases interest in service use, particularly among the most vulnerable residents. The services offered must be free, flexible and easily accessible for residents from disadvantaged neighbourhoods to consider their use. Residents immediately consider and 'translate' the relevance and acceptability of health services presented to them in light of their current situation, which affects their response. Individual contextual circumstances such as current health issues or difficult life circumstances, either promote or dampen their interest in using the services. This study is a realist evaluation of active face-to-face recruitment where HPs go from door-to-door to visit residents in disadvantaged neighbourhoods and offer them community-based health promotion and disease prevention services. A programme theory explicating the assumptions behind this recruitment approach was tested empirically in the present study. Eight direct observations of the active recruitment process in three different neighbourhoods and 17 realist interviews with residents were conducted. Sampling of residents was purposeful and opportunistic. Data were collected between March and August 2018. The findings support the use of active face-to-face recruitment in disadvantaged neighbourhoods to increase participation in health interventions. A broad range of health services should be presented to residents to accommodate their different needs and interests. Refusal to have services presented during active recruitment was rare, but more knowledge about these reasons for declining services is needed.

The Danish Health Examination Survey 2007-2008 (DANHES 2007-2008).

AIMS: The Danish Health Examination Survey (DANHES 2007-2008) was carried out by the National Institute of Public Health, University of Southern Denmark, in 13 Danish municipalities in 2007-2008. The focus of the survey was diet, smoking, alcohol, and physical activity. The aim of the survey was to establish a research database for future cross-sectional and follow-up studies. METHODS: DANHES 2007-2008 included internet-based questionnaires and a health examination. There were two different questionnaires: a basic questionnaire on socio-demography, health behaviour, self-reported health status, and living conditions, and a supplementary food frequency questionnaire. The health examination contained measurements of blood pressure, resting heart rate, height, weight, fat percentage, waist and hip circumference, blood and hair samples, spirometry, bone mineral density, physical performance, muscle strength, and aerobic fitness. RESULTS: A total of 76,484 people completed the basic questionnaire, and 18,065 adult individuals participated in the health examination, corresponding to a response rate of 14% and a participation rate of 10%, respectively. CONCLUSIONS: The database from DANHES 2007-2008 is unique in its size and diversity of measurements and questionnaire contents. Data can be linked to various registers through the Danish civil registration system, and blood samples are stored in a biobank allowing for genetic analyses. Hence, DANHES 2007-2008 forms the basis for future research projects with a focus on health behaviour and prevention of lifestyle-related diseases.

Effects of school district factors on alcohol consumption: results of a multi-level analysis among Danish adolescents.

BACKGROUND: Area-level socio-economic factors are significantly related to a population's health. This study investigates how school district-level factors affect the initiation of alcohol drinking of Danish adolescents. METHODS: A survey sample of 11,223 female and male pupils in the 7th grade from 447 schools across Denmark was analysed for the outcome variable drinking initiation and a number of individual level predictors. Aggregated variables on school district level were created from national registry data for education, occupational level and household savings of residents, type of housing and land use characteristics. RESULTS: About 40% of all respondents (45.8% males and 35.2% females) had ever drunk more than one glass of alcoholic beverage. Mixed-effects logistic regression showed that significant individual level predictors for drinking initiation were male gender, a lower performance at school, perceived peer group drinking and the perceived daily drinking of the father. On school district level, adolescents were more likely to initiate alcohol consumption in school districts with higher farming land use and less likely in those with higher proportion of private apartment buildings. Other school district factors were not associated with drinking initiation when controlled for individual level factors. CONCLUSIONS: The impact of socio-economic variables at school district level seems to be smaller in the welfare state of Denmark than known for other countries. However, residence in rural areas may be a direct disadvantage for youth, indicating a need for region-specific prevention programmes.

The Danish Youth Cohort: characteristics of participants and non-participants and determinants of attrition.

AIMS: The aim of this paper is to describe the design and methods used in the Danish Youth Cohort and to give a description of the study participants with special attention to a comparison between participants and non-participants regarding sociodemographic characteristics. METHODS: A total of 1,945 schools were invited, out of which 506 participated. The participating 7th grades comprised a total of 12,498 responding adolescents. The response rate for the Danish Youth Cohort established in 2005 was 63%. The sample of 12,498 adolescents represents 18.2% of all pupils (n = 68,764) in the 7th grade (mean age: 13.4 years) in Danish schools in 2005. The cohort was followed up in spring 2006 and spring 2007, where the adolescents were in the 8th (mean age: 14.4 years) and 9th (mean age: 15.3 years) grades, respectively. RESULTS: We found that compared with non-participants the participants were significantly more likely to be girls, to be of Danish ethnicity, and to live in one-family houses. Furthermore, participants more often came from families with two or three children, were more likely to have parents with a high occupational status, parents who were married and parents with a higher total income. Loss to follow-up was only associated with adolescents' higher probability of drinking and use of tobacco, and none of the other factors were associated with attrition. CONCLUSIONS: The participants in the Danish Youth Cohort represent a great variety of different groups of socio-demographic factors, although they differ from non-participants as regards a range of socio-demographic factors. This should be taken into account in future analyses.

Readiness to change level of physical activity in leisure time among physically inactive Danish adults.

AIMS: The study examined readiness to change the level of physical activity in leisure time among physically inactive adults, the sociodemographic, lifestyle-related and social factors associated with readiness to change, and finally the various kinds of help to become more physically active required by people who are ready to change and by those not ready to change. MATERIALS AND METHODS: Data were derived from the national representative Danish Health Interview Survey 2005 and included 9,160 physically inactive persons between 16 and 79 years of age. Data were analysed using multiple logistic regression and multiple correspondence analysis. RESULTS: In all, 52 % of the physically inactive respondents stated they were ready to change their level of physical activity. Men had higher odds of being ready to change than women. Readiness to change decreased with age and increased with increasing levels of education. Those ready to change led an active and social lifestyle characterized by considerable health-oriented engagement, while the opposite characterised those not ready to change. Those ready to change wanted help to become more physically active in the form of e.g. opportunities for physical activity at work or help and support from the family. Those not ready to change wanted help from a general practitioner or did not want help at all. CONCLUSIONS: Those ready to change and those not ready to change were characterized by very different sociodemographic, lifestyle-related and social factors. This knowledge will benefit prevention initiatives and elucidates the necessity of targeting the initiatives.

Harm minimization among teenage drinkers: findings from an ethnographic study on teenage alcohol use in a rural Danish community.

AIM: To examine strategies of harm minimization employed by teenage drinkers. DESIGN, SETTING AND PARTICIPANTS: Two periods of ethnographic fieldwork were conducted in a rural Danish community of approximately 2000 inhabitants. The fieldwork included 50 days of participant observation among 13-16-year-olds (n = 93) as well as 26 semistructured interviews with small self-selected friendship groups of 15-16-year-olds (n = 32). FINDINGS: The teenagers participating in the present study were more concerned about social than health risks. The informants monitored their own level of intoxication, but in order to reduce alcohol consumption they depended upon support from their peers. The informants preferred drinking in the company of well-known and trusted peers, and during drinking episodes they supervised and intervened in each others' drinking to the extent that they deemed it necessary and possible. In regulating the social context of drinking they relied on their personal experiences more than on formalized knowledge about alcohol and harm, which they had learned from prevention campaigns and educational programmes. CONCLUSIONS: In this study we found that teenagers may help each other to minimize alcohol-related harm, and teenage peer groups should thus be considered a resource for health promotion.

Changing living conditions, life style and health.

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.

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

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.

Experiences from three community health promotion projects in Greenland.

OBJECTIVES AND METHODS: Three community health promotion projects have been implemented in Greenland in the municipalities of Upernavik, Ittoqqortoormiit and Qasigiannguit. Based on project reports and other written material, this paper describes experiences from the three projects and discusses the implications of the differences in project design and organization for potential outcomes. RESULTS: None of the three projects were formally evaluated. They all experienced problems and have only been partially successful in reaching their goals. The Upernavik and the Ittoqqortoormiit projects were organised with strong leadership and a central organisation, whereas the Qasigiannguit project was designed as a community project with population participation in all phases of the project. The two former projects have probably had a greater direct change impact on the community, whereas the latter has strengthened aspects of community capacity building. CONCLUSION: We need to learn more about how to employ the resources of communities, how to achieve better partnerships and how to support people in their efforts in order to secure population participation at all project stages. It is important to build coalitions with broad representation in the community and to secure population participation in order to disseminate the efforts and reach the needs of the whole community.

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 father's 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.