Self-rated health among Greenlandic Inuit and Norwegian Sami adolescents: associated risk and protective correlates

Figures & data

Table I. Study descriptions: The Norwegian Arctic Adolescent Health Study (NAAHS) and Well-Being among Youth in Greenland (WBYG)

	Sami (NAAHS)	Inuit (WBYG)
Study year	2003–05	2004–05
Invited (n)^a	5877	663
Participants (n)	4880	508
Response rate (%)	83	75
Number of participating schools (n)	292^b	10
Working sample of 15–16-year olds^c	350	378

^aIncluding both indigenous Sami and Greenlandic Inuit, but also Norwegian and Danish adolescents.

^bAt 116 junior high schools one or more students reported Sami origin.

^cNAAHS: 10th graders (98% were 16 year olds); WBYG: 10th and 11th graders.

Table II. Description of the independent variables in NAAHS and WBYG

	Sami (NAAHS)		Inuit (WBYG)		NAAHS/WBYG
Variables	Item(s)	Categories	Item(s)	Categories	Measurement(s)
Socio-demographics
Socio- economic status	I think that our family, seen in relation to other families in Norway, have:	Poor economy Average economy Good economy Very good economy	What is your mother's (father's) formal education?	Elementary school High school Short vocational education Higher education, 3–4 years University education	NAAHS: Good (good, very good economy) vs. Poor (poor, average economy) WBYG: Higher educational level (college, university degree) vs. Lower educational level (elementary school, high school, short vocational education)
Parents married/ cohabiting	My parents are?	Married/cohabiting Unmarried Divorced/separated One or both are dead Other	Do your parents live together?	Yes No	Yes (married/cohabiting/ living together) vs. No (unmarried, divorced/ separated, dead, other, or not living together)
Risk correlates
Suicidal behaviour	Have you ever had suicidal thoughts?	No Yes	Have you ever seriously considered committing suicide?	No Yes	No vs. Suicidal thoughts (yes) vs. Suicidal attempts (Yes on suicidal thoughts and/or attempts)
	Have you ever had suicidal attempts?	No Yes	Have you ever attempted to commit suicide?	No Yes
Alcohol use	Have you ever drunk alcohol?	No Yes	How often do you drink alcohol?	I never drink alcohol Less than monthly About once a month About once weekly Daily or almost daily	Abstinence (Never drink alcohol or not drinking during the last year) vs. Moderate (Drinking monthly or less) vs. Frequent (Drinking once weekly or more)
	About how often in the course of the past year have you drunk alcohol?	4–7 times weekly 2–3 times weekly About once a week 2–3 times monthly About once a month A few times during the last year
		Have not drunk alcohol during the last year
Current smoking	Do you smoke, or have you smoked?	No, never Yes, but I quit Yes, occasionally Yes, daily	Do you smoke?	No Yes, but I have days where I don‘t smoke Yes, daily	No (Never or non-smokers, and quitters) vs. Yes (Occasional smokers and daily smokers)
Experienced violence	Have you yourself been exposed to violence (been hit, kicked, or similar) during the last 12 months?	Never Yes, only by youth Yes, only by adults Yes, both youth and adults	Within the last year have you been exposed to any of the following?^a Most children experience conflicts at home. Have you experienced - You were pushed and shaken in anger? - You were torn in your hair You were beaten	Yes Yes	No (Never, not exposed to violence within the last year, and not exposed to domestic violence (e.g. conflicts at home)) vs. Yes (Exposed to violence within the last year and/or domestic violence (conflicts at home)
Protective correlates
Physical activity	Out of school hours: how many times per week do you take part in sport/do physical exercise to the extent that you get out of breath or sweat?	0,1,2,3,4,5,….	How often do you exercise hard (running, soccer, something else)	Every day At least once a week Less than weekly Never	Frequent (1 or more times a week or every day) vs. Seldom (0 times a week, less than weekly or never)
Well-being in school	Do you enjoy going to school?	Fully agree Partly agree Partly disagree Fully disagree	Do you like going to school?	Very well Well Fair Not so well	Good (Fully or partly agree, well and very well) vs. Poor (Partly or fully disagree, fair or not so well)
Number of friends	About how many friends do you have (do not include siblings)	None 1 2–3 4 or more	How many close friends do you have?	No close friends at the moment 1 2–3 4 or more	Few (None or 1) vs. Many (2 or more)
Adolescent– parent relationship	If you have personal problems who could you go to?^b	Yes No I don‘t know	How easy or difficult is it for you to talk with the following persons, when you have problems?^b	Very easy Easy Difficult Very difficult I don‘t have any parents^c	Good (yes, very easy, easy) vs. Poor (no, difficult, very difficult)

^aViolence was one of ten alternatives.

^bParents were one of several alternatives.

^cThe alternative “I don’t have any parents” was categorized as missing.

Table III. Distribution of self-rated health in NAAHS and WBYG by gender

	Sami^a (NAAHS)			Inuit^a (WBYG)
	Male	Female	Total^b	Male	Female	Total^c
	n=162	n=188	N=350	n=155	n=223	N=378
Self-rated health
Very good (n, %)	64 (40)	54 (29)	118 (34)	32 (21)	32 (14)	64 (17)
Good (n, %)	83 (51)	111 (59)	194 (55)	78 (50)	93 (42)	171 (45)
Fair/Not so good (n, %)	15 (9)	20 (11)	35 (10)	44 (28)	91 (41)	135 (36)
Poor (n, %)	0 (0)	3 (2)	3 (1)	1 (1)	7 (3)	8 (2)

^aSignificant Sami–Inuit differences in SRH, disfavouring Inuit [χ² (3, 728)=77.6, ***p≤0.001], due to fewer Sami reporting not so good SRH and more Inuit reporting fair SRH.

^bNon-significant gender differences in SRH among Sami [χ² (3, 350)=6.71, p≤0.08].

^cSignificant gender differences in SRH among Inuit [χ² (3, 378)=10.14, *p≤0.05].

Table IV. The distribution of independent variables in NAAHS and WBYG by gender (n, %)

		Sami (NAAHS)				Inuit (WBYG)
					Effect of gender – Sami (p)				Effect of gender –Inuit (p)	Effect of indigenous group (p)
		Male n=162	Female n=188	Total N=350		Male n=155	Female n=223	Total N=378
Socio-demographics
Parents married/ cohabiting	Yes	88 (55)	117 (62)	205 (59)	0.15	93 (60)	130 (59)	223 (59)	0.75^a	0.88
	No	73 (45)	71 (38)	144 (41)		61 (40)	92 (41)	153 (41)
Socio-economic status	Good	102 (65)	95 (51)	197 (57)	0.01	101 (67)	140 (66)	241 (67)	0.82^a	NT^b
	Poor	56 (35)	92 (49)	148 (43)		49 (33)	72 (34)	121 (33)
Risk correlates
Suicidal behaviour	No	119 (74)	91 (49)	210 (61)	≤0.001	126 (82)	98 (44)	224 (60)	≤0.001	≤0.001
	Thoughts	31 (19)	67 (36)	98 (28)		15 (10)	50 (23)	65 (17)
	Attempts^c	10 (6)	27 (15)	37 (11)		13 (8)	73 (33)	86 (23)
Alcohol use	Abstinence	20 (14)	12 (8)	32 (11)	0.20	32 (21)	35 (16)	67 (18)	0.25	0.03
	Moderate	103 (74)	122 (80)	225 (77)		105 (68)	153 (69)	258 (68)
	Frequent	16 (12)	19 (12)	35 (12)		17 (11)	35 (16)	52 (14)
Current smoking	No	110 (68)	120 (64)	230 (66)	0.46	85 (55)	90 (40)	175 (46)	0.005^a	≤0.001
	Yes	52 (32)	67 (36)	119 (34)		69 (44)	133 (60)	202 (54)
Experienced violence	No	118 (74)	154 (82)	272 (78)	0.05	128 (83)	176 (79)	304 (80)	0.23^a	0.50
	Yes	42 (26)	33 (18)	75 (22)		27 (17)	47 (21)	74 (20)
Protective correlates
Physical activity	Frequent	144 (90)	154 (85)	298 (87)	0.17	106 (70)	105 (47)	211 (56)	≤0.001^a	≤0.001
	Seldom	16 (10)	27 (15)	43 (13)		46 (30)	117 (53)	163 (44)
Well-being in school	Good	142 (88)	170 (90)	312 (89)	0.50	115 (75)	170 (78)	285 (77)	0.62^a	≤0.001
	Poor	19 (12)	18 (10)	37 (11)		38 (25)	49 (22)	87 (23)
Number of close friends	2 or more	153 (95)	177 (95)	330 (95)	0.87	142 (92)	193 (88)	335 (90)	0.23	0.01
	0 or one friend	8 (5)	10 (5)	18 (5)		12 (8)	26 (12)	38 (10)
Adolescent–parent relationship	Good	85 (56)	96 (52)	181 (54)	0.42	104 (78)	138 (67)	242 (71)	0.03	≤0.001
	Poor	66 (44)	89 (48)	155 (46)		29 (22)	68 (33)	97 (29)

^aFisher Exact Test used. There were no significant differences in the gender distribution in NAAHS and WBYG samples; [χ² (1, n=728)=2.06, NS].

^bNT: Not Tested. Indigenous group differences were not tested due to different socio-economic measures in NAAHS (parental financial situation) and WBYG (parental educational level).

^cIncludes both suicidal attempts and suicidal thoughts. The number reporting only prior suicidal attempts and not thoughts were 15 in total (4 Sami/11 Inuit). The three categories in the suicidal behaviour item are mutually exclusive.

Table V. Simple and multiple logistic regressions of poor vs. good self-rated health in NAAHS and WBYG

		Sami (NAAHS)				Inuit (WBYG)
		Unadjusted (n=350)		Adjusted^a (n=265)^b		Unadjusted (n=378)		Adjusted^a (n=333)^b
		OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Socio-demographics
Parents married/ cohabiting	Yes	1	Ref.			1	Ref.
	No	1.56	(0.99,2.48)^NS			1.04	(0.68,1.59)^NS
Socio-economic status^c	Good	1	Ref.	1	Ref	1	Ref.
	Poor	2.81	(1.73,4.56)***	2.74	(1.60,4.69)***	0.73	(0.46,1.15)^NS
Gender	Male	1	Ref.	1	Ref.	1	Ref.	1	Ref.
	Female	1.62	(1.04,2.53)*	1.08	(0.65,1.82)^NS	1.92	(1.24,2.96)**	1.08	(0.63,1.84)^NS
Risk correlates
Suicidal behaviour	No	1	Ref.	1	Ref.	1	Ref.	1	Ref.
	Thoughts	4.57	(2.48,8.44)***	3.77	(1.96,7.25)***	2.74	(1.56,4.83)***	2.07	(1.10,3.91)***
	Attempts^d	4.27	(1.71,10.7)***	2.64	(0.98,7.08)^NS	2.50	(1.50,4.17)***	1.66	(0.87,3.18)^NS
Alcohol use	Abstinence	1	Ref.			1	Ref.
	Moderate	1.50	(0.71,3.17)^NS			1.71	(0.95,3.07)^NS
	Frequent	4.67	(1.44,15.1)**			1.58	(0.73,3.41)^NS
Current smoking	No	1	Ref.	1	Ref.	1	Ref.	1	Ref.
	Yes	2.39	(1.43,3.97)***	1.64	(0.92,2.91)^NS	2.72	(1.76,4.22)***	2.05	(1.23,3.40)**
Experienced violence	No	1	Ref.			1	Ref.
	Yes	1.81	(1.01,3.25)*			1.07	(0.64,1.81)^NS
Protective correlates
Physical activity	Seldom	1	Ref.	1	Ref.	1	Ref.	1	Ref.
	Frequent	0.17	(0.06,0.50)***	0.21	(0.07,0.63)**	0.41	(027,0.63)***	0.50	(0.31,0.81)**
Well-being in school	Poor	1	Ref.	1	Ref.
	Good	0.35	(0.14,0.87)*	0.39	(0.14,1.11)^NS
Adolescent–parent relationship	Poor	1	Ref.	1	Ref.	1	Ref.	1	Ref.
	Good	0.68	(0.43,1.08)^NS	0.39	(0.75,2.68)^NS	0.46	(0.29,0.75)*	0.59	(0.35,0.99)*
Number of friends^e	0–1 friend	1	Ref.			1	Ref.
	≥2 friends	1.03	(0.38,2.81)^NS			1.40	(0.71,2.75)^NS

Ref: reference group; OR: odds ratio; CI: confidence interval; ***p≤0.001; **p≤0.01; *p≤0.05; NS: non-significant.

^aEach independent variable was adjusted for all other socio-demographics, risk- and protective correlates.

^bNumber of cases included in the final backward logistic regression. The significance level for the variables included was set at 10%.

^cSocio-economic measures by parental financial situation in NAAHS and by parental educational level in WBYG.

^dIncludes both suicidal attempts and suicidal thoughts. The number reporting only prior suicidal attempts and not thoughts were 15 in total (4 Sami/11 Inuit). The three categories in the suicidal behaviour item are mutually exclusive.

^eNumber of friends was not included in the multivariate analyses.