Acculturation strategies and ethnic identity as predictors of behavior problems in arctic minority adolescents

Bibliometric analysis of suicide risk assessment in children and adolescents: Trends and future directions

Suicide risk among children and adolescents continues to rise, yet critical trends and research gaps in suicide risk assessment remain unexamined. This study aimed to analyze global research trends on suicide risk assessment in children and adolescents using Scopus-indexed literature from 1984 to 2024. VOSviewer was used to visualize keyword co-occurrence and thematic trends. Bibliometric data were extracted from abstracts, including publication volume, citation counts, and author productivity. The search strategy identified 1195 articles, with 259 meeting the inclusion criteria. Publications grew annually by 7.78 %, with contributions from 1243 unique authors and an average document age of 9.22 years. The United States was the leading contributor, followed by China, Spain, and the United Kingdom. The Journal of Affective Disorders is the one with the highest number of publications on network analysis in suicide risk assessment, followed by the Journal of Archives of Suicide Research and Psychiatry Research. Most documents were articles (236), with few reviews (15). Key research areas included suicidal ideation, psychometric evaluations, and stress markers. However, critical gaps persist, particularly in developing culturally sensitive assessment tools, integrating biological and psychosocial risk factors, and expanding research in low- and middle-income countries. Most assessment tools are developed in Western settings, limiting cross-cultural applicability. Given the role of sociocultural factors in suicidal behaviors, future research should prioritize culturally adapted assessment methods and validate self-report tools in diverse populations. Addressing these gaps is essential for improving global suicide prevention strategies.

Global, regional, and national burdens of depressive disorders in adolescents and young adults aged 10-24 years from 1990 to 2019: A trend analysis based on the Global Burden of Disease Study 2019

BACKGROUND

Depressive disorders (DD) including dysthymia and major depressive disorder (MDD) are common among adolescents and young adults. However, global trends in DD burden remain unclear.

METHODS

We analysed data from the Global Burden of Disease 2019 study on incidence, prevalence, disability-adjusted life years (DALYs), and mortality due to DD from 1990 to 2019 at global, regional and national levels.

RESULTS

Globally, dysthymia incidence increased notably in females, older age groups, and lower-middle income countries from 1990 to 2019. In contrast, MDD incidence decreased slightly over this period except in high-income North America. Females and middle-income countries had the highest dysthymia burden while North America had the highest MDD incidence and DALYs. Oman and Malaysia experienced largest increases in dysthymia and MDD burden respectively.

CONCLUSION

Despite certain global indicators suggesting a leveling off or decrease, it's clear that depressive disorders continue to be a significant and increasing issue, particularly among women, teenagers, and young adults. Differences between regions and countries indicate that specific interventions aimed at addressing economic inequalities, improving healthcare systems, and taking cultural factors into account could make a real difference in lessening the burden of depressive disorders. More research is needed to understand what's driving these trends so that we can develop better strategies for preventing and managing these conditions.

Because We Love You (BeWeL): A protocol for a randomized controlled trial of two brief interventions focused on social and cultural connectedness to reduce risk for suicide and substance misuse in young Alaska Native people

Background

Suicide among young people in Alaska Native (AN) communities was nearly unheard of through the establishment of statehood in 1959, but in the 1970s, AN suicide rates began to double every five years, with most of the increase due to suicide among 15 to 25-year-olds. From 1960-1995, the suicide rate increased by approximately 500% during this period of rapid, imposed social transition. For example, families were forced to live in settlements and children were sent to boarding schools. These disruptions increased conditions associated with suicide risk (e.g., substance use disorders, cultural disconnection), and challenged the community-level social safety net of youth protective factors that might have moderated effects of these traumas. The present study addresses the significant gap in culturally appropriate evidence-based programming to address suicide prevention among AN young people as part of aftercare. Our key research questions and methodology have been informed by AN stakeholders, and the intervention approach is Indigenous-led.

Methods

Our interventions are targeted toward Alaska Native young people ages 14-24 who present with suicide attempt, ideation, or associated risk behaviors, including alcohol-related injury in the Yukon-Kuskokwim region or the Interior. In a randomized controlled trial, 14-24-year-old AN individuals will receive either BeWeL (n = 185), which comprises a 45-minute virtual cultural talk addressing family and ancestral strengths and increasing protective factors, or BeWeL plus motivational interviewing with social networks, which includes an additional 15 minutes focused on discussion of the individual's social networks (n = 185). We will evaluate intervention effects on primary outcomes of suicide-intent risk, depression, anxiety, frequency of alcohol use, and alcohol consequences. Some of our secondary outcomes include individual and community protective factors, social networks, and awareness of connectedness.

Discussion

This project has the potential to expand the range and effectiveness of suicide prevention services for AN young people and will help meet the need in Alaska to link clinical behavioral health services to AN community-based networks, and to engage local cultural resources in aftercare for individuals at risk for suicide. Findings have potential to provide practical information to advance the field of suicide prevention and enhance protective factors and resiliency among this population.

Trial registration

ClinicalTrials.gov Identifier: NCT05360888.

The association between suicidal behaviour and violence, sexual abuse, and parental substance abuse among Sami and Greenlandic adolescents: the WBYG study and the NAAHS

Background

For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health and societal concerns. More knowledge is needed, as suicidal behaviour predicts later death by suicide. The aim of this study was to investigate associations between suicidal thoughts and suicide attempts and negative life events, including violence, sexual abuse, and parental substance abuse, in Sami and Greenlandic adolescents, within and between groups and gender.

Method

Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in The Norwegian Arctic Adolescent Health Study (NAAHS) and the Well-Being among Youth in Greenland (WBYG) study. Multivariable logistic regression explored associations between suicidal behaviour and violence, sexual abuse, and parental substance abuse.

Results

Across Indigenous groups, suicidal thoughts and attempts were significantly associated with violence and sexual abuse. The association between suicidal behaviour; especially suicidal thoughts, and sexual abuse was significant and strong among Sami females. Sami and Inuit adolescents with a history of childhood violence reported significantly more suicide attempts; the strongest association was found among Sami males.

Conclusion

To Sami and Greenlandic Inuit, the experiences of negative life events, such as violence or sexual abuse are significant risk factors for suicidal behaviour. Public health programmes and prevention strategies targeting youth mental health and suicide should be culturally sensitive and sensitive to gender differences in the association between negative life events and suicidal behaviour.

Heritage Culture Detachment Predicts Hope and Well-Being of Filipino Migrant Workers: A Study of Low- and Semi-skilled Filipino Workers in Macau

Heritage culture detachment occurs when migrants tend to distance themselves from their own cultural norms and values as they engage their host culture; research suggests that this approach to acculturation is often associated with psychological distress. We explore heritage culture detachment and well-being among Filipino migrant workers in Macau. Participants (N = 249) were recruited to answer a questionnaire that inquired into heritage culture detachment and several measures of well-being. The relationships between well-being and heritage culture detachment were examined by testing two structural equation models: Model 1: well-being predicts heritage culture detachment; Model 2: heritage culture detachment predicts well-being. The results show better fit between the data and Model 2; in particular, heritage culture detachment positively predicted satisfaction with life, external-peer locus-of-hope, but also negative self-esteem, and goal disengagement. Heritage culture detachment also negatively predicted external-spiritual locus-of-hope. The results are interpreted as possibly indicating how heritage culture detachment reflects efforts to adjust and cope in a new sociocultural environment. Unlike other migrants, international migrant workers may see their foreign work environment as temporary contexts and circumstances, wherein subordinating their cultural norms may have some utility. The discussion highlights how sources of well-being need to be understood within the specific temporal and sociocultural context of individuals’ life experiences.

Involuntary Cultural Change and Mental Health Status Among Indigenous Groups: A Synthesis of Existing Literature

Indigenous groups throughout the world have experienced social exclusion and have been subjected to marginalization. Globalization has resulted in significant changes in traditional lifestyles and developmental programs have not been successful in integrating Indigenous people into communities with non-Indigenous people. Although there is substantial research on acculturation and adaptation within the field of cross-cultural psychology, there are few narrative reviews of this literature. The present paper provides such a review and examines the mental health concerns of Indigenous groups undergoing acculturation. We address the consequences of involuntary cultural change and review studies that have been conducted on mental health issues, psychosomatic symptoms, substance use, and suicidality in Indigenous groups. We conclude by offering suggestions to mitigate mental health problems. Directions for future research on the acculturation of Indigenous groups are also provided.

Socio-demographic, psychosocial and environmental factors associated with suicidal behaviour in Indigenous Sami and Greenlandic Inuit adolescents; the WBYG and NAAHS studies

Background. For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health- and societal concerns. More knowledge is needed, as suicidal behaviour predictslater death by suicide.Objectives. The objective was to study associations between suicidal thoughts and suicide attempts and socio-demographic, psychosocial, and environmental factors in Sami and Greenlandic adolescents, within and between groups and gender.Methods. Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in "The Norwegian Arctic Adolescent Health Study" (NAAHS) and "Well-being among Youth in Greenland" (WBYG). Multivariable logistic regression explored associations between suicidal behaviour and family , ethnic language , school, friendship, and suicide in close relations.Results. Across Indigenous groups, suicidal behaviour was associated with the female gender, relationships with parents, suicide of friends, and rural living. Sami adolescents in stepparent families reported more suicidal behaviour. Inuit adolescents living outside the family and with poor school performance reported more suicidal thoughts. Inuit adolescents spending less time with friends reported more attempts. Gender differences occurred in both groups.Conclusion. To Sami and Greenlandic Inuit, family and peer relations are important factors of suicidal behaviour. Prevention programmes should be sensitive to gender and bereavement.

Ethnic Bullying Victimization in Italy: The Role of Acculturation Orientation for Ethnic Minority Adolescents With Differing Citizenship Statuses

This study examines the role of acculturation orientation toward home and host countries in ethnic bullying victimization, by considering citizenship status and taking into account social withdrawal. Within a larger school project with middle and high school students, we analyzed data on 252 adolescents from immigrant backgrounds: 71 born abroad without Italian citizenship (Males = 71.4%; mean age = 13.98, SD = 1.7); 96 born in Italy to immigrant parents and without Italian citizenship (Males = 58.3%; mean age = 13.26, SD = 1.6); and 85 Italian citizens born in Italy with an immigrant parent (Males = 54.7%; mean age = 13.12, SD = 1.5). At the univariate level we found that the group of adolescents born abroad with foreign parents showed significantly higher levels of ethnic victimization compared to the group of adolescents born in Italy with an Italian parent. The latter also reported a significantly higher mean in Acculturation Orientation toward their Host Country (i.e., Italy) compared to the other two groups. Looking at the processes working within each group, we found differences in the patterns of association between acculturation orientation and ethnic bullying victimization. Specifically, we found a significant and positive association between acculturation orientation toward the home country and ethnic victimization in the two groups of adolescents born in Italy, while acculturation orientation toward the host country seems to be a protective factor only for adolescents with Italian citizenship. Acculturation orientation does not play any role in ethnic victimization for the first generation of immigrants, while for this group we found a stronger positive effect of Social Withdrawal. Citizenship status appears to be a good indicator of belonging to an ethnic minority group with a background of immigration: it seems to catch specific processes in ethnic bullying victimization.

Tertiary education and its association with mental health indicators and educational factors among Arctic young adults: the NAAHS cohort study

Background

Completed tertiary education is closely associated with employment and influences income, health and personal well-being.

Objective

The purpose of the study is to explore predictors for completed tertiary education among indigenous Sami and non-indigenous young people in relation to mental health indicators and educational factors in sociocultural rural and urban contexts across the Arctic part of Norway.

Design

The Norwegian Arctic Adolescent Health Study (NAAHS) is a cross-sectional, school-based survey that was conducted in 2003–2005. Of all 5,877 10th graders (aged 15–16 years) in north Norway, 83% from all 87 municipalities participated; 450 (9.2%) reported indigenous Sami ethnicity, and 304 (6.2%) reported Laestadian affiliation. Data from NAAHS were merged with registry data from the National Education Database and Norwegian Patient Register for 3,987 adolescents who gave their consent for follow-up studies.

Results

Completion of upper secondary school is the only common predictor of a completed tertiary education degree for both genders. Among females, conduct problems was a significant predictor of lower level education, typically vocational professions, while among males severe mental health problems requiring treatment by the specialist health care system reduced the opportunity to complete tertiary education at intermediate and higher level. Parental higher educational level was associated with less lower education among females and less higher education among males. Men residing in the northernmost and remote areas were less likely to complete education on higher level. Males’ completion of higher level education was strongly but not significantly associated (p=0.057) with higher average marks in lower secondary school.

Conclusions

The gender differences found in this study emphasize the need for gender-specific interventions to encourage, support and empower young people to attend and complete tertiary education. Young females with conduct problems choose lower or intermediate education, and males in need of specialist mental health care have half the chance to complete intermediate tertiary education compared with males not in contact with the mental health service. Closer cooperation between low threshold social services, general practitioners, mental health services and higher study institutions can help young male adults complete tertiary education.

Ethnic identity negotiation among Sami youth living in a majority Sami community in Norway

BACKGROUND

This study was part of the international research project "Circumpolar Indigenous Pathways to Adulthood" (CIPA).

OBJECTIVES

To explore ethnic identity negotiation, an unexplored theme, among indigenous North Sami youth living in a majority Sami community context in Arctic Norway.

METHODS

A qualitative design was followed using open-ended, in-depth interviews conducted in 2010 with 22 Sami adolescents aged 13-19 years, all reporting Sami self-identification. Grounded theory, narrative analysis, theories of ethnic identity and ecological perspectives on resilience were applied in order to identify the themes.

FINDINGS

All 22 youth reported being open about either their Sami background (86%) and/or ethnic pride (55%). Ethnic pride was reported more often among females (68%) than males (27%). However, a minority of youth (14%) with multi-ethnic parentage, poor Sami language skills, not having been born or raised in the community and with a lack of reindeer husbandry affiliation experienced exclusion by community members as not being affirmed as Sami, and therefore reported stressors like anger, resignation, rejection of their Sami origins and poor well-being. Sami language was most often considered as important for communication (73%), but was also associated with the perception of what it meant to be a Sami (32%) and "traditions" (23%).

CONCLUSION

Ethnic pride seemed to be strong among youth in this majority Sami context. Denial of recognition by one's own ethnic group did not negatively influence ethnic pride or openness about ones' ethnic background, but was related to youth experience of intra-ethnic discrimination and poorer well-being. As Sami language was found to be a strong ethnic identity marker, effective language programmes for Norwegian-speaking Sami and newcomers should be provided. Language skills and competence would serve as an inclusive factor and improve students' well-being and health. Raising awareness about the diversity of Sami identity negotiations among adolescents in teacher training and schools in general should be addressed.

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.

Non-completion of upper secondary school among female and male young adults in an Arctic sociocultural context; the NAAHS study

Background

Education is closely associated with health. Non-completion of upper secondary school influences academic achievement, employment, income and personal well-being.

The purpose of the study is to explore predictors of non-completion of upper secondary school among female and male young adults in relation to mental health and educational factors in a socio-cultural, Arctic context.

Methods

The Norwegian Arctic Adolescent Health Study (NAAHS) is a cross-sectional, school-based survey that was conducted in 2003–2005. Eighty-three percent of the population of 5,877 10th graders participated; 49.1%females, 450 reported indigenous Sami ethnicity, and 304 reported Laestadian affiliation. Data from NAAHS were merged with registry data from the National Education Database (NUDB) Norway for 3,987 adolescents who gave their consent for follow-up studies.

Results

Non-completion of upper secondary school was 36.9 % among females and 36.6 % among males. Among females, predictors for non-completion were related to mental health symptoms, and among males, to residency in the northernmost and remote areas and self-reported functional difficulties at school, home and in leisure activities due to mental health problems.

There was marginal significance between ethnicity and non-completion of upper secondary school, measured at 41.3 % for Sami and 36.8 % for non-Sami, respectively.

Conclusions

The gender differences found in this study emphasize the need for gender-specific interventions in preventing non-completion of upper secondary school. There is a need to recognize and treat extensive pro-social behaviour and social problems in young females. Young males from remote areas and those who in early adolescence struggle with functional impairment due to mental health problems need early interventions in lower secondary school. Enhancing parents’ and teachers’ ability to detect symptoms and problems as well as low-threshold health services starting in primary school can be effective means. Education, mental health and social inclusion are prominent factors for future employment, income and independent living for young people. Future research should focus more on gender-specific patterns of risk and protective factors for completion of upper secondary school.

Problem Behavior and Acculturation in Moroccan Immigrant Adolescents in the Netherlands

The gender specificity of the relation between acculturation and problem behavior in Moroccan immigrant adolescents in the Netherlands was examined. Three previously identified classes of adolescents with similar patterns of acculturation were used: an integrated, separated, and ambivalent class. Girls with an ambivalent acculturation pattern showed more problems than the other girls on parent- and adolescent-reported internalizing and externalizing behavior. For boys, no effects of acculturation on problem behavior were found. The high number of conflicts between parents and their ambivalently acculturated daughters partly explained the relation between acculturation and problem behavior. The findings emphasized that gender and parent—child conflict should be considered when attempting to understand the complex relation between acculturation and problem behavior.

The effect of acculturation and social support on change in mental health among young immigrants

The aim of the study was to examine the mediating and moderating roles of social support in the acculturation–mental health link, and to investigate how these processes combine with self-esteem to affect mental health change. Questionnaire data were collected twice from 137 immigrant students, first at the upstart in junior high school, and then again a year later (8th and 9th grade). Acculturation was described in positive terms as a developmental process towards gaining competence within more than one sociocultural setting. Perceived discrimination and ethnic identity crisis were included as risk factors in this process. A model of structural relations was tested, which after some modifications demonstrated a close fit to the data. The results supported our suggestions of two indirect paths of effects of acculturation on mental health change: one through culture domain-specific social support and another through self-esteem. Self-esteem was also identified as a mediator of identity crisis. Significant interaction effects between social support and culture competencies were demonstrated in addition to buffer effects of class and family support in relation to identity crisis and discrimination respectively. The study adds to our understanding of positive and negative developmental pathways in multicultural societies.

Health-related quality of life in indigenous Sami schoolchildren in Sweden

AIM

To investigate health-related quality of life (HRQOL) in indigenous Sami schoolchildren in Sweden and its associations with sex, age, enculturation and ethnicity-related negative treatment.

METHODS

The study population was comprised of all children in grades 6-12 (ages 12-18 years) who attended specific Sami school programmes in Sweden. HRQOL was measured by the Kidscreen-52 self-report form, which was filled in at school (n = 121).

RESULTS

The indigenous Sami children in Sweden experienced lower HRQOL than Swedish children in general, with regard to their school situation, financial resources, parents' relations, physical well-being and social support from peers. In Sami children, functioning and well-being generally decreased by older age group and girls reported lower physical well-being, more negative feelings and more negative self-perception than boys. Finally, more than half of the Sami children had experienced ethnicity-related negative treatment, and these children reported a robustly lower functioning and well-being compared with those without this experience.

CONCLUSION

In some aspects of HRQOL, indigenous Sami schoolchildren with an explicit ethnic identity experienced less favourable functioning and well-being than Swedish children in general, which is worrisome. A high degree of ethnicity-related negative treatment may partly explain this lower HRQOL in Sami children.

The Influence of Mental Health, Psychosocial Factors, and Educational Skills on the Educational Aspirations of Indigenous Sámi and Non-Indigenous Adolescents in the Arctic

Background:

Mental health and psychosocial factors seem to influence the educational aspirations of adolescents, which are also known to be related to educational skills and sociodemographic factors such as gender, ethnicity, religious affiliation, and socioeconomic status. Previously, the relationship between educational aspirations and mental health, psychosocial factors, and educational and sociocultural conditions has not been investigated in Arctic adolescents.

Objective:

We aimed to investigate the influence of mental health, psychosocial factors, and educational skills on educational aspirations among multiethnic adolescents in an Arctic sociocultural context.

Method:

The Norwegian Arctic Adolescent Health Study, which was conducted from 2003 to 2005, is a cross-sectional school-based survey. Individuals from the total population of 5877 tenth graders between the ages of 15 and 16 years were invited to participate in the study. Of this group, 4881 participated (response rate, 83%), 50.1% were female, and 10% were indigenous Sámi.

Results:

Educational skills as measured by higher average mark were associated with higher aspirations; lower average mark was associated with lower aspirations. Weaker peer support and stronger parental involvement influenced aspirations in individuals with both higher and lower aspirations. Adolescents with lower rates of hyperactivity and inattention problems reported higher aspirations, whereas adolescents with emotional problems showed a greater inclination toward intermediate aspirations. In addition, males and Sámi adolescents showed lower aspirations and were more likely to be located in more remote and northern areas.

Conclusions:

This study confirmed earlier findings that educational skills have a strong influence on educational aspirations. However, mental health as well as social, familial, and residential contexts must be addressed to foster adolescents’ educational aspirations. Negative peer support for master’s and vocational degrees should be addressed by families and schools. Gender, ethnicity, and religious affiliation had limited effects on the educational aspirations of the students in this study.

Mapping resilience pathways of Indigenous youth in five circumpolar communities

This introduction to the Special Issue Indigenous Youth Resilience in the Arctic reviews relevant resilience theory and research, with particular attention to Arctic Indigenous youth. Current perspectives on resilience, as well as the role of social determinants, and community resilience processes in understanding resilience in Indigenous circumpolar settings are reviewed. The distinctive role for qualitative inquiry in understanding these frameworks is emphasized, as is the uniquely informative lens youth narratives can offer in understanding Indigenous, cultural, and community resilience processes during times of social transition. We then describe key shared cross-site methodological elements of the Circumpolar Indigenous Pathways to Adulthood study, including sampling, research design, procedures, and analytic strategies. The site-specific papers further elaborate on methods, focusing on those elements unique to each site, and describe in considerable detail locally salient stressors and culturally patterned resilience strategies operating in each community. The concluding paper considers these across sites, exploring continuities and discontinuities, and the influence of cross-national social policies.

Community resilience factors among indigenous Sámi adolescents: a qualitative study in Northern Norway

This qualitative study explores community resilience factors within an indigenous Sámi community in Northern Norway. Semistructured interviews were conducted with 22 informants, 12 females and 10 males, ranging in age from 13 to 19 years old, 12 of whom had reindeer husbandry affiliation. Data analysis used a modified grounded theory approach and narrative analysis. Interpretation of the data was based on ecological perspectives theory and the identification of possible community resilience factors including Sámi language competence, use of recreational and natural resources, and traditional ecological knowledge, such as reindeer husbandry related activities. These cultural factors appear to strengthen adolescents' ethnic identity and pride, which in turn act as potential resilience mechanisms. Land was a significant arena for traditional practices and recreation. The majority of the youth reported support from relationships with extended godparents (fáddarat) and extended family (sohka) networks. The fáttar network was particularly strong among adolescents with reindeer husbandry affiliations. Native language competence and reindeer husbandry were key components in adolescent social networks. Interconnectedness among the community members and with the environment seemed to promote resilience and well-being. Two factors that excluded adolescents from full community membership and participation were being a nonnative Sámi language speaker and the absence of extended Sámi family networks.

A review of protective factors and causal mechanisms that enhance the mental health of Indigenous Circumpolar youth

OBJECTIVES

To review the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North.

STUDY DESIGN

A systematic literature review of peer-reviewed English-language research was conducted to systematically examine the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with elements of a realist review. From 160 records identified in the initial search of 3 databases, 15 met the inclusion criteria and were retained for full review. Data were extracted using a codebook to organize and synthesize relevant information from the articles.

RESULTS

More than 40 protective factors at the individual, family, and community levels were identified as enhancing Indigenous youth mental health. These included practicing and holding traditional knowledge and skills, the desire to be useful and to contribute meaningfully to one's community, having positive role models, and believing in one's self. Broadly, protective factors at the family and community levels were identified as positively creating and impacting one's social environment, which interacts with factors at the individual level to enhance resilience. An emphasis on the roles of cultural and land-based activities, history, and language, as well as on the importance of social and family supports, also emerged throughout the literature. More than 40 protective factors at the individual, family, and community levels were identified as enhancing Indigenous youth mental health. These included practicing and holding traditional knowledge and skills, the desire to be useful and to contribute meaningfully to one's community, having positive role models, and believing in one's self. Broadly, protective factors at the family and community levels were identified as positively creating and impacting one's social environment, which interacts with factors at the individual level to enhance resilience. An emphasis on the roles of cultural and land-based activities, history, and language, as well as on the importance of social and family supports, also emerged throughout the literature.

CONCLUSIONS

Healthy communities and families foster and support youth who are resilient to mental health challenges and able to adapt and cope with multiple stressors, be they social, economic, or environmental. Creating opportunities and environments where youth can successfully navigate challenges and enhance their resilience can in turn contribute to fostering healthy Circumpolar communities. Looking at the role of new social media in the way youth communicate and interact is one way of understanding how to create such opportunities. Youth perspectives of mental health programmes are crucial to developing appropriate mental health support and meaningful engagement of youth can inform locally appropriate and culturally relevant mental health resources, programmes and community resilience strategies.

Lived Challenges and Getting Through Them

Because of imposed rapid social change, Alaska Native youth are growing up in a context different from their elders and suffering far worse health and behavioral outcomes. This research seeks to understand (a) their everyday struggles and life challenges, (b) the practices and resources they rely on to get through challenges, and (c) the meaning they make from these experiences. Data were generated from interviews with 20 Alaska Native youth between the ages of 11 and 18 years, balanced by gender and age-group (early and late adolescence). Purposive sampling identified participants with a broad range of experiences. Following a semistructured guide, youth participated in face-to-face, audio-recorded interviews, transcribed verbatim. A codebook was developed using an iterative process and transcripts were coded using ATLAS.ti. The most commonly identified stressors were relationship loss, “not being there for me,” nonsupportive/hostile experiences, transitioning into adulthood, and boredom. Resilience strategies included developing and maintaining relationships with others, being responsible, creating systems of reciprocity, practicing subsistence living, and giving back to family and the community. These opportunities allowed youth to gain a sense of competence and mastery. When difficult experiences align with opportunities for being responsible and competent, youth are most likely to exhibit resilience.

'Diabesity' down under: overweight and obesity as cultural signifiers for type 2 diabetes mellitus

Although overweight and obesity are increasingly seen as the key ‘risk factors’ for Type 2 diabetes mellitus (T2DM), the relationship between them is complex and not well understood. There are many ‘risk factors’ for T2DM, including ageing, genetics, previous gestational diabetes, a family history of the disease, etc. the interplay of which is not entirely clear. While weight gain is a common symptom of T2DM and the disease appears to be more prevalent among ‘obese’ people, individuals from a broad range of weights (including those considered ‘healthy’) can develop the disease. However, in recent years, the idea that fatness is the risk factor and/or central cause of T2DM has become increasingly prevalent and naturalized in popular, academic, and public health discourses in Australia. In these convergences, the complex etiology of the disease and limitations in current knowledge are blurred or reconstituted. To date, the potency of overweight and obesity as cultural signifiers for T2DM and its consequences has received little attention. Drawing on an analysis of government reports, journal articles, and media coverage published since 1998, this article sets out to trace and unpack some of the contours of these convergences, while recognizing their entanglement in earlier moralizing discourses, which continue to have considerable salience.

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

Objectives

Self-rated health (SRH) and associated risk and protective correlates were investigated among two indigenous adolescent populations, Greenlandic Inuit and Norwegian Sami.

Design

Cross-sectional data were collected from “Well-being among Youth in Greenland” (WBYG) and “The Norwegian Arctic Adolescent Health Study” (NAAHS), conducted during 2003–2005 and comprising 10th and 11th graders, 378 Inuit and 350 Sami.

Methods

SRH was assessed by one single item, using a 4-point and 5-point scale for NAAHS and WBYG, respectively. Logistic regressions were performed separately for each indigenous group using a dichotomous measure with “very good” (NAAHS) and “very good/good” (WBYG) as reference categories. We simultaneously controlled for various socio-demographics, risk correlates (drinking, smoking, violence and suicidal behaviour) and protective correlates (physical activity, well-being in school, number of close friends and adolescent–parent relationship).

Results

A majority of both Inuit (62%) and Sami (89%) youth reported “good” or “very good” SRH. The proportion of “poor/fair/not so good” SRH was three times higher among Inuit than Sami (38% vs. 11%, p≤0.001). Significantly more Inuit females than males reported “poor/fair” SRH (44% vs. 29%, p≤0.05), while no gender differences occurred among Sami (12% vs. 9%, p≤0.08). In both indigenous groups, suicidal thoughts (risk) and physical activity (protective) were associated with poor and good SRH, respectively.

Conclusions

In accordance with other studies of indigenous adolescents, suicidal thoughts were strongly associated with poorer SRH among Sami and Inuit. The Inuit–Sami differences in SRH could partly be due to higher “risk” and lower “protective” correlates among Inuit than Sami. The positive impact of physical activity on SRH needs to be targeted in future intervention programs.

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.

The characteristics and experience of community food program users in arctic Canada: a case study from Iqaluit, Nunavut

BACKGROUND

Community food programs (CFPs), including soup kitchens and food banks, are a recent development in larger settlements in the Canadian Arctic. Our understanding of utilization of these programs is limited as food systems research has not studied the marginalised and transient populations using CFPs, constraining service planning for some of the most vulnerable community members. This paper reports on a baseline study conducted with users of CFPs in Iqaluit, Nunavut, to identify and characterize utilization and document their food security experience.

METHODS

Open ended interviews and a fixed-choice survey on a census (n = 94) were conducted with of users of the food bank, soup kitchen, and friendship centre over a 1 month period, along with key informant interviews.

RESULTS

Users of CFPs are more likely to be Inuit, be unemployed, and have not completed high school compared to the general Iqaluit population, while also reporting high dependence on social assistance, low household income, and an absence of hunters in the household. The majority report using CFPs for over a year and on a regular basis.

CONCLUSIONS

The inability of users to obtain sufficient food must be understood in the context of socio-economic transformations that have affected Inuit society over the last half century as former semi-nomadic hunting groups were resettled into permanent settlements. The resulting livelihood changes profoundly affected how food is produced, processed, distributed, and consumed, and the socio-cultural relationships surrounding such activities. Consequences have included the rising importance of material resources for food access, the weakening of social safety mechanisms through which more vulnerable community members would have traditionally been supported, and acculturative stress. Addressing these broader challenges is essential for food policy, yet CFPs also have an essential role in providing for those who would otherwise have limited food access.

Being useful: achieving indigenous youth involvement in a community-based participatory research project in Alaska

Objectives

To report on a participatory research process in southwest Alaska focusing on youth involvement as a means to facilitate health promotion. We propose youth-guided community-based participatory research (CBPR) as way to involve young people in health promotion and prevention strategizing as part of translational science practice at the community-level.

Study design

We utilized a CBPR approach that allowed youth to contribute at all stages.

Methods

Implementation of the CBPR approach involved the advancement of three key strategies including: (a) the local steering committee made up of youth, tribal leaders, and elders, (b) youth-researcher partnerships, and (c) youth action-groups to translate findings.

Results

The addition of a local youth-action and translation group to the CBPR process in the southwest Alaska site represents an innovative strategy for disseminating findings to youth from a research project that focuses on youth resilience and wellbeing. This strategy drew from two community-based action activities: (a) being useful by helping elders and (b) being proud of our village.

Conclusions

In our study, youth informed the research process at every stage, but most significantly youth guided the translation and application of the research findings at the community level. Findings from the research project were translated by youth into serviceable action in the community where they live. The research created an experience for youth to spend time engaged in activities that, from their perspectives, are important and contribute to their wellbeing and healthy living. Youth-guided CBPR meant involving youth in the process of not only understanding the research process but living through it as well.

Culturally responsive suicide prevention in indigenous communities: unexamined assumptions and new possibilities

Indigenous communities have significantly higher rates of suicide than non-Native communities in North America. Prevention and intervention efforts have failed to redress this disparity. One explanation is that these efforts are culturally incongruent for Native communities. Four prevalent assumptions that underpin professional suicide prevention may conflict with local indigenous understandings about suicide. Our experiences in indigenous communities led us to question assumptions that are routinely endorsed and promoted in suicide prevention programs and interventions. By raising questions about the universal relevance of these assumptions, we hope to stimulate exchange and inquiry into the character of this devastating public health challenge and to aid the development of culturally appropriate interventions in cross-cultural contexts.

The relationship between internalizing and externalizing symptoms and cultural resilience factors in Indigenous Sami youth from Arctic Norway

OBJECTIVES

To examine whether enculturation factors, like cultural activities, ethnic pride and native language competence, are related to decreased internalizing and externalizing symptoms in Indigenous Sami youth from Arctic Norway. The impact of self-efficacy on the relationship between enculturation factors and mental health problems was also examined.

STUDY DESIGN

Population-based, cross-sectional questionnaire study.

METHODS

The Norwegian Arctic Adolescent Health Study was conducted among 10th graders in junior high schools in north Norway during 2003-2005. The study sample consisted of 450 Indigenous Sami youth, aged 15-16 years. Internalizing symptoms were measured with the Hopkins Symptom Check List-10 (HSCL-10), while externalizing symptoms were measured by two subscales of the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

For boys, self-efficacy and participation in cultural activities were associated with decreased internalizing symptoms. Additionally, self-efficacy interacted with Sami language competence and cultural activities: when self-efficacy increased, these enculturation factors were related to symptom reduction. For girls, self-efficacy had an independent effect on internalizing symptoms and also strengthened the relationship between participation in cultural activities and reduced externalizing symptoms. Sami language competence was related to the reduction of both internalizing and externalizing symptoms in girls.

CONCLUSIONS

In the present study, several enculturation factors as well as self-efficacy were identified as potential protective factors against mental health problems. In order to develop theoretical models that explain the mechanisms between cultural resilience and mental health, there is a need for both qualitative studies and longitudinal studies.

Self-reported internalization symptoms and family factors in indigenous Sami and non-Sami adolescents in North Norway

Through differences in family socialization between indigenous and non-indigenous youth, there may be cultural differences in the impact of family factors on mental health outcome. Using structural equation modelling, this population-based study explored the relationship between symptoms of anxiety and depression and family factors in indigenous Sami and non-Sami boys and girls in North Norway. The findings show that family income was to a lesser degree related to internalization symptoms for Sami youth than non-Sami youth. For all groups except for Sami girls, family conflict and moving was associated with increasing symptoms. Sami boys differed from the other three groups with regard to the relationship between family connectedness and symptom level. These interaction effects were discussed in light of traditional Sami values and gender socialization. The present study has indicated that in the family socialization context, culture may be related to internalization symptoms in youth.

Editorial: Steps towards the Renovation of Acculturation Research Paradigms: What Scientists’ Personal Experiences of Migration Might Tell Science

Acculturation refers to cultural learning and adjustment in the context of continuous cross-cultural experience. Plato, in his ‘Laws’, considered cross-cultural imitation to be a risk arising from foreign commerce. In the 19th century, European theorists wrote of the amalgamation processes by which diverse peoples were culturally unified for the purposes of the nation-state. In the 20th century, acculturation research first focused on the cultural changes of conquered and dispossessed native peoples, and later on the cultural adaptation, assimilation, or integration of immigrants and other minorities. Native peoples and immigrants were stereotyped as genetically and culturally inferior and prone to diseases and mental illness. Thus, in most research, improved health became the criterion of successful acculturation, and further confusion came from the good intentions to advise public policy. A century of such research has come to no confident conclusions and has produced little useful information. Acculturation research paradigms need renovation. As one step forward, four acculturation researchers have here reflected on their own research in the light of their own acculturation experiences. Their self-observations and insights point to new questions and constructs, and eventually to new research paradigms.

Ethnic density in school classes and adolescent mental health

OBJECTIVE

The present study set out to examine the association between ethnic composition of school classes and prevalence of internalising and externalising problem behaviour among ethnic minority and majority students.

METHODS

Data were derived from the Dutch 2002 Health Behaviour in School-aged Children (HBSC) survey, a nationally representative cross-sectional study with a total of 5,730 adolescents, aged 11-18 and attending secondary school, of which 931 belong to ethnic minority groups. The data were analysed using a multilevel regression model.

RESULTS

The study revealed that, after taking individual characteristics like age, gender, educational level and family affluence into account, ethnic minority students on average report higher levels of externalising but not internalising problems. Ethnic density on the level of school classes modified this difference, as a negative association between the proportion ethnic minority students in class and externalising problem behaviour was found, but only for ethnic minority students. No effect of ethnic composition was found with respect to internalising problem behaviour.

CONCLUSION

The data revealed that ethnic minority students report higher levels of externalising problem behaviour, but only in classes with a minority of ethnic minority students and not in classes with a culturally diverse composition. This points towards a possible beneficial effect of a more culturally diverse environment for minority students. Majority students appeared to be insensitive for the ethnic density effect. Future studies should investigate the role of the ethnic composition of the school class more in-depth.

Prevalence of suicidal behaviour among indigenous Sami in northern Norway

OBJECTIVES

To summarize knowledge about suicidal behaviour among indigenous Sami living in northern Norway.

STUDY DESIGN

This summary is based on data from a register-based follow-up study (Study I) and the North Norwegian Youth Study (Study II)--a longitudinal questionnaire study conducted in 1994-1995 and 1997-1998.

METHODS

The cohort from Study I included 19,801 persons with Sami ethnic ancestry, 10,573 (53.4%) men and 9228 (46.6%) women. The cross-sectional sample analysed from Study II (1994/1995/T1) included 2691 adolescents (1402 females, 52%, and 1,289 males, 48%) aged 16-18 years.

RESULTS

Study I indicated that there was a significant moderate increased risk for suicide among indigenous Sami (SMR = 1.27, 95% confidence interval (CI): 1.02-1.56) compared to the reference population. In Study II, there were no significant ethnic differences in the prevalence of suicide attempts between Sami adolescents (10.5%) and their non-Sami peers (9.2%).

CONCLUSIONS

Although the finding of a moderate significant increased risk of suicide among Sami is consistent with the general findings among Indigenous peoples, the suicide rates found among Sami is moderate compared to several others Indigenous peoples. When it comes to suicide attempts, no ethnic differences in prevalence of suicide attempts were found between Sami adolescents and their non-Sami peers.

Health service use in indigenous Sami and non-indigenous youth in North Norway: a population based survey

Background

This is the first population based study exploring health service use and ethno-cultural factors in indigenous Sami and non-Sami youth in North Norway. The first aim of the present study was to compare the frequency of health service use between Sami adolescents and their non-indigenous peers. The second aim was to explore the relationships between health service use and ethno-cultural factors, such as ethnic context, Sami self-identification, perceived discrimination and Sami language competence. Finally, we wanted to explore the relationship between use of health services and emotional and behavioural problems.

Method

The Norwegian Arctic Adolescent Health Study was conducted among 10th graders (15-16 years old) in junior high schools in North Norway. The sample consisted of 4,449 adolescents, of whom 450 (10.1%) were indigenous Sami and 3,999 (89.9%) were non-Sami.

Results

Sami and non-Sami youth used all health services with equal frequency. However, several ethno-cultural factors were found to influence health service use. Sami youth in more assimilated ethnic contexts used general practitioners more than non-Sami youth. Youth with Sami self-identification had a higher probability of using the school health service compared with other youth. Ethnic barriers to health service use were also identified. Sami speaking youth with a high degree of perceived discrimination had lower probability of using school health services than non-Sami speaking youth. Sami youth with conduct problems were less likely than non-Sami to use psychologist/psychiatrist. The present study demonstrated a relationship between health need and actual health service use.

Conclusion

Culture-specific factors influenced the help-seeking process in indigenous youth; some factors acted as barriers against health service use and other factors increased the probability of health service use.

Mental health, substance use and suicidal behaviour among young indigenous people in the Arctic: a systematic review

The Arctic has been a subject to various socio-cultural changes; indigenous people living in the region have experienced injustice and oppression in different forms. Furthermore, there are currently various new social, political and environmental challenges. It has been assumed that the continuous socio-cultural transition has an influence on indigenous people's wellbeing. We conducted a systematic literature review with regard to epidemiological mental health research on Arctic indigenous children and adolescents. The aim was to describe the nature and scope of research conducted and to explore for possible regional and ethnic differences in mental health. It was found that current epidemiological knowledge is based mainly on cross-sectional studies from selected regions and limited to substance use and suicidal behaviour. Youth suicide rates are alarmingly high in many parts of the Arctic, particularly in Greenland and Alaska. Differences between indigenous and non-indigenous groups are also most evident and uniform across suicide studies, with rates being systematically higher among indigenous youth. Substance use is common throughout the Arctic, however, regional and ethnic differences in usage vary considerably. Other psychosocial problems remain largely unexplored. In addition, very little is known about the causes of mental health problems in general and the impact of rapid socio-cultural changes in particular. There are several methodological limitations in the studies included here, many related to the validity of research instruments in different cultural contexts. There is a need for longitudinal comparative studies from the entire Arctic with culturally relevant instruments addressing mental health in early childhood as well.

Climate change: the importance of place

Climate change-related risks are place-specific and path-dependent. Accordingly, location is an important determinant of hazardous exposure, and certain places will bear more risk than others. This article reviews the major environmental exposures associated with risky places in the U.S., including coastal regions, islands, the desert Southwest, vectorborne and zoonotic disease border regions, cities, and the U.S. Arctic (Alaska), with emphasis on exposures and vulnerable populations of concern. In addition to these hotspots, this study considers the ways in which the concept of place--the sense of human relationship with particular environments--will play a key role in motivating, developing, and deploying an effective public health response. In considering the importance of place, we highlight the concepts of community resilience and risk management, key aspects of a robust response to climate change in public health and other sectors.

Stroke and acute myocardial infarction in the Swedish Sami population: incidence and mortality in relation to income and level of education

BACKGROUND

Gender differences in cardiovascular diseases (CVD) among the Sami have been reported previously. The aim of the present study was to investigate the incidence of and mortality from stroke, subarachnoid haemorrhage (SAH), and acute myocardial infarction (AMI) in the Swedish Sami population between 1985 and 2002, and to analyse the potential impact of income and level of education on cardiovascular morbidity and mortality.

METHODS

A Sami cohort of 15,914 persons (4,465 reindeer herding and 11,449 non-herding Sami) were followed up from 1985 to 2002 with regard to incidence and mortality rates of AMI, stroke, and SAH. Incidence and mortality ratios were calculated using a demographically matched non-Sami control population (DMC) as the standard (71,550 persons).

RESULTS

There was no elevated risk of developing AMI among the Sami compared with the DMC. However, the mortality ratio of AMI was significantly higher for Sami women. Higher incidence rates of stroke and SAH for both Sami men and women was observed, but no differences in mortality rates. Apart from the reindeer-herding men who demonstrated lower levels of income and education, the income and education levels among Sami were similar to the DMC.

CONCLUSIONS

High mortality rates from AMI rather than stroke explain the excess mortality for CVD previously shown among Sami women. The results suggest that the differences in incidence of stroke between herding and non-herding Sami men, and between Sami women and non-Sami women, are caused by behavioural and psychosocial risk factors rather than by traditional socioeconomic ones.

Eyberg Child Behavior Inventory (ECBI): Norwegian norms to identify conduct problems in children

This article presents the first Norwegian standardization of an assessment tool specifically designed to measure childhood conduct problems. Norwegian norms for the Eyberg Child Behavior Inventory (ECBI) based on data obtained from a random population sample (N= 4063) of children in the age range of 4 to 12 years are presented. The sample was drawn from rural and urban areas within three Norwegian town districts. Clinical and research advantages of having a properly standardized assessment tool for this specific subclass of childhood psychiatric problems in Norway are discussed.

Mental health in migrant children

Many factors have been identified to explain differences in mental health problems between migrant and native children: the process of migration, the ethnic minority position of migrants, their specific cultural background and the selection of migrants. In this paper, the international literature regarding mental health of migrant children is reviewed using strict selection criteria. An extensive search was carried out to locate journal articles on the subject of mental health in migrant youth published since the 1990s. Only 20 studies met all inclusion criteria. Besides the conclusion that the studies did not unequivocally find an increased risk of mental health problems in migrant children, it proved to be very difficult to draw any sound conclusions with respect to these children's risk of mental health problems, since the impact of migration on children's mental health varied with the informants used and the characteristics of the migrant group and of the host country. The lack of univocal definitions of key terms further complicated generalised conclusions in this research field. As such, this research field is in urgent need of more research using standardised research designs, methodology and definitions. A proposition for this research design is made.

Ethnicity as a variable in mental health research: a systematic review of articles published 1990-2004

The objective of the study was to investigate how the ethnic variable has been used in mental health research, in theory, in measurement and classification criteria. Journal articles published 1990-2004 that address original research on psychopathology, treatment and mental health services and with "ethnic" or "ethnicity" in their title or abstract were selected. The papers were examined for their theoretical definition of ethnicity, how the ethnic data were collected and the criteria used to identify ethnic groups. The use of comparison groups and country of the studies were recorded. A total of 421 papers were identified. An explicit theoretical definition was found in 33 (7.8%) papers. Data collection procedure was mentioned in 248 (58.9%) and 104 (24.7%) papers described how data was converted into ethnic groups. The operationalizations of ethnicity have remained almost unchanged during the 15-year review period. Generally, the ethnic variable was incompletely reported. Confusion regarding which individual or social characteristics ethnicity refers to makes the research findings of limited value in clinical settings, and may continue to create misunderstanding about the effect of ethnicity in clinical contexts.

Low frequency of the disease-associated DRB1*15-DQB1*06 haplotype may contribute to the low prevalence of multiple sclerosis in Sami

This study confirms a low frequency of multiple sclerosis (MS) among Sami. Only 12 Sami with a diagnosis of MS were identified in the Norwegian Sami population, which represents a significantly lower prevalence of MS in Sami (30/10(5)) compared with other Norwegians (73-164/10(5)). The clinical characteristics as well as the results of human leukocyte antigen (HLA)-DRB1 and -DQB1 typing of the Sami MS patients are reported, showing that three (27%) of the Sami MS patients carried the MS-associated HLA-DRB1*15-DQB1*06 haplotype. Interestingly, the DRB1*15-DQB1*06 haplotype had a significantly reduced frequency among Sami controls (0.086) compared with non-Sami Norwegian controls (0.163) (P(corrected) = 0.015). The low frequency of the disease-associated DRB1*15-DQB1*06 haplotype in the Sami population may contribute to the low prevalence of MS in Sami, in addition to other yet unidentified genetic and environmental factors.

Outdoor activities and diet in childhood and adolescence relate to MS risk above the Arctic Circle

BACKGROUND

A relationship between the latitude related distribution of multiple sclerosis (MS) and exposure to sunlight has long been considered. Higher sun exposure during early life has been associated with decreased risk of MS.

OBJECTIVE

Since Norway is an exception to the latitude gradient of MS prevalence, we tested here whether sunlight exposure or vitamin D-related dietary factors in childhood and adolescence are associated with the risk of MS.

METHODS

Retrospective recall questionnaire data from 152 MS patients and 402 population controls born at and living at latitudes 66-71 degrees N were analysed by means of conditional logistic regression analysis accounting for the matching variables age, sex, and place of birth.

RESULTS

Increased outdoor activities during summer in early life were associated with a decreased risk of MS, most pronounced at ages 16-20 years (odds ratio (OR) 0.55, 95% CI 0.39-0.78, p = 0.001, adjusted for intake of fish and cod-liver oil). A protective effect of supplementation with cod-liver oil was suggested in the subgroup that reported low summer outdoor activities (OR 0.57, 95% CI 0.31-1.05, p = 0.072). Consumption of fish three or more times a week was also associated with reduced risk of MS (OR 0.55, 95% CI 0.33-0.93, p = 0.024).

CONCLUSION

Summer outdoor activities in childhood and adolescence are associated with a reduced risk of MS even north of the Arctic Circle. Supplemental cod-liver oil may be protective when sun exposure is less, suggesting that both climate and diet may interact to influence MS risk at a population level.

Substance use in young indigenous Sami: an ethnocultural and longitudinal perspective

The cross-sectional and prospective influences of ethnocultural factors on substance use were explored among indigenous Sami in northern Norway. Longitudinal data was collected in 1994/95 (school-based survey; N = 675; RR: 85%; late adolescence: 15-19; 54% females) and 1997/98 (combined school-based and postal questionnaire study; N = 360; RR: 57%; young adulthood; 18-22; 62% females). When controlled for sociodemographics, logistic regression analyses indicated that favoring assimilation, residing in assimilated contexts, and having a weaker ethnic identity were associated with more drinking in late adolescence. Prospectively, favoring assimilation in late adolescence predicted the respondents' perception of excessive drinking in young adulthood. In late adolescence, the effect of assimilation on current smoking was moderated by living in an assimilated context and associated with stronger ethnic group identification. Prospectively, favoring assimilation in late adolescence predicted current smoking in young adulthood. Generally, less Sami oriented individuals were more likely to use substances. The implications and limitations of the findings along with recommendations for future research were discussed.

Suicide among Indigenous Sami in Arctic Norway, 1970–1998

Suicide mortality was examined between 1970 and 1998 in a cohort of 19,801 persons categorized as indigenous Sami in Arctic Norway. Standardized mortality ratios (SMR) were calculated using the suicide rates of the rural population of Arctic Norway as reference. There was a significant moderate increased risk for suicide among indigenous Sami (SMR = 1.27, 95% Confidence interval (CI): 1.02-1.56). In the study period, 89 suicides occurred in the cohort (70 men and 19 women) with increased suicide mortality both for indigenous Sami males (SMR = 1.27; 95% CI: 0.99-1.61) and females (SMR = 1.27; 95% CI: 0.77-1.99). Significant increased suicide mortality was found for young Sami aged 15-24 for both males (SMR = 1.82; 95% CI: 1.13-2.78) and females (SMR = 3.17; 95% CI: 1.17-6.91). Significant increased suicide mortality was found for indigenous Sami males residing in Sami core area (SMR = 1.54; 95% CI: 1.04-2.20) and for indigenous Sami males not belonging to semi-nomadic reindeer herding (SMR = 1.30; 95% CI: 1.00-1.65). Clusters of suicides in Sami core area may explain the increased suicide mortality found in subgroups among indigenous Sami.

Suicide attempts among indigenous Sami adolescents and majority peers in Arctic Norway: prevalence and associated risk factors

The prevalence of suicide attempts and associated risk factors such as sociodemographic conditions, emotional/behavioural problems and parent-child relationships were examined among 591 indigenous Sami and 2100 majority adolescents in Arctic Norway. There were no significant ethnic differences in prevalence of suicide attempts. In both ethnic groups, suicidal ideation, anxious/depressed problems and eating behaviour problems were associated with suicide attempts. Cross-cultural differences in risk factors associated with suicide attempts existed. For Sami adolescents, factors diverging from the traditional cultural norms were associated with suicide attempts, such as alcohol intoxication, single-parent home and paternal overprotection (p</=.05). Vocational studies, not living together with parents, current smoking and experienced sexual intercourse were ethnic specific risk factors associated with suicide attempts among majority peers (p</=.05). Clinicians should take into account that risk factors can differ between ethnic groups and should be sensitive to culturally divergent behaviour.

Predicting internalizing problems in Moroccan immigrant adolescents in The Netherlands

BACKGROUND

With the increasing number of immigrants worldwide, it is essential to have insight into the factors associated with internalizing problems in immigrant youth. However, little research on this subject has been conducted. The aim of the current study is to contribute to the knowledge in this field.

METHODS

Data were obtained from the general population of 11- to 18-year-old Moroccan immigrant adolescents in The Netherlands. Using the Child Behavior Checklist (CBCL), Youth Self-Report (YSR), and Teacher's Report Form (TRF), 415 parent, 376 self-, and 238 teacher reports were available for analysis.

RESULTS

The data showed relations between internalizing problems and several child (externalizing and chronic health problems), proximal family (paternal and maternal support and parent-child conflict), contextual family (conflicts between parents about parenting and total number of life-events), school/peer (being bored), and migration variables (adolescent's perceived discrimination). Moreover, a modest relation was found between internalizing problems and parental psychopathology. Few associations occurred with the global family factor (e.g., family educational level). Several relations between the predictors and YSR internalizing proved to be gender-specific.

CONCLUSIONS

Our results suggested that the child, school/peer, and proximal family factors are the most important in predicting the development of internalizing problems in Moroccan immigrant adolescents. The impact of the migration factor was small.

Predicting externalizing problems in Moroccan immigrant adolescents in the Netherlands

BACKGROUND

Although an increasing proportion of the population in Western countries originates from non-Western parts of the world, little research has been conducted on predictors of externalizing problems in immigrant adolescent samples. This study on the predictors of externalizing problems in Moroccan immigrant adolescents in the Netherlands was aimed to contribute to the knowledge in this field.

METHODS

We obtained 415 parent-reports, 376 self-reports and 238 teacher-reports on problem behavior in a general population sample of randomly selected 11- to 18-year-old Moroccan immigrant adolescents, using the Child Behavior Checklist, Youth Self-Report and Teacher's Report Form.

RESULTS

The data revealed a clear relation between externalizing problems and several child (gender, internalizing problems), proximal family (parental monitoring and affection, support from father and mother, and parent-child conflict), contextual family (conflicts between parents about parenting, destructive communication between parents, and total number of life-events), school/peer (problems at school, involvement with deviant peers, hanging out), and migration variables (adolescent's perceived discrimination). Hardly any association was observed between externalizing problems and parental psychopathology, and between externalizing problems and global family variables (e.g., family employment level). Most findings matched results found in earlier studies on non-immigrant youth.

CONCLUSIONS

Our results suggest that the child, school/peer, and proximal family factors are essential in models predicting the development of externalizing behavior. The impact of the migration factor on externalizing problems turned out to be relatively small.

Mental health of Sami youth

Sami children and adolescents are the indigenous youngsters in Norway, mainly resided in the arctic part of the country. While disadvantaged living conditions, risk behavior and psychososial health problems has been shown for children and youth from many indigenous groups worldwide, the research among Sami youngsters is sparse. However, recent research show that compared to the Norwegian majority group, Sami children and adolescents have just as good mental health as their majority peers. They also show less risk taking behavior as substance and drug use, have less eating problems and have a stronger body satisfaction. However, the smoking rates are high as for their Norwegian counterparts. Intragroup studies show that Sami adolescents grown up in Sami dominated areas, have a strong bicultural identification, are practicing more Sami cultural behavior and have a better mental health compared to Sami peers in marginal Sami areas. Ethnocultural factors have only a slight impact on behavior problems among young Sami and particularly among boys in the marginal Sami areas.