non-Sami Population Research Articles

Religion and Health In Arctic Norway—The association of religious and spiritual factors with non-suicidal self-injury in the Sami and non-Sami adult population—The SAMINOR 2 Questionnaire Survey

ABSTRACT Research has found psychological dimensions of religiosity/spirituality (R/S) beneficial against non-suicidal self-injury (NSSI), whereas the effect of R/S social aspects is less studied. Using data from the SAMINOR 2 Questionnaire Survey (2012, n = 10,717 ages 18–69; response rate: 27%; non-Sami: 66%; females: 55%), we examined the association of R/S—religious attendance, congregational affiliation, Laestadian family background, religious importance/view of life—with NSSI in the adult Sami and non-Sami population of Arctic Norway. We also applied multivariable-adjusted regression models and mediation analyses to explore how religious participation transmits its effect on NSSI through violence exposure and symptoms of anxiety and depression. Across ethnicities, 3.3 percent (n = 355) reported lifetime NSSI—ranging from 1.2 percent among Laestadians to 7.7 percent in unaffiliated. Regular religious attendance had a significant negative total effect on NSSI (OR = .59). Ninety-five percent of this effect seemed to be due to fewer anxiety and depression symptoms in the attendance group.

Persistent pain associated with socioeconomic and personal factors in a Sami and Non-Sami population in Norway: an analysis of SAMINOR 2 survey data

ABSTRACT In international studies, higher prevalence of persistent pain has been reported in indigenous populations compared to majority populations. The present study aimed to determine the prevalence of persistent pain within a Sami and a non-Sami population in northern Norway, with adjustment for the confounding factors of age, sex, marital status, education, income, mental health, smoking status and ethnic background. Using SAMINOR 2 survey data including Sami and non-Sami populations, we analysed 5,546 responses, from individuals aged 40–79 years, to questions concerning persistent pain (≥ 3 months). In total, 2,426 (43.7%) participants reported persistent pain with differences between Sami women and non-Sami women (44.1% versus 51.1%, respectively), but none between Sami men and non-Sami men (38.7% versus 38.2%, respectively). Elderly Sami women were less likely to report persistent pain than were elderly non-Sami women. In men, no ethnic differences in pain were observed according to age-group. Marital status, education levels, household income, psychological distress, and smoking status did not influence the association between ethnicity and pain. Pain severity and location did not differ between Sami and non-Sami participants. In this study, we found only minor ethnic differences in persistent pain. Similar living conditions and cultural features may explain these findings.

Change in prevalence and severity of metabolic syndrome in the Sami and non-Sami population in rural Northern Norway using a repeated cross-sectional population-based study design: the SAMINOR Study

ObjectiveTo examine the change in both the prevalence and severity of metabolic syndrome (MetS) in the Sami and non-Sami in Northern Norway due to a lack of knowledge regarding the...

Season of birth, stillbirths, and neonatal mortality in Sweden: the Sami and non-Sami population, 1800–1899

ABSTRACT Seasonal patterns of neonatal mortality and stillbirths have been found around the world. However, little is known about the association between season of birth and infant mortality of pre-industrial societies in a subarctic environment. In this study, we compared how season of birth affected the neonatal and stillbirth risk among the Sami and non-Sami in Swedish Sápmi during the nineteenth century. Using digitised parish records from the Demographic Data Base at Umeå University, we applied logistic regression models for estimating the association of season of birth with stillbirths and neonatal mortality, respectively. Higher neonatal mortality was found among the winter- and autumn-born Sami, compared to summer-born infants. Stillbirth risk was higher during autumn compared to summer among the Sami, whereas we found no seasonal differences in mortality among the non-Sami population. We relate the higher neonatal mortality risk among winter-born Sami to differences in seasonality of living conditions associated with reindeer herding.

The association between cold extremes and neonatal mortality in Swedish Sápmi from 1800 to 1895

ABSTRACTBackground: Studies in which the association between temperature and neonatal mortality (deaths during the first 28 days of life) is tracked over extended periods that cover demographic, economic and epidemiological transitions are quite limited. From previous research about the demographic transition in Swedish Sápmi, we know that infant and child mortality was generally higher among the indigenous (Sami) population compared to non-indigenous populations.Objective: The aim of this study was to analyse the association between extreme temperatures and neonatal mortality among the Sami and non-Sami population in Swedish Sápmi (Lapland) during the nineteenth century.Methods: Data from the Demographic Data Base, Umeå University, were used to identify neonatal deaths. We used monthly mean temperature in Tornedalen and identified cold and warm month (5th and 95th) percentiles. Monthly death counts from extreme temperatures were modelled using negative binomial regression. We computed relative risks (RR) with 95% confidence intervals (CI), adjusting for time trends and seasonality.Results: Overall, the neonatal mortality rate was higher among Sami compared to non-Sami infants (62/1,000 vs 35/1,000 live births), although the differences between the two populations decreased after 1860. For the Sami population prior 1860, the results revealed a higher neonatal incidence rate during cold winter months (<−15.4°C, RR = 1.60, CI 1.14–2.23) compared to infants born during months of medium temperature. No association was found between extreme cold months and neonatal mortality for non-Sami populations. Warm months (+15.1°C) had no impact on Sami or non-Sami populations.Conclusions: This study revealed the role of environmental factors (temperature extremes) on infant health during the demographic transition where cold extremes mainly affected the Sami population. Ethnicity and living conditions contributed to differential weather vulnerability.

No ethnic disparities in nutritional adequacy between the Indigenous Sami and the non-Sami population living in rural Northern Norway—the SAMINOR 2 Clinical Survey

The diet of the Indigenous Sami people has become more Westernized. The lack of population-based data on nutrient intake and nutritional adequacy, in combination with a high prevalence of obesity/metabolic syndrome among Sami, was the rationale behind the present study. We hypothesized that differences in nutrient intake between Sami and non-Sami populations may still exist but that these differences are likely small, especially with respect to nutritional contributors to cardiometabolic health. We used cross-sectional data from the SAMINOR 2 Clinical Survey (2012-2014) to study nutrient intake, assessed by a food frequency questionnaire, in 2743 non-Sami, 622 multiethnic Sami, and 1139 Sami participants aged 40-69 years. We applied quantile regression to study ethnic and inland/coastal regional differences. The median intake of most nutrients met the Estimated Average Requirements of the 2012 Nordic Nutrition Recommendations. However, the average intake of saturated fatty acids and sodium was higher, and average intake of fiber was lower than recommended, regardless of ethnicity and geographic region. The diet of Sami vs non-Sami participants and participants from the inland vs coastal region contained significantly more iron and vitamin B12. We found a number of statistically significant ethnic differences in nutrient intake; however, many of these differences were small (3%-4%). We observed no ethnic disparities in nutritional adequacy between Sami and non-Sami populations living in rural Northern Norway. Our results suggest that, compared to the non-Sami, the Sami have a dietary intake that may reduce their risk of iron deficiency but not their cardiometabolic risk.

Resilience to Discrimination Among Indigenous Sami and Non-Sami Populations in Norway: The SAMINOR2 Study

Discrimination is generally negative for mental health and well-being; however, few studies have examined protective effects of resilience factors, especially among minority indigenous people. Here, we validated a short version of the Resilience Scale for Adults (RSA) and examined its protective effects against discrimination among Norwegian indigenous Sami and non-Sami populations. Data come from a large population-based survey of health and living conditions in multiethnic areas among indigenous Sami and non-Sami population (the SAMINOR2 study). The information was collected in 2012 from 11,600 participants (18-69 years old). The main outcome measures were mental health (or distress) as measured with the Hopkins Symptom Check List (HSCL-10) and well-being as measured with the WHO-5 index by the World Health Organization. A 10-item short version of the original RSA (33 items) showed good model fit in all ethnic strata as well as factorial invariance, thus indicating cross-cultural validity. Being exposed to discrimination in general was more negative for the main outcome measures than exposure to ethnic discrimination alone; however, high scores on the RSA-10 almost canceled this negative effect completely. Minority participants with a strong Sami identity ( N = 1,270) were least negatively influenced by discrimination, whereas majority ethnic Norwegians ( N = 5,233) were most negatively affected. The strong Sami subgroup, thus, showed a remarkable resilience despite considerable exposure to discrimination. Members of this group were synergetically protected by individual ( personal strength) and family ( cohesion) resilience factors.

Sense of coherence of reindeer herders and other Samis in comparison to other Swedish citizens

BackgroundSamis are indigenous people in north Europe. In the territory called Sápmi (Lapland), reindeer herding is the traditional base for the Sami economy. The relation between living conditions and positive health of the Swedish Samis has been sparsely studied. As health is closely linked to sense of coherence (SOC), an understanding of the background factors to SOC may contribute knowledge that might be useful in promoting living conditions and health.MethodsThe study examines relations between the level of SOC and background factors from surveys in a Sami population (n=613) in comparison to a non-Sami population (n=525) in Sweden, and in comparison between 2 subsamples of Samis, that is, herders and non-herders.ResultsThere are more similarities than differences between the Sami and non-Sami populations. However, dividing the Sami population, reindeer herders had significantly lower SOC, and in specific the subcomponent manageability, that is, less ability to use available resources to meet different demands in life, compared to non-herders.ConclusionsIn addition to age and health, predictors of SOC are related to the life form of reindeer husbandry and the belonging to the herding community.

The confidence in health care and social services in northern Sweden – a comparison between reindeer-herding Sami and the non-Sami majority population

To investigate the confidence in primary health care, psychiatry and social services among the reindeer-herding Sami and the non-Sami population of northern Sweden. A semi-randomized, cross-sectional study design comprising 325 reindeer-herding Sami (171 men, 154 women) and a control population of 1,437 non-Sami (684 men, 753 women). A questionnaire on the confidence in primary health care, psychiatry, social services, and work colleagues was distributed to members of reindeer-herding families through the Sami communities and to the control population through the post. The relative risk for poor confidence was analyzed by calculating odds ratios with 95% confidence intervals adjusted for age and level of education. The confidence in primary health care and psychiatry was significantly lower among the reindeer-herding Sami compared with the control group. No differences were found between men and women in the reindeer-herding Sami population. In both the reindeer-herding Sami and the control population, younger people (≤ 48 years) reported significantly lower confidence in primary health care than older individuals (>48 years). A conceivable reason for the poor confidence in health care organizations reported by the reindeer-herding Sami is that they experience health care staff as poorly informed about reindeer husbandry and Sami culture, resulting in unsuitable or unrealistic treatment suggestions. The findings suggest that the poor confidence constitutes a significant obstacle of the reindeer-herding Sami to fully benefit from public health care services.

Mammographic screening in Sami speaking municipalities and a control group. Are early outcome measures influenced by ethnicity?

Objectives. Female citizens of Sami (the indigenous people of Norway) municipalities in northern Norway have a low risk of breast cancer. The objective of this study was to describe the attendance rate and outcome of the Norwegian Breast Cancer Screening Program (NBCSP) in the Sami-speaking municipalities and a control group.Study design. A retrospective registry-based study.Methods. The 8 municipalities included in the administration area of the Sami language law (Sami) were matched with a control group of 11 municipalities (non-Sami). Population data were accessed from Statistics Norway. Data regarding invitations and outcome in the NBCSP during the period 2001–2010 was derived from the Cancer Registry of Norway (CRN). The NBCSP targets women aged 50–69 years. Rates and percentages were compared using chi-square test with a p-value<0.05 as statistical significant.Results. The attendance rate in the NBCSP was 78% in the Sami and 75% in the non-Sami population (p< 0.01). The recall rates were 2.4 and 3.3% in the Sami and non-Sami population, respectively (p<0.01). The rate of invasive screen detected cancer was not significantly lower in the Sami group (p=0.14). The percentage of all breast cancers detected in the NBCSP among the Sami (67%) was lower compared with the non-Sami population (86%, p=0.06).Conclusion. Despite a lower risk of breast cancer, the Sami attended the NBCSP more frequently than the control group. The recall and cancer detection rate was lower among the Sami compared with the non-Sami group.

What is known about the health and living conditions of the indigenous people of northern Scandinavia, the Sami?

BackgroundThe Sami are the indigenous ethnic population of northern Scandinavia. Their health condition is poorly known, although the knowledge has improved over the last decade.ObjectivesThe aim was to review the current information on mortality, diseases, and risk factor exposure in the Swedish Sami population.DesignHealth-related research on Sami cohorts published in scientific journals and anthologies was used to compare the health condition among the Sami and the majority non-Sami population. When relevant, data from the Sami populations in Swedish were compared with corresponding data from Norwegian and Finnish Sami populations.ResultsLife expectancy and mortality patterns of the Sami are similar to those of the majority population. Small differences in incidences of cancer and cardiovascular diseases have been reported. The traditional Sami lifestyle seems to contain elements that reduce the risk to develop cancer and cardiovascular diseases, e.g. physical activity, diet rich in antioxidants and unsaturated fatty acids, and a strong cultural identity. Reindeer herding is an important cultural activity among the Sami and is associated with high risks for accidents. Pain in the lower back, neck, shoulders, elbows, and hands are frequent among both men and women in reindeer-herding families. For men, these symptoms are related to high exposure to terrain vehicles, particularly snowmobile, whereas for women psychosocial risk factors seem to more important, e.g. poor social support, high effort, low reward, and high economical responsibilities.ConclusionsAlthough the health condition of the Sami population appears to be rather similar to that of the general Swedish population, a number of specific health problems have been identified, especially among the reindeer-herding Sami. Most of these problems have their origin in marginalization and poor knowledge of the reindeer husbandry and the Sami culture in the majority population. It is suggested that the most sustainable measure to improve the health among the reindeer-herding Sami would be to improve the conditions of the reindeer husbandry and the Sami culture.

Norwegian Sami differs significantly from other Norwegians according to their HLA profile

This study reports extensive genomic data for both human leukocyte antigen (HLA) class I and II loci in Norwegian Sami, a native population living in the northwest of Europe. The Sami have a distinct culture and their own languages, which belong to the Uralic linguistic family. Norwegian Sami (n = 200) were typed at the DNA level for the HLA-A, -C, -B, -DRB1 and -DQB1 loci, and compared with a non-Sami Norwegian population (n = 576). The two populations exhibited some common genetic features but also differed significantly at all HLA loci. The most significantly deviating allele frequencies were an increase of HLA-A*03, -B*27, -DRB1*08 and -DQB1*04 and a decrease of HLA-A*01, C*01, -DRB1*04 and -DQB1*02 among Sami compared with non-Sami Norwegians. The Sami showed no deviation from Hardy-Weinberg equilibrium. The hypothesis of selective neutrality was rejected at all loci except for the A- and C- loci for the Sami. HLA haplotype frequencies also differed between the two populations. The most common extended HLA haplotypes were A*02-B*27-C*01-DR*08-DQB1*04 in the Sami and A*01-B*08-C*07-DR*03-DQB1*02 in the other Norwegians. Genetic distance analyses indicated that the Norwegian Sami were highly differentiated from other Europeans and were most closely related to Finns whose language also belongs to the Uralic linguistic family. In conclusion, the Norwegian Sami and the non-Sami Norwegians were significantly different at all HLA loci. Our results can be explained by the fact that the two populations have different origins and that the Sami population has remained smaller and more isolated than its neighbors.

Cancer in the Sami population of Sweden in relation to lifestyle and genetic factors

The reindeer herding Sami of Sweden have low incidences of cancer. The aim of the present study was to investigate the cancer risk in a large cohort of Swedish Sami, containing Sami with different lifestyle and genetic Sami heritage. A cohort of 41,721 Sami identified in official national registers between 1960 and 1997, was divided into two sub-populations -- reindeer herding Sami (RS) and non-reindeer herding Sami (NRS). A demographically matched non-Sami reference population (NS) was used as standard when incidence and mortality ratios were calculated. Incidence and mortality data were obtained from the Swedish Cancer and Cause of Death Registers for the period 1961-2003. For Sami men, lower risks were found for cancers of the colon and prostate, and for malignant melanoma and non-Hodkins lymphoma, but higher for stomach cancer. The Sami women showed higher risks for cancers of the stomach and the ovaries, but lower risk for cancer of the bladder. The RS demonstrated lower relative cancer risks compared with the NRS. The lowest relative risk was found among the RS men, while the highest were observed among the NRS women. The RS men who had adopted a more westernized lifestyle showed a similar relative risk for prostate cancer as that of the NS living in the same region. Most of these differences in cancer risks could probably be ascribed to differences in lifestyle. It is concluded that the traditional Sami lifestyle contains elements, e.g. dietary contents and physical activity that may protect them from developing cancer.

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

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. 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). 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. 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.

Ethnic variations in the initial phase of mental health treatment: A study of Sami and non‐Sami clients and therapists in northern Norway

Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.

Causes of death in the Sami population of Sweden, 1961–2000

Indigenous people often have a pattern of mortality that is disadvantageous in comparison with the general population. The knowledge on causes of death among the Sami, the natives of northern Scandinavia, is limited. The aim of the present study was to compare gender and cause specific mortality patterns for reindeer herding Sami, non-herding Sami, and non-Sami between 1961 and 2000. A Sami cohort was constructed departing from a group of index-Sami identified as either reindeer herding Sami or Sami eligible to vote for the Sami parliament. Relatives of index-Sami were identified in the National Kinship Register and added to the cohort. The cohort contained a total of 41 721 people (7482 reindeer herding Sami and 34 239 non-herding Sami). A demographically matched non-Sami reference population four times as large, was compiled in the same way. Relative mortality risks were analysed by calculating standardized mortality ratios (SMRs). The differences in overall mortality and life expectancy of the Sami, both reindeer herding and non-herding, compared with the reference population were relatively small. However, Sami men showed significantly lower SMR for cancers but higher for external causes of injury. For Sami women, significantly higher SMR was found for diseases of the circulatory system and diseases of the respiratory system. An increased risk of dying from subarachnoid haemorrhage was observed among both Sami men and women. The similarities in mortality patterns are probably a result of centuries of close interaction between the Sami and the non-Sami, while the observed differences might be due to lifestyle, psychosocial and/or genetic factors.