Norwegian Arctic Adolescent Health Study Research Articles

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

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. 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. 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. 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.

Against All Odds? Sami women's lower NEET experience in an Arctic Context: Education and Work Participation among Multicultural Young People in Northern-Norway, the Norwegian Arctic Adolescent Health Study (NAAHS)

The present paper explores Sami women’s lower NEET (Not engaged in Education, Employment or Training) experience in an ethnoreligious multicontext perspective. Data are derived from a cross-sectional cohort and registry follow-up study in Northern Norway, 2003–2012, and data from Statistics Norway are included for an up-to date data analysis (2021). This is a cross-sectional cohort and registry data study in Northern Norway, 2003-2012. The participants were adolescents and young people. Out of 5 877 10th graders 83% answered a questionnaire in a cross-sectional study, the Norwegian Arctic Adolescent Health Study (NAAHS), whereas consent-based follow-up consisted of 68% (3987 young people). There is an ethnic self-report of 9.2% with Sami ethnicity in the respondent/consent group, hence 10% in NAAHS. The outcome variables were educational aspirations, non-completion of upper secondary school, tertiary education, and NEET experience among female Sami young adults as explained by ethnoreligious affiliation. The explanatory variables are sociodemographic factors (gender, ethnicity, residency). Stratification of the participants are made by dividing girls and boys, Sami, and non-Sami, Laestadian and non-Laestadian and residency by counties in Arctic Norway (previously Finnmark, Troms and Nordland). The results show that Sami women stood positively out compared to majority women and all men through the footprint to work participation. Some of the conclusions from the study is that sociocultural and macroeconomic factors must be considered to create means for Sami women’s work participation.

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

ABSTRACT 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.

Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people.

The aim of this study was to examine the associations between self-harm and suicidal behavior in indigenous Sami and non-Sami adolescents and mental health and social outcomes in young adulthood. Data were obtained by linking the Norwegian Patient Registry (2008-2012), the National Insurance Registry (2003-2013), and the Norwegian Arctic Adolescent Health Study, a school-based survey inviting all 10th grade students in North Norway (2003-2005). In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage, of whom 9.2% were indigenous Sami. Multivariable logistic regression was used to explore the associations between self-harm only, suicidal ideation with and without self-harm, and suicide attempts in adolescence (≤16-year-old), and later mental health disorders, long-term medical, social welfare benefit receipt, or long-term unemployment in young adulthood. Self-harm and suicidal behavior in Sami and non-Sami adolescents were associated with increased risk of later mental health disorders, long-term welfare benefit receipt, and long-term unemployment. These associations were attenuated by adolescent psychosocial problems. No major differences between the indigenous Sami participants and their non-Sami peers were found. Young suicide attempters experienced the highest risk, with adolescent suicide attempts being significantly associated with all four adult outcomes after adjustment. Self-harm and suicidal behavior in adolescence are markers of mental health disorders and unfavorablesocial outcomes in young adulthood, mostly accounted for by adolescent psychosocial problems. In contrast to other indigenous peoples, no indigenous health disparities were found, indicating that the indigenous Sami adolescents were not worse off.

Multisite musculoskeletal pain in adolescence as a predictor of medical and social welfare benefits in young adulthood: The Norwegian Arctic Adolescent Health Cohort Study.

Pain in adolescence is associated with mental health problems, the main reason for work disability in young adults. This study explores the relationship between multisite musculoskeletal pain in adolescence and later medical (sickness and medical rehabilitation benefits) and social welfare benefits, adjusted for sociodemographic, adolescent psychosocial and mental health problems. Data were obtained by linkage between the National Insurance Registry (2003-11) and the Norwegian Arctic Adolescent Health Study, a school-based survey in North Norway (2003-05), accepted by 3987 fifteen- to sixteen-year-olds (68% of the total population). The start of the follow-up time was July 1st of the corresponding year the participants responded to the health study. Musculoskeletal pain was measured by the number of musculoskeletal pain sites. We found a positive linear relationship between adolescent musculoskeletal pain sites and the occurrence of medical and social welfare benefits in young adulthood (p≤0.001). Adolescent musculoskeletal pain was a significant predictor of sickness (p<0.001) and social welfare benefits in females (p=0.036), when adjusted for adolescent psychosocial and mental health problems. The most important adolescent psychosocial predictors were externalizing problems, less parental involvement and adverse life events. Adolescent multisite musculoskeletal pain was found to be an important predictor of later sickness and social welfare benefit receipt from adolescence to young adulthood. Adolescents with multisite musculoskeletal pain are at substantially increased risk of health and social difficulties into young adulthood. Identification and interventions for these adolescent problems could alleviate this risk and be a sound socioeconomic investment.

Multisite musculoskeletal pain in adolescence and later mental health disorders: a population-based registry study of Norwegian youth: the NAAHS cohort study

ObjectivesTo examine the association between multisite musculoskeletal pain in adolescence and mental health disorders in young adulthood.Design and settingData were obtained from a linkage between the Norwegian Patient Registry (2008–2012)...

Concurrent adversities and deliberate self-harm among indigenous Sami and majority Norwegian adolescents: the Norwegian Arctic Adolescent Health Study

Abstract Background: Few studies have investigated proximal relationships between deliberate self-harm (DSH) and concurrent adversities. Objective: We aimed to investigate these relationships in a community population of 4881 indigenous Sami and majority Norwegian adolescents, 15 to 16 years old, and related to ethnicity and gender. Methods: Youth with and without self-reports of DSH last year were compared on 12 concurrent adversities, on scales measuring family and peer functioning, and on sociodemographic conditions. Results: DSH last year was reported by 22.3% of the adolescents, and by more girls (28.8%) than boys (15.9%). All 12 concurrent adversities were related strongly to DSH last year. Deliberate self-harmers reported twice as many concurrent adversities as non-DSHs, and a large effect size (Cohen’s d = 0.80) indicated a strong multiple additive relationship, but among DSHs no ethnic or gender differences were found. Multivariately, among Sami youth sexual abuse [odds ratio (OR), 8.4] was strongly related to DSH, whereas among majority Norwegians sexual abuse (OR, 3.9) and violence (OR, 4.5) were identified as the strongest predictors. Similarly, among boys violence from adults (OR, 8.8) was associated most strongly with DSH, whereas among girls sexual abuse (OR, 4.3) was the most robust predictor. DSHs reported more conflicts with parents, less family support and involvement, and more peer problems than non-DSHs, and DHS girls had more difficulties in these relationships than DHS boys. Only small ethnic differences were found. Conclusion: Adolescent DSHs reported twice as many concurrent adversities as non-DSHs, sexual abuse and violence were strongly related to DSH. Ethnic and gender differences in risk factors were found. Clinicians should inquire about traumatic experiences such as sexual and physical abuses, and should have a family, peer, and gender perspective in their work.

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

BackgroundEducation 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.MethodsThe 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.ResultsNon-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.ConclusionsThe 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.

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

BackgroundCompleted tertiary education is closely associated with employment and influences income, health and personal well-being.ObjectiveThe 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.DesignThe 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.ResultsCompletion 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.ConclusionsThe 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.

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

Abstract 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.

Musculoskeletal pain in Arctic indigenous and non-indigenous adolescents, prevalence and associations with psychosocial factors: a population-based study.

BackgroundPain is common in otherwise healthy adolescents. In recent years widespread musculoskeletal pain, in contrast to single site pain, and associating factors has been emphasized. Musculoskeletal pain has not been examined in Arctic indigenous adolescents. The aim of this study was to explore the prevalence of widespread musculoskeletal pain and its association with psychosocial factors, with emphasis on gender- and ethnic differences (Sami vs. non-Sami), and the influence of pain related functional impairment.MethodsThis is a cross-sectional study based on The Norwegian Arctic Adolescent Health Study; a school-based survey responded by 4,881 10th grade students (RR: 83%) in North Norway, in 2003–2005. 10% were indigenous Sami. Musculoskeletal pain was based on reported pain in the head, shoulder/neck, back and/or arm/knee/leg, measured by the number of pain sites. Linear multiple regression was used for the multivariable analyses.ResultsThe prevalence of musculoskeletal pain was high, and significantly higher in females. In total, 22.4% reported 3–4 pain sites. We found a strong association between musculoskeletal pain sites and psychosocial problems, with a higher explained variance in those reporting pain related functional impairment and in females. There were no major differences in the prevalence of musculoskeletal pain in Sami and non-Sami, however the associating factors differed somewhat between the indigenous and non-indigenous group. The final multivariable model, for the total sample, explained 21.2% of the variance of musculoskeletal pain. Anxiety/depression symptoms was the dominant factor associated with musculoskeletal pain followed by negative life events and school-related stress.ConclusionsAnxiety/depression, negative life events, and school-related stress were the most important factors associated with musculoskeletal pain, especially in those reporting pain related functional impairment. The most important sociocultural aspect is the finding that the indigenous Sami are not worse off.

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.

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.

Internalization symptoms, perceived discrimination, and ethnic identity in indigenous Sami and non-Sami youth in Arctic Norway

Objective. The aim of the present study was to compare symptoms of anxiety and depression among indigenous Sami and non-Sami youth in the Arctic part of Norway, and to examine the influence of perceived discrimination and ethnic identity on these symptoms. The relationship between ethnic self-labeling and native language competence on internalization symptoms was explored for Sami adolescents. Design. The Norwegian Arctic Adolescent Health Study was conducted among 10th graders in junior high schools in North Norway in 2003–2005. The sample consisted of 4449 adolescents, of whom 450 (10%) were indigenous Sami and 3999 (90%) were non-Sami. Anxiety and depressive symptoms were assessed using a short version of the Hopkins Symptom Checklist-10. Participants also completed The Multigroup Ethnic Identity Measure (MEIM) and a measure of perceived discrimination. Results. No differences were found among ethnic groups in internalization symptoms. Sami youth reported more discrimination than the non-Sami. Both MEIM and perceived discrimination were positively associated with internalization symptoms. Moreover, Sami youth who had not learned their native language at home were more vulnerable to experiencing internalization symptoms compared to Sami youth who had learned their native language at home. Conclusion. Culture-specific protective factors were discussed as potential explanations for the similarities between Sami and non-Sami youth. The present study documented a relationship between internalization symptoms and ethnic identity, perceived discrimination, and language loss. These findings could be understood as consequences of the recent colonial history and oppression of the indigenous Sami.

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

BackgroundThis 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.MethodThe 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.ResultsSami 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.ConclusionCulture-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.