SAMINOR Study Research Articles

Do Childhood Boarding School Experiences Predict Health, Well-Being and Disability Pension in Adults? A SAMINOR Study

Indigenous Sámi and Kven minority children in Norway were during the 20th century placed at boarding schools to hasten their adoption of the Norwegian majority language and culture. This is the first population-based study examining health, well-being and disability pension rates among these children. Data stem from two epidemiological studies conducted in 2003/04 (SAMINOR 1) and 2012 (SAMINOR 2) by the Centre for Sami Health Research. The SAMINOR 1 study included N = 13,974 residents (50.1% women, Mage = 52.9 years) and n = 2,125 boarding participants (49.6% women, Mage = 56.2 years). The SAMINOR 2 part included N = 10,512 residents (55.5% women, Mage = 47.6 years) and n = 1246 boarding participants (48.7% women, Mage = 54.1 years). Main outcome measures are mental and general health, well-being and disability pension linearly regressed upon the predictors. We observed minor differences between boarding and non-boarding participants that generally disfavored the former, of which many disappeared after covariate adjustment. Boarding school participants reported more discrimination, violence, unhealthier lifestyle behavior (smoking), less education and household income compared to non-boarding participants. The exceptionally long timeframe between boarding school and the current outcome measures (40–50 years) is a likely reason for the weak associations. The study supports the international literature on health inequalities and highlights the risk of ill health following boarding school placement of indigenous or minority children. On a positive note, participants reporting stronger ethnic belonging (strong Sámi identity) were well protected, and even functioned better in terms of lower disability rates than majority Norwegians.

Coronary heart disease and stroke in the Sami and non-Sami populations in rural Northern and Mid Norway—the SAMINOR Study

BackgroundPrevious studies have suggested that Sami have a similar risk of myocardial infarction and a higher risk of stroke compared with non-Sami living in the same geographical area.DesignParticipants in the...

A descriptive study of ten-year longitudinal changes in weight and waist circumference in the multi-ethnic rural Northern Norway. The SAMINOR Study, 2003-2014.

The obesity epidemic is dynamic with varying secular trends and differences between countries and ethnic groups. The objective of this study was to describe the age- and sex-specific longitudinal changes in weight and waist circumference in a rural Norwegian population with a high proportion of the indigenous Sami population. Based on two population-based surveys, SAMINOR 1 (2003–2004) and SAMINOR 2 (2012–2014), we present longitudinal changes in weight and waist circumference according to age at baseline in the SAMINOR 1 Survey and sex during the 10-year period. The analyses included 1538 men and 1958 women aged 36 to 69 at baseline (birth year 1934 to 1967). Forty-one percent of the population were Sami. Both weight and waist circumference were measured. The mean weight increased 0.8 kg (95% confidence interval: 0.5, 1.1) in men and 0.3 kg (95% confidence interval: 0, 0.5) in women. In both men and women, younger individuals gained significantly more weight during the 10-year follow-up than older participants (p < 0.001). The mean weight showed a statistically significant increase in men aged 36–54 and women aged 36–49 at baseline and was statistically significantly reduced in men and women aged 60–69. The mean waist circumference increased by 6.3 cm (95% confidence interval: 6.0, 6.6) in men and 8.4 cm (95% confidence interval 8.1, 8.8) in women. The mean waist circumference increased statistically significantly from SAMINOR 1 to SAMINOR 2 in all age groups, and there was an inverse relationship between age at baseline and change in waist circumference (p < 0.001). Waist circumference increased more than can be explained by changes in weight and age during the 10-year period. The inverse relationships between age at baseline in SAMINOR 1 and the 10-year change in weight and waist circumference were found in both Sami and non-Sami participants. The findings underline the need for prevention of obesity, particularly in younger people, as it is difficult to achieve permanent weight loss.

Relationships between metabolic markers and obesity measures in two populations that differ in stature-The SAMINOR Study.

SummaryBackgroundThe relationships between metabolic markers and obesity measures may differ by ethnicity, sex, and height. Questions have been posed whether these relationships differ by ethnicity in the population in Northern Norway, but this has not been explored yet.ObjectivesInvestigate the relationships between metabolic markers and obesity measures in Sami and non‐Sami and explore the impact of stature.MethodsIn total, 13 921 men and women aged 30 and 36 to 79 years (22.0% Sami) from a population‐based cross‐sectional survey in Norway, the SAMINOR 1 Survey (2003‐2004, 57.2% attendance), were included. Relationships between triglycerides, high‐density lipoprotein cholesterol, glucose, systolic/diastolic blood pressure (BP), metabolic syndrome and diabetes mellitus as outcomes, and body mass index (BMI), waist circumference (WC), and waist‐to‐height ratio (WHtR), respectively, were modelled using fractional polynomial regression. Appropriate interaction analyses and adjustments were made.ResultsThe non‐Sami were approximately 6 cm taller than the Sami. No interactions were found between ethnicity and obesity. At the same levels of WC, BMI, or WHtR, levels of lipids and BP differed marginally between Sami and non‐Sami, but these were eliminated by height adjustment, with one exception: At any given WC, BMI, or WHtR, Sami had approximately 1.4 mmHg (95% CI, −2.1 to −0.7) lower systolic BP than non‐Sami (P values < .001).ConclusionsHeight explained the marginal ethnic differences in metabolic markers at the same level of obesity, except for systolic BP, which was lower in Sami than in non‐Sami at any given BMI, WC, or WHtR.

Weight underestimation linked to anxiety and depression in a cross-sectional study of overweight individuals in a Sami and non-Sami Norwegian population: the SAMINOR Study

ObjectivesUnderestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to...

Changes in conventional cardiovascular risk factors and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations in two population-based cross-sectional surveys: the SAMINOR Study

ObjectiveTo describe changes in cardiovascular risk factors and in the estimated 10-year risk of acute myocardial infarction (AMI) or cerebral stroke (CS) between SAMINOR 1 (2003–2004) and SAMINOR 2 (2012–2014),...

Estimated 8-year cumulative incidence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - The SAMINOR Study

BackgroundThe aim of the study was to estimate and compare the 8-year cumulative incidence of diabetes mellitus (DM) among Sami and non-Sami inhabitants of rural districts in Northern Norway.MethodsLongitudinal study based on linkage of two cross-sectional surveys, the SAMINOR 1 Survey (2003–2004) and the SAMINOR 2 Clinical Survey (2012–2014). Ten municipalities in rural Northern Norway were included in the study. DM-free participants aged 30 and 36–71 years in SAMINOR 1 were followed from 2 years after SAMINOR 1 to attendance in SAMINOR 2. The average follow-up time was 8.1 years. Of 5875 subjects who had participated in SAMINOR 1 and could potentially be followed to SAMINOR 2, 3303 were included in the final analysis. Self-reported DM and/or HbA1c ≥ 6.5% were used to identify incident cases of DM.ResultsAt baseline, body mass index (BMI) and waist-to-height ratio (WHtR) were higher among Sami than among their non-Sami counterparts. After 8 years of follow-up, 201 incident cases of DM were identified (6.1% both Sami and non-Sami subjects). No statistically significant difference was observed in the cumulative incidence of DM between the Sami and non-Sami.ConclusionsNo statistically significant difference in the 8-year cumulative incidence of DM among Sami and non-Sami was observed, although Sami men and women had higher baseline BMI and WHtR.

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...

The second clinical survey of the population-based study on health and living conditions in regions with Sami and Norwegian populations - the SAMINOR 2 Clinical Survey: Performing indigenous health research in a multiethnic landscape.

Background Globally, there is a huge lack of relevant research about widespread lifestyle diseases and living conditions in indigenous communities. Northern and Middle Norway have a history of multiple ethnic groups and the Sami has been acknowledged as the indigenous people of Norway by the Norwegian State. The SAMINOR 2 Clinical Survey, a part of the SAMINOR Study, was carried out to provide health information about the Sami population in Norway. Methods The cross-sectional population-based SAMINOR 2 Clinical Survey consists of both questionnaires and a clinical examination performed in 10 municipalities during 2012-2014. Results In total, 6004 men and women (participation rate 48%) aged 40-79 years took part in this study. In inland Finnmark, the Sami are in the majority (80-90%) as opposed to the coastline of Troms and Nordland, where the Sami population form a minority (20%). More women than men participated (54% versus 43%, respectively). Obesity was prevalent in this sample and a high mean glycated haemoglobin was observed. Conclusions: This article describes the methods and data collection of the SAMINOR 2 Clinical Survey and presents some characteristics of the sample. The definition of ethnic groups is a core question in the survey and includes several criteria. To ensure that indigenous values and priorities are reflected in the research themes, we recommend that future research projects be directed in close collaboration with the Sami Parliament and the local communities.

7.10-P3The Population-based Study on health and living in regions with Sami and Norwegian populations - the SAMINOR Study

7.10-P3The Population-based Study on health and living in regions with Sami and Norwegian populations - the SAMINOR Study

Same Sámi? A comparison of self-reported Sámi ethnicity measures in 1970 and 2003 in selected rural areas in northern Norway

In post-war Norway, only the 1970 national census has recorded ethnicity information about the indigenous Sámi, however restricted to those living in selected areas in the north. In this study, we combine replies about Sámi ethnicity given by the same individuals in Norway’s 1970 census and in the population-based SAMINOR study in 2003–04, to compare self-reported Sámi ethnicity at two points in time that encompass a period when the effects of a long-standing assimilation policy gradually lost ground in favour of upcoming Sámi revitalization. We found self-reported Sámi ethnicity – measured as (1) Sámi as home language in each of three generations and (2) the respondent’s self-identification as Sámi – to have remained generally stable, but some changes were observed. We argue that the results reflect interplays between societal and individual factors. We conclude that any statistical study involving an indigenous people, when clarifying the ethnicity measures, should also address the issue of ethnic mobility.

Prevalence of self-reported stomach symptoms after consuming milk among indigenous Sami and non-Sami in Northern- and Mid-Norway – the SAMINOR study

ObjectiveThe main purpose of this work was to identify the prevalence of self-reported stomach symptoms after consuming milk among Sami and non-Sami adults.Study designA cross-sectional population-based study (the SAMINOR study). Data were collected by self-administrated questionnaires.MethodSAMINOR is a population-based study of health and living conditions conducted in 24 municipalities in Northern Norway during 2003 and 2004. The present study included 15,546 individuals aged between 36 and 79, whose ethnicity was categorized as Sami (33.4%), Kven (7.3%) and Norwegian majority population (57.2%).ResultsSami respondents had a higher prevalence of self-reported stomach symptoms after consuming milk than the Norwegian majority population. The reporting was highest among Sami females (27.1%). Consumption of milk and dairy products (yoghurt and cheese) was high among all the ethnic groups. However, significantly more Sami than non-Sami never (or rarely) consume milk or cheese, and individuals who reported stomach symptoms after consuming milk had an significant lower intake of dairy products than those not reporting stomach symptoms after consuming dairy products. Sami reported general abdominal pain more often than the majority population. The adjusted models show a significant effect of Sami ethnicity in both men and women on self-reported stomach symptoms after consuming milk. In females, the odds ratio (OR)=1.77 (p=0.001) and in males OR=1.64 (p=0.001).ConclusionOur study shows that the Sami population reported more stomach symptoms after consuming milk, suggesting a higher prevalence of milk intolerance among the Sami population than the Norwegian majority population.

Ethnic discrimination and health: the relationship between experienced ethnic discrimination and multiple health domains in Norway's rural Sami population

ObjectiveSelf-reported ethnic discrimination has been associated with a range of health outcomes. This study builds on previous efforts to investigate the prevalence of self-reported ethnic discrimination in the indigenous (Sami) population, and how such discrimination may be associated with key health indicators.Study designThe study relies on data from the 2003/2004 (n=4,389) population-based study of adults (aged 36–79 years) in 24 rural municipalities of Central and North Norway (the SAMINOR study). Self-reported ethnic discrimination was measured using the question: “Have you ever experienced discrimination due to your ethnic background?” Health indicators included questions regarding cardiovascular disease, diabetes, chronic muscle pain, metabolic syndrome and obesity. Logistic regression was applied to examine the relationship between self-reported ethnic discrimination and health outcomes.ResultsThe study finds that for Sami people living in minority areas, self-reported ethnic discrimination is associated with all the negative health indicators included in the study.ConclusionWe conclude that ethnic discrimination affects a wide range of health outcomes. Our findings highlight the importance of ensuring freedom from discrimination for the Sami people of Norway.

Prevalence of self-reported myocardial infarction in Sami and non-Sami populations: the SAMINOR study

ObjectiveMeasure the prevalence of self-reported myocardial infarction (SMI) in Sami and non-Sami populations in rural areas of Norway, and explore whether possible ethnic differences could be explained by established cardiovascular risk factors.DesignCross-sectional population-based study.MethodsA health survey was conducted in 2003–2004 in areas with Sami and non-Sami populations (SAMINOR). The response rate was 60.9%. Information concerning lifestyle was collected by 2 self-administrated questionnaires, and clinical examinations provided anthropometric measurements, and data on blood pressure and lipid levels.ResultsThe total number for the subsequent analysis was 15,206 men and women aged 36–79 years (born 1925–1968). Sex-specific analyses revealed no ethnic difference in SMI. In terms of the most important risk factors such as smoking, blood pressure, and lipid levels, no or only trivial ethnic differences were found in both women and men.ConclusionIn this study, we found no difference in SMI between Sami and non-Sami in rural areas in Norway. The similar risk profile is the most plausible explanation; similar living conditions and close interaction between the ethnic groups may explain this.

Ethnic difference in the prevalence of angina pectoris in Sami and non-Sami populations: the SAMINOR study

ObjectiveTo assess the population burden of angina pectoris symptoms (APS), self-reported angina and a combination of these, and explore potential ethnic disparity in their patterns. If differences in APS were found between Sami and non-Sami populations, we aimed at evaluating the role of established cardiovascular risk factors as mediating factors.DesignCross-sectional population-based study.MethodsA health survey was conducted in 2003–2004 in areas with Sami and non-Sami populations (SAMINOR). The response rate was 60.9%. The total number for the subsequent analysis was 15,206 men and women aged 36–79 years (born 1925–1968). Information concerning lifestyle was collected by 2 self-administrated questionnaires, and clinical examinations provided data on waist circumference, blood pressure and lipid levels.ResultsThis study revealed an excess of APS, self-reported angina and a combination of these in Sami relative to non-Sami women and men. After controlling for age, the odds ratio (OR) for APS was 1.42 (p<0.001) in Sami women and 1.62 (p<0.001) for men. When including relevant biomarkers and conventional risk factors, little change was observed. When also controlling for moderate alcohol consumption and leisure-time physical activity, the OR in women was reduced to 1.24 (p=0.06). Little change was observed in men.ConclusionThis study revealed an excess of APS, self-reported angina and a combination of these in Sami women and men relative to non-Sami women and men. Established risk factors explained little or none of the ethnic variation in APS. In women, however, less moderate alcohol consumption and leisure-time physical activity in Sami may explain the entire ethnic difference.

Marginalisation and cardiovascular disease among rural Sami in Northern Norway: a population-based cross-sectional study

BackgroundLike other indigenous peoples, the Sami have been exposed to the huge pressures of colonisation, rapid modernisation and subsequent marginalisation. Previous studies among indigenous peoples show that colonialism, rapid modernisation and marginalisation is accompanied by increased stress, an unhealthy cardiovascular risk factor profile and disease burden. Updated data on the general burden of cardiovascular disease among the Sami is lacking. The primary objective of this study was to assess the relationship between marginalisation and self-reported lifetime cardiovascular disease (CVD) by minority/majority status in the rural Sami population of Norway.MethodsA cross-sectional population-based study (the SAMINOR study) was carried out in 2003-2004. The overall participation rate was 60.9% and a total of 4027 Sami individuals aged 36-79 years were included in the analyses. Data was collected by self-administrated questionnaires and a clinical examination.ResultsThe logistic regression showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely to report CVD as non-marginalised Sami living in Sami majority areas (OR 2.10, 95% CI: 1.40-3.14). No sex difference was found in the effects of marginalisation on self-reported life-time cardiovascular disease. Moderate to no intermediate effects were seen after including established CVD risk factors.ConclusionsThis study showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely as non-marginalised Sami from Sami majority areas to report lifetime cardiovascular disease (CVD). Moderate to no intermediate effects were seen after including established CVD risk factors, which suggest little difference in lifestyle related factors. Chronic stress exposure following marginalisation may however be a plausible explanation for some of the observed excess of CVD.

Which Sámi? Sámi inclusion criteria in population-based studies of Sámi health and living conditions in Norway – an exploratory study exemplified with data from the SAMINOR study

BackgroundIn a situation where national censuses do not record information on ethnicity, studies of the indigenous Sámi people's health and living conditions tend to use varying Sámi inclusion criteria and categorizations. Consequently, the basis on which Sámi study participants are included and categorized when Sámi health and living conditions are explored and compared differs. This may influence the results and conclusions drawn.ObjectiveTo explore some numerical consequences of applying principles derived from Norway's Sámi Act as a foundation for formalized inclusion criteria in population-based Sámi studies in Norway.DesignWe established 1 geographically based (G1) and 3 individual-based Sámi example populations (I1–I3) by applying diverse Sámi inclusion criteria to data from 17 rural municipalities in Norway north of the Arctic Circle. The data were collected for a population-based study of health and living conditions in 2003–2004 (the SAMINOR study). Our sample consisted of 14,797 participants aged 36–79 years.ResultsThe size of the individual-based populations varied significantly. I1 (linguistic connection Sámi) made up 35.5% of the sample, I2 (self-identified Sámi) made up 21.0% and I3 (active language Sámi) 17.7%. They were also noticeably unevenly distributed between the 5 Sámi regions defined for this study. The differences for the other characteristics studied were more ambiguous. For the population G1 (residents in the Sámi language area) the only significant difference found between the Sámi and the corresponding non-Sámi population was for household income (OR=0.69, 95% CI: 0.63–0.74). For the populations I1–I3 there were significant differences on all measures except for I2 and education (OR=1.09, 95% CI: 0.99–1.21).ConclusionsThe choice of Sámi inclusion criterion had a clear impact on the size and geographical distribution of the defined populations but lesser influence on the selected characteristics for the Sámi populations relative to the respective non-Sámi ones.

Ethnic discrimination and psychological distress: A study of Sami and non-Sami populations in Norway

The prevalence of psychological distress and its association with ethnic discrimination was examined among 13,703 participants (36 to 79 years of age) in a population-based study of health and living conditions in areas with indigenous Sami, Kven (descendants of Finnish immigrants), and Ethnic Norwegian populations (the SAMINOR study). Sami and Kven males reported greater levels of stress than Ethnic Norwegians. Ethnic discrimination was strongly associated with elevated levels of psychological distress. Results suggest that ethnic discrimination is a major potential risk factor for poor mental health, and may contribute to ethnicity-related differences in mental health between Sami and non-Sami populations.

Iron stores in relation to dietary patterns in a multiethnic population: the SAMINOR study

We evaluated the association between serum ferritin (s-ferritin), transferrin saturation and dietary patterns, in connection with ethnicity, geographical settlement and lifestyle factors. In 2003-2004, a cross-sectional study of health and living conditions was carried out in northern Norway. A questionnaire explored, among other factors, ethnicity and food consumption habits. Principal component analysis was used to assess the association between variables. Seven principal components were then used as input to a cluster analysis. To characterise food consumptions, five dietary patterns were identified and used to assess the effect of food consumption habits on Fe stores. A total of 16 323 men and women between the ages of 36 and 79 years participated. Participants who frequently consumed reindeer meat had higher levels of s-ferritin (P < 0.0001) than did individuals with other dietary patterns. This pattern was highly represented by subjects with three generations of Sami language (Sami I). Further, mean transferrin saturation in the reindeer group was higher compared with the other dietary clusters for men (P < 0.04) and women (P < 0.02). However, the reindeer pattern individuals also had the highest proportion of subjects with overweight and obesity. Obesity was positively associated with s-ferritin in both men and women (P < 0.0001). The differences in Fe status described earlier between inland Sami and non-Sami can be explained by several factors such as food habits, age and obesity. High level of s-ferritin may reflect high intake of reindeer meat. Being overweight and obese is also associated with s-ferritin levels.

The effect of coffee consumption on serum total cholesterol in the Sami and Norwegian populations

To assess coffee consumption in the Sami and Norwegian populations and to investigate the impact of unfiltered boiled coffee consumption on serum cholesterol concentrations. A cross-sectional study. Information was collected by self-administrated questionnaires and total serum cholesterol was analysed. Participants were divided into three ethnic groups: Sami I (Sami used as home language in the last three generations), Sami II (at least one Sami identity marker) and Norwegian. In an area with Sami, Kven/Finnish and Norwegian populations, the SAMINOR study, 2003-2004. A total of 5647 men and 6347 women aged 36-79 years. More than 90 % of the study populations were coffee drinkers. Only 22 % were unfiltered coffee consumers. Sami I had the highest proportion of participants who consumed nine or more cups of unfiltered coffee per day, although the number of participants was limited. Total coffee consumption was associated with increased total cholesterol for men (P < 0·01) and women (P < 0·0001). For those who drank only unfiltered coffee, a significant association was found only in Norwegian men, adjusted for physical activity in leisure time, BMI and smoking habits (P < 0·001). From the lowest (less than five cups) to the highest (nine or more cups) unfiltered coffee consumption category, the mean total cholesterol levels increased by 0·29 mmol/l in Norwegian men. Unfiltered coffee consumption was lower in the present study compared to previous reports. In general, total coffee consumption was positively associated with total cholesterol levels. However, for unfiltered coffee consumption, an association was found only in Norwegian men.