Afhængighed af pengespil i Grønland – et sociologisk perspektiv på misbrug og afhængighed i et samfund under hastig forandring

Formålet med herværende artikel er at undersøge sammenhængen mellem den samfundsmæssige udvikling og sociale problemer i Grønland eksemplificeret ved afhængighed af pengespil. Der tages udgangspunkt i en sociologisk forståelse af begrebet sociale patologier og social transition. Afhængighed af pengespil sættes ligeledes i relation til misbrug af alkohol og hash. Data er indsamlet i byer og bygder i hele Grønland som led i det internationale forskningsprojekt Inuit Health in Transition og bestod dels af en klinisk undersøgelse, samt interview og et selvudfyldt skema. I alt 2.454 personer deltog i interviewundersøgelsen (63%) og heraf udfyldte 2.189 personer det selvudfyldte spørgeskema (56%). Analysen af afhængighed af pengespil i relation til social transition viser, at afhængighed af pengespil forekommer i et mindre omfang blandt fangere og fiskere i bygderne samt de veluddannede professionelle i byerne sammenlignet med de øvrige sociale grupper i samfundet. Blandt problemspillere er både alkohol- og hashmisbrug udbredt. Den lavere forekomst af problemspil blandt fangere/fiskere i bygder samt blandt professionelle i byer kan være et tegn på, at social integration i den dominerende livsstil, der hvor man bor, har betydning for afhængigheden af pengespil. Sammenfaldet mellem misbrug viser desuden, at det ikke giver mening at betragte spilleafhængigheden som et isoleret problem. ENGELSK ABSTRACT: Christina Viskum Lytken Larsen: Pathological Gambling Among Greenland Inuit – A Sociological Approach to Addictive Behavior in a Society Undergoing Rapid Transition The aim of this paper is to analyze the social problems in Greenland in relation to the rapid transition which characterizes the Greenlandic society by using a sociological perspective on social pathologies and social transition. Pathological gambling is used as an example of the high prevalence of social problems that proposes a current challenge in modern Greenland. The association between pathological gambling, use of alcohol and marijuana is also analyzed. Data was collected in towns and villages across Greenland as a part of the international study Inuit Health in Transition. A total of 2454 persons were interviewed and 2189 of these also filled out a self-administered questionnaire. The study shows that the prevalence of pathological gambling is lower among hunters and fishermen in villages and professionals in towns than in other social groups. In addition the prevalence of harmful use of alcohol and marijuana among pathological gamblers was relatively high. A significant association between pathological gambling and social groups defined by their involvement in the ongoing social transition suggests that people caught between tradition and modern ways of life are especially vulnerable. Furthermore, the association between pathological gambling and other addictive behaviors underlines the importance of a comprehensive approach in understanding these phenomena. Keywords: gambling, inuit, Greenland, social pathology, addictive behavior

Parents’ perspectives on preparing for parenthood: a qualitative study on Greenland’s universal parenting programme MANU 0–1 year

Background The transition to parenthood has received increasing attention in research, partly due to evidence pointing out the crucial developmental period of a child’s first thousand days. Parenting programmes aim to prepare and support families in their transition and distress. For a programme to be implemented successfully it is important to consider parents’ needs and resources. Bringing parents’ perspectives and experiences to the forefront of the implementation of the Greenlandic parenting programme MANU 0–1 Year (MANU) is important for determining if the programme can meet its aim of contributing to thriving families. This study aims to investigate how parents’ notions and experiences of parenthood are reflected and challenged in MANU. Method Data were collected in three of Greenland’s five municipalities. Qualitative interviews were held with 38 mothers and 12 fathers either individually or as couples: a total of 40 interviews. Additionally, a Sharing Circle with three fathers was held. Interviews were in Greenlandic or Danish. A thematic, inductive analysis was applied. Results In their transition to parenthood, participants experienced a reprioritisation of their life and changes in their network. It is important to parents that their child experiences security and care, and participants describe this in contrast to their own childhood. Community is the most important value in child-rearing. Conversations and advice from family members and friends are mentioned as a means to prepare for birth and parenthood. Additionally, conversations with midwives and MANU sessions were also used for preparation. Parents appreciated learning from and listening to other parents in MANU sessions. However, accessing MANU depends on the individual parent’s interest and ability to attend sessions. Conclusions Parents’ notions and experiences of parenthood are addressed in the programme, but the use of MANU depends on the parents’ attendance and how it is organised and locally offered. The study suggests that MANU has the possibility to create a space for parents to reflect and prepare. However, for MANU to be universal as intended and to reach both mother and father the facilitation of sessions could be revisited

A scoping review of Indigenous suicide prevention in circumpolar regions

Background. Suicide is a serious public health challenge in circumpolar regions, especially among Indigenous youth. Indigenous communities, government agencies and health care providers are making concerted efforts to reduce the burden of suicide and strengthen protective factors for individuals, families and communities. The persistence of suicide has made it clear that more needs to be done. Objective. Our aim was to undertake a scoping review of the peer-reviewed literature on suicide prevention and interventions in Indigenous communities across the circumpolar north. Our objective was to determine the extent and types of interventions that have been reported during past decade. We want to use this knowledge to support community initiative and inform intervention development and evaluation. Design. We conducted a scoping review of online databases to identify studies published between 2004 and 2014. We included articles that described interventions in differentiated circumpolar Indigenous populations and provided evaluation data. We retained grey literature publications for comparative reference. Results. Our search identified 95 articles that focused on suicide in distinct circumpolar Indigenous populations; 19 articles discussed specific suicide-related interventions and 7 of these described program evaluation methods and results in detail. The majority of publications on specific interventions were found in North American countries. The majority of prevention or intervention documentation was found in supporting grey literature sources. Conclusion. Despite widespread concern about suicide in the circumpolar world and active community efforts to promote resilience and mental well-being, we found few recorded programs or initiatives documented in the peer-reviewed literature, and even fewer focusing specifically on youth intervention. The interventions described in the studies we found had diverse program designs and content, and used varied evaluation methods and outcomes. The studies we included consistently reported that it was important to use communitybased and culturally guided interventions and evaluations. This article summarizes the current climate of Indigenous circumpolar suicide research in the context of intervention and highlights how intervention-based outcomes have largely remained outside of peer-reviewed sources in this region of the world

A novel splice-affecting HNF1A variant with large population impact on diabetes in Greenland

Background: The genetic disease architecture of Inuit includes a large number of common high-impact variants. Identification of such variants contributes to our understanding of the genetic aetiology of diseases and improves global equity in genomic personalised medicine. We aimed to identify and characterise novel variants in genes associated with Maturity Onset Diabetes of the Young (MODY) in the Greenlandic population. Methods: Using combined data from Greenlandic population cohorts of 4497 individuals, including 448 whole genome sequenced individuals, we screened 14 known MODY genes for previously identified and novel variants. We functionally characterised an identified novel variant and assessed its association with diabetes prevalence and cardiometabolic traits and population impact. Findings: We identified a novel variant in the known MODY gene HNF1A with an allele frequency of 1.9% in the Greenlandic Inuit and absent elsewhere. Functional assays indicate that it prevents normal splicing of the gene. The variant caused lower 30-min insulin (β = −232 pmol/L, βSD = −0.695, P = 4.43 × 10−4) and higher 30-min glucose (β = 1.20 mmol/L, βSD = 0.441, P = 0.0271) during an oral glucose tolerance test. Furthermore, the variant was associated with type 2 diabetes (OR 4.35, P = 7.24 × 10−6) and HbA1c (β = 0.113 HbA1c%, βSD = 0.205, P = 7.84 × 10−3). The variant explained 2.5% of diabetes variance in Greenland. Interpretation: The reported variant has the largest population impact of any previously reported variant within a MODY gene. Together with the recessive TBC1D4 variant, we show that close to 1 in 5 cases of diabetes (18%) in Greenland are associated with high-impact genetic variants compared to 1–3% in large populations.publishedVersio

Health Aspects of Colonization and the Post-Colonial Period in Greenland 1721 to 2014

Colonization in Greenland lasted from 1721 to 1953 but even after the introduction of self-government in 2009, aspects of economic and cultural colonization persist. Several epidemics that decimated the population have been recorded from the colonial period. In the post-colonial period urbanization, immigration of Danish workers and alcohol consumption increased significantly while suicides became an important cause of death. We have outlined two parallel sequences of events, namely the general history of Greenland with emphasis on certain effects of colonization on everyday life and the epidemiological transition with emphasis on mental health. In particular, results from a health survey in 2014 among the Inuit in Greenland showed statistically significant associations between suicidal thoughts in adulthood and sexual abuse as a child as well as between sexual abuse as a child and alcohol problems in the childhood home. Among women also current socioeconomic conditions were associated with sexual abuse as a child. Colonization in Greenland was relatively benign and our results illustrate that it is not only extensive colonial stress such as genocide and loss of language and culture that has negative effects on mental health but also the more subtle stress factors that the Inuit in Greenland were exposed to

Association of food insecurity with dietary patterns and expenditure on food, alcohol and tobacco amongst indigenous Inuit in Greenland: results from a population health survey

Abstract Background Amongst the indigenous Greenlandic Inuit, the experience of food insecurity has been attributed to a lack of money to buy enough food of sufficient quality to sustain a family, although a preference for alcohol and tobacco over food has also been cited. The purpose of the article was to compare dietary patterns and expenditure on food, alcoholic beverages and tobacco between survey participants who reported food insecurity and those who did not. Methods A countrywide cross-sectional health survey was carried out among 1886 adult Greenlandic Inuit in 2018. Diet was estimated by a food frequency questionnaire. Food insecurity status was based on the household hunger scale. Analyses were carried out by univariate general linear models adjusted for age, sex and social position. Results Nine percent of the participants reported food insecurity. Food insecurity was higher among younger participants, men and participants with low social position. Food insecure participants more often chose an unhealthy dietary pattern (43% vs. 32%) and they reported a higher energy intake. The food insecure spent the same amount of money on food as other participants but less on nutritious food and more on non-nutritious food. The cost per kilojoule (kJ) of the food of the food insecure was lower than that of the food secure (DKK 8.0 and 9.0 per 1000 kJ, respectively). The food insecure participants also spent considerably more on alcohol and tobacco. Conclusions The results suggest that it is not only unemployment and lack of money that creates food insecurity and unhealthy dietary patterns in Greenland. Food insecure participants gave higher priority to buying non-nutritious food, alcohol and tobacco than did food secure participants. There seems to be at least two population subgroups in Greenland with poverty and substance use, respectively, as the immediate determinants for food insecurity. The results are important for the design of interventions against food insecurity and unhealthy dietary patterns