Public Health seen from Child Height : Indicators on child health and well-being in Greenland.

Formålet: Med basis i en overgribende analyse af børns sundhedstilstand i Grønland og punkt analyser indenfor specielt vigtige områder, er formålet at udvikle et samlet sæt af kerneindikatorer for børns sundhed og velbefindende på nationalt og kommunalt niveau set i et socialt perspektiv, og at præsentere data på disse indikatorer. Metode: Delundersøgelse 1 er et litteraturstudie om grønlandske børns sundhed og velbefindende set i en social sammenhæng. Delundersøgelse 2: Undersøger udviklingen i BMI i en retrospektiv af skolebørn i Nuuk (hovedstaden) fra 1972 til 2002. Prævalens af overvægt og fedme blandt ind- og udskolings-børn blev analyseret og for den del af børnene, der var fulgt fra indskoling til udskoling analyseredes den positive og negative prædiktive værdi af tidlig erhvervet over-vægt. Delundersøgelse 3 analyserer med lav fødselsvægt som eksempel om en internationalt brugt indikatorer umiddelbart kan overføres til brug i Grønland. I delundersøgelse 4 og 5 bliver indikatorerne, deres baggrund, og deres udvælgel-se analyseret. Indikatorerne er foreslået med baggrund i FN’s børnekonvention, internationale folkesundhedsprogrammer, det grønlandske folkesundhedspro-gram og de kommunale børn og unge-politikker. Indikatorer blev søgt i litteraturen, i internationale databaser, og på hjemmesi-der. De blev sammen med materialet om børns sundhed, sundhedsydelser, sund-hedsovervågning, data tilgængelighed og datakilder samlet i en database struk-tureret på 4 områder: demografiske og socioøkonomiske forhold, sundhed og velbefindende, determinanter for sundhed, risikofaktorer og beskyttende fakto-rer, og sundhedssystemet og sundhedspolitiske faktorer. Med baggrund i opstil-lede kriterier for udvælgelsen er foreslået 28 indikatorer fra konceptionen til 18 år på nationalt niveau og 24 indikatorer på kommunalt niveau, som umiddelbart kan implementeres. De kommunale indikatorer er modificeret under hensyn til den lille befolkning og tilgængelighed af data. Yderligere 25 indikatorer til se-nere implementering blev identificeret på nationalt niveau. Resultater: Sygdomsmønstret blandt børn domineres i dag af kroniske syg-domme, selvom alvorlige infektionssygdomme endnu ikke er under fuld kontrol og selvom dødelighed i barnealderen fortsat er høj i forhold til andre nordiske lande. Overvægt ved indskolingen steg fra 9,6 % til 22,5 % og ved 15årsalderen fra13,0 % til 19,3 % fra 1972 til 2002 og over halvdelen med tidlig erhvervet overvægtige forblev overvægtige. Lav fødselsvægt blev fundet at være en lige så god indikator her som i andre udviklede lande. En intervention overfor de mest betydningsfulde, modificerbare risikofaktorer for lav fødselsvægt må inkludere rygning under graviditeten og at sikre, at alle gravide modtager de anbe-falede antal svangerskabsundersøgelser. Data på indikatorerne viste, at en stor undergruppe af børn er sårbare på grund af sociale og demografiske forhold og at væsentlige dele af morbiditeten er højere blandt børn i yderdistrikter. Hoved-staden og byer i de større kommuner har bedre adgang til sundhedsydelser. En konsekvens er at sundhedssystemet bidrager til at øge forskellen i sundhed mel-lem mere og mindre privilegerede grupper af børn. Konklusion: De foreslåede indikatorer er et vigtigt værktøj i monitorering af kerneområder for børns sundhed og faktorer, der influerer denne. Data viste, at hvis alle børn i Grønland skal sikres lige mulighed for sundhed vil det nødven-diggøre en strategi, der er mere vidtrækkende end det nuværende folkesund-hedsprogram, og som indebærer en koordineret indsats fra alle strukturelle ni-veauer og sektorer i samfundet. Værdifuldt for det videre arbejde, er at de få veldokumenterede indikatorer er foreslået ud fra systematisk indsamlet viden og set ud fra et folkesundhedsperspektiv; og at de bygger dels på allerede indsam-lede registerbaserede data og dels på spørgeskemabaserede data, fra en lands-dækkende og internationalt baseret undersøgelse af skolebørn, der gennemføres hvert 4. år. Det giver mulighed for at analysere udviklingen over tid. Indikato-rerne sikrer mulighed for enintegreret tilgang til viden om børns sundhed med mulighed for internationale, nationale, og kommunale sammenligninger og for nogle ned til de enkelte skoler. Dog er videreudvikling påkrævet indenfor data, datakvalitet, og dataindsamlingAim: Based on a broad examination of child health in Greenland and in depth analyses in fields of special relevance, the aim is to identify a set of core indica-tors of children’s health and well-being seen in a social context at the national and municipal level, and present empirical data about them. Methods: Investigation I is a literature review on child health in its social con-text in Greenland. Investigation II analyzes the development in BMI in a retro-spective cohort of schoolchildren in Nuuk (the capital) from 1972 to 2002. The prevalence of overweight and obesity among children at school start and at graduation age was analysed, and for children followed from school start to graduation age the positive and negative predictive value of early-acquired overweight were analyzed. Investigation III analyzes with low birth weight as an example if an internationally used indicator can be used in Greenland. In Investigation IV and V indicators, their background, and their selection are ana-lyzed. The indicators were proposed based on the UN Convention on the Rights of the Child, international and national public health programmes, and Greenland’s municipal child policies. Indicators were searched for in the litera-ture, databases, and international homepages. They were together with material on child health, health care delivery, present surveillance, data sources, and data availability collected in a database structured in four domains: demographic and socio-economic conditions; health status and well-being; determinants of health, risk, and protective factors; and health systems and health policy. Based on proposed criteria, 28 indicators from conception to age 18 at the national level were identified for immediate use, and 25 indicators for later implementation. At the municipal level, 24 indicators modified according to the small popula-tions and lack of data in the municipalities was proposed. Results: Today, chronic diseases dominate in children, even if serious infec-tious diseases are not fully controlled and mortality during childhood is still high compared to the other Nordic countries. Overweight at school entry in-creased from 9.6% to 22.5% and at age 15 from 13.0% to 19.3% during the 30 years from 1972 to 2002. In more than half of the children the early-acquired overweight remained. Low birth weight was found to be as good an indicator as in other developed countries. The most important modifiable determinants of low birth weight, are smoking and antenatal care. Large subgroups of children are vulnerable because of their socio-economic and demographic conditions. Important part of the morbidity was higher among children in remote municipalities, while the capital and municipalities with lar-ger cities had better access to health care facilities. A consequence is that the health care system contributes to the health gap between privileged and less privileged children. Conclusion: The selected indicators are a powerful tool in monitoring core issues in children’s health and the factors influencing it. If equal opportunities for health are to be given to all children in Greenland, a strategy is needed, which goes beyond the proposals of the present public health program, and which includes a coordinated effort from all structural levels and sectors in so-ciety. Of value for the future work is that the few, well documented indicators that are proposed are based on systematic evidence and are seen from a public health perspective, and adapted to Greenlandic conditions. They also build on routinely collected data as well as on data from a nationwide and internationally based survey on schoolchildren health and well-being that is repeated every four years. Trend analyses are therefore possible. The indicators make it possible to gain easy and inexpensive access essential knowledge on child health, including potentials to make comparisons over time and between countries and munici-palities.Nevertheless, further development was found necessary regarding data access, data quality, and data collection

Adverse health effects of experiencing food insecurity among Greenlandic school children

Background. In vulnerable populations, food security in children has been found to be associated with negative health effects. Still, little is known about whether the negative health effects can be retrieved in children at the population level. Objective. To examine food insecurity reported by Greenlandic school children as a predictor for perceived health, physical symptoms and medicine use. Design. The study is based on the Greenlandic part of the Health Behaviour in School-aged Children survey. The 2010 survey included 2,254 students corresponding to 40% of all Greenlandic school children in Grade 5 through 10. The participation rate in the participating schools was 65%. Food insecurity was measured as going to bed or to school hungry because there was no food at home. Results. Boys, the youngest children (11–12 year-olds), and children from low affluence homes were at increased risk for food insecurity. Poor or fair self-rated health, medicine use last month and physical symptoms during the last 6 months were all more frequent in children reporting food insecurity. Controlling for age, gender and family affluence odds ratio (OR) for self-rated health was 1.60 (95% confidence interval (CI 1.23–2.06) (p<0.001), for reporting physical symptoms 1.34 (95% CI 1.06–1.68) (p=0.01) and for medicine use 1.79 (95% CI 1.42–2.26) (p<0.001). Stratification on age groups suggested that children in different age groups experience different health consequences of food insecurity. The oldest children reported food insecurity less often and experienced less negative health effects compared to the younger children. Conclusions. All 3 measures of health were negatively associated to the occurrence of food insecurity in Greenlandic school children aged 11–17. Food security must be seen as a public health issue of concern, and policies should be enforced to prevent food poverty particularly among boys, younger school children and children from low affluence homes

Gambling in Greenlandic adolescents

Gambling has never been investigated in Greenlandic adolescents. High prevalence of gambling problems and a relation to other addictive behaviours has been found in adult Greenlanders. Greenlandic adolescents are daily exposed to gambling, for example, by selling lottery tickets, through advertises and electronic devices. The aim of this study is to investigate how Greenlandic adolescents perceive gambling, and to pilot test the Lie/Bet screening-instrument.Ten semi-structured focus group interviews were conducted for 31 adolescents, aged 12–16, from 3 schools in Nuuk, Greenland.The 31 adolescents have experiences with gambling. Whether they define a game as gambling depends on: 1) Whether the game is about playing with or about money, 2) whether the game is about earning items, 3) the gain/loss, 4) who they lose money to, and 5) the purpose. If the purpose is to have fun, it is not necessarily seen as gambling. None mentioned bingo as gambling, arguing that bingo is about having fun. Two recent trends were found to have reached Greenland: The close link between sports and gambling, and skin-betting. Additionally, the Lie/Bet screen was, with slight modifications, found to be useful as a screening-instrument among Greenlandic adolescents and it is proposed to be used in future studies

Conceptualizing and contextualizing food insecurity among greenlandic children

Objective. To review the context of food insecurity in Greenlandic children, to review and compare the outcomes related to food insecurity in Greenlandic children, in other Arctic child populations and in other western societies, and to explore the measure used by the Health Behaviour in School-aged Children (HBSC) study. Design. The study includes literature reviews, focus group interviews with children and analyses of data from the HBSC study. HBSC is an international cross-national school-based survey on child and adolescent health and health behaviour in the age groups 11, 13 and 15 years and performed in more than 40 countries. The item on food insecurity is "Some young people go to school or to bed hungry because there is not enough food in the home. How often does this happen to you?\u27\u27 (with the response options: "Always\u27\u27, "Often\u27\u27, "Sometimes\u27\u27, or "Never\u27\u27). Results. The context to food security among Inuit in Arctic regions was found to be very similar and connected to a westernization of the diet and contamination of the traditional diet. The major challenges are contamination, economic access to healthy food and socio-demographic differences in having a healthy diet. The literature on outcomes related to food insecurity in children in Western societies was reviewed and grouped based on 8 domains. Using data from the Greenlandic HBSC data from 2010, the item on food security showed negative associations on central items in all these domains. Focus group interviews with children revealed face and content validity of the HBSC item. Conclusion. Triangulation of the above-mentioned findings indicates that the HBSC measure of food shortage is a reliable indicator of food insecurity in Greenlandic schoolchildren. However, more research is needed, especially on explanatory and mediating factors