585936
research-article2015
SJP0010.1177/1403494815585936M.A. Eriksen et al.Violence in Sami and non-Sami populations
Scandinavian Journal of Public Health, 1–9
Original Article
Emotional, physical and sexual violence among Sami and non-Sami
populations in Norway: The SAMINOR 2 questionnaire study
Astrid M.A. Eriksen1,2, Ketil Lenert Hansen2,3, Cecilie Javo1 &
Berit Schei4,5,6
1Sami
Norwegian Advisory for Mental Health and Substance Use (SANKS) Finnmarkssykehuset HF, Karasjok, Norway,
of Community Medicine, The Artic University of Norway, Tromsø, Norway, 3Department of Education,
UiT, The Artic University of Norway, Tromsø, Norway, 4Institute of Health and Society, Faculty of Medicine, University
of Oslo, 5Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science
and Technology (NTNU), Trondheim, Norway, and 6Department of Obstetrics and Gynaecology St. Olav’s Hospital,
Trondheim University Hospital, Norway
2Department
Abstract
Aims: To assess the prevalence and investigate ethnic differences of emotional, physical and sexual violence among a
population of both Sami and non-Sami in Norway. Methods: Our study was based on the SAMINOR 2 study, a populationbased survey on health and living conditions in multiethnic areas with both Sami and non-Sami populations in Central and
Northern Norway. Our study includes a total of 11,296 participants: 2197 (19.4%) Sami respondents and 9099 (80.6 %)
non-Sami respondents. Results: Almost half of the Sami female respondents and one-third of the non-Sami female respondents
reported any violence (any lifetime experience of violence). Sami women were more likely to report emotional, physical
and sexual violence than non-Sami women. More than one-third of the Sami men compared with less than a quarter of
non-Sami men reported having experienced any violence in their life. Sami men were more likely to report emotional
and physical violence than non-Sami men. However, ethnicity was not significantly different regarding sexual violence
experienced among men. Violence was typically reported to have occurred in childhood. Sami participants were more likely
to report having experienced violence in the past 12 months. For all types of violence, the perpetrator was typically known
to the victim. Conclusions: Regardless of gender, Sami respondents were more likely to report interpersonal
violence. The prevalence of any violence was substantial in both ethnic groups and for both genders; it was
highest among Sami women.
Key Words: Emotional violence, physical violence, sexual violence, abuse, ethnicity, Sami, SAMINOR, Norway
Background
Internationally, interpersonal violence (sexual, physical
and emotional) is recognized as a public health issue
which adversely affects mental and physical health [1].
Depression and post-traumatic stress disorder are
considered the most prevalent mental health conditions associated with violence and abuse [2,3].
Moreover, a large range of somatic symptoms is often
associated with violence [4]. International studies have
indicated a higher prevalence of interpersonal violence
in indigenous populations than in non-indigenous
population [5–7]. Canadian studies have found indigenous people to be three times more likely to experience violent victimization [5]. In Greenland, a report
on the living conditions of young people revealed that
violence, including sexual abuse, was a major problem
[8]. A comparative study of reported violence in
Greenland and Denmark found the overall prevalence
to be higher in Greenland [7]. Proportionally more
women in Greenland reported sexual abuse than men.
Correspondence: Astrid MA Eriksen, Institute of Health and Society, Faculty of Medicine, University of Oslo, Pb 1130 Blindern, 0318 Oslo, Norway.
E-mail. [email protected]
(Accepted 13 April 2015)
© 2015 the Nordic Societies of Public Health
DOI: 10.1177/1403494815585936
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
2 A.M.A. Eriksen et al.
Figure 1. Flow chart of inclusion in the study population of emotional, physical and sexual violence in the SAMINOR 2 study, 2011–2012.
The differences was largest when occurring in childhood [9].
Former national studies on violence in Norway
have not included information on Sami ethnicity
[10,11]. Hence, little is known about the prevalence
of interpersonal violence in Norway’s indigenous
population. One paper that compared Greenlandic
Inuit and Norwegian Sami adolescents reported no
differences of experienced violence. In both populations, violence was reported by approximately one in
four participants [12].
Historically, the Sami people has been a nomadic
people, living in the Artic areas of Norway, Sweden,
Finland and Russia’s Kola Peninsula [13]. In the
19th and 20th centuries, the Sami people were subjected to austere assimilation policies, with a resulting loss of language and identity [14].
Aims
This paper aims to explore the prevalence of various
types of violence in a population with both Sami and
non-Sami inhabitants in Central and Northern
Norway, and to explore whether there are differences
based on ethnicity and socioeconomic or demographic factors.
Methods
populations, the SAMINOR 2 questionnaire study.
The first population-based study on health and living
conditions in areas with both Sami and Norwegian
populations (SAMINOR 1) was conducted in
2003/2004. This study has been described in a previous paper [15]. The SAMINOR 2 questionnaire study
was designed as a follow-up study of issues addressed
in the original SAMINOR study. It was also expanded
to include additional health issues such as violence
and mental health. The SAMINOR 2 questionnaire
study has been described in a recently published paper
[16].
Sample. In selected municipalities with a mixed
Sami and non-Sami population, all residents aged
18–69 years in the National Registry were sent an
invitation to participate in the study. A questionnaire
was mailed to 44,669 persons. A total of 1424 questionnaires were returned unopened and hence classified as technically missing, leaving 43,245 persons
eligible for the study. Among these, 11,600 persons
consented by returning the completed questionnaire,
yielding a participation rate of 27%. Further methodological details are described elsewhere [16].
In the present study, 304 respondents were discarded due to missing information on ethnicity and
violence, leaving 11,296 informants as the study
group: 2197 (19.6%) Sami and 9099 (80.6 %) nonSami individuals (see flow chart Figure 1).
The SAMINOR study
This study is a sub-project of a larger questionnairebased population study on health and living conditions in areas with both Sami and Norwegian
Questionnaire
Questions regarding ethnicity. Ethnicity was assessed
using responses to the following groups of questions:
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
Violence in Sami and non-Sami populations 3
‘What language does/did you use at home?’, ‘What
language did your parents use at home?’, ‘What language did your grandparents use at home?’ and
‘What do you consider yourself to be?’ Response
options were ‘Norwegian’, ‘Sami’, ‘Kven’, ‘Other’.
Multiple answers were permitted. Participants
choosing ‘Sami’ in response to any of the three first
groups of questions, in addition to self-identification
as Sami, were classified as belonging to the Sami
ethnic group. Norwegians, Kvens (descendants of
Finnish immigrants) [17] and Others were defined
as non-Sami.
Questions on violence. Three sections in the questionnaire addressed experience of emotional, physical
and/or sexual violence. Participants who responded
positively to the question ‘Have you experienced that
someone systematically and over time has tried to
repress or humiliate you?’ were classified as ‘having
experienced emotional violence’. Participants who
responded positively to the question ‘Have you been
exposed to physical assault/abuse?’ were classified as
‘having experienced physical violence’. Participants
who responded positively to the question ‘Have you
been exposed to sexual assault?’ were classified as
‘having experienced sexual violence’. Participants
who responded positively to having experienced any
type of violence (sexual, physical and emotional)
were defined as ‘having experienced any violence’.
Moreover, participants were asked to indicate
whether the violence had occurred in childhood and/
or in adulthood.
For each type of violence, participants were asked
to indicate their relationship with the perpetrator,
with the following alternatives: ‘Stranger’, ‘Spouse’,
‘Family/relatives’ or ‘Other known’. Multiple
responses were permitted.
Background variables. Background information, such
as education, income, religion, use of substances
(alcohol and tobacco), was collected from the questionnaire. Information regarding age, gender and
home municipality of participants were provided by
Statistics Norway. Participants were placed in one of
the three age groups: 18–34 years, 35–49 years and
50–69 years. A participant’s level of education was
measured according to the number of years of education: primary school (0–9 years), secondary school
(10–12 years), higher education of 3 years’ duration
or less (13–15 years) and higher education of more
than 3 years’ duration (16 years and above). Household annual income was categorized into three
groups: low (<150,000–300,000 NOK), medium
(301,000–600,000 NOK) and high (601,000 to
>900,000 NOK).
The 25 municipalities included in the SAMINOR
2 study have been described elsewhere [16]. These
were recoded into ‘Sami minority area’ and ‘Sami
majority area’. The reasons behind such descriptions
are described in more detail in another paper [18].
The question regarding smoking reads as follows:
‘Do you smoke, or have you previously smoked? The
available responses categories were: ‘Yes, daily’, ‘Yes,
previously’, ‘Yes, sometimes’ and ‘No, never’. The
categories were narrowed down to three: No, never
(‘No never’), Yes, daily (‘Yes, daily’) and Yes, previously (‘Yes, previously’ and ‘Yes, sometimes’).
Respondents were asked to indicate how often they
had consumed alcohol in the past year: ‘Never consumed alcohol’, ‘Have not been drinking alcohol
during the last year’, ‘A few times during the last
year’, ‘About once a month’, ‘Two or three times per
month’, ‘About once a week’, ‘Two or three times a
week’ and ‘Four to seven times a week’. The three
categories that were created were ‘Never/rarely’
(‘Never consumed alcohol’, ‘Not during the last year’
and ‘A couple of times in the past year’), ‘Monthly’
(‘About once a month’ and ‘two or three times a
month’), ‘Weekly’ (‘About once a week’, and ‘Four to
seven times a week’).
Respondents were asked to indicate their affiliation with the Laestadian Church (a Lutheran denomination particularly widespread in the Northern
regions of Norway, Sweden and Finland): ‘Are your
grandparents affiliated with the Laestadian church?’,
‘Is your father affiliated with the Laestadian church?’,
‘Is your mother affiliated with the Laestadian church?’
and ‘Are you affiliated with the Laestadian church?
Multiple responses were permitted. Participants
responding positively to one or more of these options
were classified as ‘Laestadianist’. Respondents with
no positive response on Laestadian church were classified as ‘non-Laestadianist’.
Ethics. Written informed consent was obtained from
all participants. The study was approved by the
Regional Committee for Medical and Health
Research Ethics of Northern Norway and the Norwegian Data Protection Authority.
Statistical analysis
Descriptive statistics are presented according to
ethnicity and gender. The chi-square test was used
in the comparison of groups. Level of significance
was set to 5%. Logistic regression analyses were
performed to adjust for age, education, living
region, Laestadianism and alcohol intake. The
results of the logistic models are presented with
confidence intervals of 95% (95% CI). The
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
4 A.M.A. Eriksen et al.
Table I. Population characteristics in the Sami and non-Sami population of emotional, physical and sexual violence by gender in the SAMINOR 2 study, 2011–2012.
Women n=6303
Age
18–34
35–49
50–69
Education
Primary
Secondary
Higher ⩽ 3 years
Higher > 3 years
Income
Low
Medium
High
Occupation
Full time
Part time
Living area
Minority
Majority
Leastadianism
Yes
No
Smoking
Daily
Previously
Never
Alcohol
Seldom/never
Monthly
Weekly
Men n=4993 Sami
n=1242
%
Non- Sami
n=5061
%
309
373
560
24.9
30.0
45.1
1005
1726
2330
19.9
34.1
46.0
139
228
313
545
11.2
18.4
25.2
43.9
643
1277
1338
1755
12.7
25.2
26.4
34.7
199
516
477
16.0
41.5
38.4
690
1863
2350
13.6
36.8
46.4
682
282
54.9
22.7
2600
1233
51.4
24.4
466
775
37.7
62.4
4496
567
88.8
11.2
517
725
41.6
58.4
839
4222
16.6
83.4
257
441
517
20.7
35.5
41.6
932
1825
2220
18.4
36.1
43.9
534
466
229
43.0
37.5
18.4
1850
1785
1381
36.6
35.3
27.3
p
Sami
n=955
%
Non- Sami
n=4038
%
150
275
530
15.7
28.8
55.5
630
1172
2236
15.6
29.0
55.4
191
293
216
246
20.0
30.7
22.6
25.8
719
1241
1046
992
17.8
30.7
25.9
25.0
167
356
409
17.5
37.3
42.8
533
1440
1977
13.2
35.7
49.0
498
125
52.1
13.1
2424
441
60.0
10.9
387
568
40.5
59.5
3596
440
89.1
10.9
402
553
42.1
57.9
655
3383
16.2
83.8
195
375
358
20.4
39.3
37.5
664
1598
1701
16.4
39.6
42.1
266
377
301
27.9
39.5
31.5
1058
1455
1493
26.2
36.0
37.0
<.001
<.001
<.001
.082
<.001
<.001
.140
<.001
software package for statistical analysis program,
the SPSS version 22 was used for the analyses. We
also investigated potential interaction between ethnicity and living area.
Results
Prevalence of different types of violence
Population characteristics across groups are presented in Table I. Almost half of the Sami population,
45% (n=989) reported having been subjected to any
violence (Table II). For the non-Sami population, the
figure was 32.6% (n=3682) (Table II).
Among both women and men, ethnicity was associated with all types of violence, except for sexual violence among men. Women were more likely to report
being subjected to sexual violence than men, irrespective of ethnicity. Emotional violence was the
most common type of violence reported to have
occurred both in child- and adulthood, independent
of ethnicity and gender.
p
.989
.123
.001
.004
<.001
<.001
.002
.013
There was a significant age variation for any violence (Tables III and IV): violence was less reported
by respondents in age group 50–69. When assessing
the three types of violence separately, age variation
remained the same for non-Sami women. For Sami
women the pattern remained the same, but was only
significant for age group 35–49. Among men, the age
variation for non-Sami was only significant for emotional violence. For Sami men the pattern was different: emotional, physical and sexual violence increased
by age. However, it was only significant for physical
violence between age group 35–49 and 50–69 and
sexual violence between age group 18–34 and 50–69.
To have experienced any type of violence was positively associated with living in Sami majority areas,
also when adjusted to ethnicity (Tables III and IV).
When assessing the three types of violence separately,
the pattern remained the same. However, it was only
significant for physical violence among women.
Participants who reported experience of violence
in childhood: 724 (33.7%) had been exposed to two
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
Violence in Sami and non-Sami populations 5
Table II. Prevalence of emotional, physical, sexual and any violence as a child only, adult only, both as a child and as an adult and past 12
months among the Sami and non-Sami by gender in the SAMINOR 2 study, 2011–2012.
Type of violence
Emotional
No violence
Total
Child only
Adult only
Both child and adult
Past 12 months
Physical
No violence
Total
Child only
Adult only
Both child and adult
Past 12 months
Sexual
No violence
Total
Child only
Adult only
Both child and adult
Past 12 months
Any
No violence
Total
Child only
Adult only
Both child and adult
Past 12 months
Women n=6303
Men n=4993 Sami
n=1242
%
non-Sami
n=5061
%
741
479
179
225
75
50
59.7
38.6
14.1
18.1
6.0
4.0
3687
1296
472
661
163
122
72.9
25.6
9.3
13.1
3.2
2.4
921
297
119
150
28
–
74.2
23.9
9.6
12.1
2.3
–
4027
863
403
386
74
–
79.6
17.1
8.0
7.6
1.5
–
946
271
187
63
21
–
76.2
21.8
15.1
5.1
1.7
–
4120
791
547
208
36
–
81.4
15.6
10.8
4.1
0.7
–
595
610
334
311
155
52
47.9
49.1
26.9
25.0
12.5
4.2
3071
1758
973
877
366
133
60.7
34.7
19.2
17.3
7.2
2.6
p
Sami
n=955
%
non-Sami
n=4038
%
633
303
164
104
35
35
66.3
31.7
17.2
10.9
3.7
3.7
3249
750
419
261
70
101
80.5
18.6
10.4
6.5
1.7
2.5
750
180
113
51
16
–
78.5
18.8
11.8
5.3
1.7
–
3507
385
269
95
21
–
86.8
9.5
6.7
2.4
0.5
–
881
48
47
–
0
–
92.3
5.0
4.9
0.1
0
–
3750
164
145
17
–
–
92.9
4.1
3.6
0.4
0.0
–
540
379
243
136
66
37
56.5
39.7
24.4
14.2
6.9
3.9
2911
935
599
342
129
106
72.1
23.2
14.8
8.5
3.2
2.6
<.001
or more types of violence (data not shown). Among
men, this was found to be associated with ethnicity:
highest among non-Sami, 32.7%, compared with
28.8% among Sami. No effect on ethnicity was
observed among women. Of those who reported any
violence in adulthood, 27.4% had been exposed to
two or more types of violence (data not shown). This
proportion did not differ between Sami women
(35.0%) and non-Sami women (34.2%). However, a
larger proportion of Sami men reported being
exposed to two or more types of violence compared
to non-Sami men (14.7% vs. 7.9%, p⩽.001).
Overall 2.9% of the study population reported
that they had been exposed to some type of violence
in the past 12 months (Table II).
Sami respondents were nearly twice as likely to
report being subjected to violence in the past 12
months (Sami respondents: 4.1%; non-Sami
respondents: 2.6%, Table II). Estimates of associations between any violence, ethnicity and participants’
background
and
selected
lifestyle
characteristics are shown for in Table III (women)
and Table IV (men).
<.001
<.001
<.001
.002
<.001
.019
<.001
.024
–
<.001
<.001
.061
<.001
–
<.001
<.001
<.001
<.001
.004
p
<.001
<.001
<.001
<.001
.047
<.001
<.001
<.001
<.001
–
.191
.090
–
–
–
<.001
<.001
<.001
<.001
.037
Ethnicity was strongly associated with being subjected to any violence both among women and men,
and remained after adjusting for age, education, living
area, religion and alcohol intake (Tables III and IV).
For both genders, the association between ethnicity and any violence was stronger in minority areas
(data nor shown).
Perpetrators
Among those reporting any violence, most reported
it to be a known perpetrator, and one in five reported
the perpetrator to be a stranger.
Discussion
Sami respondents of both genders were more likely
to report having been subjected to any violence. Sami
women reported highest prevalence of violence exposure. Across ethnic groups and genders, emotional
violence was the most frequently reported type of
violence. Women were more likely to report sexual
violence than men, and the proportion of Sami
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
6 A.M.A. Eriksen et al.
Table III. Crude and adjusted odds ratio (OR) for any lifetime violence among women. The results are adjusted for ethnicity, age, education, living area, affiliation to Leastadianism and alcohol intake, the SAMINOR 2 study 2011–2012.
Any lifetime violence
All women (n=6303)
Ethnicity
Sami (n=1242)
non-Sami (n=5061)
Age
18–34 (n=1314)
35–49 (n=2099)
50–69 (n=2890)
Education
Primary (n=782)
Secondary (n=1505)
Higher⩽3 years (n=622)
Higher >3 years (n=2300)
Living area
Minority (n=4959)
Majority (n=1342)
Laestadianism
Yes (n=1356)
No (n=4947)
Alcohol
Weekly (n=1610)
Monthly (n=2251)
Seldom/never (n=2384)
n=6303
% with any violence
Crude OR
CI
p
610
1758
49.1
34.7
1.8
1
1.6–2.1
519
913
936
39.5
43.5
32.4
1.4
1.6
1
1.2–1.6
1.4–1.8
<.001
<.001
<.001
288
513
622
927
36.8
34.1
37.7
40.3
.863
.766
.895
1
0.7–1.0
0.7–0.9
0.8–1.0
.002
.086
<.001
.095
1762
605
35.5
45.1
1
1.5
Adjusted OR
CI
1.6
1
1.3–1.8
1.4
1.6
1
1.2–1.6
1.4–1.8
1.0
.875
.935
1
0.8–1.2
0.8–1.0
0.8–1.0
<.001
<.001
1
1.2
1.3–1.7
1.0–1.4
<.001
598
1770
44.1
35.8
1.4
1
1.3–1.6
577
839
930
35.8
37.3
39.0
.873
.929
1
0.8– 1.0
0.8–1.0
.119
.043
.224
1.3
1
1.1–1.5
.942
.928
1
0.8–1.1
0.8–1.0
p
<.001
<.001
<.001
<.001
.225
.890
.064
.323
.024
<.001
.450
.396
.226
Table IV. Crude and adjusted odds ratio (OR) for any lifetime violence among men. The results are adjusted for ethnicity, age, education,
living area, affiliation to Leastadianism and alcohol intake, the SAMINOR 2 study 2011–2012.
Any lifetime violence
All men (n=4993)
Ethnicity
Sami (n=955)
Non-Sami (n=4038)
Age
18–34 (n=780)
35–49 (n=1447)
50–69 (n=2766)
Education
Primary (n=910)
Secondary (n=1534)
Higher⩽3 years (n=1262)
Higher >3 years (n=1238)
Living area
Minority (n=3983)
Majority (n=1008)
Leastadianism
Yes (n=1057)
No (n=3936)
Alcohol
Weekly (n=1794)
Monthly (n=1832)
Seldom/never (n=1324)
n=4993
% with any violence
Crude OR
CI
379
935
39.7
23.2
2.2
1
1.9–2.5
231
389
694
29.6
26.9
25.1
1.3
1.1
1
1.3–1.1
1.1–1.0
.034
.011
.206
232
386
336
348
25.5
25.2
26.6
28.1
.875
.860
.928
1
0.7–1.1
0.7–1.0
0.8–1.1
.323
.177
0.81
.405
965
349
24.2
34.6
1
1.7
p
Adjusted OR
CI
1.9
1
1.6–2.3
1.3
1.1
1
1.0–1.6
0.9–1.2
.872
.872
.937
1
0.7–1.1
0.7–1.0
0.8–1.1
<.001
<.001
1
1.2
1.4–1.9
1.0–1.4
<.001
328
986
31.0
25.1
1.4
1
1.2–1.6
471
465
365
26.3
25.4
27.6
.935
.894
1
0.8–1.1
0.8–1.0
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
.388
.413
.169
1.2
1
1.0–1.4
0.9
0.9
1
0.8–1.1
0.8–1.0
p
<.001
.044
.014
.206
.404
.185
.122
.480
.037
.051
1.2
.314
.158
.739
Violence in Sami and non-Sami populations 7
women who reported sexual violence was higher than
non-Sami women. The impacts of ethnicity and gender were distinct, particularly in the case of sexual
violence.
Comparison of results to other indigenous
studies
Our findings are consistent with other studies which
show that indigenous people are more likely to be
exposed to violence than non-indigenous people [5–
7]. Findings for Sami women in our study (49.1%)
are congruent with a study of the Inuit population in
Greenland [9] that reported that 47% of Inuit women
were exposed to violence. However, the reported
prevalence for Inuit men (48%) was higher than for
Sami men in our study (39.7%).
In the study by Curtis et al. [9], sexual violence
was reported by one in four Inuit women (25%) and
6% of Inuit men. In our study, one in five Sami
women reported sexual violence (21.8%). The corresponding figure for Sami men was 5% in our study.
This might suggest that the prevalence of sexual violence in the Inuit and Sami people is rather similar.
Further, Curtis et al. reported that 8% of Inuit
women and 3% of Inuit men had been subjected to
childhood sexual violence. In our study, sexual violence in childhood was reported by 16.7% for Sami
women and 4.9% of Sami men. Discrepancies may
be explained by differences in phrasing the questions:
in the Curtis study the question regarding sexual
assault was phrased ‘have you ever been forced to
sex’, while in our study the question regarding sexual
violence was phrased more generally: ‘Have you been
exposed to sexual assault’. The age cut-off was also
lower in the study by Curtis et al.: less than 13 years;
the cut-off in our study was 18 years. Moreover,
regarding the potential impact of the period under
study, Curtis et al. conducted their study in Greenland
in 1993–1994. An increased openness in society in
general and the establishment of various health facilities addressing sexual violence may also have resulted
in a higher prevalence of reported sexual violence in
childhood in our study.
Comparison of results to other Nordic studies
Emotional violence. Our results for emotional violence in childhood in the total sample (14.1% for
women and 13.8% for men) is similar to a recent
Norwegian National study which reported a prevalence of exposure to violence in childhood of 15.4%
for women and 11.2% for men [10]. Moreover, the
prevalence of emotional violence for women in our
study (28.2%) is within the estimate given in an
earlier, Nordic cross-sectional study of women seeking reproductive health services that reported a prevalence of 19–37% for emotional violence [19].
Physical violence. As for any experience of physical
violence we found a prevalence of 19% for women
and 11.3% for men. The prevalence for women was
slightly lower than the prevalence presented in a
national study among pregnant women in Norway,
which presented a prevalence of 21.5%. As to physical violence in childhood by family/relatives, we
found a prevalence of 6% for women and 4.3% for
men (5.4% total). Other Norwegian studies have
reported similar figures. In a population-based
national study of students graduating from upper
secondary school, Mossinge and Stefansen [20]
found that 8% had been victim of severe physical violence from their parents. A Norwegian National
study published in 2014 [10] found that 5.0% of
men and 4.9% of women had experienced severe
physical violence from parents/caretaker (5% total).
The figures from the latter study are in accordance
with our estimate and might suggest that the question regarding physical violence in our study may
have been interpreted as severe.
Sexual violence. The prevalence estimate found in
our study for sexual violence was 17.3% for women
and 4.4% for men. The prevalence for women corresponds well with a national study among pregnant
women in Norway that presented a prevalence of
17%. In a study, Wijma et al. [19] presented a prevalence of 22.9% for sexual violence for women in
Norway. This finding among abused women in
shelter in Norway corresponds well with our estimate
for Sami women (21.8%). For sexual violence in
childhood (before age 18), our estimates for women
are 12.5% and 3.9% for men. Our findings are in line
with a recent Norwegian national study which found
a prevalence of sexual violence of 12.3% for women
and 5% for men before the age of 16 [21].
Strengths and limitations
The large number of participants (n=11,296) is a
strength of our study. Data were collected in multiethnic municipalities making it possible to assess
differences based on ethnicity. The main aim of the
study was to assess the differences in prevalence of
violence. We used a modified version of the NorVold
Abuse Questionnaire (NorAQ). The validation study
conducted in Sweden has showed that the abuse variables in the NorAQ have shown good reliability and
validity [22]. Our modified version has previously
been used in The Survey on Health and Living
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
8 A.M.A. Eriksen et al.
conditions in Oslo in 2000–2001 (the HUBRO
study) [23]. The abuse questions in NorAQ have not
been validated, either in the Sami population or
among non-Sami in Norway. Differences in cultural
and lingual interpretations may have influenced the
observed differences among the two groups. It is a
strength of the study that the questions give information of various types of violence and information
about when it had occurred. Hence, this gives us a
broader picture of the exposure of violence in this
population. When classifying ethnicity, linguistic
affiliation and self-identity were used as criteria. Both
criteria are used by the Sami Parliament for register
of voters. Hence, misclassification of responders as to
ethnicity is unlikely.
The participation rate was 27%. This low rate
must be regarded as a limitation of the study. We have
limited information about the non-respondents.
Since ethnicity is not recorded in any official register
in Norway, we are not able to assess whether the nonrespondents in the two ethnic populations differed.
However, a comparison between participations in
SAMINOR 2 and those participating in the first
SAMINOR has been conducted [16]. The proportion of participants classified as Sami did not differ
between SAMINOR 1 and SAMINOR 2. Since the
participation rate in SAMINOR 1 was considerable
higher, 60.9%, this population may have been representative for the background population. Further,
compared with participants in SAMINOR 1, participants in SAMINOR 2 tended to have higher education. Our results show that the proportion reported
violence was slightly higher in the group with high
education. This may have influenced our overall estimate by making our estimate slightly higher than
would be the case if there were no differences in education between responders and non-responders.
The information letter in SAMINOR 2 did not
specifically address violence, which makes it unlikely
that participation was influenced by selection based
on status as to having experienced violence in general. Also, our observed ethnic difference in reporting
of violence is unlikely to be influenced by differential
misclassification, since it is unlikely that non-Sami
participants were less likely to report violence than
Sami. Compared with the total invited population,
participants in our study were older. Since the proportion reported violence in our sample was higher
among the youngest, our estimates on violence are
probably conservative. On the other hand, there is a
growing openness in reporting violence in society:
this may overestimate both the prevalence and the
differences in reporting violence between age groups.
The low response rates require that generalizing of
the result must be considered with care. However,
the differences between respondents and nonrespondents are often important but rarely enough to
undermine studies. We believe that our results can be
generalized to the Sami and non-Sami living in rural
areas in Central and Northern Norway.
We had information on several assumed confounding factors and hence were able to control for
these, but unknown confounders may exist. Recall
bias is also a possible challenge in retrospective
reporting such as this, but difficult to avoid in these
kinds of surveys [24]. It is generally believed that
experiences of violence in childhood tend to be
under-reported in adulthood [25]. This may lead to a
lower prevalence estimate. On the other hand, age
may have a positive impact on reporting exposition to
violence, as negative exposures denied earlier in life
could come to awareness later on.
Conclusion
For all types of violence, Sami respondents more frequently reported having been subjected to violence,
and women in both ethnic groups reported more frequently having been subjected to sexual violence.
Our findings have implications for both health and
policy in terms of improving violence prevention
strategies. Health professionals should be aware of
ethnic differences in violence exposure.
Acknowledgements
We are grateful to all the participants who took part
in this study. We would like to thank Marita Melhus,
Department of Community Medicine, The Artic
University of Norway, and Hein Stigum, Department
of Community Medicine, University of Oslo for statistical support.
Conflict of interest
None declared.
Funding
Funding was provided by the Nothern Norway
Regional Health Authority (Helse Nord RHF) and
Sami Norwegian Advisory for Mental Health and
Substance use (SANKS).
References
[1] WHO. The WHO Multi-Country Study on Women’s Health
and Domestic Violence Against Women. Geneva, Switzerland: World Health Organization, 2005.
[2] Campbell JC. Health consequences of intimate partner violence. Lancet 2002;359:1331–6.
[3] Golding J. Intimate partner violence as a risk factor for
mental disorders: A meta-analysis. J FamilyViolence 1999;14:
99–132.
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015
Violence in Sami and non-Sami populations 9
[4] Campbell J, Jones AS, Dienemann J, et al. Intimate partner
violence and physical health consequences. Arch Intern Med
2002;162:1157–63.
[5] Brzozowski J-A, Taylor-Butts A and Johnson S. Victimization and offending among the Aboriginal population in
Canada. Juristat 2006;26(3). Statistics Canada Catalogue
no. 85-002-XIE. Ottawa: Statistics Canada.
[6]Tjaden P and Thoennes N. Prevalence, Incidence, and Consequences of Violence. Washington: U.S. Department of Justice
Office Justice Program, 2000.
[7] Sundaram V, Curtis T, Helweg-Larsen K, et al. Can we compare violence data across countries? Int J Circumpolar Health
2004;63(Suppl 2):389–96.
[8] Pedersen CP and Bjerregaard P. Det svære ungdomsliv. Unges
trives i Grønland 2011-en undersøgelse blandt de ældste folkeskoleelever [The Challenging Years in Youth. A Survey of the
Well-being among Secondary School Respondents]. København:
Statens Institut for Folkesundhed, 2012.
[9] Curtis T, Larsen FB, Helweg-Larsen K, et al. Violence, sexual abuse and health in Greenland. Int J Circumpolar Health
2002;61:110–22.
[10]Thoresen S and Hjemdal OK. Vold og voldtekt i Norge. En
nasjonal forekomststudie av vold i et livsløpsperspektiv [Violence and rape in Norway. A national study of the prevalence
of lifetime violence]. 2014 Contract No.: Report no. 1/2014.
[11] Neroien AI and Schei B. Partner violence and health: Results
from the first national study on violence against women in
Norway. Scand J Public Health 2008;36:161–8.
[12] Spein AR, Pedersen CP, Silviken AC, et al. Self-rated health
among Greenlandic Inuit and Norwegian Sami adolescents:
Associated risk and protective correlates. Int J Circumpolar
Health 2013;72. doi:10.3402/ijch.v72i0.19793.
[13] Hætta OM. SAMENE- Nordkalottens urfolk [The Sami –
The People of the North]. Kristiansand: Høyskoleforlaget,
2002.
[14] Pedersen P and Høgmo A. SÀPMI slår tilbake [Sàpmi
Strikes Back]. Karasjok: Càlliid Làgàgadus, 2012.
[15]Lund E, Melhus M, Hansen KL, et al. Population based
study of health and living conditions in areas with both Sami
and Norwegian populations – the SAMINOR study. Int J
Circumpolar Health. 2007;66(2):113–28.
[16] Brustad M, Hansen KL, Broderstad AR, et al. A population-based study on health and living conditions in areas
with mixed Sami and Norwegian settlements – the SAMINOR 2 questionnaire study. Int J Circumpolar Health
2014;73:23147.
[17] Niemi E. Kategoriens etikk og minoritetene i nord. Et historisk
perspektiv [The Ethics of Categories and Minorities in the
North. A Historical Perspective]. Oslo: NESH De nasjonale
forskningsetiske komiteer, 2002.
[18] Hansen KL. Ethnic discrimination and health: The relationship between experienced ethnic discrimination and multiple health domains in Norway’s rural Sami population. Int
J Circumpolar Health 2015;74:25125.
[19]Wijma B, Schei B, Swahnberg K, et al. Emotional,
physical, and sexual abuse in patients visiting gynaecology clinics: A Nordic cross-sectional study. Lancet
2003;361:2107–13.
[20] Mossige S and Stefansen K. Vold og overgrep mot barn
og ungeen selvrapporteringsstudie blant avgangselever i
videregående skole [Violence and Abuse against Children – A
National Survey among Graduating Students]. Nova rapport 20/2007, Norsk Institutt for forskning om oppvekst,
velferd og aldring, Oslo.
[21] Steine IM, Milde AM, Bjorvatn B, et al. The prevalence
of sexual abuse in a Norwegian representative population
sample. Tidsskrift for Norsk Psykologiforening [The Norwegian Journal of Psychological Association] 2012;49:950–7.
[22] Swahnberg IM and Wijma B. The NorVold Abuse Questionnaire (NorAQ): Validation of new measures of emotional, physical, and sexual abuse, and abuse in the
health care system among women. Eur J Public Health
2003;13:361–6.
[23] Stene LE, Dyb G, Tverdal A, et al. Intimate partner violence
and prescription of potentially addictive drugs: Prospective
cohort study of women in the Oslo Health Study. BMJ Open
2012;2:e000614.
[24]Rothman KJ. Epidemiology An Introduction, 2nd ed. New
York: Oxford University Press; 2012.
[25] Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries.
Lancet 2009;373:68–81.
Downloaded from sjp.sagepub.com at Universitet I Oslo on June 3, 2015