Eliassen et al. BMC Public Health 2012, 12:948 http://www.biomedcentral.com/1471-2458/12/948 Background Acculturation is for indigenous peoples [1] related to the process of colonisation over centuries [2]. Being one of the most cited definitions [3], Redfield, Linton and Herskovits [4] define acculturation as “those phenomena which result when groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original culture patterns of either or both groups” (p. 149). In health research the concept of accultur- ation has usually been applied to assess the health effects resulting from contact between people belonging to differ- ent ethnic groups; but the concept has also shown to be useful when exploring health implications among people subjected to rapid modernization and subsequent social and cultural change [5]. Within Alaska there are some 47.000 Inuit [6]. Ap- proximately 30% of these are Iñupiat [6-8] inhabiting the northern and western coasts as far south as Norton Sound [6]. Greenland is home to about 57.000 people, of which approximately 90% are Kalaallit (Greenlanders). The majority of Greenland’s population is situated on the south-central west coast. Only 3500 live on the east coast and less than 1000 are located in the far north. Kalaallisut (the Greenlandic language) is closely related to the Iñupiaq language spoken by Iñupiat in Alaska [9]. The traditional Sami settlement area (Sápmi) in Norway stretches from Finnmark in the north to Engerdal in Hedmark County in the south. No reliable or updated demographic record on the Sami exists. Though suffer- ing from grave deficiencies, estimates of the total num- ber of Sami in Norway usually vary between 40.000 and 50.000 [10]. The Iñupiat, Kalaallit and the Sami share a common, though independently unique, history of colonialism and have throughout history been victims of state and church driven forced assimilation [11-14]. Forced as- similation has resulted in loss or extensive change of traditional practices, native languages, and norms and beliefs [2]. As part of this process, concentration of the populations in large settlements provided most circum- polar indigenous peoples with schooling, health care, housing, water, sanitation, and imported foods and con- sumer products [14-16]. The post-World War II years in the Arctic were characterised by an intensification of so- cial and cultural change [14]. In Greenland, Alaska, and Norway an increasing urbanisation has taken place [14] and mining, industrial fishing and the discovery of oil transformed – to a varying degree – the economies [17]. In 2005 only 17% of the Greenlandic population lived in villages [9]. In the post-war period in Norway and Alaska, outmigration from rural to urban areas has also been considerable [18,19]. Today the transition from hunting and small scale fishing to a mixed cash/harvest economy is seen all across the Arctic [16]. Subsistence Page 2 of 11 and traditional foods is still a significant contributor to cultural identity and social cohesion among the Inuit and Sami [14,20,21], but unemployment is a problem in many Inuit communities which affects subsistence as this requires costly equipment such as guns, ammuni- tion, snowmobile, and petrol [14,22-24]. The role of sub- sistence is also affected by access to the resources traditionally harvested being reduced by climate change, pollution, and an increasing number of regulations and import bans [16,20,22,23,25]. Changes in living conditions and lifestyle following this development affect health in numerous ways [16]. The life expectancy of the Inuit and the Sami has drama- tically improved since 1950 [26-28], but the general health status of the Inuit is still inferior when compared with their respective state’s majority populations; this disparity has often been attributed to the Inuit’s rela- tively poorer socioeconomic status (SES) [16]. Few ge- neral health discrepancies between Sami and ethnic Norwegians are detected today. This is largely explained by little inter-ethnic variation in SES parameters [28]. The changes in occupational patterns are associated with increased acculturative stress, decreased physical activity and change in diet [16]. A number of studies on Inuit populations report a transition from the traditional and protein rich diet, to a diet of unhealthy store-bought foods thus making the Inuit susceptible to a variety of life-style diseases such as diabetes and cardiovascular disease [29]. High prevalence rates of obesity [30], and changes in diet [31] are also found in the Sami popula- tion in Norway. The effects of acculturation on chronic life-style diseases are evident in other populations and immigrant groups too [32]. Acculturative stress may be perceived as a response to life events associated with intercultural contact. To deal with various stressors, individuals will adopt different coping strategies eventually leading to some form of adaptation, of which integration may be the most health beneficial and marginalisation the least advantageous in terms of mental health [33]. The mental health effects of the various adaptations are very much debated [34]. A relationship between marginalisation and depression/ anxiety was found in a study among rural Sami adoles- cent males [35]. Similarly, in Greenland it was found that better mental health status was associated with growing up in a town and being fully bilingual, as opposed to growing up in a small village and only speak- ing Greenlandic [36]. Spein et al. [37] found that more assimilated Sami adolescents reported more smoking and drinking compared with less assimilated Sami peers. Wolsko et al. found that among Alaska Yup’ik, higher levels of acculturation was associated with greater psy- chosocial stress, less happiness, and greater use of drugs and alcohol [38,39]. Wexler reports a relationship