Eliassen et al. BMC Public Health 2012, 12:948 http://www.biomedcentral.com/1471-2458/12/948 0) Very well/Relatively well 1) With effort/A few words/ Not at all. Housing condition was not included in the regression models in Norway. Overall the standard of living is high in Norway and no variation was therefore observed in the variable. In Alaska and Greenland a score was gener- ated by adding 9 variables measuring standard of hous- ing. This score was further categorised based on its distribution. Worsening standard of housing is illu- strated with an increased score. Living in a town or vil- lage was not included in the analyses of data from Norway as all participants are by definition rural. How- ever, we included herein living in Finnmark or not, as prior studies [52] have shown that a north–south-based health gradient is relevant to account for in Norway. Statistical analyses The subsistence score and SILA were included in six separate regional- and gender-specific ordinal logistic regressions. Univariate regression and backwards step- wise regression was used to fit the models; covariates included in the final model (Model 2) were significant in at least one stratum. As sample sizes were small, mul- tiple imputation (MI) was executed to improve preci- sion. The complete regression model was applied throughout the imputation process. Wald tests of regres- sion parameters showed no evidence of systematic differ- ences between imputed and non-imputed data (data not shown). Tests of model improvement (e.g. likelihood ratio tests) were not possible as these are not directly ap- plicable to MI results [53]. All statistical analyses were performed using STATA version 12.0 (STATA Corp, College Station, TX). Ethics Detailed information on the project was given to the participants orally and in writing, and written informed consent was obtained before interviews took place. For respondents younger than 18 years, prior written informed consent from parents or legal guardians was obtained. In Norway, the study was accredited by the Norwegian Social Science Data Service and the National Committee for Research Ethics in the Social Sciences and the Humanities. In Alaska, the study was approved by the University of Alaska Institutional Review Board (IRB). In Greenland, approval from the research ethics committee was not obtained, because this is required only for medical research projects. Being responsible for data collection, Statistics Greenland guaranteed an eth- ical handling of individual data and these rules and regu- lations ensuring confidentiality for respondents were followed. The survey adheres to the Declaration of Helsinki and to the International Arctic Social Science Association’s (IASSA) Guiding Principles for the Page 4 of 11 Conduct of Research in the Arctic 1998. Representatives of the Inuit Circumpolar Conference, the Sami Council and the Russian Association of Indigenous Peoples of the North have formed advisory boards to oversee the study [54]. Indigenous steering committees approved the final questionnaire [55]. This section is also sited else- where [46]. Results The distribution of variables by country/region and gen- der included in this study is presented in Table 1. No significant gender differences in the distributions of SRH, the subsistence score, or SILA were present. The crude distributions of SRH by the included vari- ables are presented in Table 2. A close to significant rela- tionship between poorer SRH and an increased subsistence score was observed among men in Alaska (p=0.08) and Greenland (0.07). In Greenland, a signifi- cant relationship and a similar trend was observed be- tween SRH and SILA for both men (p=0.02) and women (p=0.04), while a somewhat reversed relationship was detected in Alaska (p<0.01). Multivariable analyses are displayed in Table 3. Acculturation significantly predicted poorer SRH in Greenland, and the relative effects of acculturation were stronger for men than for women, though this modifica- tion of effects was not significant (data not shown). An increased subsistence score gave an OR of 2.32 (P<0.001) for reporting poorer SRH among Greenlandic men, while an increased score for Greenlandic women generated an OR of 1.71 (P=0.01). Poorer SILA pro- duced an OR of 1.59 in men (p=0.03) and 1.43 in women (p=0.07). In Alaska, no evidence of acculturation effects was detected among Iñupiaq men. Among Iñupiaq women, an increased score represented an increased odds of 73% (p=0.026) for reporting poorer SRH. No significant effects of acculturation were detected in Norway. However, SILA was close to signifi- cant (p=0.068) among Sami men, thus suggesting a sub- stantial effect of acculturation on SRH (OR=1.74). Overall, no modifying effect of the subsistence score by levels of SILA was detected (data not shown). Fur- thermore, we found no evidence of education confound- ing or modifying the effect of acculturation (data not shown). Discussion In this article, we have presented the effects of accultur- ation on SRH among the Kalaallit of Greenland, the Iñupiat of Alaska, and Sami of Norway. This study is the first comparative analysis of acculturative effects among these indigenous peoples, and the first study of this kind ever in the adult Sami population in Norway. Accultur- ation was positively and significantly associated with