Abstract

            This review examines research on the Inuit population’s binge drinking. The dangers of binge drinking adversely affect both individuals and communities. Included are studies on pregnant Inuit women, timeline analyses, and motivational analyses of Inuit alcohol use. These studies include data which characterizes Inuit alcohol use as containing many binge drinkers and abstainers, but a relatively small number of typical drinkers. Research around pregnant women shows a prevalence of binge drinking among pregnant women, and the negative impact on their children. Timeline analysis research provides information on periods of transition in which greater alcohol use and binge drinking was discovered, as well as data on how Inuit alcohol use has developed over time. Periods of transition were linked to alcohol restrictions and prevention efforts, with a downward trend of both alcohol use and binge drinking among Inuit. Research on potential binge drinking motives focused on the urbanization of Greenland, how household crowding affects the Inuit in Greenland, and interviewing adolescents on their motivations. Studies could not link urbanization and household crowding to higher binge drinking but did find household composition and mood enhancement to be motivators. The studies’ common use of interviews to collect data was found to be a potential weakness. A lack of studies on prevention or intervention is noteworthy.

 

Introduction

Excessive alcohol use is shown by the Centers for Disease Control (2020) to increase the risk of

mental health problems, organ diseases, and some cancers in the individual. It is also linked with societal problems such as birth defects, increased car crashes, and violence (CDC 2020). Binge drinking alcohol, defined as 5 or more drinks within two hours, is the most common form of excessive alcohol use. Preventing binge drinking could lead to a significant decrease in the individual and societal problems caused by excessive alcohol use. Researchers have studied the Inuit population, which includes a high proportion of binge drinkers. In this review the studies examined were conducted in the past 20 years on the Inuit population to find possible motives, patterns, and consequences. Seven research papers found on the PubMed database were used to form this literature review. The first section includes studies of binge drinking done on pregnant Inuit women; the second section follows the patterns researchers found regarding Inuit binge drinking; and the last section includes studies focused on the possible motives of binge drinking.

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Inuit Binge Drinking During Pregnancy

            Some of the earliest research surrounding the Inuit population’s binge drinking habits focused on pregnant women. Three studies -- Muckle et al. (2011), Fraser et al. (2012), and Fortin et al. (2016) -- used a sample of pregnant Inuit women from the Nunavik region in Canada. This sample included 248 pregnant women interviewed from 1995 to 2000. The interviews were conducted at three points of time: during pregnancy, 1 month after delivery, and 11 months after delivery. Participation fell by about 30% over time due to factors such as adoption, subject relocation, miscarriages, and inability to contact the subject. The interviews were structured to find the frequency and quantity of alcohol used during each stage of the study. Subjects were questioned on the number of days where they drank, the number of drinks during those days, and the amount during binge drinking episodes. In addition, the interviews collected data on tobacco use, illicit drug use, familial status, and socioeconomic status. The studies differed in their analyses of the results.

            Muckle et al. (2011) used the sample to identify correlations between socioeconomic factors, psychological characteristics, and substance use. The study found 60% of the participants used alcohol during pregnancy, with 62% of those participants binge drinking at least once during pregnancy. This high number of binge drinkers was found to drink more frequently during the postnatal year. The study also found a prevalence of smoking and marijuana use by pregnant Inuit women: with 90% of women smoking, and one-third using marijuana. When focusing on correlations, the researchers found binge drinkers during pregnancy to be more likely to use marijuana. Regarding socioeconomic factors, binge drinking occurred more with women who were single, had fewer children, or lived in less crowded houses. In the postnatal interviews, the study found that women who used alcohol were more psychologically distressed. However, the researchers were not able to definitively determine if the distress was caused by the alcohol use or present beforehand. The study states the importance of culturally relevant prevention and intervention programs in reducing the negative impact of alcohol use on Inuit communities and child development.

            Fraser et al (2012) studied impact on child development through the effects binge drinking had on Inuit infants. They built on previous research which showed children exposed to binge drinking during gestation testing lower in verbal IQ. The researchers propose their study to be useful in that the Inuit sample’s average daily alcohol use is low, with high rates of binge drinking. This was affirmed in that only 10 of the 215 women in the sample averaged more than one drink per day, with bingeing rates staying high among the entire sample. In addition to the interviews providing information on parental alcohol bingeing, this study assessed the infants at birth and 6 months of age. Weight, length, and head circumference were measured at birth. At 6 months an examiner, blind to prenatal alcohol exposure, administered tests to determine visual acuity and cognitive development. Correlated results were based on measures of ounces of absolute alcohol per day, whether the women were binge drinking, ounces of absolute alcohol per binge, and the frequency of bingeing. The study found significant associations with all of these measures on reduced birth weight and visual acuity. The biggest link to negative factors was the frequency of bingeing. The researchers state their study provides evidence of adverse effects on infants of binge drinking during gestation, but also the need for further investigation into the timing and proximity of bingeing episodes.

While the study by Fortin et al (2016) could not analyze the specific timing or proximity of

bingeing episodes, due to using data from the same sample as Muckle et al. (2011), the researchers were able to find the trajectories of alcohol use and binge drinking in the Inuit. The study plots these trajectories at four points of time: the year before conception, at conception, during pregnancy, and the year following delivery. The researchers find these periods of time could be useful in implementing intervention programs. More women drank during all four periods than abstained, however a significant amount more never binged than binged during all four periods. The researchers state their results indicated highly varied transitions during each stage. The researchers found the most significant transition periods to be drinkers and bingers moving to abstainers between the year before conception to at conception. For abstainers moving to drinkers the significant transitions were after conception and after delivery. As the study uses data from 1995-2000, the researchers question whether the trajectories could be replicated now, but also state that Inuit alcohol use remains a problem.

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Drinking Patterns Among the Inuit

            The study by Fortin et al (2016), and its trajectories of alcohol use over time, provides a basis for how literature centered around the patterns of drinking among Inuit populations. The basis shows a focus on understanding the effects of alcohol on the Inuit population over time as with Bjerregaard et al (2020).

            The study by Bjerregaard et al (2020) used research studies from 1950 until 2018 in order to track, document, and analyze the Greenland Inuit population’s alcohol use over time. Alcohol consumption was compiled through a commission report, doctoral thesis, import statistics, and Greenland’s public statistics website. In addition, information on Denmark and Norway’s alcohol use was obtained for comparison. The study also used data from Greenland health surveys conducted from 1993 to 2018 in order to chart the population according to abstainers, rare drinkers, monthly drinkers, and weekly drinkers. Binge drinking and alcohol consumption averages were included in these surveys. The researchers charted consumption patterns of the three countries, the types of alcohol consumed, alcohol related mortality, and alcohol related domestic problems. The study’s results show a multitude of trends and relations. A focus on domestic alcohol problems found relation to increased import of alcohol and increased domestic problems such as child sexual abuse. The researchers also correlated these problems with suicide rates and alcohol abuse in the Greenland population. The study found a pattern of increase in consumption from 1950 to 1987, with significant reductions from 1956 to 1960 and 1979 to 1982. After peak consumption in 1987 the study found a continual decrease to 2018. Reductions were linked to restrictions on sale of alcohol, and institution of prevention and awareness programs. When comparing the consumption of Greenland to Denmark and Norway researchers found higher volatility in Greenland until the steady decline in use after 1987. The researchers also found that alcohol in Greenland, compared to Denmark, was consumed by fewer individuals and more concentrated on special occasions and weekends. When data was first available for binge drinking in 2005, the study found binge drinking to not decrease much from the 52.9% of the population until 2018 when it decreased to 35.4%. Though the Greenland Inuit were still found to binge drink significantly more often than the Denmark population. When looking at the pattern of the highest decile of drinkers, consumption stayed mostly the same over time. The study states the Greenland Inuit pattern of drinking consists of many abstainers, few regular drinkers, but widespread bingeing.

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Finding Motives for Binge Drinking

            Madsen et al (2005) focused research around the potential motives for Inuit binge drinking by examining the influence of urbanization and migration on alcohol use. The study’s subject population of Inuit lived in both Denmark and Greenland. The researchers analyzed data from questionnaires and, subsequently, clinical examinations and interviews. The subjects were questioned about their alcohol intake habits. In order to determine the potential effects of urbanization and migration, data was grouped by community size and length of stay. These were further divided as community size was only observed in Greenland, and length of stay was only observed in Denmark. The results showed higher average alcohol intake for men and for those living in Denmark. The lowest average alcohol intake was seen in the small communities of Greenland, and no significant difference was seen between small and large Greenland communities. The researchers found a relation between the increase of length of stay and a decrease in the prevalence of binge drinking on the Denmark population. They also found that the Greenland Inuit tested in a higher proportion for alcoholism and binge drinking. The researchers conclude their study to suggest a diversity in alcohol intake for Inuit populations due to living conditions.

            Following the path of researching urbanization in the Greenland communities was Riva et al (2014). Their study’s narrowed focus, being the effect of household size on Inuit psychosocial health, provides data on individual characteristics, mental health, household conditions, and how they relate to Inuit alcohol use and binge drinking. Data was collected on 3,108 Greenlanders via interviews and self-administered questionnaires. Data on alcohol consumption was limited due to a lower response rate during the self-administered questionnaire. Data on household crowding was defined by the number of people per room, personal compositions of the household, and characteristics such as socioeconomic status. When analyzing the data in regard to mental health, researchers found increasing levels of household crowding to associate with increased odds of depression. Higher social support was also associated with less depression. When relating findings to binge drinking, the researchers found results to relate somewhat invertedly to depression. Higher crowding led to less binge drinking, and higher social support had no significant association with binge drinking. The result of binge drinking being reported almost twice as much by respondents living without children provides a potential explanation for the inverse results. Living alone or with other adults, compared to living with children, was linked to a significantly higher likelihood of binge drinking. The study emphasizes the impact crowded living conditions has on mental distress and binge drinking.

            The most recent study, Decaluwe et al. (2019), shifted focus from the Greenland Inuit population back to the Canadian Inuit population. The study shows the prevalence of binge drinking in adolescents, as almost half of a group of Canadian twelfth graders surveyed engaged in binge drinking. It also iterates the dangers of depression, suicide, and violence linked to alcohol use. Binge drinking in this study’s sample community of Nunavik is twice as prevalent among adults to that of other Canadian adults. This study’s sample included 174 adolescents, aged 16 to 21. Adolescents were interviewed to find their motives for drinking. During the interview they were asked to rate the frequency at which they endorse each motive. Researchers compared results to their binge drinking frequency and gender. The study found that the majority of adolescents binge drank, with only 5% reporting no binge drinking, and found no major differences between the amount of binge drinking episodes for males and females. The motives for drinking found in the study were grouped into enhancement, social, and compensatory, with most adolescents claiming enhancement to be their main motive. Though females were significantly more likely than males to have a compensatory motive. The study found relations between endorsing certain motives within each motive category and the number of times a subject would binge drink being higher, especially amongst males. The sub-motives for males most related to binge drinking were to feel good, to have fun, because of friends, and to cheer up. Celebration was the only sub-motive which provided a significant relation to binge drinking for females. The study suggests interventions in decreasing the Inuit population’s binge drinking should be culturally relevant, and possibly gender adapted.

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Conclusion

            The problem of binge drinking Inuit population is well-documented as researchers have gathered data on prevalence, timelines, motives, and consequences. Though studies have found a general decrease in alcohol use, some researchers still consider Inuit alcohol use to be a significant problem. Many of the studies used interviews in order to collect data, which some researchers acknowledged as potentially unreliable due to possible underreporting. While these areas are important in recognizing the problem, a focus on prevention or intervention research is lacking.

 

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References

Bjerregaard, P., Larsen, C. V., Sørensen, I. K., & Tolstrup, J. S. (2020). Alcohol in Greenland 1950-2018: consumption, drinking patterns, and consequences. International Journal of Circumpolar Health, 79(1). doi:10.1080/22423982.2020.1814550

Centers for Disease Control and Prevention. (2020, September 21). Excessive alcohol use. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/alcohol.htm

Decaluwe, B., Fortin, M., Moisan, C., Muckle, G., & Belanger, R. E. (2019). Drinking motives supporting binge drinking of Inuit adolescents. Canadian Journal of Public Health, 110, 414-421. doi:10.17269/s41997-019-00212-5

Fortin, M., Muckle, G., Anassour-Laouan-Sidi, E., Jacobson, S. W., Jacobson, J. L., & Bélanger, R. E. (2016). Trajectories of alcohol use and binge drinking among pregnant Inuit women. Alcohol & Alcoholism, 51(3), 339-346. doi:10.1093/alcalc/agv112

Fraser, S. L., Muckle, G., Abdous, B. B., Jacobson, J. L., & Jacobson, S. W. (2012). Effects of binge drinking on infant growth and development in an Inuit sample. Alcohol, 46(3), 277- 83. doi:10.1016/j.alcohol.2011.09.028

Marie Henriette Madsen, Morten Grønbæck, Peter Bjerregaard, Ulrik Becker & The Greenland Population Study (2005) Urbanization, migration and alcohol use in a population of Greenland Inuit, International Journal of Circumpolar Health, 64:3, 234-245, DOI: 10.3402/ijch.v64i3.17987

Muckle, G., Laflamme, D., Gagnon, J., Boucher, O., Jacobson, J. L., & Jacobson, S. W. (2011). Alcohol, smoking, and drug use among Inuit women of childbearing age during pregnancy and the risk to children. Alcoholism: Clinical & Experimental Research, 35(6), 1081-1091. doi:10.1111/j.1530-0277.2011.01441.x

Riva, M., Larsen, C. V., & Bjerregaard, P. (2014). Household crowding and psychosocial health among Inuit in Greenland. International journal of public health, 59(5), 739–748. doi:10.1007/s00038-014-0599-x