Negative impact of alcohol on child health in Arctic communities: a cross-sectional comparison of alcohol import with domestic alcohol problems, violence and sexual abuse in childhood among the Kalaallit Inuit in Greenland in birth cohorts from 1950 to 2002

Background The post-colonial period in Greenland from 1953 witnessed profound social changes. Increasing urbanization and a high import of alcohol were among the most important determinants of public health. Methods Information on urbanization and import of alcohol was obtained from official registers from 1950 to present. Information about adverse childhood experiences (ACEs) was obtained for birth cohorts from 1950 to 2002 from three population health surveys with 4131 individual Kalaallit Inuit participants. Alcohol import and ACEs were compared visually by birth cohort and by linear regression models. Results Import of alcohol and prevalence of alcohol problems and violence in the childhood home and sexual abuse as a child showed similar bell-shaped curves with a maximum during the 1970s and 1980s. The similarity of the time trends and the plausibility of the mechanism are taken as evidence in support of a causal relationship between alcohol consumption and ACEs. Linear models showed statistically significant (p < 0.001) positive regression coefficients between alcohol import and the three ACEs. The point estimates of regression coefficients were 1.1/1.9 (men/women) percentage points increase per litre imported alcohol per person per year for alcohol problems, 0.6/0.8 for violence and 1.4/2.8 for sexual abuse. Urbanization was only associated with sexual violence among women with a regression coefficient of 0.2 percentage points by per cent urbanization (p = 0.02). Conclusions Among the Kalaallit Inuit in postcolonial Greenland alcohol plays a major negative role in society, especially during 1970–1994. The prevalence of ACEs fluctuated parallel to the import of alcohol. We conclude that alcohol and to a lesser extent urbanization are causally related to ACEs. The results are specific to the historical situation of the Kalaallit Inuit but many other indigenous populations share a similar colonial history with alcohol misuse and ACEs. It is therefore likely that the suggested effects of alcohol on ACEs are similar in other Arctic populations such as the Inuit and First Nations in Canada and Alaska Natives. Besides other negative effects, alcohol is a key factor in the pathogenesis and the prevention of ACEs and both prevention, including structural prevention, and treatment of families and individuals should be strengthened.