Montana State University
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Elizabeth RinkA Montana State University professor and an international team of researchers have won nearly $1 million from the National Science Foundation to help decrease unusually high rates of sexually transmitted infections among people living in Greenland.

Elizabeth Rink, a health and human development professor in MSU's College of Education, Health and Human Development, said the $959,000 grant will allow her and the team of researchers to work with three communities in Greenland for three years.

The researchers hope the program will increase understanding in Greenland about healthy sexual behavior and help lower the rates of sexually transmitted infections (STIs), which can lead to infertility.

"These silent diseases have not been addressed," Rink said. "We hope to change that."

Tim Dunnagan, who chairs MSU's Department of Health and Human Development, thinks the research team's work is important and can help people in Montana, too.

"Beth has also been doing a lot of work with reservations in Montana," Dunnagan said. "When combined with the work she's doing in Greenland, I think she's found some very innovative ways of dealing with cultures here in Montana and in Greenland.

"Someone might question why is someone at MSU doing research in Greenland, but there's a lot of commonality," Dunnagan continued. "In community-based health initiatives, one of the big things to figure out is how do you work with a culture?"

The work in Greenland complements MSU's outreach mission, Dunnagan said, and added that what Rink and the team learns in Greenland can be applied in Montana.

"Sometimes if you have a different lens, or a broader one, you can find answers to complex questions," Dunnagan said. "STIs are not an easy thing to explain."

The first part of the program calls for educational seminars, which are designed to educate community members about STIs. Focus groups, where participants will help design the program, will also be held. The researchers will also train community health outreach workers to evaluate the program. Then, the researchers will use questionnaires to measure STI rates over time. The researchers' target population is 15-19 year-old adolescents and their parents.

The program Rink and the researchers have designed relies heavily on community involvement. It uses a type of research, community-based participatory research, which is conducted as an equal partnership between traditionally trained "experts" and members of a community.

"These communities were interested in working with us partly because of the community-based nature of our work," said Rink, who had traveled to Greenland previously for research and who also does community-based research with Native Americans on the Fort Peck Reservation in northeastern Montana and the Northern Cheyenne Reservation in southeastern Montana.

Rink and the researchers plan to travel to Greenland -- which Rink calls a "wonderland" -- three times a year for two to three weeks at a time. Rink hopes to take several MSU students with her to conduct the research, she added.

Little research into STIs in Greenland has been done, but the need in Greenland and other Arctic, sub-Arctic and rural communities is great because of the risks associated with infertility, Rink said.

According to the researchers, STI rates in Arctic and sub-Arctic regions of North America, like Greenland, are higher than those reported for their southern counterparts. Serious health problems can follow. Infections like chlamydia and gonorrhea can cause chronic abdominal pain, infertility, ecotopic pregnancy, preterm birth and increased risk for HIV. In 2006, Greenland reported the highest rates of infection in the Arctic, or 554 chlamydia cases per 10,000 people, which is more than 10 times higher than those reported for Denmark.

Also, in Greenland, the number of births -- just 1,000 per year -- equals the number of induced abortions, and the reproductive rate -- 95 births per 1,000 women between 15 and 45 years of age -- is far below the rate necessary to sustain the population, Rink said. The effects of reduced fertility could be catastrophic to cultural and economic sustainability, she added. Reduced fertility leads to decreasing birth rates, which ultimately leads to a decreasing indigenous population.

While more research needs to be done, Rink pointed to ways people negotiate sexual relationships in Greenland as a possible explanation for Greenland's high rates of STIs. The culture that Rink has observed in Greenland does not include talking openly about sex, which might lead to a higher STI rate.

"Sex can be a very embarrassing and awkward topic for people to talk about if they do not receive positive role modeling from their parents, other family members and elders regarding how to foster and maintain healthy sexual relationships, or if they have a personal history of difficult sexual relationships," Rink said. "It could be that the sexual norms regarding talking about sex and sexual relationships is contributing to what we are seeing in Greenland."

Rink also noted that a program of this type in the Arctic is unique. Most STI intervention and prevention strategies have been developed primarily for urban and suburban environments, the rural South of the United States, Latino communities, and developing countries, primarily in Africa.

Along with Rink, who is the project's co-principal investigator, members of the research team include Dionne Gesink Law, an assistant professor of epidemiology in the School of Public Health Sciences at the University of Toronto: Ruth Montgomery-Andersen, who is working on a doctorate in medical anthropology and is affiliated with the University of Greenland; Gert Mulvad, a physician and researcher who has been living and working at a primary care clinic in Greenland for 30 years; Anders Koch, an epidemiologist and physician at the Statens Serum Institut in Denmark; and Jorgen Skov Jensen, an epidemiologist and physician also at the Statens Serum Institut in Denmark.

Rink hopes the team's efforts to reduce rates of STIs in Greenland will have a lasting impact.

"It's a culture that's dying," she said. "People are so focused on melting icebergs, or climate change, and how that's influencing the population. But in Greenland, there's a whole other issue with STIs that is influencing the population."

"It's also creating a decline in the culture," she added. "There's a social behavioral issue, in addition to an environmental issue, that's influencing the people of Greenland."

Elizabeth Rink, (406) 994-3833 or Elizabeth.rink@montana.edu

July 15 , 2009 -- By Anne Pettingerl, MSU News Service