Trends in smoking,diet, physical exercise,and attitudes toward health in European university students from 13 countries, 1990-2000

BACKGROUND: Smoking, diet, and physical exercise are key determinants of health. This study assessed changes over 10 years and their relationship to changes in health beliefs and risk awareness. METHOD: A survey was carried out of university students from 13 European countries (Belgium, England, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, The Netherlands, Poland, Portugal, and Spain) in 1990 (4,701 men, 5,729 women) and repeated in 2000 (4,604 men, 5,732 women). We assessed smoking, exercise, fruit and fat intake, beliefs in the importance of behaviors for health, and awareness of the influence of behaviors on heart disease risk. RESULTS: Smoking prevalence increased and fruit consumption decreased between 1990 and 2000, while physical exercise and fat intake were more stable. There were large variations between country samples. Health beliefs weakened, with marked decreases in beliefs about smoking and diet. Across country samples, changes in beliefs correlated with changes in the prevalence of behaviors. Awareness of the effects of smoking and exercise was stable, but knowledge of the role of fat intake increased over the decade. CONCLUSIONS: The differences in health behaviors, beliefs, and risk awareness between the two surveys were disappointing in this educated sector of young adult Europeans. The association between changes in beliefs and prevalence of behavior emphasizes the importance of enhancing positive attitudes to healthier lifestyles.     

Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?

BACKGROUND: Mortality rates are much more favourable in Western European countries than in those of Eastern Europe. Health behaviour and psychosocial factors have been suggested to be important contributors to East-West differences in mortality and health status. METHODS: To compare reported health status as well as health behaviours and psychosocial factors which may be related to unequal health status in different parts of Europe, standardised postal surveys of representative populations samples were conducted in six Eastern and Western European areas. RESULTS: Higher mortality in the eastern populations was associated with more reported morbidity and generally more negative health ratings. Health behaviours and psychosocial factors were also more negative in the East. Multivariate analyses suggested that the East-West difference in health status may be partly explained by differences in health behaviours and psychosocial factors. CONCLUSION: Efforts to promote health in Eastern Europe should concentrate both on the promotion of healthier lifestyles and on improvement of social and economic conditions.     

Leisure-Time Physical Exercise: Prevalence, Attitudinal Correlates, and Behavioral Correlates among Young Europeans from 21 Countries

Background.Increasing leisure time physical exercise is a major target of public health programs throughout the developed world, but few international comparisons of exercise habits among people from diverse cultures have been published. The objectives of this study were to assess the prevalence of exercise among young adults from 21 European countries, to analyze associations with health beliefs and risk awareness, and to investigate relationships among exercise, other health-related behaviors, and emotional well-being.Methods.The European Health and Behaviour Survey, a questionnaire survey of 7,302 male and 9,181 female university students ages 18–30 years from 21 countries, was analyzed.Results.Age-adjusted prevalence of physical exercise in the past 2 weeks averaged 73.2% among men and 68.3% among women, but varied markedly from more than 80% to less than 60% across country samples. Beliefs in the health benefits of exercise were consistently associated with physical exercise, as was desire to lose weight. Awareness of the influence of exercise on heart disease averaged 52% among men and 54% among women, but was not strongly associated with engagement in exercise. Associations among exercise, lack of smoking, and sleep time were observed, but results for alcohol consumption were inconsistent. Social support and depression were independently associated with physical exercise.Conclusions.Physical exercise levels are highly variable across samples of relatively privileged young Europeans from different countries. Associations with other health behaviors and with emotional well-being suggest that regular physical exercise is consistent with a healthy lifestyle. Links with health beliefs are consistent despite sociocultural differences, but deficient knowledge of the health consequences of a sedentary lifestyle remains a cause for concern.     

Nutrition and lifestyle of the elderly in Europe

Demographic changes all over the world lead to an increasing proportion of elderly people with far-reaching implications for our societies, but also for the individual. Ageing affects nutrition as well as lifestyle: adequate nutrition becomes increasingly difficult with increasing age, whereas physical activity usually decreases. Nutrition and lifestyle, however, are important determinants of health and outcome in the elderly. Our knowledge about nutrition and lifestyle of elderly people in Europe is fragmentary. The most comprehensive information originates from the longitudinal multi-centre SENECA study that started in 1988–1989 and ended in 1999. In addition, several nationwide surveys and a variety of local studies have been performed. According to these studies, nutritional status, dietary habits and food pattern, energy and nutrient intake vary widely across Europe. Median energy intake for example ranged from 7.6 to 11.8 MJ/day in men and from 6.0 to 10.1 MJ/day in women in the SENECA baseline study. The food pattern in southern countries was characterised by high intakes of grain, vegetables, fruit, lean meat and olive oil, whereas elderly people in northern countries consumed more milk products and more often reported the use of nutrient supplements. In some towns considerable proportions of elderly men and women might be at risk of vitamin or mineral deficiency. Great differences between the countries also exist with respect to physical activity of elderly people. In a recent pan-European survey physical activity was highest in Sweden and Finland, where more than 85 % of elderly subjects spent at least 3.5 h per week in physical activity, and lowest in Portugal with only 25 % of active elderly. In summary, there is great variation in nutrition and lifestyle across European countries and even within countries. Information about the situation in Eastern European countries is on the whole missing—or at least not published. The aim of the current research project Comparative analysis of existing data on nutrition and lifestyle of the ageing population in Europe, especially in the new Baltic, Central and Eastern regions of the Community, funded by the European Commission, is to collect existing data in Europe in this field and review these data critically in a comparative manner.     

A Review of Dietary Selenium Intake and Selenium Status in Europe and the Middle East

This is a systematic review of existing data on dietary selenium (Se) intake and status for various population groups in Europe (including the United Kingdom (UK)) and the Middle East. It includes English language systematic reviews, meta-analyses, randomised controlled trials, cohort studies, cross-sectional and case-control studies obtained through PUBMED searches from January, 2002, to November, 2014, for European data and from 1990 to November 2014, for Middle Eastern data. Reports were selected if they included data on Se intake and status. The search identified 19 European/UK studies and 15 investigations in the Middle East that reported Se intake and Se concentration in water and/or food and 48 European/UK studies and 44 investigations in the Middle East reporting Se status. Suboptimal Se status was reported to be widespread throughout Europe, the UK and the Middle East, and these results agreed with previous reports highlighting the problem. Eastern European countries had lower Se intake than Western European countries. Middle Eastern studies provided varying results, possibly due to varying food habits and imports in different regions and within differing socioeconomic groups. In conclusion, Se intake and status is suboptimal in European and Middle Eastern countries, with less consistency in the Middle East.     

Regional collaboration in public health training and research among countries of South Eastern Europe

It is argued that each country of South Eastern Europe should have its own school of public health. However, a basic prerequisite of modern public health training is the comprehensiveness of the programme and a worldview approach. Most of the countries of South Eastern Europe face the same difficulties to adapt their inherited communist structures of public health training to Western standards. A regional collaboration would facilitate the process of establishing schools of public health in all countries of the region and support the training of public health professionals at all levels. KEY POINTS: South East Europe includes Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Moldavia, Romania, Serbia and Montenegro, and Slovenia. Public health institutions in South East Europe face similar difficulties to adapt their inherited teaching structures to Western standards. Public health institutions in South East Europe should make a joint effort towards establishing regional training programmes. A regional approach in public health training would enable an efficient use of resources in countries of South East Europe.     

The importance of father’s and own education for self‐assessed health across Europe: an East–West divide?

How are one’s own education, father’s education, and especially the combination of the two, related to self‐assessed health across European societies? In this study, we test hypotheses about differences in self‐assessed health between 16 post‐socialist countries in Central and Eastern Europe and 17 Western European countries. We find substantial cross‐national variation in the (relative) importance of own and father’s education for self‐assessed health. Over 65 per cent of this cross‐national variation is accounted for by the East–West divide. This simple dichotomy explains cross‐national differences better than gross domestic product or income inequality. An individual’s father’s education is more important, both in absolute and relative terms, for self‐assessed heath in Eastern Europe than in Western Europe. Intergenerational mobility moderates the relative effects of one’s own and one’s father’s education. In Eastern Europe the relative importance of one’s father’s education is greater than it is in Western Europe – particularly for those who are downwardly mobile and have a father with tertiary education. The results are sometimes contradictory to initial expectations; the theoretical implications are discussed.     

Quantity in health care is not always a substitute for quality

Examines the outcomes of attempts to improve health services in the former Communist countries of Eastern Europe and in the West European democracies. Discovers that while the East Europeans focused their efforts on increasing the numbers of doctors and beds per patient, while keeping to relatively low levels of investment in technological advances, West European countries have taken the opposite approach, emphasizing quality of care, particularly advanced care, reducing the numbers of physicians and hospital beds, acquiring advanced technological systems for diagnosis and treatment and spending ten times as much per patient as in Eastern Europe. Concludes that the West European approach has led to far better results.     

Trends in mortality from major diseases in Europe, 1980–1993

Trends in age-standardized death certification rates from all causes, coronary heart disease (CHD), cerebrovascular diseases, all neoplasms and lung cancer were analysed over the period 1980–1993 in 20 major European countries. There were steady and substantial declines of overall mortality in all western European countries for both sexes, although appreciable geographic differences persisted. These favourable trends reflect a decline in CHD mortality in most western countries, besides a persisting fall in cerebrovascular disease, and a substantial stability (with some decline in a few northern and central European countries) in cancer mortality. In contrast, in eastern European countries appreciable rises were registered in mortality from major causes of death considered for males. For females, only moderate declines were observed in Eastern Europe. In the early 1990s, overall mortality was 30 to 100% higher for males and 20 to 100% higher for females as compared to Western Europe. As indicated by the trends in lung cancer death rates, this reflects a major impact of the tobacco-related disease epidemic in subsequent cohorts, as well as more unfavourable lifestyle factors (i.e. aspects of diet, other environmental factors), and a delayed control of hypertension in Eastern Europe, together with a substantial excess of suicides, (road) accidents, homicides and alcohol-related diseases, and the delayed introduction of rational treatment for some conditions. An indication of reversal of mortality trends was evident in the early 1990s only in Poland. In conclusion, there is ample scope for intervention on avoidable mortality in eastern European countries.     

What the experts think: A European survey of expert opinion about the influence of lifestyle on health

This paper describes an assessment of expert medical and epidemiological opinion about the role of lifestyle in health, carried out by means of a questionnaire survey of senior members of academic departments of public health, epidemiology and social medicine in Western European universities. Estimates were made of the influence of eight lifestyle factors — smoking, alcohol consumption, exercise, stress, body weight, dietary fat, fibre and salt — on the aetiology or course of five disorders: heart disease, high blood pressure, lung cancer, breast cancer and diabetes. One hundred and fifty responses were received from scientists and clinicians from 16 countries. Respondents had an average of 17.8 years experience in their discipline (range 5–40 years). The only links to be endorsed asdefinite by over 90% of respondents were those between smoking and both heart disease and lung cancer. However, more than 70% considered alcohol consumption, exercise, stress body weight and dietary fat to bedefinite or probable influences on heart disease. Smoking, alcohol, exercise, stress, body weight and salt intake were endorsed as relevant to high blood pressure by more than 70%. Opinions differed widely about the influence of lifestyle on breast cancer and diabetes. Experts from the United Kingdom and Republic of Ireland were less positive than respondents from other countries about the influence of stress, dietary fat, fibre and salt on disease. The results indicate that comparatively few lifestyle factors were believed to be unequivocally related to any of the five disorders. Experts from the UK and Ireland were generally less likely to endorse lifestyle-disease links than those from other European countries. Informing the public about the risks associated with lifestyle is an important component of health promotion, but the diversity of opinion identified in this study suggests that consensus on health and lifestyle has yet to be reached.     

Towards a common public health strategy for the region of South Eastern Europe

Aim

A seminar organised in the framework of the Public Health Collaboration in South Eastern Europe programme (PH-SEE), Belgrade, Serbia and Montenegro, 23–28 August 2004, aimed to answer the question: Is there a real need for a regional public health policy framework in South Eastern Europe (SEE)? The answer is probably yes because the specific situation in the SEE region has to be taken into account for the development of relevant and realistic public health goals.

Methods

To evaluate the current situation in the SEE region, Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology was applied. A set of key messages and recommendations have been formulated. Based on the priorities identified and agreed upon, PH-SEE experts formulated five goals.

Results

The result of very intensive work was a framework for a regional SEE public health strategy being drafted during the seminar. An initial 5-year term was established beginning in 2005. This framework represents only a first step towards an officially agreed upon regional strategy framework.

Conclusions

The purpose of that exercise was to demonstrate the benefits of regional collaboration by using the technical competence and experience of public health professionals in the region. Moreover, the harmonisation with European Union (EU) public health standards and policies must be considered in health policy development in the region.     

Health among hospital employees in Europe: a cross-national study of the impact of work stress and work control

This article analyses the effect of working conditions on the health of hospital employees across Europe. Hospital employees often have demanding jobs that increase their stress levels and, consequently, their risk of health problems. Work control - typified by employee autonomy and working time flexibility - helps them cope with high levels of work stress. Researchers have traditionally studied the relationship between working conditions, coping strategies and occupational health from an individual perspective. We argue that the individual work-health relationship is closely connected with the social and institutional context. This study explores how work stress and work control influence the health of hospital employees and aims to understand cross-country differences in this respect. Using data on over 1500 hospital employees who participated in the study 'Quality of work and life in a changing Europe' (2007) in eight European countries, we used ordinal regression analyses to test a range of hypotheses. The results show that work stress has a negative effect on the health of hospital employees, while work control is not found to have any effect on their health. Comparative analyses reveal that the effects of working conditions on health vary across European countries. While working overtime is more closely related to poorer health in Eastern European countries, we found evidence of a positive relationship between job autonomy and health in Western Europe only, indicating that circumstances in the working environment have differing effects on employee health in Eastern and Western Europe.     

Managing the transitions: a Western European View of Health Care Development in Eastern Europe

The health care systems of Eastern Europe are undergoing rapidchange. Ministries of Health in the Eastern countries are turningto the West for solutions. This paper offers an overview ofthe health systems of four Eastern European countries, the catalystsof reform in those countries, and possible strategies for managingthe transitions. The objectives of health care reform are outlinedas well as the key issues and obstacles facing Eastern governmentsas they attempt to change both the structure and function ofhealth care systems.     

Homosexuality and HIV/AIDS prevention: the challenge of transferring lessons learned from Western Europe to Central and Eastern European Countries

In order to stem the rapidly growing HIV/AIDS epidemics in Eastern Europe a transfer of prevention know-how and experience from Western European countries is necessary. The success of such a transfer is contingent on addressing a number of challenging issues. Monolithic ideas of East/West difference need to give way to the growing empirical evidence which not only shows a tremendous diversity but also many similarities among the 51 countries within the WHO European region. These include similarities regarding sexual attitudes and HIV prevention needs. Western constructs such as a gay identity need to be de-emphasized however, when it comes to promoting human rights (and thus improving HIV prevention for men who have sex with men) in Central and Eastern Europe. In asking the question of what should be transferred from Western Europe to other countries, both the strengths and weaknesses of the last 20 years of prevention need to be considered. In terms of Western European research the strength lies in identifying the social structural causes of HIV transmission. In terms of practice, the successes of instituting country-level structures while also working within the gay community are to be emphasized. Short-comings are evident in terms of reaching men of lower socio-economic status, cultural minorities and sex workers. On such questions, the expertise of Europe as a whole is needed in order to find new answers.     

Choice and solidarity: the health sector in Eastern Europe and proposals for reform

The citizens of Eastern Europe have witnessed an unprecedented social and economic transformation during the past decade of transition from socialism to market-based economies. We describe the legacy of socialism and summarize the current state of the health sector in ten Eastern European countries, including financing, delivery, purchasing, physician incomes and the widespread phenomenon of under-the-table payments. The proposals for reform, derived from explicit guiding principles, are based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services, and managed competition, with attention to incentives and regulation to impose a constraint on overall health spending.     

Changing dietary habits of ethnic groups in Europe and implications for health

A systematic review of the literature suggests the dietary habits of some ethnic groups living in Europe are likely to become less healthy as individuals increase consumption of processed foods that are energy dense and contain high levels of fat, sugar, and salt. Such products often replace healthy dietary components of the native diet, such as fruits, vegetables, nuts, and grains. Mixed food habits are emerging mainly amongst younger people in the second and third generations, most likely due to acculturation and adoption of a Western lifestyle. Age and immigrant generation are the major factors accounting for changes in dietary habits, whilst income, level of education, dietary laws, religion, and food beliefs are also important factors. Obesity, cardiovascular disease, diabetes, and hypertension present major problems for the mainstream European population. However, the risk of chronic disease is reported to be higher in ethnic populations, particularly South Asians, African Caribbeans, and Mexicans.     

East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden

AIM: Research on the east-west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that. METHODS: This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25-84, who arrived in Sweden after 1944 and were interviewed during 1993-2000 along with their 35,711 Swedish counterparts. RESULTS: Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden. CONCLUSIONS: Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries.     

Patterns of healthy lifestyle and positive health attitudes in older Europeans

Objectives: To determine (i) the extent to which recommended lifestyle healthy behaviors are adopted and the existence of positive attitudes to health; (ii) the relative influence of socio-demographic variables on multiple healthy lifestyle behaviors and positive attitudes to health; (iii) the association between healthy lifestyle behaviors and positive attitudes to health.Design: two distinct healthy behavioral measures were developed: (i) healthy lifestyles based on physical activity, no cigarette smoking, no/moderate alcohol drinking, maintaining a “healthy” weight and having no sleeping problems and (ii) positive health attitudes based on having positive emotional attitudes, such as: self-perceived good health status, being calm, peaceful and happy for most of the time, not expecting health to get worse and regular health check-ups. A composite healthy lifestyle index, ranging from 0 (none of behaviors met) to 5 (all behaviors met) was calculated by summing up the individual’s scores for the five healthy lifestyle items. Afterwards, each individual’s index was collapsed into three levels: 0–2 equivalent to ‘level 1’ (subjectively regarded as ‘too low’), a score of 3 equivalent to ‘level 2’ (‘fair’) and 4–5 as ‘level 3’ satisfactory ‘healthy lifestyle’ practices. The same procedure was applied to the positive health attitudes index. Multinomial logistic regression analyses by a forward selection procedure were used to calculate the adjusted odds ratio (OR) with 95% confidence interval (95% CI).Participants: a multi-national sample consisting of 638 older Europeans from 8 countries, aged 65–74 and 75+, living alone or with others.Results and conclusions: maintaining a “healthy” weight was the most frequently cited factor in the healthy lifestyles index and therefore assumed to be the most important to the older Europeans in the study; positive attitudes to health were relatively low; participants achieved a ‘satisfactory’ level for healthy lifestyles index (level 3) more frequently than a satisfactory level for positive attitudes to health; having a satisfactory ‘healthy lifestyle’ was directly related to having a satisfactory level of positive attitudes to health based on the positive health attitudes index; income and geographical location in Europe appeared to be key predictors for meeting both the recommended healthy lifestyle factors in the index and having positive health attitudes however, the composition and nature of the study sample should be taken into consideration when considering the impact of the location on healthy lifestyles and attitudes to health across Europe. more details at www.foodinlaterlife.org.     

Environmental pollution and child health in central and Eastern Europe.

For the last 50 years, the economic and industrial development of the nations of Central and Eastern Europe has been achieved at the cost of environmental degradation. The health risks posed by this pollution to children and the steps necessary to ameliorate such risks are only beginning to be investigated. At a recent conference in Poland, sponsored in part by the National Institute of Environmental Health Sciences, participants from 11 countries in the region, together with scientists from Western Europe and the United States, met to share information regarding pediatric environmental health in Central and Eastern Europe, to consider methodologic issues in the design and conduct of such studies, and to discuss preventive strategies. This report summarizes the deliberations, outlines problem areas such as heavy metals and air pollution, delineates research and training needs to help Central and Eastern Europeans deal more effectively with such problems, and recommends specific future actions and collaborative efforts.     

The sexual attitudes and lifestyles of London's Eastern Europeans (SALLEE Project): design and methods

Background  

Since May 2004, ten Central and Eastern European (CEE) countries have joined the European Union, leading to a large influx of CEE migrants to the United Kingdom (UK). The SALLEE project (sexual attitudes and lifestyles of London's Eastern Europeans) set out to establish an understanding of the sexual lifestyles and reproductive health risks of CEE migrants. CEE nationals make up a small minority of the population resident in the UK with no sampling frame from which to select a probability sample. There is also difficulty estimating the socio-demographic and geographical distribution of the population. In addition, measuring self-reported sexual behaviour which is generally found to be problematic, may be compounded among people from a range of different cultural and linguistic backgrounds. This paper will describe the methods adopted by the SALLEE project to address these challenges.