Promoting smoking cessation in Russian Karelia: a 1-year community-based program with quasi-experimental evaluation

Cigarette smoking is a major contributor to the East–Westhealth gap in Europe, a situation which is particularly evidentin comparisons of mortality and health behavior in Finnish andRussian Karelia. With technical assistance from the North KareliaProject in Finland, a Quit and Win smoking cessation contestwas organized in the district of Pitkäranta in RussianKarelia. Local health care workers organized media publicityand community support, including news about competition winnersand participants, and distribution of leaflets featuring storiesabout how local people were able to stop smoking during theQuit and Win contests. The Pitkäranta campaign was evaluatedin a quasi-experimental study in which panels of 176 and 202smokers, identified in a random population sample survey atthe outset, were followed for 1 year in Pitkäranta anda comparable neighboring district. Cessation rates were estimatedto be 7–26% in Pitkäranta and 1–2% in the comparisonarea, a statistically significant indication of experimentaleffects. These findings demonstrate that community campaignscan effectively reduce smoking in the present difficult conditionsin Russia.     

Effects of a population-based smoking cessation programme on smoking in pregnancy.

A controlled study was conducted to evaluate the effects of a low-intensity population-based smoking cessation programme in maternity care clinics. Quitting smoking during pregnancy was assessed by a self-administered questionnaire and verified by hair nicotine concentration. In the intervention area, 58/306 women (19.0%) reported quitting smoking during pregnancy whereas in the reference area the numbers were 22/152 (14.5%) (difference = 4.5%, 95% confidence interval: -2.6%-11.6%). The intervention group indicated that they received more information on adverse effects of smoking, studied the material more actively, and felt that material from maternity care influenced their smoking behaviour more than the reference group.     

Oral contraception and smoking: Time trends for a risk behaviour in Finland

The main health risks of modern oral contraceptives (OCs) areassociated with simultaneous smoking. According to current medicalguidelines in Finland, OCs should not be prescribed for smokersaged over 30 years. We report how smoking and OC use were relatedfrom 1975 to 1993. The data were collected from 3 national postalsurveys: a biannual survey of 16 and 18 year old girls since1981 (sample sizes of 462–1,667 and response rates of83–91%), an annual survey of 20–39 year old womensince 1978 (size of 5 year age groups of 205–375 and responserates of 68–91%) and a survey of 20–39 year oldtwins in 1975 and 1981 (size of 5 year age groups of 758–3,366and response rates of 85–90%). Early initiation of OCsbecame more frequent. Half of the 16 year old and one-thirdof 18 year old OC users were smokers in the most recent survey.Adult women aged under 30 years more than doubled their OC useduring the 1980s. Although smoking showed a declining trend,the proportion of women having combined use of OCs and tobaccoincreased (up to 9–13% in the most recent surveys). Womenaged over 30 years increased their OC use in the late 1980s(10–18% in the most recent surveys). The combined useof OCs and tobacco has become more frequent both among adolescentand adult women. The lifetime duration of combined use willprobably increase without more active intervention on smokingin the family planning clinics, even among young women.     

The effects of a three-year smoking prevention programme in secondary schools in Helsinki

BACKGROUND: This study evaluates the effects of a 3-year smoking prevention programme in secondary schools in Helsinki. The study is part of the European Smoking prevention Framework Approach (ESFA), in which Denmark, Finland, the Netherlands, Portugal, Spain and the UK participated. METHODS: A total of 27 secondary schools in Finland participated in the programme (n = 1821). Schools were randomised into experimental (13) and control groups (14). The programme included 14 information lessons about smoking and refusal skills training. The 3-year smoking prevention programme was also integrated into the standard curriculum. The community-element of the programme included parents, parish confirmation camps and dentists. The schools in the experimental group received the prevention programme and the schools in the control group received the standard health education curriculum. RESULTS: Among baseline never smokers (60.8%), the programme had a significant effect on the onset of weekly smoking in the experimental group [OR = 0.63 (0.45-0.90) P = 0.009] when compared with the control group. Being female, doing poorly at school, having parents and best friends who smoke and more pocket money to spend compared with others were associated with an increased likelihood of daily and weekly smoking onset. These predictors did not have an interaction effect with the experimental condition. CONCLUSION: This study shows that a school- and community-based smoking prevention programme can prevent smoking onset among adolescents.     

Analysis of community-based cardiovascular disease prevention studies--evaluation issues in the North Karelia Project and the Minnesota Heart Health Program

Karelia project of the Minnesota Heart Health Program. International Journal of Epidemiology 1986, 15: 176-182. Community-based cardiovascular disease control studies represent an effort to change cardiovascular disease rates in entire communities. Communities, rather than individuals, are the primary units of analysis. The cross-community multiple time series model to estimate and test the effects is based on multiple communities that are evaluated at several points over time. Issues that influence the power of the analysis include: the number of communities to be studied, community size and composition, sample sizes of surveys, the decision to use cohorts or cross-sectional surveys, the number of surveys conducted in each community, and assumptions of latencies in the effects. These points are illustrated using the experiences of the North Karelia Project and the Minnesota Heart Health Program. The North Karelia Project was a community-based cardiovascular disease (CVD) prevention programme consisting of a five-year intervention period in 1972-7. It took place in two provinces in Finland. The Minnesota Heart Health Program is similar, taking place between 1980 and 1990 in six communities in the American Midwest.     

Students and smoking: Targeted tobacco promotion in the North East of England

Background: The aim of this study was to Investigate the extentto which students in the North East of England are exposed totwo alternative tobacco marketing tactics: direct mailing (‘junkmail’) and the sponsorship of musicoriented events particularlyattractive to young people (e.g. discos, ‘raves’or concerts). Method: Self-completion questionnaires were administeredto convenience samples of predominantly first-year studentsaged 16–24 years attending further education collegesin Gateshead and South Tyneside. The questionnaire assessedthe receipt of smoking-related ‘junk mail’ and attendanceat music-oriented events sponsored by tobacco companies. Results:Almost one in nine students, one in seven smokers and one in13 non-smokers had been exposed to one or both types of tobaccopromotion. One in 12 of the under-18s (including over one ineight smokers and almost one in 17 non-smokers) had been exposedto one or both types of tobacco promotion. Conclusions: Thefindings provide evidence that the tobacco industry is violatingthe UK Voluntary Agreement on Tobacco Products' Advertisingand Promotion, with companies sponsoring events particularlyappealing to young people and the continued inclusion of youngpeople on mailing lists. This study provides further evidenceof the ineffectiveness of voluntary agreements in regulatingthe promotional activities of the tobacco Industry. It is recommendedthat, in the wake of the European Union directive on tobaccoadvertising, a more active and formal mechanism for monitoringtobacco promotion and verifying the claims of the tobacco industrybe introduced.     

Results of a five-year community-based programme for cardiovascular disease prevention: The ATS-Sardegna Campaign

The objective of this study was to evaluate the effects of the ATS-Sardegna Campaign on lifestyle and cardiovascular disease (CVD) risk factors in the Sardinian population. The Campaign was a community-based public health action programme funded by the Sardinian Government with a view to prevent CVD and promote healthy behaviour. It was also part of the Targeted Project FAT.MA. of the Italian National Research Council (CNR), with the main purpose of evaluating the effects of this public health initiative after a five- year intervention. The evaluation was effected with three parallel procedures: individual interviews with 1486 randomly chosen people; assessment of eating patterns through a food-frequency questionnaire; measurement of the mean levels of the major CVD risk factors in 1729 randomly chosen subjects (1044 in the calendar year 1992, and 685 in 1995, two and five years, respectively, after the beginning of the Campaign). Overall, we recorded a favourable trend in eating habits in both sexes; a significant decrease in LDL-cholesterol in males, and in systolic and diastolic blood pressure in both sexes; a non- significant decrease in prevalence of smokers among males and increase among females. The ATS-Sardegna Campaign was the first CVD prevention programme in Italy to have attained reduction in the risk profile of an entire region at the lowest ever borne cost.     

Social determinants of ever initiating smoking differ from those of quitting: a cross-sectional study in Estonia

BACKGROUND: To study the association of socioeconomic and demographic indicators with ever initiating regular smoking and quitting smoking among ever regular smokers in Estonia in order to identify target groups for equity-oriented tobacco control policies. METHODS: Data for 4277 individuals in the 25-64 age group come from three cross-sectional studies conducted in 2000, 2002 and 2004. Age-standardized prevalence rates and odds ratios with 95% confidence intervals were calculated. RESULTS: High rates of ever initiation were observed for lower educated men and women after controlling for other socioeconomic indicators. This association was not observed for women above age 50. Independent, although weaker associations were found among men who were unemployed or with a low occupational status. Low cessation rates were observed among men who were unemployed, who had a lower occupational position or who had a low income. These associations remained after controlling for other socioeconomic variables. The effect of income became stronger in the older age groups among men. Rates of ever initiation and cessation also varied strongly in relationship to some demographic variables. The highest initiation rates were found among divorced women and among women living in the capital city. The lowest cessation rates were found among divorced women, and among Russian men. CONCLUSIONS: While educational level was the strongest predictor of ever initiating regular smoking, smoking cessation was related more directly to aspects of social disadvantage originating in adult life. To be effective, tobacco control interventions should not only target lower educated, but also those in material disadvantage.     

Social acceptance of smoking regulations in the workplace: A study from Southern Germany

Smoking regulations in the workplace are increasingly employedto protect non-smokers against passive smoking. Nevertheless,concern about their social acceptance hinders their implementationin many instances. Social acceptance of worksite smoking regulationswas assessed in a cross-sectional study, which was conductedin 1992 among 930 employees of a Southern German telephone company.A minority of 16.5% among employees who smoked felt discriminatedagainst. Perceived discrimination of smokers was strongly associatedwith the number of cigarettes smoked per day, but not with existingsmoking regulations. Most smokers (79.2%) and non-smokers (94.9%)were in favour of some type of smoking restrictions; proportionswere even higher in workplaces where smoking restrictions werealready in effect. Among current smokers, a preference for smokingrestrictions was positively associated with a desire to stopor reduce smoking. These results suggest that smoking regulationsin the workplace can be accepted by smokers and non-smokersand are perceived as an aid to stop or reduce smoking ratherthan a discriminating measure among current smokers.     

Eight-year follow-up results of an adolescent smoking prevention program: the North Karelia Youth Project

In the North Karelia Youth Program five to 10 classroom sessions over two years taught skills to resist pressures to start smoking to 13 to 15 year old students. Compared to students from comparison schools, the treatment groups reported less smoking immediately after the intervention and in a four-year follow-up survey. At the eight-year follow-up, there was consistent evidence of possible preventive effects only among those who had been non-smokers when the program began.     

Prevalence and trends of cigarette smoking in different occupational groups: Results of the Minnesota Heart Survey 1980-1982 and 1985-1987

The association between smoking and occupational status is exploredusing data from the Minnesota Heart Survey. 7,381 currentlyemployed subjects were included in the study (2,949 from the1980–1982 survey and 4,432 from the 1985–1987 survey).In the first survey the prevalence of current smokers rangedfrom 23 (professional) to 57% (service occupations) in men andfrom 15 (artists and writers) to 59 (repair and craft occupations)in women. Educational level, age, race, and sex were importantpredictors of smoking status in a logistic regression analysisusing combined data from the two surveys; occupational statuswas significantly associated with smoking after controllingfor these covariables. Public health efforts should focus moreon preventing smoking in lower educational groups and in thoseoccupational groups that have the highest prevalence of smoking.     

The Finnmark Intervention Study: Design, Methods and effects of a 2 year community-based intervention

Two fishing municipalities with a total population of 6,500in Finnmark county were exposed to different hearth interventionprogrammes, both aiming at minimizing inequalities in healththrough empowerment and community involvement. One intervention(Nordkapp) was mainly focused on factors related to the workingenvironment of fishermen and within the fishing industry, whilethe other (Bitsfjord) addressed the population as a whole indefining health problems, setting priorities and planning strategiesand implementation. This paper describes the design and methodsof intervention and evaluation and examines effects regardingknowledge about and discussions of the projects, acquisitionof new information, attitudes and serf-reported behaviour changesafter 2 years of intervention in a randomized sample of almost2,000 individuals in the 2 communities. In Nordkapp, 27% ofthe men and 20% of the women knew about the project, with thehighest level being among fishermen and the male employees inthe fishing industry. The corresponding percentages for BStsfjordwere 77 and 82%. Approximately 1 in 5 in Nordkapp and 2 in 5in Bitsfjord had discussed the projects with somebody. In particular,in Bitsfjord knowledge about and discussion of the projectsincreased with the length of formal education, whereas acquisitionof new information and self-reported behaviour change was highestamong those with the lowest level of education in both communities.Approximately 40% of those aware reported behaviour change dueto the interventions. These findings suggest that the projectshave favoured the target groups of the intervention.     

Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany

BACKGROUND: General practitioners (GPs) can contribute substantially to the promotion of smoking cessation in the general population. However, engagement of GPs in helping their patients to quit remains very limited in many countries, including Germany. Therefore, new strategies to foster implementation of evidence-based methods in smoking cessation assistance have to be identified, and data for current practice of and barriers against smoking cessation promotion in general practice are needed. METHODS: A cross-sectional survey among all 657 general practitioners practising in the Rhein-Neckar Region of Germany was conducted in spring 2002 using a postal questionnaire (response rate 48%). RESULTS: The majority (54%) of GPs reported having treated less than 10 patients for smoking cessation (by any means including mere advice to quit) within the last three months, 23% of GPs never received any education or training in smoking cessation promotion, and only one-third of GPs rated their training as adequate. The factor most strongly associated with low activity in smoking cessation promotion (defined as having treated less than 10 patients within the last three months) was perceived lack of training (odds ratio 2.70, 95% confidence interval 1.68 - 4.32), followed by perceived lack of demonstration material (2.10, 1.31 - 3.39) and perceived lack of time (1.65, 1.02 - 2.66). Furthermore, there was a clear dose-response relationship between the time spent on training and the activity in smoking cessation promotion. CONCLUSION: Adequate training may be a key factor to enhance engagement of general practitioners in the promotion of smoking cessation.     

Tobacco smoking, an independent determinant for unhealthy diet?: A cross-sectional study of Norwegian workers on platforms in the North Sea

The objective of the study was to examine whether male tobaccosmokers had a more unhealthy diet than non-smokers. Data onsmoking and other variables were collected by questionnaireinterviews and food intake by one 24 h recall. The setting was2 oll platforms. The participants were 310 healthy men workingon 2 platforms in the Norwegian sector of the North Sea. Themean ages were 37 and 39 years for non-smokers and smokers.The prevalence of smoking was 50.3%. Smoking decreased withincreasing level of education, but increased with degree ofurbanization. Smokers consumed less vegetables, fruit and fish,but more meat, soft drinks containing sugar and more coffeethan non-smokers. Smokers had a higher intake of fat and a lowerintake of carbohydrate, vitamins A, D and C and dietary fibre.Smoking was an independent predictor for increasing the consumptionof coffee and high intake of energy, energy from fat and cholesteroland a decreasing consumption of vegetables, fruit, energy fromcarbohydrates, dietary fibre and vitamins A and C. It is concludedthat smokers had a more unhealthy diet than non-smokers.     

Predictors of perceiving smoking cessation counselling as a midwife's role: a survey of Dutch midwives

BACKGROUND: Smoking during pregnancy can have many serious consequences. As the usual providers of pregnancy care in the Netherlands, midwives could serve as effective counsellors to pregnant women about cigarette smoking. The aim of the present study was to identify relevant factors that hamper or promote the provision of effective smoking cessation advice and counselling. METHODS: Questionnaires were mailed to midwives; 237 (64.4%) were returned. Questions were asked about advantages and disadvantages of giving smoking cessation advice, perceived health benefits for mother and child, smoking behaviour and normative beliefs of colleagues, self-efficacy and role definition of midwives with regard to giving smoking cessation advice. RESULTS: Midwives who have a more positive role definition regarding giving smoking cessation advice are more convinced of the advantages of giving advice, the advantages of quitting for their clients and perceive more support from their colleagues with regard to giving advice. CONCLUSION: In general, midwives were motivated to provide their clients with smoking cessation advice. They were less comfortable with guiding women through the cessation process. Therefore, effective materials and training should be developed to facilitate and stimulate midwives in their role as effective counsellors.