The geographical epidemiology of smoking-related premature mortality: A registry-based small-area analysis of the Czech death statistics.

OBJECTIVES: Smoking-related mortality varies over different social, environmental, and policy contexts. However, spatial patterns, examined at a small area level, have been seldom considered. Therefore, the study provides a detailed analysis of socio-spatial inequalities in premature mortality related to smoking in the contemporary Czech adult population. DESIGN, SETTINGS, AND METHODS: We conducted a population-based, cross-sectional study to investigate the spatial pattern of the age-adjusted smoking-related mortality across Czechia. The spatial inequalities, as measured at the municipality level, were investigated using geostatistical modeling techniques. The ecological regression of the local mortality risk on socioeconomic composition of municipalities was also conducted. The target population was defined as permanent adult residents of Czechia aged 25-64 years in the period of 2011-2015. RESULTS: Among both sexes, a significant spatial gradient in the South-East (lower relative risk) - North-West (higher relative risk) axis was detected. The local mortality risk was significantly related to the level of relative deprivation of the municipalities (a composite index comprised from unemployment rate and level of education): adjusted RR among males (for an increase by 1 SD): 1.21 [95% CI: 1.158-1.256], p < 0.001; adjusted RR among females (for an increase by 1 SD): 1.14 [95% CI: 1.090-1.186], p < 0.001. Mortality among males was approximately twice as high as opposed to females. Regarding the spatial inequalities of the phenomena, however, only rather minor sex-specific patterns were identified. Contrasted to males, mortality among females was unrelated to unemployment rates. CONCLUSIONS: Consistent spatial patterns of the premature mortality were identified. The mortality risk was significantly related to socioeconomic composition of the Czech municipalities. The higher the level of local deprivation, the higher the local mortality risk. The results of the study can be found beneficial for planning of both socially and spatially integrated public health policy.

Changing trends in adolescent alcohol use among Czech school-aged children from 1994 to 2014.

BACKGROUND: For an efficient planning of public health policy, the regular monitoring over health-related behaviors among vulnerable population groups is necessary. The aim of this study is to examine the temporal trends in alcohol use among the Czech adolescent population. DESIGN AND METHODS: Data from the Health Behaviour in Schoolaged Children (HBSC) project conducted in Czechia from 1994 to 2014 were used. Adolescent alcohol use was assessed via two indicators: i) weekly alcohol use (beer, wine, and/or spirit), ii) repeated lifetime drunkenness (having been drunk on two or more occasions in life). Trends in alcohol use were modelled separately for boys and girls. Binary logistic regression was conducted with survey period as an independent predictor of the alcohol indicator. RESULTS: There were significant changes in adolescent alcohol use since 1994. Between 1994 and 2010, there was a gradual upward in the prevalence. However, in the recent period of 2014, an unprecedented drop in alcohol use was recorded. CONCLUSIONS: Despite the significant drop in the prevalence of alcohol use among the Czech youth in recent years, alcohol drinking in adolescence remains an important challenge for the national health policy. Further research will show whether these changes in adolescent health-related behavior are of a temporary or a permanent nature.

Violence in persons with and without psychosis in the Czech Republic: risk and protective factors.

PURPOSE: To prevent violence among persons with psychosis, further knowledge of the correlates and risk factors is needed. These risk factors may vary by nation. PATIENTS AND METHODS: This study examined factors associated with violent assaults in 158 patients with psychosis and in a matched control sample of 158 adults without psychosis in the Czech Republic. Participants completed interviews and questionnaires to confirm diagnoses, report on aggressive behavior, current and past victimization, and substance use. Additional information was collected from collateral informants and clinical files. Multiple regression analyses were conducted to identify factors that were independently associated with committing an assault in past 6 months. RESULTS: The presence of a psychotic disorder was associated with an increased risk of assaults (OR =3.80; 95% CI 2.060-7.014). Additional risk factors in persons with and without psychosis included recent physical victimization (OR =7.09; 95% CI 3.922-12.819), childhood maltreatment (OR =3.15; 95% CI 1.877-5.271), the level of drug use (OR =1.13; 95% CI 1.063-1.197), and the level of alcohol use (OR =1.04; 95% CI 1.000-1.084). Increasing age (OR =0.96; 95% CI 0.942-0.978) and employment (OR =0.30; 95% CI 0.166-0.540) were protective factors. Except for drug use, which appeared to have greater effect on violence in the group without psychosis, there were no major differences between patients and controls in these risk and protective factors. To our knowledge, this is the first published comparison of assault predictors between schizophrenia patients and matched controls. CONCLUSION: Recent physical victimization was the strongest predictor of assaults. Our findings are consistent with the emerging empirical evidence pointing to the very important role of victimization in eliciting violent behavior by the victims. Some current prediction instruments may underestimate the risk of violent behavior as they take little account of current victimization. Although psychosis per se elevates the risk of violence, other risk and protective factors for violence in persons with psychosis and comparison group are largely similar.

Trends in Tobacco Smoking among Czech School-aged Children from 1994 to 2014.

OBJECTIVE: The aim of the article is to examine trends in tobacco consumption among the Czech school-age population. METHODS: For the analysis, data from the Czech Health Behaviour in School-aged Children project, conducted between 1994 and 2014 were used. Trends in tobacco smoking were determined separately for boys and girls, applying the binary logistic regression with survey period as an independent variable for the smoking status. RESULTS: The analysis showed that there have been significant changes in adolescent tobacco smoking for the recent 20 years. While the share of current school-aged smokers was continuously increasing since the mid-1990s, the trend reached its peak in the mid-2000s. CONCLUSION: In recent years, the prevalence of adolescent smokers has significantly declined in the Czech Republic. Despite this recent decline, adolescent smoking remains a major challenge for the national health policy.

Trends in Lifetime Cannabis Use among Czech School-aged Children from 2002 to 2014.

OBJECTIVE: The aim of the study was to examine trends in the prevalence of lifetime cannabis use among the Czech 15-year old students. METHODS: Data from the nationally representative Health Behaviour in School-aged Children Survey, conducted in the Czech Republic in 2002, 2006, 2010 and 2014, were used. Trends in cannabis use among both boys and girls were modelled through binary logistic regression with period as a predictor of the lifetime cannabis use. RESULTS: The prevalence of lifetime cannabis use has significantly decreased among young Czechs, particularly among boys. Gender differences in cannabis use have been also gradually decreasing since 2002, with no significant differences between genders in recent period. CONCLUSIONS: Although there are positive changes in the prevalence of adolescent cannabis use, from the European perspective, Czech students still belong to those with significantly higher rates in this respect. Thus, alongside with the use of other substances, adolescent cannabis consumption remains an important challenge for the national public health policy.

Multiple health risk behaviour in Czech adolescents: family, school and geographic factors.

The study examines the relationship of family, school and geographic factors in relation to the prevalence of different health risk behaviours among Czech adolescents (aged 15-16 years) based on cross-sectional study design. Risk behaviours such as cigarette smoking, alcohol drinking and marijuana use among adolescents have often been shown to co-occur with each other. Data from the European School Survey Project on Alcohol and Other Drugs 2007 were used. A total of 7616 students from the Czech Republic were analysed in the study. About two thirds of students (63.5%) did not engage in any type of considered health risk behaviour, 21.1% reported one risk, 10.8% two risks, and 4.6% three risks. Thus, in sum 15.4% of Czech, students were engaged in multiple risk behaviour forms. Separate multilevel logistic regression models were performed in order to explore the redistribution of factors on categories of multiple health risk behaviour.