European medical schools and tobacco.

Following a survey in 19 European countries of the habits, attitudes and knowledge of medical students regarding tobacco, World Health Organisation European Office and the International Union against Tuberculosis and Lung Disease jointly circulated to the Deans of all European medical schools a summary of the results, including figures for mortality for smoking-related diseases in their countries and a brief questionnaire concerning faculty action on the tobacco problem. The response rate was just over 50%, higher in Northern Europe (66%) than in Southern (35%) or Eastern (38%). Only 8% of faculties had a specific teaching module on tobacco. In most it was either systematically (35%) or unsystematically (55%) integrated in other teaching. Teaching hospitals, teaching areas and faculty meetings were said to be smokefree by over 90%; figures were lower for other areas. Seventy-seven per cent of Deans intended to discuss our approach with their teaching staff; 72% gave the name of a staff member with a particular tobacco interest.

Tobacco or health.

Tobacco smoking is the major cause of premature death among men in the CCEE/NIS. Reliable information on smoking prevalence and tobacco use is scarce, but the overall evidence points to two different patterns: a traditional and a high prevalence pattern. The traditional pattern dominates in the NIS and some of the CCEE, and is characterized by a high smoking rate in men (about 50%) and a low rate in women (10%). Smoking by women, however, is increasing, starting with the younger age groups. The high prevalence pattern found in the Czech Republic, Hungary and Poland, for example, shows a high smoking prevalence in women (about 25%) in addition to a high prevalence in men. Predictions made in 1990 indicated further increases or stable tobacco consumption in the CCEE/NIS by the year 2000, in contrast with the steady decrease in western European countries. When smoking is combined with other types of harmful health behaviour and environmental influences, the result is some of the highest mortality rates from lung cancer and other diseases in the world. This situation has caused severe concern in public health professionals in many of the affected countries, but not in the public and policy-makers. The fundamental changes in social and economic structures have both improved and decreased opportunities to promote nonsmoking. In the short term, the negative influences seem to dominate, although some countries, such as Lithuania and Poland, are now introducing their first realistic policies on tobacco. In most countries, however, tobacco control has to compete with other issues for priority on a crowded public health agenda.(ABSTRACT TRUNCATED AT 250 WORDS)

National TV smoking cessation program and contest in Finland.

BACKGROUND: In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity. RESULTS: Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001). CONCLUSIONS: The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.

Ten-year results of hypertension care in the community. Follow-up of the North Karelia hypertension control program.

The development of hypertension care over the 10-year period 1972-1982 in North Karelia and a reference area was assessed using three separate random samples of the population aged 30-59 years. The results show a clear improvement in the blood pressure levels of the population and in the hypertension care in North Karelia between 1972 and 1977 when the activities of the hypertension program of the North Karelia Project were gradually implemented. Awareness of elevated blood pressure increased from 39% to 71% among men and from 60% to 87% among women. The proportion of men under antihypertensive drug treatment increased from 4% to 10% and that of women increased from 10% to 15%. After 1977, the hypertension care was maintained but no further improvements were observed in general blood pressure levels. An improvement in hypertension care started in the reference area later than in North Karelia. In spite of favorable changes, the blood pressure level of the population was still high in 1982, the mean casual value among men being 145/87 mmHg and that among women being 141/84 mmHg. It is obvious that further progress in hypertension care is needed.

Hypertension treatment without labelling effects: the North Karelia Project.

Increases in disability and work loss have been noted following hypertension identification and treatment. To determine if iatrogenic disability is a necessary side-effect of successful treatment, self-reports of days lost from work and days spent in bed because of illness in the year before interview were compared in 1972 and 1977 for three groups in eastern Finland: hypertensives who had been told of their hypertension before 1972, hypertensives newly identified by screening in 1972, and a group of normal controls. The groups were stratified by sex and residence (urban or rural), and analysis of covariance was used to adjust for the effects of age differences among the groups. In 1972, the hypertensives identified before 1972 were significantly older and had significantly higher systolic blood pressure levels than the hypertensives identified in 1972. Hypertensives identified before 1972 had higher work loss and days spent in bed than hypertensives identified in 1972. This association was independent of age, sex, residence, and systolic blood pressure. Upon resurvey in 1977, the group with hypertension newly identified in 1972 had no greater increase in work loss or days spent in bed due to illness than the normal controls. These data support the hypothesis that hypertension identification and treatment can be but does not have to be associated with significant increases in occupational disability and days spent in bed due to illness.

Trends in stroke mortality and in antihypertensive treatment in Finland from 1972 to 1984 with special reference to North Karelia.

Trends in antihypertensive treatment and stroke mortality were analysed in the province of North Karelia where the first systematic hypertension control programme in Finland was started in 1972. Surveys carried out in random samples of the middle-aged population of North Karelia showed that the control of hypertension was better than in the reference area, especially from 1972 to 1977. From 1972 to 1984, mortality from stroke fell on average 6.3% and 7.6% per annum, in North Karelian men and women aged 35-64 years. These declines were steeper than those observed in the rest of Finland. In the age group of 65-74 years the decline in stroke mortality was also steeper in North Karelia. From 1978 to 1984 the self-reported awareness of hypertension and the proportion of people receiving antihypertensive drug treatment decreased in the middle-aged population in Finland, suggesting lesser efforts at detection and treatment. During the same period, the steep national decline in stroke mortality levelled off, but the mortality rate remained higher than in the USA and in other Western European countries. Prevention of stroke through hypertension control in the community still remains a major challenge for health care.

A television format for national health promotion: Finland's "Keys to Health".

A series of televised risk reduction and health promotion programs have been broadcast in Finland since 1978. The five series of programs were the product of a cooperative effort by Finland's television channel 2 and the North Karelia Project. The series has featured a group of volunteers who are at high risk of diseases because of their unhealthful habits and two health educators who counsel the studio group and the viewers to make changes in health behaviors. The "Keys to Health 84-85" was the fifth of the series and consisted of 15 parts, 35 minutes viewing time each. Results of the evaluation surveys, which are presented briefly, indicate that viewing rates were high. Of the countrywide sample, 27 percent of men and 35 percent of women reported that they had viewed at least three parts of the series. Reported changes in behaviors were substantial among the viewers who had seen several parts of the series and were meaningful, overall, for the entire population. Of the countrywide sample, 7.1 percent of smoking viewers reported an attempt to stop smoking--this number was 3.6 percent of all smokers. The percentages of weight loss among viewers and the total population sample were 3.9 for men and 2.1 for women. The reported reductions in fat consumption were 27.2 percent for men and 15.0 percent for women. The reported effects in the demonstration area of North Karelia were even higher, mainly because of higher viewing rates.

Comparison of the levels of cardiovascular risk factors between eastern and south-western Finland in 1982.

Altogether 6,523 persons aged 25-64 years were studied in eastern and south-western Finland to determine their cardiovascular risk factor levels. Among men, smoking was more prevalent in the south-western area (41 vs. 37%), serum cholesterol levels were higher in the eastern area (6.2 vs. 6.0 mmol/l) and blood pressure levels were the same in both areas (145/86 in the east vs. 144/86 in the south-west). Among women, smoking was also more common in the south-western area (24 vs. 16%) and serum cholesterol levels were higher in the eastern area (6.1 vs. 6.0 mmol/l) as well as blood pressure levels (142/84 vs. 138/81 mmHg). Among both genders, prevalence of hypertension and proportion of persons on antihypertensive drug therapy was higher in eastern Finland. The comparison of these findings with the results from previous studies carried out among men in these two areas indicates that the risk factor levels have been decreasing in both areas and that the previously observed differences in risk factor levels between eastern and south-western Finland (the levels used to be higher in the east) have levelled off. The favourable development in eastern Finland may be a result of the North Karelia Project.

The influence of socioeconomic factors on blood pressure control during a community-based hypertension control programme.

The hypertension programme of the North Karelia Project aimed at lowering the high blood pressure level among the whole population. The influence of socioeconomic factors on the effect of reorganized hypertension care was analyzed among a cohort of 222 hypertensive patients during the five year follow-up. The fall in mean arterial pressure was significantly greater in North Karelia than in the reference area. A slight but not significant difference was found in blood pressure reduction between high and low socioeconomical classes. The results were better in higher socioeconomic groups, but the blood pressure reduction was clear also in lower socioeconomic groups. Our results indicate that the systematic community-based hypertension control programme will result in favourable changes in blood pressure level in the entire population without any clear preference on particular socioeconomic subgroups.

Effectiveness of treatment with antihypertensive drugs and trends in mortality from stroke in the community.

A study was made of the changes in the treatment of hypertension, in the effectiveness of that treatment, and in mortality from cerebrovascular stroke in men and women in two counties in Finland. One of these counties was North Karelia, where a comprehensive cardiovascular programme based in the community had been launched in 1972. Cross sectional surveys in large representative samples of the middle aged populations were carried out in 1972, 1977, and 1982. Average annual mortality from stroke adjusted for age was calculated for the two year periods 1971-2, 1977-8, and 1980-1. The proportion of hypertensive men being effectively treated for their hypertension increased in both areas from 1972 to 1977 and further from 1977 to 1982. Mortality from stroke in middle aged men decreased in both areas during both observation periods. The proportion of hypertensive women being effectively treated greatly increased in both areas from 1972 to 1977. This was associated with a large decline in mortality from stroke. In North Karelia the proportion of women being effectively treated was remarkably high but decreased somewhat between 1977 and 1982; this decrease was associated with an increase in mortality from stroke in the women aged 35-64. These results support the idea that effective antihypertensive treatment in the community is a major determinant of mortality from stroke in both men and women.