THYROID CANCER AS A PUBLIC HEALTH CHALLENGE IN GEORGIA.

Thyroid cancer (TC) is the most common endocrine cancer. The increase in thyroid cancer incidence has been observed in both developed and developing countries in different Geographical and climate areas The share of thyroid cancer drastically increased during the last decades in Georgia and ranked as the second most prevalent cause of cancer among women. Although for addressing the burden of cancer, important steps were taken by the State during the last decades, the burden of this disease is still significant. The presented paper aims to provide an overview of the current burden of thyroid cancer in Georgia, delving into its risk factors. To explore the opinion of key stakeholders about the factors causing the increased trend of thyroid cancer in Georgia in-depth interviews were used. The study was conducted from March to August 2023 in the capital of Georgia - Tbilisi. Women and men who had thyroid cancer and survived, women and men who are suffering from thyroid cancer along with healthcare providers, policymakers, and national professional bodies were the respondents in this study. The guides for the in-depth interviews were prepared based on the literature review. Stakeholders agreed that the number of thyroid cancer cases has increased during the last decades. The concern that the prevalence and incidence of thyroid cancer is the highest in the world in Georgia and it is the second leading cause of cancer among women was also expressed by respondents. According to study findings, new diagnostic methods revealed more cases of thyroid cancer. Other respondents stated that the development of the cancer registry, and the improvement of the reporting system existing cases of this disease. The issue of over-diagnosis was also mentioned by the stakeholders, Almost all study participant patients are challenged by the post-operational period. Some of them had not gotten information on how to deal with this period. Several patients mentioned financial problems due to fee-for-service or co-payments. According to the study participants, the recent sharp increase in the incidence and prevalence of thyroid cancer cases might be associated with overdiagnosis and the lack of monitoring and unified diagnostic and treatment methods.

KNOWLEDGE OF GEORGIAN POPULATION TOWARDS AIR POLLUTION AND HEALTH EFFECTS OF LEAD CONTAMINATION.

The goal of this study was to assess the level of knowledge about air pollution and the health effects of lead exposure among the population of Georgia. In 2019, a project entitled "Protect Environment" was conducted by the National Center for Disease Control and Public Health and the Health Research Union. The online survey was carried out using a Facebook advertisement, which included the title, body text, the banner, and a link to the questionnaire. The target population was the entire country and the language used was Georgian. We collected information on knowledge about health problems caused by polluted air, diverse environmental pollutants (such as the smoke of burning leaves, cigarette butts and smoke, effects of lead), and the effectiveness of a face mask to filter pollutants. Finally, we assessed awareness of the informational website www.air.gov.ge. The study was conducted over 3 days among 349 respondents in October 2019. Most (90.3%) of the respondents correctly answered the question related to air pollution causing different types of diseases, a similar proportion were concerned about the impact of environmental pollution and the impact of exposure to lead (76.8%). These findings indicate the importance of promoting educational websites that provide detailed information about various contaminants, as well as different preventive measures to mitigate environmental pollution. This study provides important information about the level of awareness among the Georgian population regarding air pollution and lead poisoning, research which is still very nascent. These findings should inform the development of educational campaigns to raise awareness about air pollution.

THE CRITICAL NEED FOR ENHANCING THE RESEARCH CAPACITY REGARDING THE INTERSECTION OF AIR POLLUTION AND NON-COMMUNICABLE DISEASES IN GEORGIA.

Globally, 7 million deaths are attributable to the joint effects of indoor and ambient air pollution annually, with ~94% occurring in low- and middle-income countries (LMICs). While 51% of cities in high-income countries with ≥100,000 residents meet WHO air quality guidelines, only 3% of such cities in LMICs meet them. In the country of Georgia, adverse environmental exposures cause 21% of disease burden and 25% of deaths,including30% of disease burden and 14% of deaths among children. According to 2016 WHO data, Georgia's mortality index attributed to ambient and indoor air pollution was 204.9, the 3rd highest in the world. Indoor air pollution is largely a result of indoor cooking/heating using solid fuel and second hand smoke (SHS). Worldwide, 40% of children, 35% of female nonsmokers, and 33% of male nonsmokers are exposed to SHS. Annually, SHS exposure causes ~600,000 deaths (1% of mortality), with half of those deaths in women and over a quarter in children. LMICs are disproportionately impacted by SHS and related morbidity and mortality. In Georgia, the smoking prevalence is 58% in men (6th highest in the world) and 6% in women. Moreover, prior research found that 30% of Georgian adults were exposed the SHS in the past week in public places and 54% at home; 42% reported daily exposure. Georgia's 2017-2021 National Environment and Health Action Planhighlights that addressing air pollution is among the most prominent public health priorities. However, there is limited in-country capacity to conduct research regarding the impact of such environmental hazards on health. Thus, efforts must enhance such research capacity in order to reduce air pollution and its effects on health.

Illicit drugs use in Georgian students; pilot study rigorously following criteria of European School Project on Alcohol and Other Drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. This summary presents key results from the Alcohol Use in Georgian Students, pilot study rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD). The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. 22% of the surveyed students perceive cannabis to be easily available, and boys consider cannabis slightly more accessible than girls do, the gender difference is rather big (31% vs.13%). Amphetamines and ecstasy are not perceived to be as easily available as cannabis. On average, 33% of the boys and 8% of the girls have tried illicit drugs at least once during their lifetime (20% for all students). After cannabis, ecstasy is in second position, being mentioned by 7.5% of the students and the figure for amphetamines is about 2%. Lifetime use of crack was reported by fewer students (1.1%) and the rate for heroin was even lower (1%). Lifetime cocaine and heroine experiences were reported by 0.6% of the students on average. Just as few reported experience of GHB and anabolic steroids or drug use by intravenous administration. Since cannabis is the most frequently used illicit drug, it could be worthwhile to have a closer look at this substance. Use of cannabis in the past 12 months was reported by 17% of the boys and 3% of the girls (10% for all students) while use in the past 30 days was stated by 6.5% of the boys and 0.8% of the girls (3% mean). Using drugs is less problematic in Tbilisi adolescents but still needs urgent public health interventions. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study results show the importance of knowledge on these issues and therefore including the healthy lifestyle subject in school curricula. The need to repeat this exercise at regular intervals is important in order to be aware of newer trends and to serve as a basis for policy direction and change.

Alcohol use in Georgian students; pilot study rigorously following criteria of European school project on alcohol and other drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. In the article the results of the pilot study of Alcohol Use among Georgian Students, rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD) are presented. The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. The survey revealed that alcoholic beverages, especially beer and wine are considered easily available; 73% found beer and 70% wine easy to obtain. 90% of the surveyed students have tried alcohol at least once during their lifetime. 80% have done so in the last 12months and 40% in the past 30 days. Gender differences become apparent when frequency of use is considered: boys have used alcohol more often than girls. 7.5% of the students state that, they never drink alcohol at all. Wine and beer are the two most important types of beverage for the students. On average, 40% of students on the latest drinking day consumed wine and 38% - beer. Champagne and spirits consumed 29% and 22% of students, respectively. On average, half of the students have been intoxicated, at least once during their lifetime, to the point of staggering when walking, having slurred speech or throwing up. 40% reported intoxication in the last 12 months and 12% in the past 30 days. Another way to measure drunkenness is to ask about a specific amount of alcohol consumed within a certain period of time. The students were asked if they had had five drinks or more on one occasion during the past month; this is referred to here as "heavy episodic drinking", 40% reported this; more boys than girls did so (45% versus 33%). More than half of the questioned students had consumed at least one glass of alcohol at the age of 13 or younger, and 25% had been drunk at that age. Having been intoxicated during the past 30 days, in turn, co-varies both with anticipating more positive consequences from drinking and with having experienced more negative personal consequences when drinking. Alcohol remains the number one problem. The fact that more than 90% of respondents have had drunk alcohol at least once and that more than 43% have had their last drink at home and more than 27% at friend's home, indicates the great reflection of the cultural acceptance of alcohol within Georgian society and within Georgian families. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study showed the importance of knowledge of alcohol use and the necessity including the healthy lifestyle subject in school curricula.

Tobacco use among georgian schoolchildren; pilot study following criteria of European school project on alcohol and other drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. This summary presents key results from the Tobacco Use in Georgian Students, pilot study rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD). The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. On average, in our survey, about half of the surveyed students reported having tried smoking cigarettes at least once and 16% had used cigarettes during the past 30 days. 1.1% of all students had smoked at least a packet of cigarettes per day during the last 30 days. On average 60% of surveyed students replied that they find it fairly or very easy to get cigarettes if they want to. On average, 30% (10% - 9 years old or less) of the students said that they had been smoking cigarettes on a daily basis at the age of 13 or younger. The proportion of students who smoked on a daily basis at the age of 13 or younger is 4.3%. Adolescent's tobacco use is a great public health concern in Georgia. Smoking is quite prevalent among Georgian adult population which on one hand reflects their children's habits and on the other hand reflects not only their, but their families and broader community's health. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study results show the importance of knowledge on these issues and therefore including the healthy lifestyle subject in school curricula.

[Youth health behavior survey].

High-risk behaviours -- smoking, drug use, alcohol use and etc. are the main risk factors of non-communicable diseases and main reasons of morbidity and mortality in many countries of the world. We conducted the "Youth Health Behaviour Survey" among the students in Tbilisi, Mtskheta and Dusheti. The survey included questioning of students (14-17 years old) by modified questionnaire. There were questioned 300 students, 100 in each region. Mtskheta is very close to Tbilisi, it's a peri-urban area; Dusheti is quite far rural area. The survey results show that teenagers both in central and peripheral areas are becoming familiar with alcohol in early ages and using alcohol is several times higher in Tbilisi. In Tbilisi as in Mtskheta and Dusheti students use wine and spirits with same frequency. Smoking is a bit high in Tbilisi and Mtskheta; regular smoking starts at age 13-14, boys are smoking more than girls. Drug use wasn't identified. Sexual intercourse had almost half of boys from Tbilisi and about one third of boys in Mtskheta and Dusheti. Safe sex methods more frequently are used in Tbilisi. Propaganda of healthy life style is essential in supporting healthy youth development. It's very important to set different interventions in different regions of Georgia, to adapt materials to real situation.