Adam Fronczak

Prevention and control of childhood asthma and allergy in the EU from the public health point of view: Polish Presidency of the European Union

The leading priority for the Polish Presidency of the Council of the European Union was to reduce health inequalities across European societies, and, within its framework, prevention and control of respiratory diseases in children. This very important paper contain proposal of international cooperation on the prevention, early detection and monitoring of asthma and allergic diseases in childhood which will be undertaken by the EU member countries as a result of EU conclusion developed during the Polish Presidency of the Council of the European Union. This will result in collaboration in the field of chronic diseases, particularly respiratory diseases, together with the activity of the network of national institutions and NGOs in this area. Paper also contains extensive analysis of the socio‐economic, political, epidemiological, technological and medical factors affecting the prevention and control of childhood asthma and allergy presented during Experts presidential conference organized in Warsaw‐Ossa 21–22 September 2011.

Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009–2010)

BackgroundExpanding the information on determinants of smoking cessation is crucial for developing and implementing more effective tobacco control measures at the national as well as European levels. Data on smoking cessation and its social correlates among adults from middle-income countries of Central and Eastern Europe are still poorly reported in the literature. The aim of the study was to analyze the association of socio-demographic indicators with long term tobacco smoking cessation (quit smoking for at least one year prior to interview) among adults. Moreover, we evaluated motives for giving up smoking from former smokers.MethodsData on former as well as current smokers’ socio-demographic and smoking-related characteristics were derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, nationally representative household survey implemented in Poland between 2009 and 2010. GATS collected data on a representative sample of 7,840 individuals including 1,206 individuals who met the criteria of long-term smoking cessation and 2,233 current smokers. Smoking cessation rate was calculated as the number of former smokers divided by the number of ever smokers. Logistic regression analyses were used to obtain odds ratios (ORs) and 95% confidence interval (CI) of the broad number of variables on successful cessation of smoking.ResultsAmong females the quit rate was 30.4% compared to 37.9% in males (p < 0.01). Former smokers declared concerns about the health hazard of smoking (60.8%) and the high price of cigarettes (11.6%) as primary reasons for smoking cessation. Older age, high education attainment, awareness of smoking health consequences was associated with long-term quitting among both genders. Also employed males had over twice the probability of giving up smoking compared with unemployed, and being religious did not contribute to successful smoking cessation.ConclusionResults indicated that smoking cessation policies focused on younger age groups are vital for curbing tobacco epidemic in Poland and should become a public health main concern. There is also the need for interventions to raise awareness on smoking health risks and quitting benefits are crucial to increase cessation potential among adult smokers. Nevertheless further effort needs to be done to prevent smoking uptake.

Prevalence and socio-demographic correlates of daily cigarette smoking in Poland: Results from the Global Adult Tobacco Survey (2009–2010)

ObjectivesThe aim of the study was to evaluate the prevalence and socio-demographic correlates of daily cigarette smoking among adults in Poland.Materials and MethodsA nationally representative household study was implemented between 2009 and 2010 to explore smoking pattern among the population aged 15 years and older. The smoking status and socio-demographic data were determined based on the Global Adult Tobacco Survey (GATS) questionnaire. Out of the 14000 households selected for the survey, 7840 sampled persons completed the interviews, including 2162 respondents who declared daily smoking of cigarettes. Logistic regression models were applied to assess factors related to daily cigarette smoking.ResultsOver 33% of men and 21% of women (p < 0.01) reported tobacco smoking on a daily basis. The significantly higher risk of smoking on a daily basis was observed among the male and female 20–59 years of age compared to the 60 or older population (p < 0.05). For men and women with the lower educational (primary/vocational/secondary) level, the risk of smoking was significantly higher than for the subjects with university degree (p < 0.05). The unemployed men smoked daily significantly more frequently than the employed ones (OR = 1.8; 95% CI: 1.4–2.4). This association was not observed among women (p > 0.05). The residents of urban areas smoked significantly more frequently than people living in rural settings (p < 0.05).ConclusionsActions to tackle socio-economic inequalities in smoking need to be intensified. The antismoking efforts should be focused on the population of Poles at large and people with lower educational levels, unemployed men, and residents of large urban settings in particular. The tobacco control interventions should also address the population of women at reproductive age.

Determinants of heavy smoking: Results from the global adult tobacco survey in Poland (2009–2010)

ObjectiveThe aim of current analysis was to identify socio-demographic correlates of heavy smoking.Materials and MethodsGlobal Adult Tobacco Survey (GATS), a nationally representative household study was implemented in Poland between 2009 and 2010. We used data on representative sample of 1915 adults, age 25 years and older. The Odds Ratios (OR) and 95% Confidence Intervals (CI) for heavy smoking to the broad number of variables including age, age at smoking onset, education, occupational classification, living conditions, place of residence, place of residence at age about 14 years, awareness of smoking health consequences were tested in logistic regression model.ResultsAmong daily smokers the rate of heavy smokers was 63% in males and 45% in females (p < 0.001). The present study indicated that three characteristics: age, early age at smoking onset and lack of awareness of smoking health consequences were significantly associated with heavy smoking among both genders. Significantly higher risk of heavy smoking was observed among the 50–59 years of age population compared to the youngest group. The heavy smoking rate was highest among males who started smoking under age 14 years (OR = 3.1; 95% CI: 1.4–6.7; p < 0.001) and females that started smoking at age 14–17 years (OR = 2.3; 95% CI: 1.5–3.5; p < 0.0001) compared to those who started smoking at age 21 years or older. Heavy smoking was significantly correlated to lack of awareness of adverse health consequences of smoking (OR = 1.5; 95% CI: 1.1–2.03; p < 0.01 and OR = 1.5; 95% CI: 1.0–2.2; p < 0.01 for men and women, respectively) compared to aware respondents.ConclusionsThese outcomes should be taken into account while developing tobacco control measures. Among other things, educational interventions to increase knowledge of adverse tobacco health effects should be widely implemented.

Implementation of smoke-free homes in Poland.

OBJECTIVES Exposure to environmental tobacco smoke (ETS) constitutes a threat to the health of many people. In order to diminish ETS exposure, countries (including Poland) implemented legal restrictions of smoking in public places and worksites. Currently more attention is also paid to reduce overall and residential ETS exposure by voluntary smoke-free home policy adoption. The aim of current analysis was to evaluate the prevalence and determinants of implementing smoking bans at place of residence among economically active males and females in Poland. MATERIAL AND METHODS Data from cross-sectional, household study - Global Adult Tobacco Survey (GATS 2009-2010) were analyzed. The logistic regression model was applied for appropriate calculations. RESULTS Out of 3696 studied subjects only 37.1% adopted total smoking ban within the home. Decreased likelihood of adopting total smoking bans was associated with current smoker status, low education attainment, lack of awareness on adverse health consequences of ETS, low level of support for tobacco control policies, and cohabitation with a smoker in both genders. Having smoke-free homes was also linked with age in women, place of residence and work smoking policy in indoor areas in men. CONCLUSIONS Targeted activities to encourage adopting voluntary smoke-free rules among groups least likely to implement 100% smoking bans in the home and activities to decrease social acceptance of smoking in the presence of nonsmokers, children, pregnant woman are urgently needed.

Disparities in exposure to tobacco smoke pollution at Romanian worksites

INTRODUCTION Differences in the risk of being exposed to second-hand smoke (SHS) in the workplace may occur not only between countries, but also within a country among socio-economic groups. OBJECTIVES The aim of the study was to examine the associations of exposure to SHS at worksites with selected factors in non-smoking Romanian employees. MATERIAL AND METHODS Data on exposure to SHS at worksites and other characteristics of respondents came from the Global Adult Tobacco Survey (GATS). GATS is a nationally representative household survey of adults 15 years of age or older, using a standard protocol. RESULTS Among 4,517 respondents who completed the questionnaire there were 1,333 subjects, including 859 non-smokers who worked in an indoor area outside the home. The prevalence of exposure to SHS was 31.2% among non-smoking male and 23.9% among non-smoking female employees (p<0.05). Employees with primary education had odds of exposure to SHS at work nearly twice as high, compared to the respondents having high education attainment (OR=1.9; 95% CI: 1.2-2.9). Moreover, exposure to SHS at worksites was significantly associated with a low level of support for tobacco control policies among workers (OR = 1.8; 95% CI: 1.2-2.8). CONCLUSIONS In spite of the increasing presence of smoking bans in public and workplaces, enforcement still seems to be unsuccessful in the occupational space in Romania. In order to reduce SHS exposure in workplaces, strengthening support for tobacco control policies is essential.

Quality of pregnant women's diet in Poland - macro-elements.

Introduction The objective was to assess the quality of pregnant womens diet in Poland concerning macro-elements and to analyze reasons for low or high quality diets. Material and methods Five hundred and twelve pregnant women in their 20th to 30th week of pregnancy took part in the research conducted by means of a 7-day observation of diet. Consumed products were analyzed by means of DIETETYK software developed by the Polish National Food and Nutrition Institute. Obtained macro values were averaged. The results were compared with the recommendations from the World Health Organization, European Union and Polish National Food and Nutrition Institute and analyzed statistically (χ2 test). Results The pregnant women consumed an average of 1898 ±380 kcal daily. Average value of macro components supplied with the diet did not deviate from EU and NFNI nutrition recommendations: protein – 72.1 g/person daily, fats overall – 72.8 g, polyunsaturated fatty acids – 10.93 g, cholesterol – 283 mg, carbohydrates – 257 g. The study proved a significant relation between a higher quality diet of pregnant women and tertiary or secondary education (p = 0.05) as well as urban residence (p = 0.01). Conclusions Pregnant womens diet in Poland is not significantly different from diet quality of pregnant women from other countries. A lower quality diet was observed among women who smoked during pregnancy and lived in rural areas.

Residential exposure to environmental tobacco smoke, and its associates: Findings from the Global Adult Tobacco Survey in Poland.

OBJECTIVES Expanding the information on exposure to environmental tobacco smoke (ETS) at home and its associates is of great public health importance. The aim of the current analysis was to evaluate associates of exposure to environmental tobacco smoke among economically active male and female adults in Poland in their place of residence. MATERIAL AND METHODS Data on the representative sample of 7840 adults from the Global Adult Tobacco Survey (GATS) carried out in Poland in the years 2009 and 2010 were applied. The Global Adult Tobacco Survey is a nationally representative household study. The logistic regression model was used for relevant calculations. RESULTS The exposure to environmental tobacco smoke in the place of living affected 59% of studied subjects. Out of non-smokers 42% of males and 46% females were exposed to the ETS in the at home. Increased risk of residential ETS exposure was associated with low education attainment, lack of awareness on adverse health consequences of second hand smoke (SHS), low level of support for tobacco control policies, living with a smoker. One of the factors associated with the ETS exposure was also the approval for smoking at home of both genders. The residential ETS exposure risk was the highest among males (odds ratio (OR) = 7.1, 95% confidence interval (CI): 6.1-13.8, p < 0.001) and females (OR = 8.1, 95% CI 6.5-11.8, p < 0.001) who declared that smoking was allowed in their place of residence compared to respondents who implemented smoking bans at their place of residence. CONCLUSIONS Campaigns to decrease social acceptance of smoking and encourage adopting voluntary smoke-free rules at home might decrease the ETS exposure and reduce related risks to the health of the Polish population. Educational interventions to warn about adverse health effects of the ETS should be broadly implemented particularly in high risk subpopulations.

Breast cancer and cervical cancer prevention programmes carried out by local government units in Poland in 2009–2014

Background In 2014 the standardised incidence rate for breast cancer in Poland reached 51.6/100,000, while the mortality rate reached 14.8/100,000. The incidence rate for breast cancer in the EU was 106.6/100,000, the mortality rate – 22.4/100,000. In 2014 the incidence rate for cervical cancer in Poland was 8.8/100,000, the mortality rate – 4.5/100,000. The incidence rate in the EU was 11.3/100,000 and the mortality rate – 3.7/100,000. Objective The aim of the paper was to establish the number of health policy programmes concerned with breast cancer and cervical cancer in women carried out in 2009–2014 by local government units, with specification of the type of programme, type of local government units that carried out the programmes and the costs of implementation of the programmes. Methods The study was based on a desk research. The analysis covered data included in annual reports submitted by voivodes to Minister of Health, concerning health policy programmes implemented by local government units in 2009–2014. Results The greatest number of programmes concerned with prevention of breast cancer and cervical cancer were implemented in municipalities, followed by counties and finally – self-governed voivodeships. The number of programmes concerned with primary prevention was three times smaller (656) than the number of programmes concerned with secondary prevention (2,229). The greatest number of primary prevention programmes were implemented in Dolnośląskie, Wielkopolskie and Mazowieckie Voivodeships, and the greatest number of secondary prevention programmes – in Wielkopolskie, Mazowieckie and Zachodniopomorskie Voivodeships. Conclusion It was found that the number of programmes implemented by particular local government units and the financial resources employed in the implementation of the programmes were different. It is probable that some of the initiatives of local government units related to secondary prevention coincide with the actions undertaken under the National Programme for Fighting Cancer. The entities that carry out breast cancer and cervical cancer prevention programmes need to coordinate their actions.

Prevention of Overweight and Obesity among Children and Youth in Local Government Health Policy Programs in between 2009-2015

Background: Overweight and obesity are among the so-called epidemics of the 21st century. An increasing number of children and youth are also affected by them. According to the forecasts of the “Institute of Mother and Child”, over the next decade each year the number of overweight children will increase by 400 thousand, including approximately 80 thousand obese children. Overweight and obesity are particularly dangerous for children at preschool and school age as it increases the risk of numerous diseases as well as physical and emotional problems.Objective: The objective of this article is to present implementation of health policy programs concerning prevention and treatment of overweight and obesity among children and youth between 2009-2015 by local government units.Methods: The study was conducted based on desk research. Databases of the Ministry of Health prepared by each voivodeship containing information about implemented health policy programs with regards to overweight and obesity among children and youth were used.Results: Between 2009-2015, local government units at all levels implemented 215 health policy programs concerning overweight and obesity among children and youth. Most programs were implemented by municipalities and counties. The costs incurred by counties and voivodeships were significantly higher than costs incurred by municipalities. Most programs were implemented in the West Pomeranian, Silesian and Masovian Voivodeships. The most common activities included consultations with a dietician, group trainings for children within school classes and various competitions concerning healthy diet and physical activity. The Podlaskie and Świetokrzyskie Voivodeships implemented the smallest number of programs.Conclusion: Programs implemented by local government units were poorly adjusted to the actual health needs of children and youth in terms of prevention and treatment of overweight and obesity. Local government units indicated insufficient engagement in prevention and treatment of overweight and obesity among children and youth. Programs implemented by local government units is have not any casual relationship on obesity prevalence. An insufficient number of program participants were observed. It demonstrates the need to evaluate the activities aimed at fighting overweight and obesity among children and youth. The number of health policy programs should be increased and the forms of program implementation should be more attractive-this will allow more people to be included in the activities.