Kaj Koskela

The North Karelia youth project: Evaluation of two years of intervention on health behavior and CVD risk factors among 13- to 15-year old children☆

A school and community based intervention to influence health behavior and cardiovascular disease (CVD) risk factors in 13- to 15-year-old children was carried out in North Karelia, Finland. The intervention was carried out on two levels: (a) an intensive intervention (II) in two schools and (b) a county-wide intervention (CI) in the rest of North Karelia. For the evaluation three matched pairs of schools were chosen: the two schools of the II, two schools to represent the CI and two schools from a reference county (R). 851 children, their parents, and their teachers were studied at the outset in 1978 and after the intervention in 1980. During the program the proportion of boys reporting to smoke at least 1–2 times per month increased 12.6% in II, 8.2% in CI and 29.7% in the R schools (P < 0.001 between II and R) and in girls 9.0%, 18.0% and 20.0%, respectively, (P < 0.05 between II and R). The mean serum total cholesterol was 5.1 mmol/liter in 1978 and it decreased among boys 0.5 mmol/liter in all three school groups. Among girls, the decrease was 0.43 mmol/liter (II), 0.35 mmol/liter (CI), and 0.21 mmol/liter (R) (P < 0.01 between II and R). The mean amount of fat from milk and butter changed among boys −8 g (II), 0 g (CI), and +3 g (R) and among girls −16 g, −2 g, and −5 g, respectively (both P < 0.01 between II and R). The intervention had no effect on blood pressure although there was some reported reduction in the salt consumption in the intervention schools. A relative decrease according to the intervention level was observed among North Karelian children in occurrence of psychosomatic symptoms. The effects were not related to increases in health knowledge or changes in attitudes and did not lead, on an average, to any harmful emotional consequences.

Nicotine-containing chewing gum in smoking cessation: a double blind trial with half year follow-up

A double-blind trial on the effect of nicotine-containing chewing gum compared with a placebo gum in smoking cessation was organized in connection with smoking cessation course activity in North Karelia, Finland. During the three-week course 70% of the active group (N = 84) and 54% of the placebo group (N = 76) stopped smoking (P < 0.05). A difference was found also after six months (35% vs 28%), although no more statistically significant. There were no major differences between the groups in the amount of withdrawal symptoms or side-effects.

Debt and suicidal behaviour in the Finnish general population

We studied the significance of debt as a risk factor for suicidal ideation and suicide attempts in a nation‐wide sample (n= 4868) of the Finnish general population. Those experiencing difficulties in repaying their debts more often than others (37 vs. 16%, P > 0.001) had a probable minor mental disorder (GHQ‐12 score 3≥3). Nevertheless, difficulties in repaying debts were found to be a factor independently associated with suicidal ideation (OR, 2.8; 95% CI, 1.9–4.2). The clinical implication of these findings is that individuals experiencing difficulties in repaying their debts may require psychiatric evaluation as well as socio‐economic counselling.

The North Karelia Project: a Programme for Community Control of Cardiovascular Diseases

The North Karelia Project: a programme for community control of cardiovascular diseases. Puska, P., Koskela, K., Pakarinen, H., Puumalainen, P., Soininen, V., and Tuomilehto, J. (Co-ordinating Centre of the North Karelia Project, University of Kuopio, Kuopio, Finland). In this article the background and principles of the intervention and evaluation of the North Karelia Project are presented. The project is a comprehensive community control programme concerning cardiovascular diseases in the province of North Karelia, Eastern Finland. In the baseline survey of the project (1972), 25–59-year-old males had a particularly high of CVD level risk factors: there were 54% current smokers, the mean cholesterol was 269 mg% and the mean casual blood pressure was 147/90 mmHg. According to the myocardial infarction register the incidence rate of acute myocardial infarction was, during the first year of the project (1972), 13.8 per thousand among 30–64-yearold males. During the first 2 1/2 of the intervention the percentage of current smokers decreased among males from 54 to 42. The percentage of males using low-fat milk increased from 17 to 48. The percentage of males who had had their blood pressure measured during the previous half year increased from 28 to 56 and those under antihypertensive drug treatment from 3.1 to 9.1. Local groups for secondary prevention of myocardial infarction were established all over the province. On the basis of the accumulated experience and theoretical considerations, the project plan has further been elaborated.

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.

Suicidal ideation and parasuicide in the Finnish general population

In a sample of the Finnish general population (n= 4868), 2.4% of women and 2.3% of men reported having thought about suicide during the preceding 12 months. The prevalence of parasuicide was correspondingly 0.9% in women and 1.1% in men, higher figures than have previously been found or estimated. Most suicidal individuals (85%) had contacted general practitioners or other primary care services during the previous 12 months, and a minority (20%) had made contact with psychiatric services. General practitioners and other primary care services are thus in a key position to identify suicidal behaviour in the Finnish general population.

The association between economic and social factors and mental health in Finland

The aim of the study was to examine the social and economic variables associated with mental health by means of telephone interviews of a randomly chosen population sample (n= 1557) in Finland in 1993. Mental health was evaluated by means of a 12‐item General Health Questionnaire. A mental disorder, indicated by the GHQ score, was detected in 18.3% of the interviewees. Mental disorders were more common in women than in men. Other factors associated with a mental disorder were unemployment, financial difficulties and insufficient social support from other people. Mental disorders, indicated by the GHQ score, were common in the long‐term unemployed, users of hypnotics and sedatives, and in those who were uncertain about their future. In stepwise logistic regression analyses the statistically independent associates with impaired mental health were suicidal thoughts, receiving of housing allowance and female sex. On the other hand, being on salary was a protective factor.

Unemployment and mental wellbeing: a factory closure study in Finland.

The mental wellbeing of the entire personnel (n= 211) of a wood‐processing factory located in Hämeenlinna, Finland was studied by mailing a questionnaire to the subjects 6 months after the factory was closed down. The entire personnel (n= 305) of a similar wood‐processing factory acted as a control group. Mental wellbeing was measured by means of the 12‐item General Health Questionnaire (GHQ score), the 13‐item Beck Depression Inventory (BDI score), and the 13‐item questionnaire assessing psychosomatic symptoms. Seventy‐nine per cent of the study group and 65% of the control group returned the questionnaire. The two groups were similar sociodemographically. Mental wellbeing was poorer in the men of the study group than in the controls. No such difference was detected in women. Mental wellbeing was poorer in all age groups in the study group, especially in married men, than in the controls. The impaired mental wellbeing in the men in the study group was associated with insufficient social support, subjectively poor health, low income and uncertainty about the future. Based on a discriminant analysis, the two groups differed most in terms of GHQ score, income, sex and BDI score.

Mental health at population level during an economic recession in Finland

The aim of this study was to investigate the prevalence of mental disorder and associated factors during an economic recession. Random samples of Finnish general population were collected in 3 consecutive years, 1993-95. The prevalence of mental disorders was assessed by means of the 12-item General Health Questionnaire (GHQ). The prevalence of mental disorders varied among Finnish men from 15.6% to 19.2% and among women from 21 to 24.5%. Mental disorder was more common among women than among men in every study year. Mental disorder was more common among the unemployed than among other respondents both in women and men in every year. Subjective poor health, suicidal thoughts and poor economic situation were constantly associated with mental disorder in both sexes every year. Using logistic regression analyses, problems with a partner, uncertain future orientation and use of psychoactive drugs, in particular, were found to be fairly permanent independent risk factors in relation to mental disorder. As stud...The aim of this study was to investigate the prevalence of mental disorder and associated factors during an economic recession. Random samples of Finnish general population were collected in 3 consecutive years, 1993-95. The prevalence of mental disorders was assessed by means of the 12-item General Health Questionnaire (GHQ). The prevalence of mental disorders varied among Finnish men from 15.6% to 19.2% and among women from 21 to 24.5%. Mental disorder was more common among women than among men in every study year. Mental disorder was more common among the unemployed than among other respondents both in women and men in every year. Subjective poor health, suicidal thoughts and poor economic situation were constantly associated with mental disorder in both sexes every year. Using logistic regression analyses, problems with a partner, uncertain future orientation and use of psychoactive drugs, in particular, were found to be fairly permanent independent risk factors in relation to mental disorder. As studied by gender no major changes occurred in the mental health status of Finns during economic recession, although in many specific groups mental disorder was markedly more common than in the general population.

The North Karelia Youth Project. A community-based intervention study on CVD risk factors among 13- to 15-year-old children: study design and preliminary findings.

Abstract Cardiovascular diseases (CVD) are the major cause of mortality and morbidity in most of the industrialized world. Their prevention may be possible through reduction of well-established risk factors: smoking, elevated serum cholesterol, and hypertension. Several preventive trials among adults are under way. Ultimately, however, we should aim at preventing the development of risk factors in childhood. An intervention study begun in the county of North Karelia, Finland, aimed to test the feasibility and effects of a comprehensive school- and community-based program to reduce risk factors during adolescence. The target population is the children of North Karelia who were, at the outset of the program, in the seventh grade (13 years). Two schools received intensive intervention; the others received general county-wide intervention. A matched county was used as reference. The baseline survey in autumn 1978 in three matched pairs of schools involved approximately 1,000 children, their parents and teachers, and information about school diets. The participation rates of children and parents was more than 99%. A similar survey will be carried out among the same subjects after the 2-year intervention period. A high serum cholesterol level (5.1 mmol/liter—equivalent to 197 mg/dl) among the children studied was an outstanding finding of the baseline survey. Study design, methods of intervention, and other results of the baseline survey are presented.