Kersti Pärna

Cigarette and waterpipe smoking among adolescents in Estonia: HBSC survey results, 1994–2006

BackgroundSmoking is a major single cause of preventable morbidity and premature mortality. Tobacco use among adolescents is a significant public health problem as smoking behaviour is undeniably established in adolescence. While cigarette smoking among adolescents has been a significant public health problem for years, waterpipe smoking is considered to be a new global public health threat. The objectives of this study were to describe trends of cigarette smoking and the prevalence of waterpipe smoking and to study the association between cigarette and waterpipe smoking among adolescents in Estonia.MethodsThis study was based on a four-yearly HBSC survey of health behaviour among school-aged children conducted in 1994–2006 in Estonia. It was a school-based survey of a nationally representative sample using standardized methodology. The target group of the survey were 11-, 13-, and 15-year-old schoolchildren (N = 13826), 6656 boys and 7170 girls. Cigarette and waterpipe smoking was determined on a 4-stage scale: every day, at least once a week, less than once a week, not smoking. Logistic regression analysis was applied to examine gender- and age-specific smoking trends and to study the association between cigarette and waterpipe smoking.ResultsPrevalence of smoking was higher among boys than girls in all age groups during the whole study period. The prevalence of cigarette smoking increased in 1994–2002 and then slightly decreased in both genders. The increase in smoking was larger among girls. Among girls, daily smoking increased during the whole study period. Among 15-year-old schoolchildren one-third of the boys and one quarter of the girls were cigarette smokers, 21% of the boys and 12% of the girls were daily smokers in 2006. One fourth of the boys and one sixth of the girls were waterpipe smokers. A logistic regression analysis revealed a strong association between cigarette and waterpipe smoking among schoolchildren.ConclusionThe results of this study can significantly enhance the capacity to develop and implement tobacco prevention and control programmes among the youth in Estonia.

Alcohol consumption in Estonia and Finland: Finbalt survey 1994-2006

BackgroundAlcohol consumption has been regarded as an important contributor to the high premature mortality rates. The objective of this paper was to provide an overview and comparison of alcohol consumption and its socio-demographic determinants among adults in Estonia and Finland.MethodsThe study was based on a 25-64-year-old subsample of nationally representative postal cross-sectional surveys conducted in Estonia (n = 10,340) and Finland (n = 19,672) during 1994-2006. Abstinence, frequency, and the amount of alcohol consumed were examined. Logistic regression models were used to test the socio-demographic differences in alcohol consumption at least once a week. The effect of socio-demographic factors on pure alcohol consumed per week was calculated using linear regression.ResultsThe proportion of abstainers was 1.5 times higher among women than men in both countries. Throughout the study period, the amount of alcohol consumed per week increased for both genders in Estonia and for women in Finland, but was stable for men in Finland. In the final study year, medium risk amount of alcohol consumed per week was nearly 1.5 times higher among men in Estonia than in Finland, but about half that among women in Estonia than in Finland. Compared to ethnic majority in Estonia, alcohol consumption at least once a week was lower among men, but amount of pure alcohol drunk per week was higher among women of ethnic minority. In Finland, alcohol consumption at least once a week was more prevalent among women of ethnic minority, but the amount of pure alcohol drunk per week was lower for both gender groups of ethnic minority. Compared to married/cohabiting respondents, alcohol consumption at least once a week was less pronounced among single respondents in Finland, divorced or separated women in both countries, and widowed respondents in Estonia. Greater amount of alcohol consumed per week was more prevalent among single and divorced or separated respondents in Finland, but only among divorced or separated men in Estonia. Frequency of alcohol consumption was lower among less educated than higher educated respondents in Finland, but not in Estonia. The amount of consumed alcohol per week was higher among less educated men in Estonia, but lower among women with basic education in Finland.ConclusionsAlcohol consumption has increased in Estonia and Finland. National alcohol policies should reflect findings of alcohol epidemiology in order to introduce measures that will reduce alcohol related harm in the population effectively.

A rapid situation assessment of the market for surrogate and illegal alcohols in Tallinn, Estonia.

SummaryObjectives:To understand the phenomenon of consumption of surrogate and illegal alcohols in Tallinn, capital of Estonia.Methods:This study, conducted in Tallinn in May 2006, used rapid situation assessment. Interviews with key informants in relevant settings such as emergency departments of hospitals, accommodation for the homeless, police etc. (n = 22), with alcohol abusers (n = 33), natural observations of surrogate sale and consumption venues (n = 46), and tracking of trade data were carried out.Results:Key informants confirmed that consumption of illegal and surrogate alcohols are widely used by alcohol abusers, a finding confirmed by the alcohol abusers. Availability of surrogates varied by area of the city, mainly sold from street kiosks. Illegally produced spirits were also easily available. Sales of surrogates appear to have increased in recent years.Conclusion:A range of alcohol-containing substances that appear to be easily available at low cost, and that have high concentration of ethanol or contaminants known to be toxic, were identified in Tallinn. Alcohol policies in Estonia should address the consumption and availability of these substances.

Using ‘amenable mortality’ as indicator of healthcare effectiveness in international comparisons: results of a validation study

Background and study aims There is widespread consensus on the need for better indicators of the effectiveness of healthcare. We carried out an analysis of the validity of amenable mortality as an indicator of the effectiveness of healthcare, focusing on the potential use in routine surveillance systems of between-country variations in rates of mortality. We assessed whether the introduction of specific healthcare innovations coincided with declines in mortality from potentially amenable causes in seven European countries. In this paper, we summarise the main results of this study and illustrate them for four conditions. Data and methods We identified 14 conditions for which considerable declines in mortality have been observed and for which there is reasonable evidence in the literature of the effectiveness of healthcare interventions to lower mortality. We determined the time at which these interventions were introduced and assessed whether the innovations coincided with favourable changes in the mortality trends from these conditions, measured using Poisson linear spline regression. All the evidence was then presented to a Delphi panel. Main results The timing of innovation and favourable change in mortality trends coincided for only a few conditions. Other reasons for mortality decline are likely to include diffusion and improved quality of interventions and in incidence of diseases and their risk factors, but there is insufficient evidence to differentiate these at present. For most conditions, a Delphi panel could not reach consensus on the role of current mortality levels as measures of effectiveness of healthcare. Discussion and conclusions Improvements in healthcare probably lowered mortality from many of the conditions that we studied but occurred in a much more diffuse way than we assumed in the study design. Quantification of the contribution of healthcare to mortality requires adequate data on timing of innovation and trends in diffusion and quality and in incidence of disease, none of which are currently available. Given these gaps in knowledge, between-country differences in levels of mortality from amenable conditions should not be used for routine surveillance of healthcare performance. The timing and pace of mortality decline from amenable conditions may provide better indicators of healthcare performance.

Comparison of knowledge, attitudes and behaviour regarding smoking among Estonian and Finnish physicians.

Summary.Objectives: To compare smoking behaviour, attitudes and opinions towards smoking and smoking cessation among Estonian and Finnish physicians.Methods: A cross-sectional postal survey using a self-administered questionnaire was carried out among 2 480 Estonian and 2 075 Finnish physicians.Results: Daily smoking prevalence was higher among Estonian physicians than among their Finnish counterparts in both male (18.6% and 6.7%) and female (6.6% and 3.6%). Compared to Estonia, physicians in Finland more often agreed that smoking is very harmful to their health, that trying to convince people to stop smoking is their responsibility and that smoking prevention should be part of the normal and special training of health professionals. In both countries, non-smoking physicians held more unfavourable attitudes towards smoking than those who were smoking.Conclusions: Physicians’ own smoking patterns and quitting behaviour are important because physicians serve as models for their patients and play a key role in the reinforcement of smoke-free health facilities. These results remain a challenge to medical educators, especially in Estonia. Estonia needs to improve medical education in terms of motivating physicians to ask about the smoking patterns of their patients and of training medical students and resident physicians to counsel their patients to stop smoking.Zusammenfassung.Vergleich der Kenntnisse, Einstellungen und des eigenen Verhaltens bezüglich des Rauchens zwischen der estnischen und der finnischen ÄrzteschaftFragestellung: Es werden die Unterschiede in den Rauchgewohnheiten, in der Einstellung und den Ansichten über das Rauchen und die Raucherentwöhnung zwischen estnischen und finnischen Ärzten untersucht.Methoden: Eine Querschnittsstudie mit selbstauszufüllendem Fragebogen wurde bei 2 480 estnischen und 2 075 finnischen Ärzten durchgeführt.Resultate: Die tägliche Rauchprävalenz war sowohl bei den Ärzten (18,6%) als auch bei den Ärztinnen (6,6%) in Estland höher als bei ihren finnischen Kollegen (6,7%) und Kolleginnen (3,6%). Verglichen mit Estland, waren Ärzte in Finnland öfters der Meinung, dass Rauchen sehr schädlich für ihre Gesundheit ist, dass sie dafür verantwortlich sind, ihre Patienten davon zu überzeugen, dass es wichtig ist, aufzuhören zu rauchen, und dass Tabakprävention ein Teil der normalen und speziellen Ausbildung von Gesundheitsfachleuten sein sollte. In beiden Ländern hatten nichtrauchende Ärzte gegenüber dem Rauchen eine stärker ausgeprägte negative Haltung als die rauchenden.Schlussfolgerung: Dem Rauchverhalten der Ärzteschaft selbst kommt wegen deren Vorbildfunktion gegenüber den Patienten eine Schlüsselrolle bei der Erreichung von rauchfreien Gesundheitseinrichtungen zu. Diese Resultate zeigen, dass die medizinische Ausbildung vor allem in Estland betreffend Rauchen noch ein Verbesserungspotential hat. Estland muss die medizinische Ausbildung so verbessern, dass Ärzte mehr motiviert sind, mit ihren Patienten über das Rauchen zu sprechen. Zudem sollten Studierende der medizinischen Fächer aber auch bereits praktizierende Ärzte dahingehend geschult werden, dass sie ihre Patienten stärker zur Raucherentwöhnung motivieren können.Résumé.Connaissances, attitudes et comportements des médecins estoniens et finlandais envers le tabagismeObjectifs: Comparer les habitudes de consommation de tabac, les attitudes et les opinions concernant le tabagisme et la cessation tabagique parmi les médecins estoniens et finlandais.Méthodes: Enquête par questionnaire auto administré, auprès de 2 480 médecins estoniens et de 2 075 médecins finlandais.Résultats: La prévalence du tabagisme était plus élevée parmi les médecins estoniens que parmi leurs collègues finlandais, tant pour les hommes (18,6% et 6,7%) que pour les femmes (6,6% et 3,6%). Les médecins en Finlande ont accepté plus souvent qu’en Estonie l’idée que le tabagisme est très nuisible pour leur santé, qu’il est de leur responsabilité de convaincre les gens de cesser de fumer et que la prévention du tabagisme devrait être un sujet normalement abordé dans la formation des professionnels de la santé. Dans les deux pays, les médecins non-fumeurs avaient une attitude plus défavorable envers le tabagisme que les médecins fumeurs.Conclusion: L’attitude des médecins concernant le tabagisme et la cessation tabagique est importante car ils servent de modèles pour leurs patients et ils jouent un rôle-clé pour assurer que le système de santé offre un environnement sans tabac. L’Estonie surtout a besoin d’améliorer la formation des médecins pour inciter ces derniers à interroger leurs patients sur leurs habitudes tabagiques et pour enseigner aux étudiants et aux internes comment informer leurs patients sur les programmes de cessation tabagique.

Dramatic increase in alcoholic liver cirrhosis mortality in Estonia in 1992-2008.

AIMS The aim of the study was to describe trends in alcoholic liver cirrhosis mortality rates in 1992-2008 and to examine socio-demographic differences in alcoholic liver cirrhosis mortality. METHODS Individual records of deaths from alcoholic liver cirrhosis among 25-64-year olds in 1992-2008 in Estonia were analysed. Age-standardized mortality rates for men and women aged 25-44 and 45-64 were calculated. Association between alcoholic liver cirrhosis mortality and socio-demographic variables (age, education and ethnicity) for the data of the years around the census in 2000 was measured by mortality rate ratios using Poisson regression models. RESULTS In 1992-2008, alcoholic liver cirrhosis mortality rates were higher among men than that in women and that in the older than in the younger age group. Over the whole study period, mortality from alcoholic liver cirrhosis increased steeply. The increase was sharper among men and women in the older age group. In 1998-2001, higher alcoholic liver cirrhosis mortality rates occurred in non-Estonians and those with lower levels of education. CONCLUSION Alcoholic liver cirrhosis mortality has increased steadily in Estonia, and is reflected in an increase in heavy drinking. National alcohol policies should address all strata of society. However, in order to reduce alcohol-related damage in the population most effectively, special attention should be paid to non-Estonians and people with low levels of education.

Contrasts in alcohol-related mortality in Estonia: education and ethnicity.

AIMS The aims of this study were to examine socio-demographic differences in alcohol-related mortality in Estonia, and how they changed over time. METHODS Individual death records (age at death 25-64) in Estonia from the late Soviet era (1983-1991) to Estonian re-independence (1992-2005) were analysed using a case-control design. Cases were deaths from alcohol-related causes (7981 deaths). Controls were deaths (13,820) from those neoplasms that are considered not to show variation in death risk according to the socio-demographic variables (that is, excluding cancer of the upper aero-digestive tract, lung, stomach, colon and female breast). Differences in alcohol-related mortality between socio-demographic groups were measured by mortality odds ratio. RESULTS In the study period as a whole, in both genders, an inverse relationship between the educational level and risk of alcohol-related death was apparent. Non-Estonians were more likely to die from alcohol-related causes than Estonians. Risk of alcohol-related death varied over time, being lowest just before Estonia regained its independence, and highest in the most recent period. In men, the educational gradient in the mortality odds ratio almost disappeared in 1988-1991, but reappeared in the transition period, while the impact of ethnicity remained stable over time. In women, educational contrasts in the risk of death existed throughout all subperiods, and ethnical inequalities widened in the re-independence period. CONCLUSION Rapid societal changes had profound effects on alcohol-related mortality. Strategies to prevent alcohol misuse should include all sections in society, paying special attention to less educated and non-Estonians.

Comparison of socioeconomic differences in self-perceived health in Estonia and Finland

Aim: To compare self-perceived health in relation to socioeconomic factors in Estonia and Finland. Methods: This study was based on the 25—69 year old adult population of the European Social Survey, conducted in Estonia and in Finland in 2006. Self-perceived health was rated on the five-point scale as very good, good, fair, poor, and very poor. The socioeconomic position was measured by the level of education, economic activity, and self-rated financial situation. Logistic regression analysis was applied to assess the association between self-perceived health and the socioeconomic factors. Results: The prevalence of less-than-good health was significantly higher in Estonia than in Finland. Significant associations with less-than-good self-perceived health were found for less educated, economically non-active respondents with poorer self-rated financial situation in both countries. After adjustment, economic non-activity among women and self-rated financial situation among men appeared not to be associated with less-than-good self-perceived health in Finland. Conclusions: Self-perceived health was poorer in Estonia than in Finland, but Estonia shares with Finland a similar socioeconomic pattern of health. Further research is needed to monitor socioeconomic variations in health behaviour and mortality in both countries.

Anxiety about environmental hazards among teenagers in Helsinki, Moscow and Tallinn.

Comparative research of environmental attitudes has concentrated on adults of Western countries, whereas knowledge of environmental consciousness of East European people is modest. This article compares anxiety that teenagers in Helsinki, Moscow and Tallinn express about environmental hazards and their health effects. The data (Helsinki, N = 1396; Moscow, N = 618; Tallinn, N = 1268) were collected in schools by questionnaires from pupils between 13 and 18 years in 1994-1995. Air pollution, water pollution and survival of plant and animal species were considered most worrying environmental threats in every city. Environmental concern was usually highest in Moscow, but the effects of pollution on an individuals health worried Estonian teenagers most. The worry was most consistent in Moscow, where sex, class level or opinion of the state of ones own living environment did not usually have an effect on attitudes. Finnish girls and pupils in higher school classes were environmentally more conscious than boys or younger teenagers. In Tallinn, the sex and age differences in worry were smaller. Environmental worry seemed to have connections to a general sense of responsibility and risk behaviour such as heavy drinking and smoking. For all sites those pupils who often throw empty packages onto the street or into the nature expressed lower environmental concern than their more responsible peers. The differences of worry between the cities were difficult to interpret, but the greater total concern of young Muscovites may be part of their general social anxiety, which is associated with the instability of the Russian society.

Long-term outcome of bystander-witnessed out-of-hospital cardiac arrest in Estonia from 1999 to 2002

OBJECTIVE To assess the long-term outcome of bystander-witnessed out-of-hospital cardiac arrest victims in Estonia by using the survival rate and quality of life assay. METHODS All resuscitation attempts made from 01.01.1999 to 31.12.2002 in Estonia were retrospectively screened for bystander-witnessed adult out-of-hospital cardiac arrests of cardiac origin. The patients who survived hospital discharge were included in the study. Their long-term survival data were retrieved from Estonian Population Registry on March 15, 2004. Quality of life was assessed by RAND-36 questionnaire. Comparisons were made with population norms, and patients suffering from myocardial infarction or angina pectoris. RESULTS 854 bystander-witnessed resuscitation attempts were made in four years. 91 patients (10.7%) survived to hospital discharge. Their one-year survival rate was 77.0% and five-year survival rate 64.3%. 44 patients responded to quality of life questionnaire, sent 16-62 months after out-of-hospital cardiac arrest (response rate 77.2%). Respondents rated their quality of life significantly worse than general population in five out of eight categories. The out-of-hospital cardiac arrest survivors with known cardiovascular disease in history (n=30) had quality of life similar to patients suffering from myocardial infarction or angina pectoris who had not required resuscitation. CONCLUSION In Estonia majority of bystander-witnessed out-of-hospital cardiac arrest victims who survive hospital discharge are alive one and also more than three years after resuscitation. Their quality of life is worse than that of general population.