Linas Šumskas

Trends in drinking habits among adolescents in the Baltic countries over the period of transition: HBSC survey results, 1993–2002

BackgroundThe Baltic countries – Estonia, Latvia, and Lithuania – are considered to be an example of regional homogeneity over the period of transition. The World Health Organization cross-national study on Health Behavior in School-aged Children (HBSC) allows a comparison and time trends analysis of behavioral patterns among adolescents in this region. The aim of this study was to estimate the prevalence and trends of alcohol consumption and drunkenness among adolescents of Estonia, Latvia, and Lithuania in 1993/94, 1997/98, and 2001/02.MethodsRepresentative samples of 5286 boys and 6485 girls aged 15 from Estonia, Latvia, and Lithuania were surveyed in 1993/94, 1997/98, and 2001/02 school-year within the framework of HBSC study. The standardized survey methods were applied. The research focused on the following outcome variables: i) frequency of drinking beer, wine, and spirits; and ii) frequency of drunkenness. The same wording of questions on the consumption of alcohol was retained in each survey.ResultsBeer was the most frequently used alcoholic beverage across the Baltic countries among adolescents. The rate of weekly drinking of any alcoholic beverage increased considerably during the eight years of observation, especially among Estonian and Lithuanian students. In 2001/02, 25% of boys and 12.5% of girls have reported drinking alcohol at least weekly. The rate of regular alcohol drinking was two times higher in boys, while irregular drinking was more prevalent in girls. Two or more episodes of drunkenness in the lifespan were reported by 30% of boys and 15% of girls in 1993/94 and by 52% of boys and 36% of girls in 2001/02. The use of alcoholic beverages was related to the perceived family wealth: the students from the families perceived by them as wealthy were more likely to drink weekly as compared to the students from the families perceived by them as not wealthy.ConclusionOver the period between 1993 and 2002 the prevalence of alcohol consumption among adolescents increased considerably across the Baltic countries. The efforts of dealing with this problem should employ a combination of measures, including the strategies relevant for the period of transition.

In search for a public health leadership competency framework to support leadership curriculum-a consensus study.

BACKGROUND Competency-based education is increasingly popular, especially in the area of continuing professional development. Many competency frameworks have been developed; however, few address leadership competencies for European public health professionals. The aim of this study was to develop a public health leadership competency framework to inform a leadership curriculum for public health professionals. The framework was developed as part of the Leaders for European Public Health project-supported by the EU Lifelong Learning Programme. METHODS The study was carried out in three phases: a literature review, consensus development panel and Delphi survey. The public health leadership competency framework was initially developed from a literature review. A preliminary list of competencies was submitted to a panel of experts. Two consensus development panels were held to evaluate and make changes to the initial draft competency framework. Then two rounds of a Delphi survey were carried out in an effort to reach consensus. Both surveys were presented through Survey Monkey to members of the Association of the Schools of Public Health in the European Region Working Group on Innovation in Public Health Teaching and Education. RESULTS The framework was developed consisting of 52 competencies organized into eight domains: Systems Thinking; Political Leadership; Collaborative Leadership: Building and Leading Interdisciplinary Teams; Leadership and Communication; Leading Change; Emotional Intelligence and Leadership in Team-based Organizations; Leadership, Organizational Learning and Development and Ethics and Professionalism. CONCLUSION The framework can serve as a useful tool in identifying gaps in knowledge and skills, and shaping competency-based continuing professional development leadership curricula for public health professionals in Europe.

An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania - a qualitative study

BackgroundThe aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level.MethodsA qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clinical settings, were held in Poland and Lithuania. Seven well-informed health care experts were recruited in both countries to provide information during the in-depth interviews. In both formats, questions were devoted to three main areas of health promotion and disease prevention competences: (1) educational, (2) clinical, (3) organisational. A qualitative content analysis was performed.ResultsLithuanian and Polish family physicians/general practitioners view preventive care as one of their main responsibilities. Among 3 areas of competences, participants identified clinical competences as the most important in everyday practice. They also acknowledged that organisational and educational competences might be below the level required for effective preventive care. Only clinical competences were indicated as sufficiently developed during under- and post-graduate medical education.ConclusionsIn addressing current health promotion and disease prevention challenges, teachers of family medicine need to critically consider the training that currently exists for physicians. Development of a high-quality preventive service is not only a matter of proper education in the clinical field but also requires training in practice organisation and patient education.

Determinants of self-rated health in elderly populations in urban areas in Slovenia, Lithuania and UK: findings of the EURO-URHIS 2 survey

Background Ageing imposes extra financial burdens on social and health services in developed countries. Self-rated health (SRH) is considered to be both a reliable measurement of overall health status including morbidity and mortality and an important predictor of hospitalization, functional impairment and greater demand for health-care services in the elderly. Our aim was to identify factors associated with poor SRH in elderly populations and investigate possible differences between urban areas in Slovenia, Lithuania and UK. Data were obtained from population-based surveys from the European Urban Health Indicator System Part 2 project. The stratified representative sample (41% men and 59% women) consisted of a total of 2547 respondents aged ≥65 from the urban areas in the three countries. The prevalence of poor SRH was highest in Lithuanian urban areas. The strongest factors associated with poor SRH were low education [OR (odds ratio) 4.3, 95% CI (confidence interval) 2.5-7.3, P < 0.001], restriction of activities attributable to a chronic disease (OR 2.6, 95% CI 2.2-3.0, P < 0.001), inadequate physical activity (OR 1.7, 95% CI 1.2-2.5, P = 0.007) and poor mental health (OR 1.1, 95% CI 1.1-1.2, P < 0.001). The main factors associated with poor SRH by country included the following: living alone (Slovenia) (OR 2.0, 95% CI 1.1-3.7, P = 0,023), female sex (Lithuania) (OR 2.0, 95% CI 1.0-4.2, P = 0.058) and inadequate physical activity (UK) (OR 2.2, 95% CI 1.3-3.6, P = 0,003). Despite different levels of poor SRH, the factors associated with poor SRH were similar for the urban areas of the three countries. Factors associated with poor SRH in the urban areas could also reflect either cultural differences or specific situations for elderly in that country, which need further research.

Family Social Environment and Parenting Predictors of Alcohol Use among Adolescents in Lithuania

The role of the family as the social environment in shaping adolescent lifestyle has recently received substantial attention. This study was focused on investigating the association between familial and parenting predictors and alcohol use in school-aged children. Adolescents aged 13- and 15-year from a representative sample (N = 3715) of schools in Lithuania were surveyed during the spring of 2014. The methodology of the cross-national Health Behaviour in School-aged Children (HBSC) study was applied. HBSC international questionnaires were completed in the classroom anonymously for obtaining information about drinking of alcoholic beverages and family characteristics—family’s affluence and structure, style of communication in the family, parenting style, parental monitoring, family time together, etc. Univariate and multivariate logistic regression analysis was applied for assessment of the association between familial variables and weekly alcohol use. Analysis has demonstrated that adolescents from non-intact families tended to show significantly higher risk of being weekly drinkers (OR = 1.69; 95% CI: 1.30–2.19). The following parenting factors were associated with weekly use of alcohol: father’s and mother’s low monitoring, father’s authoritarian-repressive and mother’s permissive-neglectful parenting style. Frequent family time together and frequent electronic media communication with parents showed an inverse negative effect than was predicted. The study suggests that alcohol misuse among adolescents could be associated with a non-intact family structure as well as with complex family and parenting determinants which should be investigated more thoroughly by further studies.

Health-behaviour inequalities among Russian and ethnic majority school-aged children in the Baltic countries

Aims: The main aim of this paper was to investigate whether ethnic heath inequalities exist in self-rated health and risk-taking behaviours (smoking, drunkenness, use of cannabis) between ethnic majority (Estonian, Latvian, Lithuanian) and minority (Russian) population groups of school-aged children in three Baltic countries. Methods: Investigation was carried out in the framework of Health Behaviour in School-aged Children (HBSC) study. Randomly selected students aged 11, 13, and 15 years answered questionnaires in the classroom in 2006. In total, 14,354 questionnaire forms were selected for analysis. Results: Russian boys were more likely (p<0.05) to evaluate their self-rated health positively in schools with Russian teaching language. Odd ratios for current smoking and drunkenness were significantly lower among Russian boys in the schools with Russian language of instruction (p<0.05) in comparison with the reference group. Russian girls did not differ significantly (the exceptions were smoking in Estonia and cannabis use in Latvia) from the majority population girls by self-rated health as well as by the risk of smoking, drunkenness, and use of cannabis. Conclusions: The study found some differences in self-rated health and in risk-taking behaviours between Russian minority and ethnic majority students as well as between students of schools with different language of instruction (majority language vs. Russian) in Estonia, Latvia, and Lithuania. Being a member of minority group was not related with poor self-rated health or involvement in risk-taking behaviours in school-aged children in the Baltic countries.

Health behavior inequalities among Lithuanian, Polish and Russian school-aged children in Lithuania

The aim of this study was to compare and get a deeper insight into issues of the health and health behavior inequalities among Lithuanian, Polish and Russian school-aged children in national and international contexts. Investigations were carried out in the framework of Health Behavior in School-aged Children (HBSC) study — a WHO collaborative cross-national survey. Five thousand seven hundred and seventy six randomly selected students aged 11, 13, and 15 years of age answered questionnaires in the classroom in 108 schools located in different regions in Lithuania in March–April of 2006. Questions on perceived health and health related behaviors were addressed to the respondent (response rate was 95 %). 5632 questionnaires were selected for further analysis by the international data center in Bergen. SPSS version 11.5 and multilevel analysis program MLwiN 2.0 was applied for statistical analysis of data. Relatively minor inequalities in health and health behavior were established when comparing different health and health behavior indicators in Lithuanian, Polish and Russian school-aged children in Lithuania. These disparities are lower in comparison with differences, which were established among respondents of HBSC international studies. Odds ratios to have negative self-rated health evaluation were higher in girls of Russian (OR-1.71, p<0.05) and Polish (OR-1.62, p<0.05) nationality. Therefore, Russian and Polish students were tending to have higher odds ratios for perception of happiness (p<0.05). Respondents of Russian nationality have expressed less somatic and psychological complaints. Polish boys (OR=1.38, p<0.05) were tending for higher prevalence of headache, but have expressed fewer complaints for depression (OR=0.65, p<0.05), anxiety (OR=0.71, p<0.05). Chances to be involved in risk taking behaviors (alcohol consumption, smoking, drug use) were lower among Polish and Russian respondents. In schools with Lithuanian language based-schoold, health and health behavior indicators were more negative in Polish and Russian respondents in comparisons with their Lithuanian peers However, Lithuanian students, who were enrolled in Russian and Polish schools, tending to have better perceived health evaluation and better health behavior in comparison with their peers of Polish and Russian nationality. Analysis shows, that Polish and Russian students are integrated well into Lithuanian society and being a member of the minority class is not related to poor health or negative lifestyle. Therefore, with few exceptions universal health promotion programs should be provided to school-aged children of all ethnicities and cultural backgrounds.

Is blended learning and problem-based learning course design suited to develop future public health leaders? An explorative European study

BackgroundPublic health leaders are confronted with complex problems, and developing effective leadership competencies is essential. The teaching of leadership is still not common in public health training programs around the world. A reconceptualization of professional training is needed and can benefit from innovative educational approaches. Our aim was to explore learners’ perceptions of the effectiveness and appeal of a public health leadership course using problem-based, blended learning methods that used virtual learning environment technologies.Case presentationIn this cross-sectional evaluative study, the Self-Assessment Instrument of Competencies for Public Health Leaders was administered before and after an online, blended-learning, problem-based (PBL) leadership course. An evaluation questionnaire was also used to measure perceptions of blended learning, problem-based learning, and tutor functioning among 19 public health professionals from The Netherlands (n = 8), Lithuania (n = 5), and Austria (n = 6).Participants showed overall satisfaction and knowledge gains related to public health leadership competencies in six of eight measured areas, especially Political Leadership and Systems Thinking. Some perceptions of blended learning and PBL varied between the institutions. This might have been caused by lack of experience of the educational approaches, differing professional backgrounds, inexperience of communicating in the online setting, and different expectations towards the course.ConclusionsBlended, problem-based learning might be an effective way to develop leadership competencies among public health professionals in international and interdisciplinary context.

“Let's grow up healthy:” A health education pilot project for primary schools in Lithuania

Health is markedly influenced by lifestyle health behaviours which require good practices or habits related to nutrition, exercise, the avoidance of smoking and alcohol, sleep and leisure activities, personal hygiene and dental hygiene. As a minimum, the adoption of healthy lifestyle habits requires health knowledge and a positive attitude to health, although these do not guarantee the performance of appropriate health behaviours because other factors may interfere. Children may be precluded from engaging in good lifestyle behaviours because of environmental factors such as their family circumstances. In addition, there are strong peer pressures that influence young people to adopt health risk behaviours such as smoking and drinking. Influential adults, such as parents and teachers, may also present role models that encourage children to try unhealthy lifestyle behaviours. Teaching children to lead a healthy lifestyle is an important task for present day Lithuania. Initial attempts at health education in the 1920s and 1930s were suppressed by the Soviet school and health care system. Although Soviet health care was formally based on principles of disease prevention, in reality, health promotion and health education were not supported. All resources were used to build hospitals and train doctors to treat disease. Despite the resources put into treatment, neither Lithuania nor any of the other republics of the former USSR compare favorably with the West on key health indicators including longevity or infant mortality.1 Unlike the former USSR, most countries in the West over the last few decades have devoted considerable attention to the promotion of healthy lifestyles among children and young people and have accumulated a rich experience about how to do so. For example, such projects can be mentioned as: Know Your Body in the USA and other countries,2,3 Westchester County Intervention Trial in New York, USA4, North Karelia Youth Project in Finland5, Oslo Youth Study in Norway6, Lifestyle Education Programme in Australia7, and Keep Your Body Healthy in Israel8.