Andrzej Pająk

Smoking Epidemic in Krakow

Elimination of tobacco smoking is an important measure to support health and increase life expectancy. Availability of local data on smoking prevalence and health consequences of smoking is of crucial importance for any anti-smoking campaign.
The aim of the present paper is to: 1) describe prevalence of smoking in population of middle-aged residents of Krakow, 2) assess a smokingrelated total mortality risk, and 3) evaluate an excess total mortality attributed to smoking.
The study was based on data from Polish part of the HAPIEE Project (Health, Alcohol, Psychosocial Factors in Eastern Europe), a prospective study initiated in 2002. Krakow residents at age 45–69 years were randomly selected within age and gender strata from population registers. Out of initial 10,728 participants, 4857 men and 5127 women were included to the present analysis. Out of them 1630 (34%) men and 1330 (26%) women were current smokers, and 1763 (36%) men and 1077 (22%) women were former smokers. Altogether 71% men and 48% women were ever-smokers. Mean follow-up time was 61 (SD = 10.6) and 62 (SD = 8.0) months for men and women respectively. During the follow-up period there were 294 (6.1%) deaths in men and 135 (2.7%) deaths in women. In total 51,345 person-years were observed. After adjustment to the main cardiovascular risk factors (age, education, BMI, systolic blood pressure , total cholesterol, physical activity and alcohol consumption) more then 3 times higher hazard ratio (HR = 3.3, 95% CI: 2.25–4.99) for currently smoking men and 2 times higher hazard ratio (HR = 2.2, 95% CI: 1.29–3.39) for women compared to non-smokers were observed. In ever-smokers the hazard ratios were as follows: HR = 2.6, 95% CI: 1.78–3.71 for men and HR = 1.8, 95% CI: 1.17–2.69 for women. Among former smokers, the lowest hazard ratio was observed in those who quit smoking more than 15 years ago. In total, 53% of all deaths in men and 18% of all deaths in women were attributed to smoking.
In conclusion, implementation of an effective intervention program on smoking cessation should be one of the main targets of public health and preventive medicine in Krakow.

About 40% of men and 25% of women in Poland are smokers and smoking causes approximately 50 000 premature deaths annually. According to the WHO experts, a tobacco cessation short intervention program provided by primary care physicians is one of the most important prevention measures. In 2004 National  Cardiovascular Disease Prevention Program was launched as a procedure funded by National Health Funds (NFZ), which included the identification of smokers, assessment and treatment of smoking habit. In 2007, the Polish Forum of Prevention issued guidelines that can serve as an effective framework for tobacco cessation intervention in primary care clinics.
The aim of this paper is: 1) evaluation the effectiveness of primary care in professional assistance for smoking patients, 2) evaluation of the impact of the NFZ program on frequency of professional consultations on smoking cessation and evaluation of the impact of the NFZ program on smoking prevalence. There were 66 primary care clinics which were recruited to participate the project; 33 clinics participated in NFZ program, the remaining 33 constituted a control group.
Random sample of persons at age 35–55 years was selected from all persons registered in each clinic. Eligible for the study were patients free of cvd for whom medical records were available from January 1st 2005 at least. Finally 3940 patients in NFZ clinics, 3162 patients in control clinics were included. For each eligible patient medical records were reviewed and information was collected using a standard questionnaire.
All patients were invited for a visit in the clinic. Finally, 2314 persons from the NFZ clinics and 2107 persons from the control clinics participated were examined.
That effectiveness of the routine management of smoking cessation in primary care practices was very low. Equally in the NFZ clinics and the control group about 45% of participants were current smokers. Only 15% of patients had recorded information on smoking status in medical documentation and no significant difference between the NFZ clinics and the control group was observed. The NFZ program increased identification of smoking patients (up to about 80%). Physicians and nurses provided advising to 80% and 30% patients, respectively and the other measures to facilitate smoking cessation were used in small proportion of patients. For instance nicotine replacement therapy, including bupropion, was advised to less than 10% of smokers.
With the exception to distribution of leaflets which were distributed more frequently in patients of clinics which participated in the NFZ program (22.5%) as compared to control clinics (12.8%), there were no statistical differences in proportion of patients getting professional assistance or other intervention measures between the studied groups. The NFZ program appeared to play important role in identification of smokers. However, the program was not effective enough in treatment of patients addicted to smoking. There is a need to supply the NFZ program by more effective procedure, a kind of structured intervention, which would allow to lower smoking prevalence in primary care patients.

Comparison between SCORE performance and the estimated risk of death due to cardiovascular disease in Poland

Polish Cardiac Society recommends to use SCORE tables to estimate the risk of cardiovascular disease (CVD) in clinical practice.

The aim of the study was (1) to compare the estimates of the risk of death from cardiovascular disease (CVD) obtained by using a SCORE function calibrated for the Polish population in 2007 with the risk calculated from the observed number of CVD deaths in the last decade, and (2) to compare the estimates of the risk of death from CVD obtained by using a SCORE function calibrated for the Polish population in 2015 with the CVD risk estimated from the observed number of deaths in 2012, using data on the prevalence of risk factors from the two studies of the representative samples of Polish adult population (WOBASZ and WOBASZ 2).
The risk identified by the SCORE 2007 function was higher than the observed risk by 20–40% in men and 18–33% in women. This indicated that the SCORE 2007 function overestimated cardiovascular risk. The risk calculated by using the SCORE 2015 function was more similar to the CVD risk estimated by using the current mortality data. However, SCORE 2015 function may overestimate CVD risk in future if the decreasing mortality trend would persist in Poland.

Psycho-social factors related with smoking in the Polish population

Aim of the study is to examine the relationship between smoking and psychosocial factors – in the Polish population aged 20–74 years.
Methodology: Results are based on data from WOBASZ. Survey covered a representative sample of men and women aged 20–74 years. Data was collected from the response to the questions from the questionnaire. Smoker was defined as the person who regularly smokes at least 1 cigarette per day.
Results: From the drawn sample 13,285 people were examined – 6291 men and 6994 women. Smokers were 42% of men and 25% of women. Most smokers were pointed out in the groups aged 35–44 (44% M, 32% W) and 45–54 years (46% M and 31% W). The least smokers were in the oldest group aged 65–74 22% M and 5% W. The average age of initiation is low – 18 ± 3.6 years for men and 20 ± 4.9 years for women. Most smokers have primary education (69% M and 53% W), several times more in compare to those with higher education (6% M and 10% W). Most often smoker is a person doing physical work (43% M and 29% W). Single men smoked more often (43% M). Most smokers were in the lowest income group (44% M and 27% W) compared to those with the highest income (25% M, 18% W). People with low social support have a higher frequency of smoking (35% M, 41% W), and persons with depressive symptoms (23% M, 30% W). Most of the smokers declared intention to quit smoking (85% M and 83% W). The most common reasons for quitting were self-motivation (more than 40% of smokers), and fear of disease (17% W, 18% M).