The content of tar in cigarettes sold in Poland in the years 1983–2000

Cigarette smoke contains over forty carcinogenic compounds, including tar that is evaluated as carcinogen A for human beings. The World Health Organization recommends reduction of carcinogenic and toxic substances in cigarettes as one of the elements in cancer control programs and tobacco control policies. In the beginning of 1990s, the Polish norm for tar, nicotine and carbon monoxide was first time enforced in Poland. This paper makes an attempt to collect available data on the content of tar in cigarettes sold in Polish market between 1983 and 2000, analyze time trends for average tar content in these cigarettes, compare Polish data with study results from Unites States, Finland and other Central and Eastern European countries, and evaluate whether tobacco product control measures that have been enforced at that time contributed to reduction of tar in cigarettes sold in Poland and what was its potential impact on time trends in lung cancer mortality in the last decades.

Smoking prevalence in Poland at the background of European Union countries

Smoking prevalence in Europe is worth analyzing in order to observe exposure of population to tobacco smoke, what is informative and  mportant from the public health point of view. Aim of the paper was to compare smoking prevalence between European Union countries, with the special attention to Poland. The analysis was conducted separately by age, sex and smoking categories. Results part contains systematic review of the 2002 data for Poland at the background of the rest of the EU countries. Presented analysis shows past and present state of tobacco epidemics in Poland and is a good indicator of tobacco-related health threats in Polish population. Discussion part contains between others methodological considerations on how to read the smoking prevalence analysis results to avoid producing misleading message.

Prevalence of tobacco use and environmental tobacco smoke in polish population research. WHO-CINDI Programme in 1991–2007

This article is a report from comparison surveys, carried out in connection with WHO-CINDI Programme during the years 1991–2007. The analysis was based on random sampling tests concerning big Polish cities’ inhabitants, all in all almost 11.5 thousand respondents. Taking everything into consideration, it has been established, that:1. Regular smoking frequency becomes smaller (the effect of implemented prophylactic programmes, a so-called ‘intervention variable’).
2. Still, propagation of environmental smoking is an alarming   phenomenon, however it is definitely improving. Despite the fact, that more and more respondents are living in a free-smoking zone, each 5-6 adult city inhabitant spends over 5 hours a day in a room full of smoke.
3. Within time passing, as a result of quitting an addiction, a belief concerning harmful smoking consequences grows. This tendency is not yet sufficiently justified. Becoming alarmed with the concerning phenomenon is definitely not enough when making an opinion in this matter

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).

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.

Opinions of the adolescents on ban of smoking in public places

Introduction: There have been attempts to introduce the ban of smoking in public places for several years.
Aim of the project was to find out the teenagers’ opinion on introducing the total ban of smoking in public places.
Materials and methods: The research was conducted in January 2009 among 88 students of secondary schools in Town of Płońsk. The diagnostic survey method was used.
Results: 59,0% of the questioned teenagers claim that the Total ban of smoking should be introduced in public places but only 30,6% declared their support to introduce such ban.
The places where the total ban should be introduced included clinics and hospitals (93,2%), children’s playgrounds (88,6%), sport facilities (62,5%), schools and universities (22,7%), bars, pubs, discos (5 questioned people!), private cars (2 people!).
Only 22,8% of the questioned know the law rules concerning the ban on smoking in public areas. Over the half claimed that the obligations are not obeyed.
Conclusions: Total ban of smoking should be promoted more widely in Poland. We should follow the example of other European countries in this respect. The stress should be put on introducing the ban in such places as bars or pubs and discos where the young generation spends their free time and can experience passive smoking. The issue of nicotine and its bad influence should be promoted widely in mass media.
Another group which should be educated in that area are adults who should be encouraged to giving up smoking and introducing the free from smoke houses.

Global Adult Tobacco Survey (GATS) Project in Poland

Social and economical consequences of using tobacco products are commonly known. This is an issue of a global scale and requires systematic monitoring. The need of in depth examination of this issue concerns also Poland. In 2008 Polish Ministry of Health joined Global Adult Tobacco Survey (GATS). This survey is conducted under Bloomberg Global Initiative to Reduce Tobacco Use. In Poland GATS is being coordinated by World Health Organization. Three institutions were selected to conduct the survey: Maria Sklodowska-Curie Oncology Center (Centrum Onkologii – Instytut im. M. Skłodowskiej-Curie), Pentor Research International and Warsaw Medical University (Warszawski Uniwersytet Medyczny). GATS survey is national, representative survey of households conducted amongst adult population. Globally standardized protocol is being used to implement the survey in Poland. The protocol has been adapted to the Polish needs and reality.
The main aim of the project is to assess the usage of tobacco products and examination of the size of the problem, exposure to the tobacco smoke and perception, attitudes and knowledge regarding tobacco products use as well issues concerning taxes on tobacco products. Information gained during GATS will support tobacco control policy. Experience gained during the survey implementation will, in the future, allow building systematic monitoring system of tobacco use and other health behaviors in our country.

Polish Forum for Prevention in years 2005–2009

In 2005 the Health Promotion Committee of the Polish Cardiac Society (PTK) invited seven other Polish professional societies to collaborate in a development of unified recommendations on CVD prevention in Poland. To coordinate the collaboration Polish Forum for Prevention (PFP) was founded. The PFP recommendations are in concordance with the current European guidelines however national characteristics and local epidemiologic data are also considered. They are broadly distributed to the subscribers of all official journals of the PFP Member Societies, and additionally published in Polish Heart Journal. The same information are published in a patient – friendly format on the website and as  a booklet. Additionally, PFP does efforts to influence the health policy and currently is especially involved now in encouraging politicians to ban smoking in public places.

Epidemiological survey and antitobacco intervention in Polish 400 Cities Projec

Cardiovascular diseases (CVD) represent the principal cause of death in Poland. The main reasons are high prevalence and low detectability of main risk factors: arterial hypertension, diabetes and hyprelipidaemia.
Also smoking is one of the main CVD risk factor. Polish 400 Cities Project consists of the following modules:
1. social marketing preceding screening tests and education,
2. medical intervention – screening tests,
3. education for local leaders regarding health promotion and CVD prevention,
4. antitobacco intervention,
5. educational intervention for children: training program for teachershealth promotion among pupils,
6. training programs for doctors and nurses,
7. education for patients with newly-detected diseases.
Antitobacco module contains the following interventions:
1) social marketing via mass media,
2) education among children in schools,
3) education for smoking patients with newly-detected diseases,
4) training program for doctors: treatment of nicotinism,
5) training program for local representatives: elaboration of local antitobacco program,
6) in 2006 new module – antitobacco intervention for pregnant women.
In years 2003–2006 screening tests were performer among 92378 adults. Tobacco smoking was reported by 12.3% of woman and 21.9% of men, mainly in the age group 25–45 (W 21.1%; M 28.5%). Data from intervention among children show that among 24,005 ten years old boys and girls, 5.7% girls and 12.8% boys say “yes” for the question “have you ever smoke” in the questionnaire interview. In years 2006–2008 the main antitobacco module was antitobacco intervention for pregnant women. The purpose of the research was to measure phenomenon of active and passive smoking among pregnant women in the smallest cities with surrounding villages. The aim was also to trace social features associated with smoking and develop the strategy for future antitabacco interventions. The research was conducted along with intervention based on American College of Obstetricians and Gynecologists 5 A’s model tailored for pregnant women adjusted to Polish organizational limitations. The model include 1) asking about tobacco smoking during every contact with pregnant women, 2) advising not to smoke or avoid passive exposure, 3) assessing the determination to make a quit attempt, 4) assist with the trial, 5) arrange next meeting with the focus on the problem. During the research 919 pregnant women were questioned and examined with micro Co device. Among that number were 22% of active smokers and 31% exposed on passive smoking in their home or work. The prevalence of smoking were higher among lower educated – 46% of women with only primary school compared with 7% of women with university diploma. Smoking was more frequent among women with lower per capita personal income. 80% of smoking pregnant women were motivated to make a quit attempt.

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.