Cross-sectional study of the associations between the implementation of the WHO FCTC tobacco advertising, promotion and sponsorship bans and current e-cigarette use among youth from countries with different income levels.

BACKGROUND: The WHO Framework Convention on Tobacco Control (WHO FCTC) Article 13 requires countries to ban tobacco advertising, promotion and sponsorship (TAPS), and bans are recommended to cover electronic cigarettes (e-cigarettes). We examined youth e-cigarette prevalence by TAPS regulations in countries with different income levels. METHODS: We analysed data on 165 299 respondents from 48 countries with 2016/2018 WHO FCTC implementation reports and 2016-2019 Global Youth Tobacco Survey. We used multilevel logistic regressions to examine associations between TAPS regulations and current e-cigarette use, stratified by country income. RESULTS: About 1 in 10 respondents was currently using e-cigarettes. Respondents in countries with TAPS bans on the internet were less likely to use e-cigarettes (adjOR=0.58; 95% CI 0.39 to 0.86) than youth in countries without such bans. In lower middle-income and low-income countries, bans on displaying tobacco products at the point of sale (adjOR=0.55; 95% CI 0.34 to 0.90), bans on product placement (adjOR=0.44; 95% CI 0.28 to 0.69) and strength of additional TAPS measures were associated with lower prevalence of e-cigarette use among students. Being taught about the dangers of the use of tobacco in school was associated with lower odds of e-cigarette use. No differences in the use of e-cigarettes were observed by types of TAPS among respondents in high-income countries. CONCLUSIONS: Strengthening implementation of TAPS policies and assuring they cover new and emerging products, online channels and points of sales are essential, especially in lower income countries. Maintaining tobacco health education is also important to protect youth from e-cigarette use.

Impact of the WHO FCTC on tobacco control: perspectives from stakeholders in 12 countries.

BACKGROUND: The WHO Framework Convention on Tobacco Control (WHO FCTC), the first WHO treaty, entered into force in 2005. In April 2015, a seven-member independent expert group (EG) was established by a decision of the FCTC Conference of the Parties to assess the impact of the Treaty in its first decade.One component of the EG's methodology was to gather evidence on WHO FCTC impact from Parties themselves. This paper presents findings from 12 country missions on how the FCTC impacted progress on tobacco control. METHODS: Between November 2015 and May 2016, EG members conducted missions in 12 countries representing each of the six WHO regions and the four World Bank economic development levels. In each country, the EG interviewed a broad range of stakeholders to assess the extent to which the FCTC had contributed to tobacco control. The primary objective was to assess whether tobacco control measures would have been developed or passed, or implemented at all, or as quickly, if there had been no FCTC. Through this counterfactual inquiry, the EG sought to determine the FCTC's causal role. CONCLUSION: The FCTC was reported to have made contributions along the entire policy/regulation process: the development of a measure, building legislative and political support for a measure and its implementation. These stakeholder perspectives support the conclusion that the FCTC has played a pivotal role in accelerating and strengthening the implementation of tobacco control measures, although tobacco industry interference continues to be a significant obstacle to further advancement.

" Nature step" to prevent noncommunicable inflammatory disease.

The prevention of many diseases has significantly improved by intervening in known risk factors. However, the causes of the increase in allergy and type 1 diabetes are unknown. These diseases are often associated with a low-grade inflammation and immunological imbalance. The lifestyle and environment of urbanized populations have changed causing imbalance in the human normal flora and affecting immune regulation. We discuss everyday factors affecting immune regulation, using allergy as an example. Health may be promoted through the "nature step", by supporting the connection between humans and nature.

Trends and educational differences in non-communicable disease risk factors in Pitkäranta, Russia, from 1992 to 2007.

AIM: Mortality and morbidity from non-communicable diseases (NCDs) is a major public health problem in Russia. The aim of the study was to examine trends and educational differences from 1992 to 2007 in NCD risk factors in Pitkäranta in the Republic of Karelia, Russia. METHODS: Four cross-sectional population health surveys were carried out in the Pitkäranta region, Republic of Karelia, Russia, in 1992, 1997, 2002, and 2007. An independent random sample of 1000 persons from the general population aged 25-64 years was studied in each survey round. The total number of respondents in the four surveys was 2672. The surveys included a questionnaire, physical measurements, and blood sampling, and they were carried out following standard protocols. RESULTS: The NCD risk factor trends generally increased in Pitkäranta during the study period with the exception of systolic blood pressure and smoking among men. Especially significant increases were observed in alcohol consumption among both sexes and in smoking among women. Educational differences and differences in trends were relatively small with the exception of a significant increase in smoking in the lowest female educational category. CONCLUSIONS: Trends showing an increase in some major NCD risk factors and signs of emerging socio-economic differences call for stronger attention to effective health promotion and preventive policies in Russia.

Forty-year trends in cardiovascular risk factors in Finland.

BACKGROUND: Finland has experienced remarkable changes in population levels of coronary heart disease risk factors and mortality over the past decades. The National FINRISK studies have monitored risk factors in major non-communicable diseases from 1972 to 2012. The 40-year changes in those risk factors are presented. METHODS: Study population included participants aged 30-59 years in the series on independent random population samples. Data were collected in 5-year intervals in 1972-2012. FINRISK studies so far comprised 53 589 men and women who participated in a health examination, gave a venous blood sample and filled in questionnaires. Serum total cholesterol, systolic and diastolic blood pressure, and body mass index (BMI) were measured using standardized protocol, and smoking status was recorded. RESULTS: Total serum cholesterol decreased remarkably until 2007, but after that has increased. Systolic blood pressure has continued to decline over time since 1972, while decrease in diastolic blood pressure has levelled off during the last 10 years. Smoking prevalence has markedly decreased. BMI has increased in the population, but most significantly in the earlier survey years, not the past 10 years. CONCLUSIONS: After three decades of favourable development, the population risk factor levels showed some increase in total cholesterol and diastolic blood pressure. This emphasizes the need for continued efforts towards national disease prevention and health promotion.

Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.

BACKGROUND: Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the eff ect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level. METHODS: For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population. FINDINGS: Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9-9·6) of type 2 diabetes, 10% (5·6-14·1) of breast cancer, and 10% (5·7-13·8) of colon cancer. Inactivity causes 9% (range 5·1-12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0·68 (range 0·41-0·95) years. INTERPRETATION: Physical inactivity has a major health eff ect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially. FUNDING: None.

Awareness and use of the Heart Symbol by Finnish consumers.

OBJECTIVE: To study the awareness of the Heart Symbol in different age and educational groups, and changes in the awareness over a 9-year period. In addition, the reported use of products with the symbol was examined. DESIGN: A series of annual cross-sectional postal surveys on Health Behaviour and Health among the Finnish Adult Population. SETTING: A random sample (n 5000 per annum) from the Finnish population aged 15-64 years, drawn from the National Population Register, received a questionnaire. SUBJECTS: Men and women (n 29 378) participating in the surveys in 2000-2009. RESULTS: At the early 2000s, 48 % of men and 73 % of women reported to be familiar with the symbol. The corresponding rates were 66 % for men and 91 % for women in 2009. The reported use of products with the symbol increased from 29 % to 52 % in men and from 40 % to 72 % in women. In men, the awareness did not vary by age, whereas older women (45-64 years) were less likely to be aware of the symbol compared with younger women (25-34 years). Men and women with the highest education were best aware of the symbol and more likely to use the products in the early 2000s. The educational differences diminished or disappeared during the study period. CONCLUSIONS: The majority of Finnish adults are familiar with the Heart Symbol, and the reported use of such products increased in all age and educational groups, especially among the less educated. The symbol may work as an effective measure to diminish nutrition-related health inequalities.

How to make better use of scientific knowledge for cancer prevention.

Cancer prevention research has produced profound scientific knowledge that has led to the development of several evidence-based prevention strategies. But do these research outcomes lead to preventive action in real life? Many factors contribute to the so-called 'implementation gap' between prevention recommendations and their application and adherence, including individual actions and behaviour, health service structures and political actions. This article discusses factors underlying the implementation gap in both clinical- and population-based prevention. Understanding how these factors contribute to the implementation gap is important for planning successful cancer prevention strategies, as well as generally achieving disease prevention.

Health in all policies-the Finnish initiative: background, principles, and current issues.

Many historical developments, such as the Alma Ata Declaration or the Ottawa Charter, have drawn attention to the need for intersectoral work and for considering the health aspects of different policy proposals. In the 1970s, Finland started broad actions to change national diets to reduce the high mortality associated with cardiovascular diseases (CVDs). This and other work in Finland have involved many sectors and policies, resulted in significant public health improvements, and paved the way for the Health in All Policies (HiAP) initiative started during the Finnish European Union (EU) presidency in 2006. The initiative and the principles have encouraged further developments in Finland and have been linked with related developments within the EU and the World Health Organization (WHO).

The North Karelia Project: Prevention of Cardiovascular Disease in Finland Through Population-Based Lifestyle Interventions.

The North Karelia Project was started in 1972 as a response to the high cardiovascular mortality among men in North Karelia, Finland's easternmost province. Prevalent cardiovascular disease risk factors in the province included elevated serum cholesterol, hypertension, and smoking. Through a sociobehavioral framework utilizing community-based interventions and national-level policy changes and legislation, the project targeted lifestyle changes as a means to alleviate cardiovascular disease risk factors. Diet recommendations included minimizing the use of saturated fats and decreasing salt intake. Another target of the project was to reduce the prevalence of smoking. As a result of the lifestyle interventions that continued beyond the initial 5 years of the project and then expanded to all of Finland, there were significant reductions in serum cholesterol levels, hypertension, smoking prevalence, and cardiovascular disease mortality. The North Karelia Project demonstrates that successful population-based lifestyle interventions serve as a sustainable public health solution to the growing chronic disease burden.

Fat and heart disease: yes we can make a change--the case of North Karelia (Finland).

BACKGROUND/METHODS: The exceptionally high mortality from cardiovascular disease (CVD) in the Finnish population in the 1970s ensued the initiation of preventive health interventions, which were first started in the Province of North Karelia and later on extended to all other regions of Finland. Their aim was to change population diets, especially with respect to the quality of fat: to reduce saturated and increase unsaturated fat intake. In addition, emphasis was placed on increased vegetable intake and salt reduction. The aim of this paper was to illustrate the effect of combined efforts of several stakeholders on CVD. This comprehensive action in Finland has involved health education programs, preventive measures in health services, actions at schools, broad collaboration with non-governmental and private sector organizations, government policies, population-based monitoring and evaluation, and international collaboration. RESULTS: The combined efforts of all stakeholders have greatly helped people to reduce the intake of saturated fat and to replace this with unsaturated fat. This has been associated with an improved quality of the dietary fat (e.g. in 1972, over 90% of the population used butter on their bread compared to <5% at present) and a remarkable reduction in blood cholesterol levels. It has led to a 80% reduction in annual CVD mortality rates among the working aged population, to a major increase in life expectancy and to major improvements in functional capacity and health. Studies have shown that the reduction in blood cholesterol levels, explained by the target dietary changes, have had the greatest impact on these very favorable health changes. CONCLUSION: The Finnish experience shows both the feasibility and great potential of CVD prevention and heart health promotion through general dietary changes in the population.