Smoking is a Risk Factor for Generation Z, Too: The Evolution of the Attitudes.

Objectives: Generation Z, defined as "post-millennial," is considered to be the first generation that could end smoking. The objective is also to take into account the evolutionary aspect of the smoking and attitudes of the Generation Z. The aim of this study was to explore the willingness of Generation Z in Slovakia to comply with the legislation adopted in the field of anti-tobacco policy and to investigate some selected social factors-intention, subjective norm and percevied behavioral control-that contribute to a lower rate of compliance. Methods: Global Youth Tobacco Survey (GYTS) data on cigarette smoking among 3,557 adolescents (age range 13-15) in 2016 as well as on attitudes towards tobacco use and control measures were used to explore the level of compliance of adolescents with anti-tobacco regulations in Slovakia within the Framework Convention of Tobacco Control (FCTC). We used the concept of intention as explained in Ajzen's theory of planned behaviour (1985), focusing on the role of subjective norm and perceived behavioural control. Results: We found a decrease in ever smoking, current smoking and frequent smoking. We found that these adolescents start experimenting with dependence-causing substances, such as tobacco, regardless of existing rules. Conclusion: Adolescents were attracted to smoking, although they were aware of health effects of passive smoking, and a vast majority liked smoke-free places. They are also influenced by their peers and parental models.

Does tobacco use among adolescents come out of style in Czechia and Slovakia? Findings from the Global Youth Tobacco Survey between 2002 and 2016.

OBJECTIVES: The aim of this study is to analyse Global Youth Tobacco Survey (GYTS) data on a prevalence of tobacco use, indicators of tobacco control and pro-tobacco activities in Czechia and Slovakia between 2002 and 2016. METHODS: GYTS is a school-based survey of students aged 13-15 years carried out in Czechia and Slovakia in 2002/2003, 2007, 2011 and 2016. Standardized uniform questionnaires provided representative data. RESULTS: Between 2002 and 2016 the current cigarette smoking declined both in Czechia and Slovakia (from 34.6% and 26.4% to 15.2% and 17.1%, respectively). Indicators of tobacco control activities either did not change (access to buy cigarettes by minors) or decreased (school-based and mass media interventions). Indicators of pro-tobacco activities declined (being ever offered by a free tobacco product and having something with a tobacco product brand logo on it). CONCLUSIONS: Tobacco use is on decline and the situation becomes similar to the most of European countries. Preventive activities are only partially responsible for the process. Rather effect of global trends accelerated by widespread use of social media can play a role.

Determination of Cadmium and Chromium in Fruit Spirits Intended for Own Consumption Using Graphite Furnace Atomic Absorption Spectrometry.

INTRODUCTION: Analysis of the occurrence of cadmium and chromium in selected samples of fruit spirits intended for own consumption. MATERIAL AND METHODS: In our pilot study, we analysed 89 samples of fruit spirits intended for own consumption. The samples were mineralized with use of microwave decomposition system MULTIWAVE 60 50 Hz and analysed by atomic absorption spectrometry with a graphite furnace (AAS GBC XPLORAA 5000 with GF 5000). RESULTS: Most of the analysed samples originated from plums (39), apples (38) and pears (5). The average ethanol concentration was 53.7%. Cadmium and chromium were detected in all samples. The highest concentration of chromium and cadmium was found in the apple spirit (31.9 ± 6.6 µg/l and 40.1 ± 8.3 µg/l). CONCLUSIONS: The ethanol concentration in the samples was higher than in distribution spirits. Concentrations of chromium in all samples did not exceed the limit given by the Slovak legislation or the limit of the AMPHORA. The permissible cadmium concentration (10 µg/l according to the AMPHORA) was exceeded in 9 samples. This indicates the potential importance of cadmium compared to chromium. Due to the lack of information in this field, the study presents an important starting point for further research.

Eating-Disordered Behavior in Adolescents: Associations with Body Image, Body Composition and Physical Activity.

Eating disorders (EDs) represent a disparate group of mental health problems that significantly impair physical health or psychosocial functioning. The aim of this study was to present some evidence about the prevalence of eating-disordered behavior (EDB) in adolescents, and explore its associations with body image (BI), body composition (BC) and physical activity (PA) in this age group. Data from 780 adolescents participating in a health behavior in school-aged children (HBSC) study conducted in Slovakia in 2018 were used (mean age 13.5 ± 1.3; 56% boys). Differences in mean values of numerical indicators were evaluated using the independent samples t-test. Differences between nominal variables were assessed by the chi-square test. Pearson correlation was used to describe the associations between all the selected variables. EDB was positively screened in 26.7% (208/780) of adolescents, with a higher prevalence in girls (128/344, 37.2%) than in boys (80/436, 18.3%). Significantly higher means of BI, body weight (BW), body mass index (BMI), body fat mass (BFM), body fat percentage (BFP), body fat mass index (BFMI), fat free mass index (FFMI), and SCOFF questionnaire score (SCOFF QS) were found in those positively screened for EDB. Pearson correlation analysis revealed positive associations between EDB and BI, BW, BMI, BFM, BFP and BFMI. The prevalence of EDB is high in Slovak adolescents. Positive associations between EDB, BI, BMI and fat-related body composition parameters support the idea of a more integrated approach in EDs and obesity prevention and treatment. At the same time, gender differences suggest the need for considering gender-specific strategies aimed at girls and boys separately.

The Effects of a Workplace Health Promotion Program to Decrease Cadmium Exposure Levels in Nickel-Cadmium Battery Workers.

OBJECTIVE: Cadmium exposure is a common problem in the production of nickel-cadmium batteries. However, keeping the respective legislative occupational and safety policies is essential, but there are problems with compliance. We analysed the effect of strategies to increase compliance with precautions during 20132015 on 59 workers at a nickel-cadmium battery factory. MATERIAL AND METHODS: A health promotion program was implemented in two phases. The first phase included comprehensive education on the importance of appropriate behaviour and changes to the sanitation program. The second phase included renovation of sanitary facilities and modernization of the air exhaust ventilation. RESULTS: The initial median cadmium urinary level in workers was 1.9 µg/g creatinine. After the first phase of interventions, levels dropped to 1.0 µg/g creatinine. After the second phase no significant further decrease was observed. CONCLUSION: Comprehensive education and changes in the sanitation program were able to halve cadmium levels and can be considered a useful and cost-effective preventive tool.

Body-image Dissatisfaction and Weight-control Behaviour in Slovak Adolescents.

OBJECTIVES: The aim of the study was to examine body-image dissatisfaction in adolescents aged 13-15 years reporting to be on a diet and to assess gender and age differences in weight-reduction behaviour in Slovak adolescents. METHODS: Data on a representative sample of 2,765 adolescents (mean age 14.37 years) from the Slovak part of Health Behaviour in School Aged Children Study carried out in 2014 were analysed. Self-reported body-image dissatisfaction and engagement in weight-reduction behaviour of 13 to 15-year-old adolescents was assessed using multiple logistic regression models. RESULTS: More that 20% of boys and 35% of girls perceived themselves to be too fat. Girls reported being on a diet more frequently than boys (28.8% vs. 14.9%). The most frequent weight-reduction behaviours were drinking more water (67.7%), eating more fruits and vegetables (67.1%), and consuming fewer sweets (60.5%) and soft drinks (51.7%). Girls prevailed above boys in the use of these dietary methods. Age differences were not apparent, except for smoking, believed to help in weight reduction and used upmost by 15-year-olds (8.9%) followed by 14 and 13-year-olds, 6.0% and 4.1%, respectively. CONCLUSIONS: Body-image dissatisfaction and weight-control behaviour are issues particularly in girls, however, they did not necessarily correspond with actual obesity. The most commonly used weight-reduction behaviours are in the same way important aspects of a healthy lifestyle. There is room to improve obesity control, particularly within primary health care.

Is educational differentiation associated with smoking and smoking inequalities in adolescence? A multilevel analysis across 27 European and North American countries.

This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO-Collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, which included 48,025 15-year-old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country-level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.

Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries.

INTRODUCTION: There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. METHODS: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. RESULTS: For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. CONCLUSIONS: Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.

Trends in the co-occurrence of tobacco and cannabis use in 15-year-olds from 2002 to 2010 in 28 countries of Europe and North America.

BACKGROUND: Cannabis and tobacco use frequently co-occur. Adolescents who consume both substances experience more respiratory distress and psychosocial problems and are less likely to stop compared with those who use either tobacco or cannabis alone. This study examined time trends in tobacco and cannabis use among 15-year-olds in Europe and North America between 2002 and 2010. METHODS: Twenty-eight countries were included and merged into six regions based on their welfare systems. Adolescents (n = 142 796) were divided in four 'user groups': 'no-users', 'tobacco and cannabis users', 'tobacco-only users' and 'cannabis-only users'. Prevalence rates are reported by study-wave and region. Logistic regressions with study wave as independent variable were used to study trends in the user groups and regions. Interaction effects between time and gender were considered. RESULTS: Overall, tobacco use, and concurrent tobacco and cannabis use decreased by 3 and 3.7%, respectively, but prevalence rates varied by region. Only in North America, an interaction effect between time and gender was found in tobacco and cannabis users. CONCLUSIONS: Although this study demonstrates a decrease in tobacco and cannabis use in most regions, it also shows that the use of both substances is related. Therefore, studying the co-occurring use of tobacco and cannabis is necessary.

Perceived teacher unfairness and headache in adolescence: a cross-national comparison.

OBJECTIVES: The present study examines the prevalence of headache in early adolescents in 21 European and North-American countries and the role of perceived teacher unfairness in predicting this health complaint across different countries. METHODS: Data were taken from the "Health Behaviour in School-aged Children" study (HBSC), a World Health Organization cross-national survey on health behaviors in 11-, 13- and 15-year-old students. Headache and perceived teacher unfairness were measured through a self-administered questionnaire filled out by 115,212 adolescents. RESULTS: The overall prevalence of frequent headaches (at least once a week) was 28.8%, ranging from 18.9% in Slovenia to 49.4% in Israel. After adjusting for gender, grade, family affluence, school achievement, being bullied and lifestyles (drinking, smoking, eating and physical activity), teacher unfairness showed a significant association with frequent headache in all but two countries (Ukraine and Luxembourg). CONCLUSIONS: Our results show that headache is a common health symptom in European and North-American countries, even though there are substantial differences in its prevalence across countries. The study indicates that perceived teacher unfairness can be a significant predictor of frequent headache during adolescence, and this association is consistent across countries.

The role of family background on cigarette smoking among adolescent school children in Slovakia: findings from the 2007 Slovakia Global Youth Tobacco Survey.

OBJECTIVES: To analyse Global Youth Tobacco Survey (GYTS) data to determine the role of family background on cigarette smoking among adolescents in Slovakia. METHODS: The GYTS is a school-based survey of students aged 13-15 years developed by the World Health Organization and the Centers for Disease Control and Prevention. The GYTS was conducted in Slovakia in 2007. RESULTS: Students from families where one or more parents were smokers were significantly more likely to report lifetime smoking, current cigarette smoking and signs of nicotine dependence (only girls). Socioeconomic status of parents as measured by parent educational level and employment status was not statistically associated with students' smoking status. Girls from families with lower socioeconomic status showed more frequently positive attitudes regarding smoking of their peers. CONCLUSIONS: Considering family background, parental smoking plays the most important role in smoking of their children regardless of employment status and educational level. The findings suggest that the tobacco control program effort in Slovakia needs to focus on implementation and enforcement for those policies already in place as well as expansion into additional measures.

Prevalence of youth cigarette smoking and selected social factors in 25 European countries: findings from the Global Youth Tobacco Survey.

OBJECTIVES: To present Global Youth Tobacco Survey (GYTS) data on the prevalence of cigarette smoking and selected social factors among students aged 13-15 years in 25 European countries. METHODS: The GYTS is a school-based survey of students aged 13-15 years. The GYTS was conducted in 25 European countries (2002-2005) and produced representative data for each country. RESULTS: In 25 European countries studied, 22% of boys and 18% of girls smoked cigarettes. In 17 of 25 countries, current cigarette smoking did not differ between boys and girls. Exposure to secondhand smoke is very high throughout the 25 countries. Exposure to pro-tobacco indirect advertising (having tobacco company logos on promotional items and being given free cigarettes) is frequent throughout the countries. CONCLUSIONS: Intensified efforts to lessen harm caused by tobacco use among youth in 25 European countries included in this study are urgently needed. These countries need to develop and implement comprehensive tobacco control programs including public education campaigns, cessation programs, enforcement of existing measures, and related policy efforts. The WHO FCTC provides a useful framework for implementing such a comprehensive approach.

Environmental tobacco smoke of youngsters in Czech Republic, Hungary, Poland and Slovakia--findings from the Global Youth Tobacco Survey (GYTS).

OBJECTIVES: To present data on Environmental Tobacco Smoke (ETS), Global Youth Tobacco Survey (GYTS), Czech Republic, Hungary, Poland and Slovakia. METHODS: A questionnaire survey of a representative sample of 16 918 schoolchildren aged 13-15 years (2002-2003). RESULTS: Exposure to ETS was reported more frequently in public places than in homes and more frequently from current smokers (CS) than from never smokers (NS). ETS in homes was lower in Czech (57.6% in CS, 24.7% in NS) than in other countries (the highest in Poland: 93.0% in CS, 80.9% in NS). ETS in public places was highest in Hungary (96.9% in CS, 89.2% in NS), lowest in Czech (90.1% in CS, 57.3% in NS). Most students considered ETS as harmful and presented positive attitudes towards smoking ban. DISCUSSION: ETS in studied countries, save the Czech Republic, exceeded the global prevalence, while the situation is better than in numerous other Eastern European countries.

Increasing trends of tobacco use in medical students in Slovakia--a reason for concern?

OBJECTIVE: The article analyses changes in tobacco use in medical students in Slovakia in 1995, 1999 and 2004. METHODS: Questionnaire survey in 448 students of the Jessenius Faculty of Medicine, Comenius University in Martin, Slovakia, was carried out in October and November 2004. Data were compared with similar surveys carried out in 1995 and 1999. RESULTS: Prevalence of daily smoking in men increased from 11.1 in 1995 to 21.8% in 2004. In women, within 1995-2004, daily smoking increased from 5.2% to 12.3%, occasional smoking from 11.6% to 19.8%. Also proportion of women initiating smoking during their university study increased. In both genders the proportion of never smokers dramatically dropped between 1995 and 1999 (in men from 43.2% to 23.2%; in women from 61.9 to 18.2). CONCLUSION: Upward trend in tobacco use, particularly in women, is a reason for concern. In medical faculties, principles of prevention should be more emphasized and the students motivated for healthy life-style and to fulfill their future role in public health. The situation noted among medical students indicates that a community in Slovakia is still not satisfactory inclined towards non-smoking and a dramatic decrease of tobacco use can hardly be expected either in the near future.

Findings from the Global Youth Tobacco Survey (GYTS) in Czech Republic, Hungary, Poland and Slovakia--smoking initiation, prevalence of tobacco use and cessation.

OBJECTIVES: To show selected findings from the Global Youth Tobacco Survey (GYTS) conducted in Czech Republic, Hungary, Poland and Slovakia. METHODS: Representative sample of 16918 school children aged 13-15 years; data were obtained through uniform questionnaires. The fieldwork was conducted in 2002 and 2003. RESULTS: Age at initiation of smoking was particularly earlier in Czech Republic, Poland, and Slovakia than in Hungary. Over one third of the students reported current cigarette smoking in Czech Republic (34.9%) and Hungary (33.5%) compared to about one-fourth in Slovakia (24.3%) and Poland (23.3%). Among current smokers, about two thirds in Slovakia (64.0%) desired to stop smoking, while only one third in Hungary (36.7%). The prevalence of current cigarette smoking was similar between genders. DISCUSSION: Smoking prevalence in these countries is considerably higher than worldwide data. Women's smoking could be an important public health problem in the future. Repeated surveys could show trends and give a clearer picture of the epidemiological situation.

Economic rewarding of smoking cessation-facilitating drugs--a comparison of over-the-counter and prescribed nicotine replacement therapy.

Smoking cessation represents a very difficult task for the smoker, often requiring medical assistance. The introduction of smoking cessation drugs has been crucial to this process. Currently, there are two standardly used treatments: nicotine replacement therapy (NRT) and the antidepressant bupropion. Soon after their introduction, NRTs were sold over-the-counter (OTC), as oppose to on prescription, although in most countries, bupropion remains available only on prescription. Both prescribed and OTC NRTs have similar efficacy (i.e., their use approximately doubles the cessation rate among users and their use has shown a high level of economic rewarding). The most important advantage of OTC NRT is availability, as some patients may not be comfortable with the use of prescribed drugs. The introduction of OTC NRT has led to a substantial rise in their use, increasing the proportion of ex-smokers in the population. However, there are a lack of published, cost-benefit analysis data comparing prescription with OTC NRT. Considering the different economic, social and cultural conditions within particular countries, it is difficult to formulate a common optimal economic model for the distribution of NRT. Authentic studies and trials in this field in order to develop the appropriate policies in each particular country, are clearly required.