The changing smoking and health scene in the Czech Republic

Abstract

The Czech Republic’s reunion with other democratic, market-economy countries in 1989 brought about not only pronounced changes in the economic and social sector but also surprisingly reflected the trends in the health status of the population. In the period between 1989 and 1997, the expected average life expectancy for men increased from 68.1 to 70.5 y and for women increased from 75.4 to 77.5 y. During the same period, the standardized death rate (European World Health Organization [WHO] standard) for men dropped from 1528.7 to 1251.4 and for women dropped from 902.9 to 744.3 for a population of 100 000.1 Experts say these positive changes came about as a result of a change in the population’s nutritive habits. They believe this pronounced behavioral change correlates to the introduction of market prices (R. Poledne, personal communication, 1999). Similarly, as in developed countries, diseases of the circulatory system and malignant tumors contribute in large measure to the population’s total death rate in the Czech Republic. Tobacco smoking is a significant risk factor for the occurrence and development of many of these diseases. Developed societies’ effort to limit the adverse health effects caused by smoking is therefore not merely understandable but has also become more and more evident in the past years. Epidemiologic findings on smoking habits and an understanding of their sociopsychological context are crucial to limit smoking successfully. Results are available in the Czech Republic from several representative studies that have monitored the occurrence of various forms of smoking in the adult population and in school-aged children and adolescents. The recently published results of the WHO MONICA2 study indicate a considerable decline in the prevalence of smoking from 49% to 37% for adult men in the period between 1985 and 1997. For women, the proportion of smokers did not change (28% in 1985 and 26% in 1997 and 1998). Not only are men smokers more frequently than women, but they also smoke more cigarettes on average. The average daily cigarette consumption was 16.4 (68.6) for men and 11.3 (67.0) for women. In 1996, the National Institute of Public Health conducted a study to monitor health indicators for adult smokers.3 Under investigation were the subjective health condition, number of illnesses in the past year, and the average number of days sick. These variables were related to the categorized average daily cigarette consumption and the score on the Fagerstrom test of nicotine dependency. The results confirmed the statistically significant correlation between the intensity of the smoking habit and the health condition in the past year. For example, smokers with a weak degree of dependency (FTND score of 0 to 1) reported an average of 10.6 sick d in the past year. Smokers with an FTND score of 2 or more were sick an average of 21.2 d in the past year. The results of the MONICA study and that of the National Institute of Public Health confirmed the indirect relationship between educational level and smoking, with this relationship being much stronger for men than for women. If there was observed a decline in adult smoking during the past 10–15 y, even though the total decline was due more or less to the decline in smoking among men, research carried out among youth shows evidence of a converse trend. The results of two extensive research projects performed in the 1990s in the Czech Republic in the international context—the WHO International Project: The Health Behaviour of School-Aged Children (HBSC) in 19944 and 19985 and the European School Project on Alcohol and Other Drugs (ESPAD) in 19956 and 19997—indicate a dramatic growth in regular smoking habits (Table I). The growth in the occurrence of regular smoking behavior is evident starting with adolescents in their last year of elementary school (from 13.9% in 1994 to 19.9% in 1998) and especially after their transition to secondary school. In 1995, among students in their first or second year of secondary school, 22.6% of students reported that they smoke daily; the figure was 30.3% in 1999. Although we do not precisely know what caused this great change, we do believe that it is associated with producers’ and vendors’ efforts to turn profits in Central and Eastern European countries. Note that Philip Morris made one of the two largest foreign investments in the Czech Republic after 1989. Producers are heading an unusually fierce advertising campaign in the Czech Republic, evidently aimed mostly at young people (total expenditures for advertising tobacco products exceeded 500 million CZK in 1998). In contrast, legislation geared toward