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In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6–9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region. The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding from the following: Albania: WHO through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Austria: Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Republic of Austria; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe; Czechia: Ministry of Health of the Czech Republic, grants AZV MZČR 17-31670 A and MZČR – RVO EÚ 00023761; Cyprus: not available; Denmark: Danish Ministry of Health; Estonia: Ministry of Social Affairs, Ministry of Education and Research (IUT 42-2), WHO Country Office, and National Institute for Health Development; Finland: Finnish Institute for Health and Welfare; France: Santé publique France, the French Agency for Public Health; Georgia: WHO; Greece: International Hellenic University and Hellenic Medical Association for Obesity; Hungary: WHO Country Office for Hungary; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Kazakhstan: Ministry of Health of the Republic of Kazakhstan and WHO Country Office; Kyrgyzstan: World Health Organization; Latvia: Ministry of Health, Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO; Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro; North Macedonia: funded by the Government of North Macedonia through National Annual Program of Public Health and implemented by the Institute of Public Health and Centers of Public Health in the country. WHO country office provided support for training and data management; Norway: Ministry of Health and Norwegian Institute of Public Health; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russian Federation: WHO; San Marino: Health Ministry, Educational Ministry, Social Security Institute and Health Authority; Serbia: World Health Organization (Ref. File 2015-540940); Slovakia: Biennial Collaborative Agreement between WHO Regional Office for Europe and Ministry of Health SR; Slovenia: Ministry of Education, Science and Sport of the Republic of Slovenia within the SLOfit surveillance system; Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Sweden: Public Health Agency of Sweden; Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health; Turkey: Turkish Ministry of Health and World Bank. info:eu-repo/semantics/publishedVersion

The Childhood Obesity Surveillance Initiative (COSI) routinely measures height andweight of primary school children aged 6–9 years and calculates overweight andobesity prevalence within the World Health Organization (WHO) European Regionusing a standard methodology. This study examines the trends in the prevalence ofoverweight and obesity from the first round of COSI carried out in 2007/2008 to thelatest of 2015/2017 in 11 European countries in which data were collected for atleast three rounds. In total 303,155 children were measured. In general, the preva-lence of overweight and obesity among boys and girls decreased in countries withhigh prevalence (Southern Europe) and remained stable or slightly increased in North-ern European and Eastern European countries included in the analysis. Among boys, the highest decrease in overweight (including obesity) was observed in Portugal (from40.5% in 2007/2008 to 28.4 in 2015/2017) and in Greece for obesity (from 30.5% in2009/2010 to 21.7% in 2015/2017). Lithuania recorded the strongest increase in theproportion of boys with overweight (from 24.8% to 28.5%) and obesity (from 9.4% to12.2%). The trends were similar for boys and girls in most countries. Several countriesin Europe have successfully implemented policies and interventions to counteract theincrease of overweight and obesity, but there is still much to be done. The authors gratefully acknowledge support through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries included in this study was made possible through funding from: Bulgaria: Ministry of Health, National Center of Public Health and Analyses, and WHO Regional Office for Europe; Czechia: WHO grants AZV MZČR 17-31670 A MZČR-RVO EÚ 00023761, World Health Organization Regional Office for Europe, and WHO country office; Greece: International Hellenic University and Hellenic Medical Association for Obesity; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Latvia: Ministry of Health and Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences, Lithuanian Science Council, and WHO; Norway: Ministry of Health and Norwegian Institute of Public Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates, and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Slovenia: Ministry of Education and Science and Sport of the Republic of Slovenia within the SLOfit surveillance system; and Spain: Spanish Agency for Food Safety and Nutrition (AESAN). info:eu-repo/semantics/publishedVersion

Background: The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6–9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published. Objectives: The aim of this work was to present the prevalence of severe obesity in school-aged children from 21 countries participating in COSI. Method: The data are from cross-sectional studies in 21 European WHO member states that took part in the first three COSI rounds of data collection (2007/2008, 2009/2010, 2012/2013). School-aged children were measured using standardized instruments and methodology. Children were classified as severely obese using the definitions provided by WHO and the International Obesity Task Force (IOTF). Analyses overtime, by child’s age and mother’s educational level, were performed in a select group of countries. Results:A total of 636,933 children were included in the analysis (323,648 boys and 313,285 girls). The prevalence of severe obesity varied greatly among countries, with higher values in Southern Europe. According to the WHO definition, severe obesity ranged from 1.0% in Swedish and Moldovan children (95% CI 0.7–1.3 and 0.7–1.5, respectively) to 5.5% (95% CI 4.9–6.1) in Maltese children. The prevalence was generally higher among boys compared to girls. The IOTF cut-offs lead to lower estimates, but confirm the differences among countries, and were more similar for both boys and girls. In many countries 1 in 4 obese children were severely obese. Applying the estimates of prevalence based on the WHO definition to the whole population of children aged 6–9 years in each country, around 398,000 children would be expected to be severely obese in the 21 European countries. The trend between 2007 and 2013 and the analysis by child’s age did not show a clear pattern. Severe obesity was more common among children whose mother’s educational level was lower. Conclusions: Severe obesity is a serious public health issue which affects a large number of children in Europe. Because of the impact on educational, health, social care, and economic systems, obesity needs to be addressed via a range of approaches from early prevention of overweight and obesity to treatment of those who need it.

Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for 1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for

Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this study was to measure parental perceptions of their child’s weight status and to identify predictors of potential parental misperceptions. Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children’s weight status as “underweight,” “normal weight,” “a little overweight,” or “extremely overweight.” We categorized children’s (6–9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child’s weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of parents categorized their child’s weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child’s weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child’s weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24). Overall, parents’ BMI was not strongly associated with the underestimation of children’s weight status, but there was a stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child’s weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live. The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding by: Albania: World Health Organization through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, World Health Organization Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and World Health Organization Regional Office for Europe; Czechia: Grants AZV MZČR 17-31670 A and MZČR – RVO EÚ 00023761; Denmark: Danish Ministry of Health; France: French Public Health Agency; Georgia: World Health Organization; Ireland: Health Service Executive; Italy: Ministry of Health; Istituto Superiore di sanità (National Institute of Health); Kazakhstan: Ministry of Health of the Republic of Kazakhstan and World Health Organization Country Office; Latvia: n/a; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and World Health Organization; Malta: Ministry of Health; Montenegro: World Health Organization and Institute of Public Health of Montenegro; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support of Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russia (Moscow): n/a; San Marino: Health Ministry; Educational Ministry; Social Security Institute; the Health Authority; Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: World Health Organization Country Office in Tajikistan and Ministry of Health and Social Protection; and Turkmenistan: World Health Organization Country Office in Turkmenistan and Ministry of Health. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. info:eu-repo/semantics/publishedVersion

Childhood obesity is a serious global health problem. Waist circumference (WC) and waist-to-height ratio (WHtR) reflect body fat distribution in children. The objectives of this study were to assess WC and WHtR in 7-year-old children and to determine body mass index (BMI), WC, and WHtR differences in children from 10 selected countries across Europe (Bulgaria, Czechia, Greece, Ireland, Latvia, Lithuania, North Macedonia, Norway, Spain, and Sweden) participating in the World Health Organization (WHO) Europe Childhood Obesity Surveillance Initiative (COSI). The 50th and 90th percentile of WC (according to COSI and "Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS" (IDEFICS) cutoff values) and WHtR above 0.5 were used as measures of abdominal obesity in a unique sample of 38,975 children aged 7.00-7.99 years. Southern European countries, including Greece and Spain, showed significantly higher BMI, WC, and WHtRin both genders (p < 0.0001) than Eastern and Northern Europe. The highest values for WC were observed in Greece (60.8 ± 7.36 cm boys; 60.3 ± 7.48 cm girls), North Macedonia (60.4 ± 7.91 cm boys; 59.0 ± 8.01 cm girls), and Spain (59.7 ± 6.96 cm boys; 58.9 ± 6.77 cm girls). WC and WHtRin may add an information about the occurrence of central obesity in children.

Pain among adolescents is prevalent that may negatively affect adolescents’ general well-being of which sleep is an important domain. This study aims to explore the associations between weekly pain and medicine use for relevant pain and insufficient sleep duration among 11-, 13- and 15-year-old adolescents in Latvia by assessing the moderation effect of gender and age. Data from the Health Behaviour in School-aged Children Study on 2017/2018 of Latvia (n = 4412; 49.6% boys) were used. Logistic regression was applied to analyse the odds of insufficient sleep (

Background Objective was to measure preventable premature loss of life in countries from same geographical area but with considerable differences in social and economic development. By comparing inter-country differences and similarities in premature mortality, acceleration of health-in-all-policies is enhanced. Methods Preventable premature deaths were described by Potential Years of Life Lost (PYLL). Data consisted of death registers for 2003, 2009 and 2013. PYLL-rates were age-standardized by using standard OECD population from 1980 and expressed as sum of lost life years per 100 000 citizens. Results In Northern Dimension area, PYLL-rates had declined from 2003 to 2013. In 2013, worst PYLL-rate was in Belarus 9851 and best in Sweden 2511. PYLL-rates among men were twice as high as among women. Most premature losses (1023) were due to external causes. Malignant neoplasms came second (921) and vascular diseases third (816). Alcohol was also an important cause (270) and country differences were over 10-fold. Conclusions In ND-area, the overall development of public health has been good during 2003–13. Nevertheless, for all countries foci for public health improvement and learning from each other could be identified. Examining the health of populations in countries from relatively similar geographical area with different social history and cultures can provide them with evidence-based tools for health-in-all-policies to advocate health promotion and disease prevention. Gender differences due to preventable premature deaths are striking. The higher the national PYLL-rate, the bigger the PYLL-rate difference between men and women and the loss of human capital.

To evaluate the association between adverse childhood experiences - e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration - and the health of young adults in eight eastern European countries.Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10,696 respondents - 59.7% female - aged 18-25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide.Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of health-harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval, CI: 1.32-2.15) - for physical inactivity - to 48.53 (95% CI: 31.98-76.65) - for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population.Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in eastern European.Évaluer l'association entre des expériences négatives vécues pendant l'enfance (comme des abus, des négligences, des violences domestiques, la séparation des parents, l'usage de substances illicites, des maladies mentales ou l'incarcération) et la santé des jeunes adultes dans huit pays de l'Europe de l'Est.Entre 2010 et 2013, des enquêtes sur des expériences négatives vécues pendant l'enfance ont été menées en Albanie, en Lettonie, en Lituanie, au Monténégro, en Roumanie, en Fédération de Russie, dans l'ex-République yougoslave de Macédoine et en Turquie. On a compté 10 696 répondants, dont 59,7% de femmes, âgés de 18 à 25 ans. Une modélisation à variables multiples a été utilisée pour étudier les relations entre des expériences négatives vécues pendant l'enfance et les comportements mettant la santé en danger au début de l'âge adulte, notamment l'usage de substances illicites, l'inactivité physique et les tentatives de suicide.Plus de la moitié des répondants ont déclaré au moins une expérience négative vécue pendant l'enfance. Le fait d'avoir vécu une expérience négative pendant l'enfance augmentait la probabilité de vivre d'autres expériences négatives pendant l'enfance. Le nombre d'expériences négatives vécues pendant l'enfance était positivement corrélé avec les signalements ultérieurs de comportements mettant la santé en danger. Par rapport aux personnes qui n'ont déclaré aucune expérience négative, les répondants qui ont déclaré au moins 4 expériences négatives vécues pendant l'enfance présentaient un risque significativement augmenté de nombreux comportements mettant leur santé en danger, avec des rapports de cotes variant de 1,68 (intervalle de confiance de 95%, IC: 1,32–2,15) pour l'inactivité physique, à 48,53 (IC de 95%: 31,98–76,65) pour les tentatives de suicide. La modélisation a indiqué que la prévention des expériences négatives vécues pendant l'enfance réduirait considérablement l'occurrence de nombreux comportements mettant la santé en danger au sein de la population étudiée.Nos résultats indiquent que les individus qui ne développent pas de comportements mettant leur santé en danger sont plus susceptibles d'avoir été protégés et éduqués pendant leur enfance. Les programmes fondés sur les faits visant à améliorer l'éducation des enfants et à soutenir leur développement nécessitent un déploiement à grande échelle en Europe de l'Est.Evaluar la relación entre las experiencias adversas en la infancia, por ejemplo, abusos, abandono, violencia doméstica y separación de los padres, consumo de sustancias, enfermedad mental o encarcelamiento, y la salud de los adultos jóvenes en ocho países orientales de Europa.Entre 2010 y 2013 se llevaron a cabo encuestas sobre experiencias infantiles adversas en Albania, Letonia, Lituania, Montenegro, Rumania, la Federación de Rusia, la antigua República Yugoslava de Macedonia y Turquía. El número de encuestados fue de 10 696 - 59,7 % mujeres - de entre 18 y 25 años. Se empleó un modelo multivariado para examinar las relaciones entre las experiencias infantiles adversas y los comportamientos dañinos para la salud en las primeras etapas de la vida adulta, incluido el consumo de sustancias, la inactividad física y el intento de suicidio.Más de la mitad de los encuestados informó de al menos una experiencia adversa en la infancia. Haber sufrido una experiencia adversa en la infancia aumentó la probabilidad de tener otras experiencias adversas en la infancia. El número de experiencias adversas en la infancia se correlacionó positivamente con los informes posteriores acerca de comportamientos dañinos para la salud. En comparación con aquellos que no comunicaron experiencias adversas, los encuestados que informaron de al menos cuatro experiencias adversas en la infancia presentaban un riesgo significativamente mayor de muchas conductas dañinas para la salud, con un cociente de posibilidades que variaba de 1,68 (intervalo de confianza del 95 %, IC: 1,32–2,15) para la inactividad física a 48,53 (IC del 95 %: 31,98–76,65) para el intento de suicidio. El modelado indicó que la prevención de experiencias adversas en la infancia podría reducir sustancialmente la incidencia de muchos de los comportamientos dañinos para la salud en la población de estudio.Nuestros resultados indican que los individuos que no desarrollan comportamientos dañinos para la salud tienen más probabilidades de haber tenido una infancia segura y educativa. Los programas basados en la evidencia para mejorar la crianza de los hijos y apoyar el desarrollo infantil necesitan un despliegue a gran escala en la región oriental de Europa.تقييم الارتباط بين خبرات الطفولة السيئة – مثل سوء المعاملة أو الإهمال أو العنف المنزلي أو انفصال الأبوين أو تعاطي المخدرات أو الاعتلال النفسي أو الحبس – وصحة صغار البالغين في ثمانية بلدان أوروبية شرقية.أجريت بين عامي 2010 و2013 مسوح حول خبرات الطفولة السيئة في ألبانيا ولاتفيا وليتوانيا والجبل الأسود ورومانيا والاتحاد الروسي وجمهورية مقدونيا اليوغوسلافية السابقة وتركيا. وشارك في المسح 10696 شخصاً – 59.7 % منهم من الإناث – اللاتي تتراوح أعمارهن من 18 إلى 25 سنة. وتم استخدام النمذجة متعددة المتغيرات لتحري الارتباط بين خبرات الطفولة السيئة والسلوكيات الضارة بالصحة في البلوغ المبكر بما في ذلك تعاطي المخدرات والخمول البدني ومحاولة الانتحار.أبلغ ما يزيد عن نصف المشاركين عن خبرة واحدة على الأقل من خبرات الطفولة السيئة. وازدادت مع التعرض لخبرة واحدة من خبرات الطفولة السيئة احتمالية التعرض لخبرات الطفولة السيئة الأخرى. وارتبط عدد خبرات الطفولة السيئة إيجابياً بالتقارير اللاحقة حول السلوكيات الضارة بالصحة. وتزايدت على نحو كبير خطورة اكتساب العديد من السلوكيات الضارة بالصحة لدى المشاركين الذين أبلغوا عن أربع خبرات على الأقل من خبرات الطفولة السيئة مقارنة بالذين لم يبلغوا عن خبرات سيئة، وتراوحت نسب الاحتمال من 1.68 (فاصل الثقة 95 %: 1.32 - 2.15) – فيما يخص الخمول البدني – إلى 48.53 (فاصل الثقة 95 %: 31.98 - 76.65) – فيما يخص محاولة الانتحار. وأشارت النمذجة إلى أن توقي خبرات الطفولة السيئة قد يحد بدرجة كبيرة من وقوع العديد من السلوكيات الضارة بالصحة داخل فئة الدراسة.تشير نتائجنا إلى أنه من الأرجح أن يتمتع الأشخاص الذين لا يكتسبون سلوكيات ضارة بالصحة بطفولة تتميز بالأمان والرعاية. ويتعين نشر البرامج المستندة إلى البيّنات على نطاق واسع في أوروبا الشرقية بغية تحسين إعداد الآباء لرعاية الأبناء ودعم نمو الأطفال.评价八个东欧国家虐待、忽视、家庭暴力和父母分离、吸毒、精神疾病或监禁等儿童期不良经历与年轻人健康之间的联系。在2010年至2013年之间，在阿尔巴尼亚、拉脱维亚、立陶宛、黑山共和国、罗马尼亚、俄罗斯联邦、前南斯拉夫马其顿共和国和土耳其展开儿童期不良经历调查。共有10696名18-25岁之间的受访者，其中女性占59.7%。使用多变量模型来研究儿童期不良经历与成年早期危害健康的行为的关系，包括吸毒、缺少运动和自杀企图。超过半数的受访者表示至少有一次儿童期不良经历。有一次儿童期不良经历增加遭受其他儿童期不良经历的概率。儿童期不良经历数量与危害健康行为的后续报告呈正相关。较之没有报告不良经历的受访者，报告至少有四个儿童期不良经历的受访者其许多危害行为的风险显著增加，优势比从缺乏锻炼的1.68（95%置信区间（CI）：1.32–2.15）到自杀企图的48.53（95% CI：31.98–76.65）。模型表明，预防儿童期不良经历将会大幅度减少研究人群中许多危害健康行为的发生。我们的结果表明，没有养成危害健康行为的个体更可能是渡过安全、受到关爱的童年。需要在东欧大规模部署以证据为基础的项目，以改善教育和支持孩子发展。Оценить связь негативных впечатлений в детстве — например, плохое обращение, пренебрежение, насилие в семье, расставание родителей, употребление психоактивных веществ, психические заболевания или лишение свободы — со здоровьем молодых людей в восьми восточноевропейских странах.В 2010-2013 гг. в таких странах, как Албания, Латвия, Литва, Черногория, Румыния, Российская Федерация, бывшая югославская Республика Македония и Турция были проведены опросы среди молодежи, посвященные негативным впечатлениям в детстве. В опросах принимали участие 10 696 респондентов, включая 59,7% девушек в возрасте 18–25 лет. Исследование взаимосвязи между негативными впечатлениями в детстве и вредным для здоровья поведением в старшем подростковом возрасте, в том числе употребление психоактивных веществ, отсутствие физической активности и попытки самоубийства, проводилось методом многомерного моделирования.Более половины респондентов сообщили по меньшей мере об одном негативном впечатлении в детстве. Наличие одного негативного впечатления увеличивало вероятность наличия и последующих негативных впечатлений в детстве. Число негативных впечатлений в детстве положительно коррелирует с последующими сообщениями о вредном для здоровья поведении. По сравнению с теми, кто не переживал негативных впечатлений в детстве, у респондентов, указавших по меньшей мере четыре случая негативных впечатлений, имелся значительно больший риск вредного для здоровья поведения с отношением рисков от 1,68 (95%-й доверительный интервал, ДИ: 1,32–2,15) для физической неактивности и до 48,53 (95% ДИ: 31,98–76,65) для попыток самоубийства. Моделирование показало, что предотвращение негативных впечатлений в детстве существенно уменьшает возникновение многих случаев пагубного поведения внутри исследуемой популяции.Результаты показывают, что лица, у которых не развивается вредное для здоровья поведение, скорее всего имели благополучное детство и родительскую заботу. В восточноевропейских странах требуется масштабное развертывание доказательно обоснованных программ по улучшению семейного воспитания и поддержке развития детей.

Background This cross-sectional study aims to assess the 12-month prevalence of major and minor depression in the Latvian population, and to evaluate associated health care utilization. Methods Trained interviewers conducted face-to-face interviews with a multistage stratified probability sample of the Latvian general population, ages 15–64 (n=3003). Participants were interviewed using the depression module of the Mini International Neuropsychiatric Interview. Self-reported health care utilization and somatic illness were also assessed. Multinomial logistic regressions were applied. Results The 12-month prevalence of major depression was 7.9% (95%CI 7.0–8.9), while for minor depression it was 7.7% (95%CI 6.8–8.7). We did not find a substantial difference in the relative risk ratio (RRR 1.7 for female) for having major depression by gender. RRR of having major depression was higher for those who had used healthcare services six or more times (RRR 2.0), those who had three or more somatic disorders during the past 12 months (RRR 2.3), those who perceived their health status as being below average (RRR 8.3), and those who were occasional smokers (RRR 3.0). RRR of having minor depression was increased for those who had at least three somatic disorders (RRR 2.3), those who received disability pension (RRR 1.9), and those who perceived their health status to be below average (RRR 3.0). Limitations The study was cross-sectional. Other psychiatric comorbidity was not assessed. Conclusions This is the first population based study reporting the 12-month prevalence of depression in Latvia. Certain factors associated with depression have been found.

Aims: Suicide rates in Latvia are among the highest in the EU. Among 18–25 year-old young adults, it is the second leading cause of death. This study investigates the prevalence of self-reported suicide attempts in young adults and examines its association with neglect or violence of a physical, emotional or sexual nature. Methods: A questionnaire was administered to 1259 young adults 18–25 years of age, selected by targeted quota sampling from secondary and vocational schools. Results: The prevalence of self-reported suicide attempts was 6.1%. Physical and emotional adverse experiences showed clear associations with attempted suicide. Although prevalence of reported physical neglect was higher than for physical violence (27.0% versus 16.3%, respectively) the latter posed a higher risk for attempted suicide (OR = 4.0; 95% CI, 2.4–6.6). Conversely, emotional violence had a higher prevalence than emotional neglect (31.5% vs. 23.6%, respectively), but neglect showed a stronger association with attempted suicide (OR = 4.4; 95% CI, 2.6–7.3). Conclusions: The high OR for attempted suicide associated with emotional neglect, together with findings that emotional violence had the highest prevalence, and that emotional neglect and emotional violence showed the highest population attributable risk fraction (PopAR%) of 46.8 and 40.4, respectively, suggested that emotional factors merit special attention in further investigations of attempted suicide among young adults in Latvia. The targeted quota sampling method from five cities representing all regions of Latvia and 43.8% of its population, ensure national relevance of our findings for policy and program development by legislative, educational and public health institutions.

To investigate the prevalence of bullying among adolescents in Latvia and Lithuania and to study its association with self-rated health, health complaints, and life satisfaction.A total of 3417 students in Latvia and 5626 in Lithuania were surveyed using the Health Behaviour Study among School-aged Children 2001/2002 (HBSC) questionnaire and research protocol.Being a victim, bully, or bully/victim was reported by 30.1% adolescents in Latvia and 52.3% in Lithuania with the highest proportion reporting being a victim. Bullying was associated with poor subjective health and low life satisfaction.The factors explaining the difference of bullying prevalence between both countries should be studied to develop effective anti-bullying interventions relevant to local conditions.

ObjectiveTo examine educational differences among people who consume foods containing fat in Finland and the Baltic countries.DesignData were collected from cross-sectional postal Finbalt Health Monitor surveys that were carried out in 1998, 2000 and 2002.SettingEstonia, Finland, Latvia and Lithuania.SubjectsFor each survey, nationally representative random samples of adults aged 20–64 years were drawn from population registers (Estonia,n = 3656; Finland,n = 9354, Latvia,n = 6015; Lithuania,n = 5944).ResultsDifferences were revealed between the countries in the consumption of foods that contain fat. Finnish people consumed butter on bread, high-fat milk, meat and meat products, and vegetable oil for cooking less frequently than people in the Baltic countries. Cheese was most popular in Finland. Educational differences in fat-related food habits were examined by applying logistic regression analysis. A positive association was found between level of education and consumption of vegetable oil used in food preparation. Drinking high-fat milk was associated with low education in all countries. People with higher education tended to consume cheese more often. Educational patterns in the consumption of butter on bread and in the consumption of meat and meat products differed between countries.ConclusionsThe consumption of foods containing fat was related to educational levels in all four countries. The diet of better-educated people was closer to recommendations for the consumption of saturated and unsaturated fats than the diet of people with lower level of education. The educational gradient was more consistent in Finland than in the Baltic countries. These existing educational differences in sources of fat consumed should be taken into account in the development of national cardiovascular disease prevention programmes.

The fact that Latvia is among the countries with the highest suicide mortality rates in the European Union highlights the importance of research in this field.The aims of the study were to determine the 2010 prevalence of self-reported suicidal behaviours in Latvia, to identify sociodemographic risk factors and to examine sequences for reporting of suicidal behaviours.Computer assisted personal interviews were carried out to gather information on a representative sample of the Latvian population aged 18 to 64 (n = 2816). The study sample was selected using a combination of stratified random sampling and quota methods.Last year prevalence of any type of suicidal behaviour was 18.5% - nearly threefold lower than observed in 2000 (52.6%). Middle age, non-cohabitation status and lower level of education were significant risk factors for serious types of suicidal behaviour (suicidal ideation, suicidal plans, suicide attempts) among men, but only lower level of education was for women. Risk factors regarding mild types of suicidal behaviour (life-weariness, death wishes) were the same for men and women: older and middle aged, non-cohabitation status, and lower level of education. A total of 79.6% reported a continuous pattern of suicidal behaviours.Several sociodemographic risk factors for suicidal behaviours have been found. Further research is needed to clarify additional risk factors, especially in the high-risk groups studied and specific determinants contributing to reduction in prevalence of suicidal behaviours and suicide mortality in Latvia.

Aims: To investigate time trends in the smoking prevalence and the sociodemographic and psychosocial background of smoking in the Baltic countries in comparison with Finland during 1994—2002. Methods: Differences in daily smoking according to age, education, urbanization, and psychological distress in the Baltic countries and Finland were studied using postal surveys in 1994, 1996, 1998, 2000, and 2002 among adults (20—64 years old) in Estonia (n=6,271), Latvia (n=6,106), Lithuania (n=9,824), and Finland (n=15,764). Results: In 1994, 1996, 1998, 2000, and 2002 the prevalence of smoking in Estonia, Latvia, Lithuania, and Finland was 47%, 54%, 46%, and 29% among men, and 21%, 19%, 11%, and 19% among women, respectively. Smoking increased among Lithuanian women from 6% in 1994 to 13% in 2002, but decreased among Estonian men and women. Smoking was generally more common among younger individuals, the less educated, and people with distress in all four countries. The odds ratios for smoking for those with low education compared with those with high education were 2.18 (1.69—2.81), 3.32 (2.55—4.31), 2.20 (1.79—2.70) and 2.80 (2.40—3.27) in men, and 1.90 (1.42—2.52). 3.09 (2.28—4.18), 0.86 (0.59—1.26), and 3.00 (2.53—3.55) in women, in Estonia, Latvia, Lithuania, and Finland, respectively. There were indications of increasing educational differences in Latvian men. Smoking was less common among rural women in all countries except Estonia. Conclusions: Estonia, Latvia, and Finland show characteristics of the ``mature'' phase of a smoking epidemic, and smoking may not increase in these countries. In Lithuanian women smoking may increase. Smoking may be increasingly unequally distributed in the future in all the studied countries.

Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical ctivity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children’s weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children’s BMI/A Z-scores was calculated. Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%95% of schools) and school nutrition environment scores (range: 0.300.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.201.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the “unhealthy” school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies., peer-reviewed

Background The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Methods Using cross-sectional nationally representative samples of 6−9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. Results At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 − 31% of boys and 5 − 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from −0.4 to +0.3) and BMI-for-age Z-scores (range: from −0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. Conclusions Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-806) contains supplementary material, which is available to authorized users.

ObjectivesAs beliefs and knowledge about the possible effects of foods on health can influence food behaviours, this study examined selected dietary beliefs in the Baltic countries and the association of beliefs related to salt intake and to types of fat with food behaviours.DesignA cross-sectional study.SettingData from three surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used to describe the prevalence of dietary beliefs in these countries and to investigate the association between beliefs and behaviours (using logistic regression).SubjectsRepresentative national samples of adults were selected in each country (Estonia,n=2018; Latvia,n=2308; Lithuania,n=2153).ResultsMisunderstood concepts (myths) related to dietary salt, types of fat, meat consumption and bread and potatoes were observed in high proportions of the population. Education level was an important correlate of beliefs related to salt intake and types of fat, people with a higher education level being more likely to be familiar with these issues. Correct beliefs were not consistently associated with healthier behaviours (e.g. less frequent use of salt at the table and use of non-animal fats for cooking), except for salt intake in Estonia.ConclusionsSeveral misunderstood dietary concepts (myths) are still prevalent in the Baltic countries. Correct beliefs related to salt intake and types of fat were not consistent predictors of healthier food behaviours. In-depth qualitative investigations are needed to better describe and understand dietary beliefs and attitudes in the Baltic countries, and to identify barriers to the adoption of healthy food habits.

Background. Physical inactivity is a known risk factor for heart disease and obesity, two major health problems in the Baltic Republics. This study examined patterns of physical activity level in these countries, and correlates of leisure-time sedentary behavior. Methods. Data from three national surveys of adults conducted in Estonia, Latvia, and Lithuania in 1997 were used. Respondents who provided information on their activity level were included in this study (Estonia: n = 2,018; Latvia: n = 2,303; Lithuania: n = 2,140). Results. One in three Estonians and one in five Latvians and Lithuanians had a low physical activity level at work. Half the respondents (Lithuania: 60%, Latvia: 52%, Estonia: 43%) participated only in sedentary activities during their leisure time. Leisure-time sedentarity was inversely related to education level in men and women and with income in men. It was also associated with smoking in men and with inadequate vegetable intake in men and women. Conclusions. Sedentary behavior during leisure time should be a public health issue in the Baltic Republics. Health promotion strategies aiming at increasing leisure-time physical activity level will need to target the general population, but particularly individuals from lower socioeconomic strata.

STUDY OBJECTIVES—Premature mortality associated with alcohol intake is of particular concern in several countries of the former Soviet Union. This study explored self reported alcohol consumption (beer, wine, spirits) and its determinants in the Baltic Republics. DESIGN—Cross sectional surveys conducted in 1997. SETTINGS—Estonia, Latvia and Lithuania. PARTICIPANTS—Representative samples of adults age 19-64 (Estonia n=2010; Latvia n=2258; Lithuania n=2139). METHODS—Between country differences in the frequency of alcohol intake were estimated. The odds of consuming alcohol weekly according to socioeconomic characteristics (age, ethnicity, rural/urban area, education, income) were calculated using multiple logistic regression analyses, adjusting for all variables simultaneously. MAIN RESULTS—The proportion of respondents consuming alcohol weekly varied by country (p

ObjectivePreviously recorded rates of obesity in the Baltic Republics have been among the highest in the world although little is known about how they vary within the population. This study investigates the distribution of body mass index (BMI) and obesity in these countries.DesignThree cross-sectional surveys conducted in the summer of 1997.SettingEstonia, Latvia and Lithuania.SubjectsRepresentative national samples of adults with measured weight and height (Estonia: n = 1154; Latvia: n = 2292; Lithuania: n = 2096).ResultsBetween-country differences are particularly large among women: women from Latvia and Lithuania are approximately three times as likely to be obese as those from Estonia (17.4%, 18.3%, 6.0% respectively); only about one-third of this difference is explained by the sociodemographic and behavioural factors studied. In men, the prevalence of obesity varied only slightly among countries (Estonia: 9.9%; Latvia: 9.5%; Lithuania: 11.4%). While the prevalence of obesity increases with age within each republic, particularly in women, it is not associated with nationality or urban/rural region, and no consistent association is observed with income. Obesity is inversely related to education in Latvia and in Lithuanian women. Latvian men and women and Lithuanian men who smoked had a lower prevalence of obesity than non-smokers. Leisure time physical activity was not associated with obesity.ConclusionsObesity is a major health problem in the Baltic Republics, particularly among Latvian and Lithuanian women. The lack of association between obesity and most demographic, socioeconomic and behavioural factors suggests that the problem is generalized. Health promotion strategies aiming at preventing and controlling excess weight gain in the Baltic Republics will need to target the general population.

Aims: The main aim of this paper was to investigate whether ethnic heath inequalities exist in self-rated health and risk-taking behaviours (smoking, drunkenness, use of cannabis) between ethnic majority (Estonian, Latvian, Lithuanian) and minority (Russian) population groups of school-aged children in three Baltic countries. Methods: Investigation was carried out in the framework of Health Behaviour in School-aged Children (HBSC) study. Randomly selected students aged 11, 13, and 15 years answered questionnaires in the classroom in 2006. In total, 14,354 questionnaire forms were selected for analysis. Results: Russian boys were more likely ( p

Background European citizens are increasingly being offered Internet health services. This study investigated patterns of health-related Internet use, its consequences, and citizens' expectations about their doctors' provision of e-health services. Methods Representative samples were obtained from the general populations in Norway, Denmark, Germany, Greece, Poland, Portugal and Latvia. The total sample consisted of 7934 respondents. Interviews were conducted by telephone. Results 44 % of the total sample, 71 % of the Internet users, had used the Internet for health purposes. Factors that positively affected the use of Internet for health purposes were youth, higher education, white-collar or no paid job, visits to the GP during the past year, long-term illness or disabilities, and a subjective assessment of one's own health as good. Women were the most active health users among those who were online. One in four of the respondents used the Internet to prepare for or follow up doctors' appointments. Feeling reassured after using the Internet for health purposes was twice as common as experiencing anxieties. When choosing a new doctor, more than a third of the sample rated the provision of e-health services as important. Conclusion The users of Internet health services differ from the general population when it comes to health and demographic variables. The most common way to use the Internet in health matters is to read information, second comes using the net to decide whether to see a doctor and to prepare for and follow up on doctors' appointments. Hence, health-related use of the Internet does affect patients' use of other health services, but it would appear to supplement rather than to replace other health services.

Background: Public health problems in the Baltic countries are typical of Eastern European transition economies. A common assumption is that the economic transition has been particularly difficult for previously disadvantaged groups, and comparative research on the health differences between sociodemographic groups in the Baltic countries is therefore needed. This study compared associations of health with gender, age, education, level of urbanization and marital status in three Baltic countries and Finland. Methods: The data were gathered from cross-sectional postal surveys conducted in 1994, 1996, 1998 and 2000 on adult populations (aged 20–64 years) in Estonia ( n = 5052), Latvia ( n = 4290), Lithuania ( n = 7945) and Finland ( n = 12796). Three self-reported health indicators were used: (i) perceived health, (ii) diagnosed diseases and (iii) symptoms. Results: The prevalence of less-than-good perceived health (average, rather poor or poor) was higher in the Baltic countries (men 66–56%, women 68–64%) than in Finland (men 35%, women 31%). The odds ratios (with 95% confidence intervals) of less-than-good perceived health among the low educated compared to the highly educated in Estonia, Latvia, Lithuania and Finland were 2.03 (1.49–2.77), 2.00 (1.45–2.76), 2.27 (1.78–2.89) and 1.89 (1.61–2.20) among men, and 3.32 (2.43–4.55), 2.77 (2.04–3.77), 2.07 (1.61–2.66) and 1.89 (1.63–2.20) among women, respectively. Diseases and symptoms were also more common among the lower educated men and women in all four countries. However, urbanization and marital status were not consistently related to the health indicators. Conclusions: The Baltic countries share a similar sociodemographic patterning of health with most European countries, i.e. the lower educated have worse health. The methodological considerations of this study point out, however, that further research is needed to support public health policies aimed at the most vulnerable population groups.

Summary Background Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland. Methods The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20–64 years) in Estonia ( n =9049), Latvia ( n =7685), Lithuania ( n =11 634) and Finland ( n =18 821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms. Results The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women. Conclusions The period from 1994 to 2004 of relative stabilization since the worst conditions of the social transition has not been followed by notable changes in self-reported health, and this appears to be the situation across all educational groups in the Baltic countries. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better-educated respondents. The factors contributing towards increasing health inequalities may only be visible in the future.

Background: The Finbalt Health Monitor is a collaborative system for monitoring the health‐related behaviour, practices and lifestyles in Estonia, Finland, Latvia and Lithuania. This system is based on nationally representative samples and self‐administered mailed questionnaires. In comparing the results of national surveys, the awareness of the direction and socioeconomic patterning of the response bias is essential. Methods: The data were gathered from the cross‐sectional surveys conducted in 1998 from Estonia (n=1362), Finland (n=3504), Latvia (n=2322) and Lithuania (n=1874). An analysis was made of the prevalence of late response, completeness of information obtained from respondents and the magnitude of response bias on the prevalence estimates of health behaviour indicators. Results: The response rates were comparatively high: 68% in Estonia, 70% in Finland, 77% in Latvia and 62% in Lithuania. Late response was weakly related to age, education or place of residence. The total proportion of missing information was below 10% and the sociodemographic patterning for this missing information was similar in all countries. Thus, older and less‐educated respondents had more missing information on their questionnaires. Response bias of the prevalence estimates was minimal when it was calculated by using information obtained from late respondents. Conclusions: The level of nonresponse and missing information was comparable in different countries, not information on health behaviour. Therefore special efforts are needed to design a questionnaire form which appears equally relevant to all respondent groups. The follow‐up mailings were an effective way to increase the total response rate, but it was unlikely that they provided an effective way to reach the ‘hard core’ nonrespondents. Received 22 June 2000. Accepted 23 January 2001.

Objectives:Food insecurity has become an important issue in many countries of the former Soviet Union following the transition to a market economy. This study examined three aspects of food security in the Baltic Republics: reasons for choosing foods; level of dependence on home-grown or raised foods; and use of home-grown vegetables.Design:Cross-sectional surveys.Setting:Data from surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used to describe the three aspects of food security and their socio-economic correlates (using descriptive statistics and logistic regression).Subjects:Representative samples of adults were selected in each country (Estonia, n = 2018; Latvia, n = 2308; Lithuania, n = 2153).Results:Cost was the most commonly reported reason for choosing foods, particularly in Lithuania (67%) and Latvia (60%) (Estonia 41%), and especially among people with lower income levels. In each country, large proportions of respondents depended partially or entirely on home-grown or raised foods (Latvia 47%, Lithuania 42%, Estonia 32%) or used home-grown vegetables frequently (Lithuania 66%, Latvia 53%, Estonia 29%); this was particularly the case in rural areas.Conclusions:The issue of food security needs to be examined further in the Baltic Republics and other transitional economies as increased access to safe, healthy foods for all could help improve dietary intake and reduce the high mortality from non-communicable diseases. Access to affordable, high-quality fresh foods by different social groups should be monitored and the potential contribution of home-grown and raised foods to reduce food poverty should be explored further1.

OBJECTIVE: The objective of this study was to describe mean macronutrient and food intakes in the Baltic republics, with a particular focus on fat, vegetable and fruit consumption. DESIGN: Cross-sectional study. SETTING: Data from surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used. Information was collected using a 24 h recall of dietary intake and an interviewer-administered questionnaire. SUBJECTS: Representative national samples of adults were selected. All those with information from the dietary recall were included in the study (Estonia: n = 2015; Latvia: n = 2300; Lithuania: n = 2094). RESULTS: The mean proportion of energy from fat was high in each country, but particularly in Lithuania (44%) and Latvia (42%) compared with Estonia (36%). In contrast, percentage energy from carbohydrate, protein and alcohol was higher in Estonia. Mean protein intake was generally sufficient if not high in some population sub-groups. Median vegetable intakes were very low (

Background Despite the relatively low recorded alcohol consumption level, the Baltic countries (Estonia, Latvia and Lithuania) and neighbouring Finland suffer from similar harmful consequences related to the use of alcoholic beverages, including socio-economic inequalities in alcohol related mortality. Comparative evidence is needed to understand harmful drinking patterns and to implement preventive alcohol policies also in the Baltic countries. This study compared heavy and binge drinking by sex, age, education, urbanisation and marital status in the Baltic countries and Finland. Methods The data were nationally representative postal surveys conducted in Estonia (n = 6271), Latvia (n = 6106), Lithuania (n = 7966) and Finland (n = 15764) during 1994–2002. The criterion for heavy drinking was at least 15 portions weekly among men, and at least five among women, and for binge drinking at least six portions per one occasion. Results Heavy drinking was more common among younger participants in all countries, and in Latvia among the less-educated. Among Finnish men, and among women from all countries except Latvia, the better-educated were more often heavy drinkers. In Latvia and Finland, urban men, and in all countries, urban women, were more often heavy drinkers. Heavy drinking was more common among non-married Lithuanian and Finnish men, and Finnish women. Binge drinking was more common among less-educated Estonian and Latvian men, and among younger and less-educated women in all countries. Conclusion Our results support the continued power of traditional drinking habits in the North Eastern part of Europe. In the future the target groups for prevention of excessive drinking should also include young and less-educated women in all four countries studied.

BACKGROUND: Tobacco is a leading cause of avoidable death in the Baltic Republics but there is, as yet, relatively little information in the public domain on who is smoking and how this is changing. This information is important for those seeking to develop effective policies to tackle this issue. OBJECTIVE: To determine the pattern of smoking in Estonia, Latvia, and Lithuania. METHODS: Analysis of data on patterns of tobacco consumption from representative surveys of approximately 3000 adults aged under 65 in each country undertaken in 1997. RESULTS: The prevalence of smoking among men is 53.9%, 56.0%, and 53.2% respectively in Estonia, Latvia, and Lithuania. The corresponding figures for women are 24.1%, 10.9%, and 7.6%. For both sexes, current smoking rates are consistently lowest in the age group 50 to 64 and highest in the age group 35 to 49. Education and income are determinants of smoking rates among men but much less so among women. Russian men are more likely to smoke than are men from the majority group in each country. Smoking rates among women are much lower in rural than in urban areas of Latvia and Lithuania but this is not so in Estonia. CONCLUSIONS: Smoking rates among men in the Baltic Republics are already very high. Among women, they still vary considerably. Each country has implemented some measures to reduce smoking. These seem to have been especially effective in Lithuania but, overall, much more action is needed.