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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., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

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<0.05) to evaluate their self-rated health positively in schools with Russian teaching language. Odd ratios for current smoking and drunkenness were significantly lower among Russian boys in the schools with Russian language of instruction (p<0.05) in comparison with the reference group. Russian girls did not differ significantly (the exceptions were smoking in Estonia and cannabis use in Latvia) from the majority population girls by self-rated health as well as by the risk of smoking, drunkenness, and use of cannabis., Conclusions: The study found some differences in self-rated health and in risk-taking behaviours between Russian minority and ethnic majority students as well as between students of schools with different language of instruction (majority language vs. Russian) in Estonia, Latvia, and Lithuania. Being a member of minority group was not related with poor self-rated health or involvement in risk-taking behaviours in school-aged children in the Baltic countries.

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. 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. 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. 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: The Baltic countries--Estonia, Latvia, and Lithuania--are considered to be an example of regional homogeneity over the period of transition. The World Health Organization cross-national study on Health Behavior in School-aged Children (HBSC) allows a comparison and time trends analysis of behavioral patterns among adolescents in this region. The aim of this study was to estimate the prevalence and trends of alcohol consumption and drunkenness among adolescents of Estonia, Latvia, and Lithuania in 1993/94, 1997/98, and 2001/02., Methods: Representative samples of 5286 boys and 6485 girls aged 15 from Estonia, Latvia, and Lithuania were surveyed in 1993/94, 1997/98, and 2001/02 school-year within the framework of HBSC study. The standardized survey methods were applied. The research focused on the following outcome variables: i) frequency of drinking beer, wine, and spirits; and ii) frequency of drunkenness. The same wording of questions on the consumption of alcohol was retained in each survey., Results: Beer was the most frequently used alcoholic beverage across the Baltic countries among adolescents. The rate of weekly drinking of any alcoholic beverage increased considerably during the eight years of observation, especially among Estonian and Lithuanian students. In 2001/02, 25% of boys and 12.5% of girls have reported drinking alcohol at least weekly. The rate of regular alcohol drinking was two times higher in boys, while irregular drinking was more prevalent in girls. Two or more episodes of drunkenness in the lifespan were reported by 30% of boys and 15% of girls in 1993/94 and by 52% of boys and 36% of girls in 2001/02. The use of alcoholic beverages was related to the perceived family wealth: the students from the families perceived by them as wealthy were more likely to drink weekly as compared to the students from the families perceived by them as not wealthy., Conclusion: Over the period between 1993 and 2002 the prevalence of alcohol consumption among adolescents increased considerably across the Baltic countries. The efforts of dealing with this problem should employ a combination of measures, including the strategies relevant for the period of transition.

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: The aim of the present study is to examine the associations of the selected health behaviours (daily smoking, frequent strong alcohol use, consumption of fresh vegetables less than 3 days a week and leisure time physical activity less than two/three times a week) to the self-assessed health after adjustment to the age and education in Estonia, Finland, Latvia and Lithuania., Methods: Data from cross-sectional surveys carried out in all the above-mentioned countries were used. The methodology and questionnaires of the surveys were standardized between the participating countries within the Finbalt Health Monitor System. Logistic regression was used to assess the effect of self-perceived health status on prevalence of health behaviours., Results: In Finland both women and men rated their health better than both genders in all the Baltic countries. In Finland self-assessment of health is significantly associated with most health behaviours, but in the Baltic counties the associations are weak or unstable., Conclusion: The results suggest that in Finland as in many other stable countries self-assessed health status was related to health behaviours and can be used as an indicator of health behaviours. In the Baltic countries, factors other than health behaviours may be more relevant to the self assessment of health status.

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.

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., (Copyright 2000 American Health Foundation and Academic Press.)

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<0.001) (men: Estonia=61% Latvia=41% Lithuania=55%; women: Estonia=26% Latvia=8% Lithuania=14%). Within each country, this proportion decreased with age in both sexes (p<0. 001), and increased with income in women (p<0.01). In Estonia, the odds of drinking alcohol weekly was significantly lower in respondents of Russian than of Estonian ethnicity (odds ratios (OR) and 95% confidence intervals (95%CI): men=0.51 (0.36, 0.71); women=0. 57 (0.39, 0.81)). In Lithuania, the odds was higher in highly educated men than in those with a low education level (OR=1.48 (1.01, 2.17)). Daily alcohol intake was higher in Estonia than in the other countries, as was the percentage of respondents drinking heavily (equivalent to 80 g/day)., Conclusions: Approximately half the men and one in six women in the Baltic States reported consuming alcohol at least weekly. Age and income were the strongest and most consistent correlates of the likelihood of consuming alcohol weekly. Ethnic differences were observed only in Estonia.

Objective: Previously 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., Design: Three cross-sectional surveys conducted in the summer of 1997., Setting: Estonia, Latvia and Lithuania., Subjects: Representative national samples of adults with measured weight and height (Estonia: n=1154; Latvia: n=2292; Lithuania: n=2096)., Results: Between-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., Conclusions: Obesity 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.