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Introduction and Aims Alcohol consumption has become a global health threat and there is need for an evidence‐based global alcohol policy. This study aimed to describe alcohol consumption in parallel with alcohol policy in 2000–2017 in Estonia in the context of Baltic and Nordic countries. Design and Methods A review of routine statistics concerning alcohol consumption and the pertinent legislation in Estonia was performed. The measures used to assess the effects of alcohol policy were adult (15 and older) pure alcohol per capita consumption (APC) in litres, alcohol outlet densities and opening hours, taxes and the price of alcoholic beverages. Results Adult domestic APC in Estonia increased from 9.3 to 14.8 in 2000–2007 and thereafter decreased to 10.2 in 2016 (10.3 in 2017). Adult APC in Estonia was lower than that in Latvia and Lithuania but higher than that in Nordic countries. Since 2010, beer has been the most prevalent alcoholic beverage in Estonia. The density and opening hours of alcohol retail shops were much higher in Estonia and other Baltic countries than in Nordic countries. The alcohol retail price increased twice from 2006 to 2017 in Estonia, resulting in a double price difference with Latvia. Discussion and Conclusions Evidence‐based comprehensive alcohol policy should continue in Estonia. Based on the example of Nordic countries, more attention should be paid to the physical availability of alcohol in Estonia. In terms of economic availability, it is important to focus on the cross‐border alcohol trade to achieve improvements in public health.

In order to implement evidence-based strategies, there is a need to assess (1) time trend in leisure time physical activity (LTPA) and (2) the relationship between trend of LTPA and trend of potential explanatory factors in Estonia from 2000 to 2018. Data from 25−64-year-old adults (n = 16,903) were drawn from cross-sectional surveys of Health Behavior among Estonian Adult Population. Joinpoint regression analysis was used to calculate annual percentage changes (APCs) and to identify whether there was a significant change in trends of LTPA. Logistic regression analysis was used to assess associations of LTPA with socioeconomic, health-related and health-behavioral factors. Prevalence of LTPA increased from 26.2% to 44.1% among men and from 28.0% to 40.6% among women from 2000 to 2018 (p &lt, 0.001). Average APC for men was 3.4% (95% CI 2.6−4.3) and for women 2.4% (95% CI 1.4−3.4). Adjusted logistic regression model showed that LTPA was statistically significantly associated with higher education and income, economic inactivity, at-least-good self-rated health (SRH) and non-smoking. Interaction of SRH with study year was significant indicating that the association of at-least-good SRH changed over time (p = 0.016). Health promotion activities should be addressed in particular to adults with lower levels of LTPA, paying attention to the factors associated with LTPA.

Aims: (1) To describe the time trends of monthly cannabis use and (2) to analyse the association between the trends of monthly cannabis use and trends of different explanatory factors among adolescents in Estonia in 2003–2019. Methods: Nationally representative data from five waves of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) among 15–16-year-old adolescents ( n = 11,348) in Estonia were analysed. Tests for trends were used to assess significant changes in monthly cannabis use and explanatory variables over time. Logistic regression analysis was used to analyse the association between monthly cannabis use and perceived easiness of getting cannabis, perceived health risk of cannabis use, parental factors, risk behaviours, and leisure time activities. The model included interaction terms between the study year and each explanatory variable. Gender-adjusted odds ratios ( OR) with 95% confidence intervals (CI) were calculated. Results: Monthly cannabis use increased from 5.3% in 2003 to 7.7% in 2015 and thereafter decreased to 6.6% in 2019 among adolescents in Estonia ( P = 0.007). The association between monthly cannabis use and alcohol use was significant over the study period and the interaction of alcohol use with study year indicated significantly increased effect of alcohol use over time ( P = 0.038). The association between monthly cannabis use and perceived easiness of obtaining cannabis, perceived low health risk from cannabis use and smoking was significant, but remained unchanged over the study period. The relationship between monthly cannabis use and low parental control was significant in two last study years but did not show any changes over time. Conclusions: The findings of this study demonstrate the need for the implementation of multi-component substance use prevention programmes among adolescents in Estonia that also pay attention to the factors associated with the cannabis use.

ObjectivesThe aims of the study were (1) to describe trends in the prevalence of monthly alcohol use from 2003 to 2015 and (2) to analyse the associations between alcohol use and family-related and school-related factors, risk behaviours and perceived alcohol availability in Estonia compared with Latvia, Lithuania, Finland and Sweden.MethodsThe study used nationally representative data of 15–16-year-old adolescents from the European School Survey Project on Alcohol and Other Drugs. Data from Estonia, Latvia, Lithuania, Finland and Sweden collected in 2003, 2007, 2011 and 2015 were utilised (n=57 779). The prevalence of monthly alcohol use including light and strong alcohol use was calculated for each study year. A χ2 test for trend was used to evaluate statistically significant changes in alcohol use over the study period. A multilevel logistic regression analysis was used for assessing the association between alcohol use and explanatory factors. Marginal ORs with 95% CIs for each country were calculated.ResultsMonthly alcohol use decreased significantly among boys and girls in all countries from 2003 to 2015. In 2015, the prevalence of monthly alcohol use among boys was 36.1% in Estonia, 44.3% in Latvia, 32.4% in Lithuania, 32.3% in Finland and 22.4% in Sweden. Among girls, it was 39.1%, 45.9%, 35.6%, 31.8% and 29.1%, respectively. In all countries, higher odds of monthly alcohol use were observed among adolescents who skipped school, smoked cigarettes, used cannabis, perceived alcohol to be easy to access and had parents who did not know always/often about their child’s whereabouts on Saturday nights. Compared with Estonia, associations between alcohol use and explanatory factors were similar in Latvia and Lithuania but different in Finland and Sweden.ConclusionResults of cross-national comparison of alcohol use and explanatory factors could be effectively used to further decrease alcohol use among adolescents.

Background Family physicians have an excellent opportunity at primary health care level to influence patients' smoking behavior. Routine screening of all patients for tobacco use is recommended. The objective of the present study was to explore factors related to addressing patients' smoking habits among FPs. Methods Two postal cross-sectional surveys were conducted among the sample of all practicing physicians in Estonia (n = 4140 in 2002, n = 5666 in 2014). Questionnaires of under 65-year-old FPs were included (n = 473 in 2002, n = 468 in 2014). Frequency of addressing patients' smoking habits and agreement with statements concerning perceived barriers, along with confidence intervals (CI) were calculated. Associations of addressing patients' smoking habits at least once during last 7 days with perceived barriers were calculated using logistic regression analysis. Fully adjusted odds ratios (OR) were determined with corresponding 95% (CI). Results The prevalence of addressing patients' smoking at least once during last 7 days was 96.4% (95% CI 94.2-98.7) in 2002 and 97.1% (95% CI 95.0-99.1) in 2014. FPs who agreed that lack of time is a barrier to addressing patients' smoking, were significantly more likely to address patients' smoking (OR 3.53; 95% CI 1.36-9.16) compared to FPs who did not agree with the statement. FPs who agreed that lack of habit is a barrier, were significantly less likely to address patients' smoking (OR 0.14; 95% CI 0.06-0.34) compared to FPs who did not agree. FPs smoking status was not significantly associated with addressing patients' smoking. Conclusions Majority of family physicians addressed patients' smoking habits. Addressing patients' smoking habits was significantly associated with agreeing that lack of time and lack of habit is a barrier to addressing patients' smoking. Results of the present study are useful for policymakers and other institutions involved in organization and development of smoking prevention training and cessation services. Key messages Majority of family physicians addressed patients’ smoking. Addressing patients’ smoking was significantly associated with lack of time and lack of habit as barriers to addressing patients’ smoking. Smoking prevention training and organization of cessation services would further enable family physicians to routinely address patients’ smoking habits.

Background Leisure-time physical activity (LTPA) can be an effective tool in the prevention and treatment of the majority of noncommunicable diseases, which are the leading cause of death worldwide. Therefore, the knowledge on the level and trends of LTPA is an important task for the public health sector and enables identification of adults at high risk of hypokinetic diseases. The aim of this study was to describe LTPA trend among adults in Estonia in 2000-2016 and to analyze the association between LTPA and sociodemographic, -economic, health- and work-related factors, and risk behaviours. Methods This study was based on 25 − 64-year-old adults (n = 16,903) of the postal cross-sectional surveys of Health Behaviour among Estonian Adult Population in 2000-2016. For data analysis, LTPA was divided into two categories: physically active (at least 2 − 3 times per week) and physically inactive (less than 2 times a week). Chi-square test was used to analyze changes in prevalence trend of LTPA over the study period. Logistic regression analysis was used to test associations between LTPA and different factors. Results The prevalence of LTPA increased from 26.2% to 42.6% among men (p Conclusions Based on the study results, health promotion activities should be addressed in particular to the adults with lower LTPA paying attention to the factors associated with LTPA. Key messages LTPA increased significantly among men and women in Estonia in 2000 − 2016 being higher among women than men. Health promotion activities should be addressed in particular to the adults with lower LTPA paying attention to the different factors associated with LTPA.

Background: For health professionals, personal and contextual factors influence addressing patients’ smoking habits. The objective of the study was to describe frequency of addressing patients’ smoking in 2002 and 2014 and to analyse factors related to addressing patients’ smoking habits. Methods: Data of physicians from 2 postal cross-sectional surveys were used (n = 4140 in 2002, n = 5666 in 2014). The number of respondents was 2747 in 2002 and 2903 in 2014. The corrected response rate was 67.8% and 53.1%, respectively. Age-standardized frequency of addressing patients’ smoking during the last 7 days was determined. Distribution of other variables along with confidence intervals (CI) was calculated. Logistic regression was used to analyse association of addressing patients’ smoking with attitudes and perceived barriers regarding addressing patients’ smoking and with background factors. Fully adjusted odds ratios (OR) with 95% CIs were calculated. Results: The age-standardized prevalence of addressing patients’ smoking habits among men was 84.4% (95% CI 80.3–88.5) in 2002 and 88.3% (95% CI (84.5–92.2) in 2014, among women 82.1% (95% CI 80.2–83.9) and 89.0% (95% CI 87.2–90.8), respectively. According to logistic regression analysis, in 2014, significantly more physicians agreed that it is doctors’ responsibility to convince people to stop smoking (among men, OR 2.32; 95% CI 1.19–4.54, among women OR 1.41; 95% CI 1.06–1.88), that smoking prevention should form part of health professionals’ training, that physicians should have smoking related hand-out materials, and that lack of time was a barrier to addressing patients’ smoking. Addressing patients’ smoking was significantly associated with attitudes and perceived barriers regarding addressing patients’ smoking, age, and other background factors (among women only). Conclusions: Addressing patients’ smoking habits was more common in 2014 than in 2002, but the change was significant among women only. Compared to 2002, in 2014 physicians’ attitudes regarding addressing patients’ smoking were more approving. Results of this study are useful for policymakers and institutions involved in organization and development of smoking prevention training and cessation services.

Smoking withdrawal can be difficult due to nicotine dependence (ND). The study objective was to describe ND and to analyze the association between ND and factors related to smoking cessation among daily smoking physicians in Estonia. Data was collected in 2014, using cross-sectional postal survey sampling all practicing physicians (n = 5666) in Estonia, of whom 2939 responded (corrected response rate 53.1%). The study sample was restricted to daily smoking physicians (n = 171). Results of the Fagerstr&ouml, m Test for Nicotine Dependence (FTND) were described and ND scores calculated. Logistic regression was used to determine the association of ND (at-least-moderate vs. low) with factors related to smoking cessation. Crude and fully adjusted ORs with 95% CIs were calculated. The mean FTND score was 2.8 &plusmn, 2.1. The odds of having at-least-moderate ND decreased significantly with each year postponing smoking initiation (OR = 0.82, 95% CI 0.72&ndash, 0.94). After adjustment, ND was no longer associated with the desire to quit smoking and motives to quit. In conclusion, more than half of daily smoking physicians had low ND. Higher ND was associated with younger age of smoking initiation. Knowledge of ND and factors related to smoking cessation is useful in the prevention of smoking and in development of cessation counselling tailored for physicians.

Background: Patterns of alcohol use often start developing during adolescence and are associated with alcohol use and dependence during adulthood. The aims of the study were to describe trends in the prevalence of monthly alcohol use from 2003 to 2015 and to analyze the associations between alcohol use and family-related and school-related factors, risk behavioral factors and perceived alcohol availability in Estonia, Latvia, Lithuania, Finland, and Sweden.Methods: The study used nationally representative data of 15–16-year-old adolescents from the European School Survey Project on Alcohol and Other Drugs (ESPAD). Data from Estonia, Latvia, Lithuania, Finland, and Sweden collected in 2003, 2007, 2011, and 2015 were utilized (n=57,779). The prevalence of monthly alcohol use and light and strong alcohol use was calculated for each study year in all countries. A chi-square test for trend was used to evaluate statistically significant changes in alcohol use over the study period. Logistic regression analysis was performed to analyze the association between alcohol use and different factors. Fully adjusted odds ratios with 95% confidence intervals were calculated.Results: Monthly alcohol use decreased significantly among 15–16-year-old boys and girls in Estonia, Latvia, Lithuania, Finland, and Sweden from 2003 to 2015. In 2015, the prevalence of monthly alcohol use among boys was 36.1% in Estonia, 44.3% in Latvia, 32.4% in Lithuania, 32.3% in Finland, and 22.4% in Sweden, and among girls, it was 39.1%, 45.9%, 35.6%, 31.8%, and 29.1%, respectively. In Estonia, Latvia, Lithuania, and Sweden, girls had higher odds of monthly alcohol use than boys. In all countries, higher odds of monthly alcohol use were observed among adolescents who skipped school, smoked cigarettes, used cannabis, perceived alcohol to be easy to access and had parents who did not know always/often about their child’s whereabouts on Saturday nights.Conclusion: From 2003 to 2015, monthly alcohol use decreased in Estonia as well as in neighboring countries such as Latvia, Lithuania, Finland, and Sweden. The factors related to alcohol use in all five countries were generally similar. Based on the study results, health promotion and alcohol policy interventions could be improved to decrease and prevent alcohol use among adolescents.

Background: In the context of declining smoking rates in Estonia, this study aims to analyze the recent trends in e-cigarette use and its associations with smoking status and sociodemographic factors. Methods: Nationally representative data from biennial cross-sectional health surveys in 2012−2018 (n = 9988) were used to describe the prevalence of smoking and e-cigarette use by smoking status in Estonia. Multivariate logistic regression analysis was used to describe the sociodemographic patterns of e-cigarette use in three subgroups: the general population, smokers, and ex-smokers. Results: The prevalence of current smoking decreased from 45.4% in 2012 to 31.5% in 2018 among men and from 26.6% to 20.0% among women. At the same time, e-cigarette use in the general population had increased to 3.7% among men and to 1.2% among women. The increase in the prevalence of e-cigarette use was statistically significant among men in the general population, smokers, and ex-smokers, but non-significant among women. In addition to period effects, e-cigarette use was patterned by age, gender, and education. Conclusion: In 2002−2018, the e-cigarette use had increased but smoking had decreased in Estonia. A timely and targeted tobacco policy may alleviate the harm of e-cigarette use from the public health perspective.

Background Smoking is a risk factor for several diseases. Physicians are role models for their patients. Physicians who smoke underestimate the health risks of smoking and may be less likely to offer advice to help their patients to quit. The aim of this study was to: provide an overview of smoking behaviour among Estonian physicians; assess the relationship between smoking and ischaemic heart disease (IHD), chronic bronchitis (CB), and lung emphysema (LE); and estimate fractions of prevalences of the three diseases attributable to smoking. Methods Self-administered questionnaires were sent to practising physicians (n = 5666) in Estonia in 2014. Prevalence of smoking and relative risks for IHD, CB and LE as well as the risks of IHD, CB and LE attributable to smoking were calculated by age and sex. Post-stratification was used to compensate non-response. Results There were 535 male and 2404 female physicians participating. The prevalence of daily smoking was 12.4% (95% CI 10.4–14.4%) among men and 5.0% (95% CI 4.4–5.6%) among women. Mean duration of smoking among male and female daily smokers was 28.6 (95% CI 26.1–31.1) and 28.6 (95% CI 27.1–30.2) years. Compared to lifelong non-smokers, the age-adjusted risk for IHD was 1.29 times (95% CI 0.88–1.89) higher for men, but 1.69 times (95% CI 1.17–2.40) lower for all women who have ever smoked. The risk for CB was 2.29 (95% CI 1.30–4.03) times higher for smokers among men and, 1.32 (95% CI 0.95–1.82) among women; the risk ratio for LE was 4.92 (95% CI 1.14–21.1) among men and 2.45 (95% CI 0.63–9.52) among women. The smoking-attributable risk for IHD was 3.2% (95% CI 2.3–4.1%) among men and − 0.1% (95% CI -0.7–0.4%) among women; for CB 6.9% (95% CI 6.0–7.8%) and 4.2% (95% CI 3.5–4.8%); and for LE 18.8% (95% CI 17.0–22.5%) and 22.6% (95% CI 18.5–26.9%), respectively. Conclusion Prevalence of daily smoking was relatively low among Estonian physicians (and twice lower among female physicians). The risk attributable to smoking was higher for LE and CB than for IHD. Electronic supplementary material The online version of this article (10.1186/s12889-018-5105-6) contains supplementary material, which is available to authorized users.

Background Smoking surveys among physicians have proved useful in highlighting the importance of physicians as healthy life style exemplars and role models in tobacco control and smoking cessation. The aim of this study was to give an overview of smoking behaviour among Estonian physicians from 1982 to 2014. Methods Three cross-sectional postal surveys using a self-administered questionnaire were carried out among all practising physicians in Estonia. The number of physicians participating in this study was 3786 in 1982, 2735 in 2002, and 2902 in 2014. Data analysis involved calculating the age-standardized prevalences of smoking, prevalences of smoking by age group and mean age of smoking initiation. A non-parametric test for trend was used to assess significant changes in smoking over time. Results Age-standardized prevalence of current smoking among men was 39.7% in 1982, 20.9% in 2002, and 14.3% in 2014 and among women 12.2%, 8.0%, and 5.2%, respectively (p

Background Smoking withdrawal can be difficult due to nicotine dependence (ND). Individual, environmental and social factors must be considered when researching ND. The objective of the present study is to describe ND and to analyse associations between ND and smoking-related and background factors among daily smoking Estonian physicians. Methods A cross-sectional postal survey was used to collect data from Estonian physicians in 2014. The initial sample consisted of all practising physicians in Estonia (n=5666). In total, 2939 physicians participated. The corrected response rate was 53.1%. The current study sample was restricted to physicians who smoked daily (n=171). The outcome variable was ND level, measured using the Fagerström Test for Nicotine Dependence (FTND). The mean age of smoking initiation was calculated, along with the standard deviation and the distribution of ND levels with 95% confidence intervals (CIs). T-tests and chi-square tests were used to test for differences between groups. To compensate for non-response, the data were weighted. Using multiple logistic regression, the association between ND level (at-least-moderate vs low) and smoking-related and background factors was determined. Crude and fully adjusted odds ratios (ORs) with 95% CIs were calculated. Results The mean FTND score for daily smoking physicians was 2.8±2.1, and 60.8% of them had low, 33.1% moderate and 6.1% high ND levels. The mean age of smoking initiation differed statistically between physicians with low and at-least-moderate ND levels (21.0±5.1 and 18.4±3.3, respectively) (p

Background Alcohol is one of the most common psychoactive substances used by adolescents. The aim of the study was to describe the prevalence of alcohol use in 2003-2015 and to analyse association of alcohol use with family- and school-related factors, other risk behaviors, and perceived alcohol availability. Methods This study was based on data of 15-16-year-old adolescents (n = 9559) from the cross-sectional studies of European School Survey Project on Alcohol and Other Drugs conducted in Estonia in 2003-2015. Prevalence of past 30-day alcohol use was calculated for each study year. Chi-square test for trend was used to assess statistically significant changes of alcohol use over the study period. Logistic regression analysis was used to analyse association between alcohol use and study year, family- and school-related factors, risk behaviors, and perceived alcohol availability. Fully adjusted odds ratios with 95% confidence intervals were calculated. Results In 2003-2015, alcohol use decreased significantly among adolescents in Estonia (p < 0.001). In 2015, the prevalence of alcohol use was 36.1% (95% CI 33.4 − 38.8) among boys and 39.1% (95% CI 36.3 − 41.8) among girls. Fully adjusted logistic regression models showed that alcohol use among boys and girls was statistically significantly associated with study year, lower parental awareness where the child spends Saturday evenings, skipping the lessons, smoking, cannabis use and easy access to alcohol. Alcohol use was associated with lower socioeconomic status of the family and with unusual family structure among girls only. Compared to the first study year, alcohol use was lower in the last study year (OR = 0.52, 95% CI 0.43 − 0.64 among boys, OR = 0.46, 95% CI 0.38 − 0.56 among girls). Conclusions In order to continue reduction of alcohol use among adolescents, the health promotion interventions should take into account the factors related to alcohol use in Estonia. Key messages Alcohol use decreased among adolescents in Estonia in 2003–2015. Alcohol use was associated with study year, family- and school-related factors, other risk behaviors and perceived alcohol availability.

BackgroundPoor self-rated health (SRH) and smoking have consistently been shown to be related to mortality. The aim of this study was to explore SRH and smoking among physicians and general population with higher education in Estonia in 2002 and 2014 and to analyse the association of SRH with smoking and sociodemographic factors.MethodsThis study was based on cross-sectional postal surveys among physicians and general population with higher education in Estonia n in 2002 and 2014. Calculation of age-standardized prevalence of SRH and current smoking with 95% confidence intervals (CI) was performed. Multivariate logistic regression analysis was used to measure association between SRH (at-least-good vs less-than good) and smoking status, study year, age group, ethnicity, and marital status. Fully adjusted odds ratios (OR) with 95% CI were computed.ResultsAge-standardized prevalence of at-least-good SRH was 71.3 and 80.6% among male physicians, 68.4 and 83.1% among female physicians, 45.4 and 67.4% among men with higher education, and 44.7 and 63.1% among women with higher education in 2002 and 2014, respectively. Age-standardized prevalence of current smoking was 26.0 and 15.6% among male physicians, 10.2 and 5.9% among female physicians, 38.7 and 22.2% among men with higher education, and 20.9 and 16.4% among women with higher education in 2002 and 2014, respectively. There was no significant gender difference in at-least-good SRH, but prevalence of current smoking was significantly higher among men in both study groups in 2002 and 2014. Compared to year 2002, odds to have at-least-good SRH was higher in 2014 (OR = 1.64; 95% CI 1.16–2.31 among male and OR = 2.36; 95% CI 2.02–2.75 among female physicians, OR = 1.49; 95% CI 1.07–2.07 among men and OR = 2.40; 95% CI 1.84–3.13). Odds to have at-least-good SRH was significantly higher among non-smokers (except female physicians), in the youngest age group, and among Estonians.ConclusionsThis study gave an overview of differences in SRH and smoking between two target groups with higher education in two timepoints highlighting the importance of addressing smoking cessation counselling and health promotion campaigns in the population by different subgroups in Estonia.

Background Exposure to second-hand smoke (SHS) is a preventable cause of disease and disability that can effectively be tackled by tobacco legislation. The aim of the study was to analyse the trends of SHS exposure and its sociodemographic patterning during 1996–2016 in the context of tobacco policy changes in Estonia. Methods Nationally representative data from biennial health surveys in 1996–2016 (n = 14 629) were used to present prevalence ratios for SHS exposure among non-smokers in Estonia. Joinpoint regression and multivariable logistic regression were used to study the sociodemographic and socio-economic differences in SHS exposure and its changes during the period. Results Exposure to SHS among non-smoking men and women has declined 3.6 and 5 times, respectively, during 1996–2016. While the rate of change was constant among men throughout the period, the decline in SHS exposure among women became significantly faster after 2006 compared with the previous period. However, 15.6% [95% confidence interval (CI) 13.1–18.3%] of men and 8.8% (95% CI 7.1–10.6%) of women were still exposed to SHS in 2016 with higher odds found for younger age groups, non-Estonians and those with lower education and income. Conclusions The consistently declining prevalence of SHS exposure among non-smoking population can be at least partially attributed to implementation of tobacco legislations in 2000s. However, the existing sociodemographic and socio-economic differences in SHS exposure require further attention as those in more vulnerable positions are also more exposed to SHS-related health harms.

Introduction Smoking is a major health threat and quitting smoking would be a notable benefit. The aim of the present study was to explore factors associated with desire to quit smoking among Estonian physicians in 2002 and 2014. Methods Self-reported data of current smokers were drawn from Estonian physicians' cross-sectional postal surveys in 2002 (n=322) and 2014 (n=189). A logistic regression model was used to analyse the association between desire to quit smoking and factors related to smoking behaviour among 'current smokers'. Results The prevalence of desire to quit smoking among physicians was 55.3% in 2002 and 52.9% in 2014. Physicians who were concerned about harms of smoking, had higher odds for desire to quit compared with those who were not concerned (OR=9.06; 95% CI: 4.15-19.74). Compared to physicians with no quit attempts, odds for desire to give up smoking were significantly higher among physicians with quit attempts. Wish to set a good example was significantly associated with desire to quit (OR=2.38; 95% CI: 1.12-5.09). Compared to specialist doctors, dentists had higher odds for desire to quit smoking (OR=2.42; 95% CI: 1.25-4.69). Conclusions More than half of Estonian smoking physicians expressed the desire to quit. Desire to quit was associated with concern about harms of smoking, number of previous quit attempts, setting a good example, and medical specialty. The findings suggest that there is a need for smoking cessation counselling services that are addressed, especially for physicians in Estonia.

ObjectivesTo explore smoking prevalence and attitudes towards smoking among Estonian physicians in 2002 and 2014.DesignTwo self-administered cross-sectional postal surveys were conducted among practising physicians in Estonia.ParticipantsInitial sample consisted of all practising physicians in Estonia. The corrected response rate was 67.8% in 2002 and 53.1% in 2014. Present study sample was restricted to physicians younger than 65 years (n=2549 in 2002, n=2339 in 2014).MethodsAge-standardised prevalence of smoking and prevalence of agreement with seven statements concerning attitudes towards smoking was determined. To analyse association of physicians’ attitudes towards smoking with study year and smoking status, logistic regression analysis was used. Adjusted ORs of agreement with the seven statements were determined. Corresponding 95% CIs were calculated.ResultsThe age-standardised prevalence of current smoking among men was 26.8% in 2002 and 15.3% in 2014, among women 10.4% and 5.8%, respectively. Compared with the year 2002, in 2014, prevalence of agreement with statements declaring harmfulness of smoking was higher and prevalence of agreement with statements approving smoking was lower. Adjusted ORs showed that compared with 2002, physicians’ attitudes towards smoking were less favourable in 2014, and physicians’ attitudes towards smoking were associated with their smoking status.ConclusionsCompared with 2002, the age-standardised smoking prevalence among male and female physicians was lower, and attitudes towards smoking were less approving in 2014. The smoking physicians had more approving attitudes towards smoking than their non-smoking colleagues.

Objectives To analyze the factors that hinder physicians addressing patients' smoking behavior in Estonia where relatively high smoking among physicians has been previously reported. Study design Cross-sectional study. Methods Data from a nationwide cross-sectional postal survey of professionally active physicians in Estonia and multinomial logistic regression were used to explore the factors predicting the frequency (never vs always, often vs always) of addressing patients' smoking behavior. Results The majority of physicians had asked about the smoking behavior of their patients either always (14.2%) or often (75.7%). Odds of never asking (10.1% of physicians) were higher for dentists, current smokers, and for those reporting lack of time, habit, or skills. Higher odds for less frequent (vs always) asking were found for male physicians, medical residents, and among those reporting lack of time and habit. Conclusions Addressing patients' smoking behavior is associated with physicians' demographic characteristics, specialty, and smoking status. Also, lack of time, habits, and skills are common barriers that need to be tackled for more efficient smoking cessation counseling.

Introduction Previous reports have shown that physicians who smoke underestimate the effects of smoking on health and this influences their practice. This study was designed to investigate the views of Estonian physicians on the role of smoking in smoking-related diseases. Material and Methods Cross-sectional postal surveys were sent to all practising physicians in Estonia in 1982, 2002 and 2014 providing data from 3504, 2694, and 2865 physicians respectively. Data analysis involved calculation of the prevalence of smoking with 95% confidence intervals and calculation of the prevalence of agreement with a causal role of smoking in ischaemic heart disease (IHD), lung cancer and chronic bronchitis. Logistic regression was used to analyse associations between agreement with the statements that smoking is a cause of IHD, lung cancer, chronic bronchitis and study year, smoking status, age group and ethnicity. Fully adjusted odds ratios with 95% confidence intervals were calculated. Results The age-standardized prevalence of current smoking among men decreased from 39.6% in 1982 to 14.2% in 2014, and among women from 12.4 to 5.1%, respectively. Compared with 1982, the proportion of physicians agreeing with statements that smoking is a major cause or one of the causes of IHD, lung cancer, or chronic bronchitis was significantly higher in 2002 and 2014. Past and never smokers were more likely to admit a causal role of smoking in lung cancer than smokers. Agreement with a causal role of smoking in IHD and chronic bronchitis was significantly higher among never and past smoking women only. Compared with non-Estonians, the odds ratio indicating agreement with all three statements was significantly higher among Estonians. Conclusions From 1982 to 2014, physicians’ attitudes towards the health risks of smoking improved in Estonia. However, their assessment of a causal role of smoking in smoking-related diseases was related to their own smoking habits and ethnicity. A further decline in smoking among Estonian physicians would require special efforts targeted at physicians. Societal pressure from a national policy could support a further decline in the social acceptability of smoking in Estonia and developments in medical education could provide continuing evidence-based information about the health effects of smoking to Estonian physicians.

RATIONALE, AIMS AND OBJECTIVES: Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries (United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. METHODS: We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). RESULTS AND CONCLUSIONS: The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care.

Background: Governments have identified innovation in pharmaceuticals and medical technology as a priority for health policy. Although the contribution of medical care to health has been studied extensively in clinical settings, much less is known about its contribution to population health. We examine how innovations in the management of four circulatory disorders have influenced trends in cause-specific mortality at the population level. Methods: Based on literature reviews, we selected six medical innovations with proven effectiveness against hypertension, ischaemic heart disease, heart failure and cerebrovascular disease. We combined data on the timing of these innovations and cause-specific mortality trends (1970-2005) from seven European countries. We sought to identify associations between the introduction of innovations and favourable changes in mortality, using Joinpoint-models based on linear spline regression. Results: For both ischaemic heart disease and cerebrovascular disease, the timing of medical innovations was associated with improved mortality in four out of five countries and five out of seven countries, respectively, depending on the innovation. This suggests that innovation has impacted positively on mortality at the population level. For hypertension and heart failure, such associations could not be identified. Conclusion: Although improvements in cause-specific mortality coincide with the introduction of some innovations, this is not invariably true. This is likely to reflect the incremental effects of many interventions, the time taken for them to be adopted fully and the presence of contemporaneous changes in disease incidence. Research on the impact of medical innovations on population health is limited by unreliable data on their introduction.

Background Self-rated health (SRH) and socioeconomic position (SEP) as important determinants of health differences are associated with health and economic changes in society. The objectives of this paper were (1) to describe trends in SRH and (2) to analyze associations between SRH and SEP among adults in Estonia in 1996–2014. Methods The study was based on a 25–64-year-old subsample (n = 18757) of postal cross-sectional surveys conducted every second year in Estonia during 1990–2014. SRH was measured using five-point scale and was dichotomized to good and less-than-good. Standardized prevalence of SRH was calculated for each study year. Poisson regression with likelihood ratio test was performed for testing trends of SRH over study years. Age, nationality, marital status, education, work status and income were used to determine SEP. Logistic regression analysis was used to assess association between SRH and SEP. Results The prevalence of dichotomized good self-rated health increased significantly over the whole study period with slight decrease in 2008–2010. Until 2002, good SRH was slightly more prevalent among men, but after that, among women. Good SRH was significantly associated with younger age, higher education and income and also with employment status among both, men and women. Good SRH was more prevalent among Estonian women and less prevalent among single men. Conclusions There was a definite increase of good SRH over two decades in Estonia following economic downturn between 2008 and 2010. Good SRH was associated with higher SEP over the study period. Further research is required to study the possible reasons behind increase of good SRH, and it’s association with SEP among adults in Estonia.

Aims: To investigate alcohol consumption patterns in Estonia in 1996, which represents the transition period after the collapse of the Soviet Union, and in 2006, which is characterized by economic growth. Methods: Data from all 25 – 64 year olds from the nationally representative 1996 and 2006 Estonian Health Interview Surveys were analysed. The frequency of alcohol consumption and heavy episodic drinking (HED) were examined. The odds ratios of at least weekly alcohol consumption and HED according to socio-demographic characteristics were calculated using logistic regression models. Results: In comparison with 1996, at least weekly alcohol consumption was nearly twice as high among men in 2006. No association between HED and the study year was found. Alcohol consumption was lower among respondents in the oldest age group. Weekly alcohol consumption was lower among non-Estonian men in both study years. HED was higher among non-Estonian men and women in 1996 but this difference disappeared in 2006. Weekly alcohol consumption was lower among less educated men in 1996 but not in 2006. No clear tendency in weekly alcohol consumption by education was found among women. HED was higher among less educated men in both study years; however, this association was weaker in 2006. While HED was not associated with education among women in 1996, an inverse relationship was found in 2006. Conclusions: The study confirmed that rapid societal changes had an effect on alcohol consumption patterns in Estonia. Estonia needs the implementation of a comprehensive alcohol policy to decrease harmful alcohol consumption in the whole society.

Aims: The aim of the study was to describe trends in alcoholic liver cirrhosis mortality rates in 1992-2008 and to examine socio-demographic differences in alcoholic liver cirrhosis mortality. Methods: Individual records of deaths from alcoholic liver cirrhosis among 25-64-year olds in 1992-2008 in Estonia were analysed. Age-standardized mortality rates for men and women aged 25-44 and 45-64 were calculated. Association between alcoholic liver cirrhosis mortality and socio-demographic variables (age, education and ethnicity) for the data of the years around the census in 2000 was measured by mortality rate ratios using Poisson regression models. Results: In 1992-2008, alcoholic liver cirrhosis mortality rates were higher among men than that in women and that in the older than in the younger age group. Over the whole study period, mortality from alcoholic liver cirrhosis increased steeply. The increase was sharper among men and women in the older age group. In 1998-2001, higher alcoholic liver cirrhosis mortality rates occurred in non-Estonians and those with lower levels of education. Conclusion: Alcoholic liver cirrhosis mortality has increased steadily in Estonia, and is reflected in an increase in heavy drinking. National alcohol policies should address all strata of society. However, in order to reduce alcohol-related damage in the population most effectively, special attention should be paid to non-Estonians and people with low levels of education.

Aim: To compare self-perceived health in relation to socioeconomic factors in Estonia and Finland. Methods: This study was based on the 25—69 year old adult population of the European Social Survey, conducted in Estonia and in Finland in 2006. Self-perceived health was rated on the five-point scale as very good, good, fair, poor, and very poor. The socioeconomic position was measured by the level of education, economic activity, and self-rated financial situation. Logistic regression analysis was applied to assess the association between self-perceived health and the socioeconomic factors. Results: The prevalence of less-than-good health was significantly higher in Estonia than in Finland. Significant associations with less-than-good self-perceived health were found for less educated, economically non-active respondents with poorer self-rated financial situation in both countries. After adjustment, economic non-activity among women and self-rated financial situation among men appeared not to be associated with less-than-good self-perceived health in Finland. Conclusions: Self-perceived health was poorer in Estonia than in Finland, but Estonia shares with Finland a similar socioeconomic pattern of health. Further research is needed to monitor socioeconomic variations in health behaviour and mortality in both countries.

Aims : The aims of this study were to examine socio-demographic differences in alcohol-related mortality in Estonia, and how they changed over time. Methods : Individual death records (age at death 25–64) in Estonia from the late Soviet era (1983–1991) to Estonian re-independence (1992–2005) were analysed using a case-control design. Cases were deaths from alcohol-related causes (7981 deaths). Controls were deaths (13,820) from those neoplasms that are considered not to show variation in death risk according to the socio-demographic variables (that is, excluding cancer of the upper aero-digestive tract, lung, stomach, colon and female breast). Differences in alcohol-related mortality between socio-demographic groups were measured by mortality odds ratio. Results: In the study period as a whole, in both genders, an inverse relationship between the educational level and risk of alcohol-related death was apparent. Non-Estonians were more likely to die from alcohol-related causes than Estonians. Risk of alcohol-related death varied over time, being lowest just before Estonia regained its independence, and highest in the most recent period. In men, the educational gradient in the mortality odds ratio almost disappeared in 1988–1991, but reappeared in the transition period, while the impact of ethnicity remained stable over time. In women, educational contrasts in the risk of death existed throughout all subperiods, and ethnical inequalities widened in the re-independence period. Conclusion: Rapid societal changes had profound effects on alcohol-related mortality. Strategies to prevent alcohol misuse should include all sections in society, paying special attention to less educated and non-Estonians.

Objective: To assess the long-term outcome of bystander-witnessed out-of-hospital cardiac arrest victims in Estonia by using the survival rate and quality of life assay. Methods: All resuscitation attempts made from 01.01.1999 to 31.12.2002 in Estonia were retrospectively screened for bystander-witnessed adult out-of-hospital cardiac arrests of cardiac origin. The patients who survived hospital discharge were included in the study. Their long-term survival data were retrieved from Estonian Population Registry on March 15, 2004. Quality of life was assessed by RAND-36 questionnaire. Comparisons were made with population norms, and patients suffering from myocardial infarction or angina pectoris. Results: 854 bystander-witnessed resuscitation attempts were made in four years. 91 patients (10.7%) survived to hospital discharge. Their one-year survival rate was 77.0% and five-year survival rate 64.3%. 44 patients responded to quality of life questionnaire, sent 16–62 months after out-of-hospital cardiac arrest (response rate 77.2%). Respondents rated their quality of life significantly worse than general population in five out of eight categories. The out-of-hospital cardiac arrest survivors with known cardiovascular disease in history (n = 30) had quality of life similar to patients suffering from myocardial infarction or angina pectoris who had not required resuscitation. Conclusion: In Estonia majority of bystander-witnessed out-of-hospital cardiac arrest victims who survive hospital discharge are alive one and also more than three years after resuscitation. Their quality of life is worse than that of general population.

Objectives: To understand the phenomenon of consumption of surrogate and illegal alcohols in Tallinn, capital of Estonia.

To compare smoking behaviour, attitudes and opinions towards smoking and smoking cessation among Estonian and Finnish physicians.A cross-sectional postal survey using a self-administered questionnaire was carried out among 2,480 Estonian and 2,075 Finnish physicians.Daily smoking prevalence was higher among Estonian physicians than among their Finnish counterparts in both male (18.6% and 6.7%) and female (6.6% and 3.6%). Compared to Estonia, physicians in Finland more often agreed that smoking is very harmful to their health, that trying to convince people to stop smoking is their responsibility and that smoking prevention should be part of the normal and special training of health professionals. In both countries, non-smoking physicians held more unfavourable attitudes towards smoking than those who were smoking.Physicians' own smoking patterns and quitting behaviour are important because physicians serve as models for their patients and play a key role in the reinforcement of smoke-free health facilities. These results remain a challenge to medical educators, especially in Estonia. Estonia needs to improve medical education in terms of motivating physicians to ask about the smoking patterns of their patients and of training medical students and resident physicians to counsel their patients to stop smoking.

Objectives: Although widely used in epidemiological studies, self-report has been shown to underestimate the prevalence of smoking among pregnant women. Objectives of this study were to examine the discrepancy between self-reported and cotinine-validated smoking status, and the sociodemographic characteristics associated with the misclassification of real smoking status among pregnant women in Tallinn, the capital of Estonia. Methods: Serum cotinine assays were performed on a subsample (n= 1360) of the pregnant women, who had participated in a recent study of human papillomavirus type 16 (HPV-16) seroprevalence in Estonia. In the present study, serum concentrations ≥15 ng/ml were used to distinguish current smokers from nonsmokers. The serum-validated smoking level was compared with the self-reported level in the records of the Estonian Medical Birth Registry. For the group of self-reported non-smokers, the differences between the cotinine-validated smokers and the cotinine-validated nonsmokers, with respect to their sociodemographic characteristics (age, ethnicity, educational level, employment status, marital status, parity), were estimated by logistic regression. Results: Of 1239 women who reported being nonsmokers, 259 (20.9%) had serum cotinine levels ≥15 ng/ml, and can be regarded as current smokers. Among self-reported nonsmokers, nondisclosure of current smoking was significantly more frequent in non-Estonian, less educated, socially inactive, cohabiting and multiparous women. Conclusions: Self-reported data on smoking in pregnant women underestimates the real smoking prevalence in Estonia. Maternal unwillingness to declare smoking during pregnancy needs to be taken into account in the practice of maternal and child health to better target prenatal smoking cessation interventions.

Summary Objectives This study examined the smoking habits and attitudes towards smoking among Estonian physicians. Study design and methods Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey. Results The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models. Conclusions This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians’ attitudes towards smoking. The results provide an important challenge to medical education in Estonia.

Aims To describe the pattern of current smoking and its relation to socio-demographic factors in Estonia. Design Nationwide cross-sectional survey. Setting Estonia in 1996. Participants Stratified random sample of 2086 adults aged 30–59. Measurements Prevalence of current smoking; socio-demographic factors related to smoking, investigated by logistic regression analysis. Findings The prevalence of current smoking was 57.9% among men and 25.7% among women. For both genders, smoking rates were consistently lowest in the age group 50–59 years and highest in the age group 30–39 years. Smoking was significantly more common among divorced and widowed people. Education was associated with smoking among men but not among women. No relationship, however, was established between smoking and ethnicity, type of residence, and household income. Conclusions Estonia needs an effective antismoking policy. Public health efforts need to be focused on quitting smoking in younger adults and prevention efforts should target less educated socio-economic groups.

Background Smoking behaviour is determined by different social contexts (family, peer, school) providing adolescents with important role models. Methods This study was based on the WHO study of Health Behaviour School-Aged Children conducted in 2009/2010 in Estonia. The target group were 13- and 15-years-old adolescents (N = 2799), 1347 boys and 1452 girls. Cigarette smoking of adolescents was determined in 4-step scale: every day, at least once a week, less than once a week and do not smoke. Social …

Estonian Genome Bank is a population based biobank what combines DNA samples with general health questionnaire data. This repository contains data of more than 50,000 people. Database involves general data about the donors lifestyle (smoking, dinking, education, jobs etc) and about their health. We included to our analysis only these persons who responded about their smoking habits. Smoking status was divided into three categories: current smoker, former smoker and persons never smoked. Half of smokers have smoking duration over 20 years. Health status describes the disease people have. Our analysis focused on the smoking behaviour and its relations to the heart and lung disease and to the malignancies. Preliminary data analysis indicated that former smokers had higher prevalence of COPD and lung cancer than current smokers and never smokers. This finding may reflect that former smoker quit smoking due to emerging health problem.