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Objectives: To analyse how psychosocial determinants of lifestyle changes targeted in the Greater Green Triangle Diabetes Prevention Project conducted in Southeast Australia in 2004-2006 predict changes in dietary behaviour and clinical risk factors., Methods: A longitudinal pre-test and post-test study design was used. The group program was completed by 237 people at high risk of type 2 diabetes. Associations between changes in the variables were examined by structural equation modelling using a path model in which changes in psychological determinants for lifestyle predicted changes in dietary behaviours (fat and fibre intake), which subsequently predicted changes in waist circumference and other clinical outcomes. Standardised regression weights are presented, with β=±0.1 and β=±0.3 representing small and medium associations, respectively., Results: Improvements in coping self-efficacy and planning predicted improvements in fat (β=-0.15, p<0.05 and β=-0.32, p<0.001, respectively) and fibre intake (β=0.15, p<0.05 and β=0.23, p<0.001, respectively) which in turn predicted improvements in waist circumference (β=0.18, p<0.01 and β=-0.16, p<0.05, respectively). Improvements in waist circumference predicted improvements in diastolic blood pressure (β=0.13, p<0.05), HDL (β=-0.16, p<0.05), triglycerides (β=0.17, p<0.01), and fasting glucose (β=0.15, p<0.05)., Conclusions: Psychological changes predicted behaviour changes, resulting in 12-month biophysical changes. The findings support the theoretical basis of the interventions., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To assess the impact of the 1976 Tobacco Control Act (TCA) on smoking initiation across socioeconomic groups., Methods: Nationwide data from independent annual cross-sectional postal surveys in 1978-2002 in Finland. Subjects were 25-64-year-old men and women born 1926-1975 (n=68 071). Socioeconomic status was derived individually from population census data. Logistic regression was applied to assess the impact of the 1976 TCA on the prevalence of ever daily smoking in birth cohorts and socioeconomic groups., Results: Clear socioeconomic differences in ever daily smoking among men and women were found. In all socioeconomic groups a declining cohort trend was observed among men whereas women showed an increasing trend in early cohorts and a declining one thereafter. A statistically significant decline in the proportion of ever daily smokers compatible with the impact of the TCA was found in all socioeconomic groups except farmers. Among women the decline was roughly similar in each socioeconomic group, while among men it varied and was most pronounced among white collar employees., Conclusions: The impact of the 1976 TCA was less pronounced among male lower socioeconomic groups. In spite of the even impact of the TCA on female smoking across socioeconomic groups, large socioeconomic disparities remain. Tobacco control policy measures specifically directed at lower socioeconomic groups are needed.

Background: Cholesterol-lowering drugs may metabolically interact with cholesterol-lowering bread spreads. This study analyses the prevalence of use of drugs, bread spreads or the combination of both in people aware of their high/elevated cholesterol level, and compares users of the three therapies on health behavior and demographics., Methods: Participants (9581, 25-74 years) from The National FINRISK 2002 Study filled out a questionnaire on demographics and health (related) issues. Blood samples, blood pressure, body weight and height were measured., Results: Of those who reported to have a high cholesterol level (31% of the study population), 19% used cholesterol-lowering drugs, 11% used cholesterol-lowering bread spreads and 5% combined both therapies. On a population level, only 1% jointly used a drug and bread spread therapy. The combination was used by especially highly educated people and those having a healthy diet., Conclusion: Combining a cholesterol-lowering drug with a bread spread regimen is relatively rare, even among those being aware of their high cholesterol levels. The combined usage was most frequent among 'the better off'. Public health risks of a metabolic interaction between both therapies may not be of major importance yet, but future follow-up is recommended.

We summarize here the evidence from the 1960s and 1970s of exceptionally high risk of cardiovascular disease (CVD) in Finland. In parallel with voluntary and governmental prevention programs, the level of risk factors and CVD attack rates have shown dramatic improvement in the past 25 years, but the decline has slowed in recent years. This experience strongly supports population-wide strategies for primary prevention, and it also highlights the continued need for primordial prevention directed toward youth in high-risk societies.

Background: The prevalence of hypertension among the population of Tianjin is one of the highest in China. We attempted to assess the changes in blood pressure, body mass index, and salt consumption in Tianjin from 1989 to 1996., Methods: Two independent cross-sectional population surveys with the representative samples of 14,046 persons in 1989 and 2,000 persons in 1996 were carried out in Tianjin. A salt surveillance system was established with four salt consumption surveys (in 1992, 1993, 1994, and 1996) to estimate the changes in salt consumption at the household level., Results: From 1989 to 1996, the prevalence of hypertension and obesity decreased among people aged 45-64 years in both genders. Mean systolic blood pressure decreased significantly in women and leveled off in men. Diastolic blood pressure increased significantly. Body mass index remained unchanged. The unfavorable trends were mainly attributable to the negative changes in younger people (15-34 years) in both genders. There were no changes in salt consumption between 1992 and 1996 at the house level., Conclusions: There was a favorable development in prevalence of hypertension and obesity among individuals in the age group of 45-64 years in the study population. Health education needs to pay more attention to young people., (Copyright 1999 American Health Foundation and Academic Press.)

Background: During the past 20 years the age-standardized cardiovascular disease mortality rate has declined in Finland by 50%. The aim of this study was to examine the social cost consequences of this decline., Methods: The prevalence-based cost-of-illness analysis was applied to estimate both direct and indirect costs of cardiovascular disease in 5-year intervals from 1972 to 1992 (in 1992 prices). Summary data from the national registers covered all persons with cardiovascular disease who were treated, received sickness insurance benefits, or died from the disease., Results: Direct health care costs increased, but the decline in indirect costs overcompensated that increase. The total cost among all persons age 35 and over, including the retired, was $2.7 billion in 1972 and $2.6 billion in 1992, which is a 4% decrease. In the age group of 35-64 years the total costs fell from $2.5 billion to $1.9 billion (25%). In terms of cost per capita the decline was 26 and 40% in the respective age groups., Conclusions: The costs of cardiovascular disease decreased since 1972. However, total costs declined clearly less than the cardiovascular disease mortality rate. This implies that considerable savings in total costs, especially in direct health care costs, may not be expected as a result of even very successful prevention programs.

Background: Self-rated health is a useful indicator of the population's health. Yet follow-up studies on perceived health trends are scarce. The aim of this paper is to assess perceived health trends in Finland between 1972 and 1992., Methods: Five cross-sectional studies were done in two areas in eastern Finland every 5th year since 1972 and in a third area in southwestern Finland since 1982. The total number of respondents was 33,962. The respondents filled in a questionnaire, followed by a health examination. The subjects were categorized by age, education, and household income., Results: In 1972, one-third of the population reported good health, whereas in 1992 the rates were 50 and 60% for men and women, respectively. Younger persons reported better general health than older persons. High education and high household income were undisputed indicators of good health. Among men, their importance as predictors of good health diminished during the 20 years., Conclusions: Finnish people today not only live longer but also feel healthier. In order to achieve good health for all population groups we need continual efforts to diminish the socioeconomic disparities.

Background: Coronary heart disease mortality has declined in Finland by 55% among men and 68% among women between 1972 and 1992. About three-quarters of this decline has been explained by changes in the main coronary risk factors, the decrease in serum cholesterol being the most important one. The aim of this study was to analyze to what extent dietary changes could explain the change in serum cholesterol., Methods: Cardiovascular risk factor surveys have been carried out in Finland from 1972 to 1992 at 5-year intervals. Dietary surveys were carried out in connection with these surveys in 1982 and 1992. An earlier, representative dietary survey carried out in 1969-1972 was used as the baseline measure for diet., Results: The total fat content of the Finnish diet changed from 38% of energy to 34%, saturated fat from 21 to 16%, and polyunsaturated fat from 3 to 5% and the intake of cholesterol decreased by 16%. Based on Keys equation these changes could have decreased serum cholesterol level by 0.6 mmol/liter (23 mg/dl) in both genders. A shift from boiled to filtered coffee could have further decreased serum cholesterol by 0.3 mmol/liter (11 mg/dl). Thus, these changes together could explain the total change in serum cholesterol, which has been on average 1.0 mmol/liter (38 mg/dl). Several other changes in the diet have also been favorable. Fruit and vegetable consumption has increased two- to three-fold during this time period. Supplementation of fertilizers with selenium since 1985 has tripled the intake of selenium., Conclusions: Dietary changes seem to explain the decrease in serum cholesterol. Together with a decline in smoking among males as well as better blood pressure control they have contributed to the dramatic decline in coronary heart disease mortality in Finland.

The interdependence of the associations of physical activity, smoking, and consumption of alcohol and coffee with serum high-density lipoprotein and non-high-density lipoprotein cholesterol concentrations was studied in 9,347 persons ages 25-64 years from east and southwest Finland. In covariance analyses with corrections for age, body mass index, saturated fat index, and fasting time, the mean adjusted serum high-density lipoprotein to non-high-density lipoprotein cholesterol ratio was high among physically active male non-smokers but not among smokers (P = 0.024 for two-way interaction). The cholesterol ratio was lower among both men (P = 0.010 for two-way interaction) and women (P = 0.030 for two-way interaction) reporting no or very little use of alcohol, and this association was stronger among smokers and women with high coffee consumption (P less than 0.001 for two-way interaction). Our data suggest that the elevating effect of regular physical exercise on serum high-density lipoprotein cholesterol may be absent in smokers, whereas that of alcohol is greater in smokers than nonsmokers. High coffee consumption associates with decreased serum high-density lipoprotein cholesterol levels in smokers but increased levels in non-smokers.

The role of dietary fat in human blood pressure control was studied among 84 middle-aged subjects (mainly couples) in two semirural communities in North Karelia, Finland. The families were randomly allocated into two groups that, after a baseline period of 2 weeks, changed their diet for a 12-week intervention period so that the proportion of energy derived from fats was similarly reduced in both groups, from 38 to 24%, but the polyunsaturated/saturated fatty acid (P/S) ratio was increased--from 0.2 to 0.9 in group I and to 0.4 in group II. After the intervention period, both groups switched back to their usual diet for a period of 5 weeks. During the intervention period, total serum cholesterol was reduced by 16% in group I and 14% in group II. Mean body weight and urinary sodium, potassium, calcium, and magnesium excretion changes were small or nonexistent. Mean systolic blood pressure decreased 4 mm Hg in group I (P less than 0.01) and 3 mm Hg in group II (P less than 0.01), and mean diastolic blood pressure decreased 5 mm Hg (P less than 0.001) and 4 mm Hg (P less than 0.01), respectively. The reductions were reversed during the switch-back period (P less than 0.01). These results confirm previous findings of the blood-pressure-reducing effect of a low-fat/high-P/S diet. Although a number of possible confounding factors can be ruled out, the dietary constituent accounting for the blood pressure change cannot be ascertained definitely. The results showed no significant further blood pressure reduction with more than a moderately increased P/S ratio when the saturated fat intake was markedly reduced.

The North Karelia Youth Project was a 2-year intervention study aimed at preventing cardiovascular diseases risk factors among 13-year-old adolescents at the project's start. It was carried out during the years 1978 to 1980 in the county of North Karelia, Finland. The smoking prevention portion of the program was aimed at teaching children skills necessary to handle the social and psychological pressures associated with starting to smoke. During the 2-year program, 10 sessions were carried out in two schools by the project team and by specially trained peer leaders. In about half of the remaining 22 schools in North Karelia, a five-session program was carried out voluntarily by the teachers. After the program, 20% of the children in the two schools where the direct intervention was carried out reported smoking at least once a month. The same rate also was observed in two matched schools representative of the rest of the schools in North Karelia. In two other matched control schools in another county, 30% of the pupils reported to be smokers by the same criteria. Two years after the program (4 years after the beginning of the program), the reported smoking rates in the different school groups were 27, 26, and 37%, respectively. The results of this pilot study indicate that it is possible to reduce smoking onset by this kind of innovative program and that the beneficial effect can last several years.