Twenty year smoking trends in a community-based cardiovascular diseases prevention programme - Results from the North Karelia Project

Objectives: to evaluate long-term changes associated with a community-based cardiovascular disease prevention programme on smoking. Methods: the North Karelia project was started in 1972 to carry out a comprehensive community-based programme to reduce the exceptionally high rates of cardiovascular diseases (CVD) in North Karelia, an eastern province in Finland. Among the main intermediate objectives was the reduction of smoking rates, particularly among the male population. The programme was evaluated by standardized examinations of large representative cross-sectional population samples in 1972, 1977, 1982, 1987 and 1992 in North Karelia and in the Kuopio province, another province in eastern Finland, which was initially chosen as reference area for the first project period. Results: in men the percentage of current smokers decreased during the 20 years from 52 to 32% in North Karelia and from 50 to 37% in the initial reference area (p<0.05). Smoking declined faster in the first 10 years (from 1972 to 1982) than in the last 10 years. During the first 10 years the decline was more remarkable in North Karelia than in the reference area. The main reason for the decline in smoking during the first 10 years was smoking cessation and during the last 10 years the increase in the number of people who had never smoked regularly. Among women the proportion of smokers increased in both areas from approximately 10 to approximately 20%. This increase was greatest in the youngest age group. Conclusions: the community-based cardiovascular disease prevention programme was an effective way to reduce smoking in the general population in men and sustained decline could be achieved.