Launched in 1972 in North Karelia, Finland, this community-based anti-smoking programme sought to reduce smoking rates, especially among the male population, which had much higher cardiovascular disease (CVD) and smoking rates than the female population. Created by the government of Finland in cooperation with the World Health Organization (WHO), the project revolved around health education activities in the form of increased health information, persuasive messages, provision of social support, and certain environmental modifications. For instance, local authorities and civic organisations were asked to promote no-smoking areas in their facilities. Local physicians and nurses were asked to inquire about smoking and to give advice to their patients about cessation. Specific smoking cessation courses were organised. Printed information on smoking was included in patient cards and files. A network of lay leaders was established and trained to support the community activities.
The programme was evaluated by standardised examination of large representative cross-sectional population samples in 1972, 1977, and 1982, in North Karelia and in a matched reference area.
During the initial 5-year project period, 39 seminars were arranged for the training of local health personnel in various health education skills. Also, local newspapers published about 250 articles on smoking. The local radio station broadcast the project's specific non-smoking messages. During the same period, 45,000 anti-smoking leaflets were distributed in addition to other anti-smoking materials, including 150,000 copies of signs and stickers with the message, "Do not smoke here - we are in the North Karelia Project."
The proportion of current smokers among 30- to 59-year-old men in North Karelia decreased from 52% in 1972 to 44% in 1977, and to 38% in 1982. In the reference area the respective smoking rates were 50, 45 and 45%. About 27% of male smokers in North Karelia stopped smoking during the project period, while in the reference area the proportion was 10% (P<0.001). Among women the initially low smoking rates increased in both areas by 7% - due to new birth cohorts with higher smoking rates entering the age group of the study. At the same time, the prevalence of ex-smokers among women increased markedly, especially among the younger females. The net reduction in North Karelia in the mean amount of daily smoking (per inhabitant) among men was 28% (P<0.001) and in women 14% (not significant, or n.s.). Serum Thiocyanate was used to validate the self-reports of smoking. In 1982 the mean was among men 71 µmol/L in North Karelia and 81 µmol/L in the reference area (:<0.001) and among women 55 and 58 (n.s.), respectively.
"Community-based Strategies to Fight Smoking: Experiences from the North Karelia Project in Finland", by Pekka Puska and Kaj Koskela. In The Cigarette Underworld, ed. Alan Blum. New Jersey: Lyle Stuart Inc., pp. 95-98; and "Ten-year Results of a Community-based Anti-smoking Program (as Part of the North Karelia Project in Finland)", by Erkki Vartiainen, Pekka Puska, Kaj Koskela1, Aulikki Nissinen and Jaakko Toumilehto. Health Education Research, Vol. 1, No. 3, 175-184, 1986.
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