tion
Tobacco products have been in use for a long time but the side effects have been well
known since 1960. The first study British Doctors Study was set up in 1951 and for the
first time the association between smoking and mortality from lung cancer and ischaemic
heart disease was found (1).
The burden of disease caused by tobacco use is 4.9 million deaths a year and is still rising,
a figure expected to rise to 10 million death a year by 2030, 70% of them in developing
countries (2).
For WHOs Europe Region Peto et all. estimated that each year tobacco use is responsible
for more than 1,2 million death and 700 000 of them in the countries of Central and
Eastern Europe (3).
The tobacco use is increasing in the developing countries and among children in the
developed and in the developing countries.
The prevention of diseases associated with tobacco use is one of the priority health issues
of WHO.
Children and Tobacco
One in four of new smokers in the Netherlands were in the youngest age category 15 -19
years (4). Children are a vulnerable group concerning smoking and environmental tobacco
smoke (ETS) exposure. Exposure begins early in life if a parent smokes or if the mother is
exposed to ETS during pregnancy. Childrens exposure to tobacco smoke may cause
growth restriction, many respiratory health problems such as lower respiratory illness,
asthma and reduced lung growth and functioning. The adverse effects may start in
infancy, childhood and adolescence and may persist throughout life (5).
Tobacco use in Slovenia and tobacco legislation
In Slovenia, according to a Public opinion surveys
1
the number of adult smokers are
diminishing from 28,7% to 23,7% (from 34,7 to 22,7% in males and from 28 to 20,1% in
females) from the survey in 1994-98 compared to 1999-2001(6).
Tobacco use among the youth according to the ESPAD data
2
increased from 16% in
1993-96 to 26% in 1997-2001 (in boys 16 to 25% and in girls 17 to 26%) (7).
Modern and restrictive legislation on Tobacco Use has been introduced in Slovenia in
1996: ban on tobacco vending machine, ban on tobacco advertising, ban on sponsorship
by tobacco industry, health warnings on packets of tobacco products, prohibition of sale
Data for 1994: no definition or age group available Source: Public opinion survey
Data for 2001: definition daily smokers; age: 2564 years Source: Zakotnik-Mavcec, J. et al. Public opinion survey
2
Data for 1995: definition: lifetime use of cigarettes 40 times and more, age group: 15-16 years Source: The 1995 ESPAD
Report Stockholm. The Swedish Council for Information on Alcohol and Other Drugs (CAN), 1997. http:/www.can.se
Data for 1999: definition: lifetime use of cigarettes 40 times and more, age group: 15-16 years Source: The 1999 ESPAD
Report Stockholm. The Swedish Council for Information on Alcohol and Other Drugs (CAN), 2000. http://www.can.se
1 of tobacco products to persons under the age of 15, smoking restriction in public places
and workplaces (8)
GYTS- goals and objective
In 1999 the WHO in collaboration with US Centers for Disease Control and Prevention
and UNICEF, began a project called the Global Youth Tobacco Survey (GYTS) to
enhance tobacco surveillance related to young people in a global level.
The Ministry of Health of Republic Slovenia conducted the GYTS since there were no
accurate or representative data on the prevalence of smoking among children and youth.
The GYTS provides a mechanism by which countries can monitor tobacco use among
young people and guide the implementation and evaluation of tobacco prevention and
control programs.
The goals of GYTS, school-based tobacco survey focusing on adolescent age 13-15, are
to:

determinate the level of smoking cigarettes and other tobacco products in
schoolchildren,

estimate the age of initiation of cigarette use

estimate the smoking cessation desire

estimate schoolchildren exposure to environmental tobacco smoke (ETC),

estimate knowledge of schoolchildren towards cigarette smoking

estimate the role of media and advertising,

estimate access to cigarettes and other tobacco products.
Methods
Sample description and study design
GYTS Slovenia 2003 is a school-based cross sectional survey. Data about schools and
number of students by grade were obtained from Ministry of Education, Science and
Sport. In Slovenia 448 primary schools containing 7
th
grade and 8
th
grade and 150
secondary schools 1
st
grade that contained 40 or more students were included in the
sample frame.
A two-stage cluster sample design was used to produce a representative sample of
students.
Schools were grouped in three strata
1) Schools in Capital town of Ljubljana
2) Schools in West regions of Slovenia (obalno-kraka, severno-primorska, gorenjska,
krako -notranjska and ljubljanska without schools in capitol city of Ljubljana and
zasavsko-revirska)
3) Schools in East regions of Slovenia (dolenjska, celjska, koroka, mariborska,
pomurska and posavska).
In the first stage schools were selected with probability proportional to school enrollment
size. In total, 60 school were selected, 20 from each strata.
The second sampling stage consisted of a systematic equal probability sample, with the
random start, of classes from each school that participated in the survey. All students in
the selected classes were eligible to participate.
The questionnaire
The questionnaire consisted of the «Core European questionnaire GYTS and contained
90 multiple-choice questions and was translated to Slovene language. Questionnaire gathered data on the following topics:

prevalence of smoking cigarettes and other tobacco products

environmental tobacco smoke (ETC)

cessation of cigarette smoking

access to cigarettes and other tobacco products

knowledge and attitudes of young people towards cigarette smoking

tobacco related school curriculum

role of media and advertising on young peoples of cigarettes
Data Collection
A letter of invitation was sent to headmaster of each selected school inviting them to
participate in the survey. Childrens parents in the selected classes were informed by letter
and were asked to allow their child to participate in the survey. Survey procedures were
designed to protect the students privacy by allowing for anonymous and voluntary
participation. The trained field staff (1 school doctor, 6 school nurses, one health worker
and three students) administrated the questionnaire in the classroom. Students recorded
their responses directly on an answer sheet that could be scanned by a computer.
Analysis
A weighting factor was applied to each student record to adjust for non-response and for
the varying probabilities of selection. SUDAAN and EpiInfo were used to compute
weighted estimates and 95% confidence intervals for the estimates. Statistical differences
included in this report were determined by comparing the range of the 95% confidence
intervals for the estimates. If the range for the 95%CI did not overlap then the difference
was statistically significant.
Ethical Approval
Ethical commission of Ministry of Health of Republic Slovenia approved the GYTS
survey in Slovenia.
Results
Response rate
For the GYTS Slovenia 2003, 4727 questionnaires were completed in 57 schools. For
schools overall response was 95,0% (57 of the 60 sampled schools participated) and for
students 89,1% (4727 of the 5307 sampled students completed usable questionnaires).
Overall response rate was 84,6 %.
Prevalence
Almost two-third (66,4%) of students had ever smoked cigarettes, and 26,2% initiated
smoke before age 10 (TABLE 1A). Boys significantly more likely initiate to smoke than
girls before age of 10.
Almost three in ten students currently smoke cigarettes (28,5%). Over one-fifth (21,2%)
of current smokers used hand-rolled cigarettes, with boys significantly more likely than
girls smoke hand-rolled cigarettes. Over 90% of current smokers used manufactured
cigarettes.