BACKGROUND: There is a consensus among the international community about the importance of
clarifying the meaning of “nursing” since it is believed that it influences the practice of nursing
and its social status in different countries. AIMS: To explore the concept of nursing in Greece through the perceived meaning of the word “nursing” among nurses and nursing students and to form a definition of the term “nursing”. METHODOLOGY: Five focus groups were conducted, in Athens, Thessaloniki, and in smaller
cities situated in rural regions of Northern and Western Greece. Each discussion lasted from 90 to
120 minutes; they were carried out in Greek language and were all audio-taped. At the
beginning of each focus-group discussion, the researcher explained the purpose of the study and
the voluntary nature of participation. Data were analysed using content analysis. RESULTS: The majority of the participants were female (n=29, 85.29%), married (n=23, 67.65%), mean age 32.12 ± 11.9 (min 18, max 55). Five categories were emerged from the data analysis:1) The practice of nursing, 2) Nursing as a profession or as a service, 3) Nursing as a branch of medicine, 4) Nursing as a science and an art, and 5) The social status of nursing. The deriving definition of nursing is: Nursing is a science and an art, a profession of relatively low social status and a service to the society. Nursing is the provision of care to patients with the aim of treatment and rehabilitation as well as, to families and populations. Nursing also
includes psychological support, prevention, and health promotion.
Background. Low-frequency (LF) oscillations in heart rate (HR) are largely an index of baroreflex gain. Controlled 0.1 Hz breathing maybe used as input stimuli for study of this resonance phenomenon in LF oscillations in HR. The aim of this study was the investigation of the dynamic characteristics of LF oscillations in the heart rate (HR) of chronic heart failure (CHF) patients during bicycle exercise (BE) tests, under 0.1 Hz controlled breathing. Methods. Forty five male patients aged 50±3 years with left ventricle ejection fraction (EF) <50% and 35 male patients aged 52±6 years with EF>50% participated in the study. BE tests were performed for all participants. Five-minute recording of R-R intervals was performed first in sedentary posture and in 25 W load stage of BE test. The frequency estimates of heart ratevariability in LF spectrum bands were obtained. Results. Under the load rising till 25 W in CHF patients with EF<50%, consequent depression of LF band power was observed 2-3 times in comparison with the relaxed condition. There was no similar significant expressed dynamic in the group with EF>50%. Conclusions. The stability of LF oscillations in HR to low-intensity loads depends from the severity of myocardial contractility damage. The power dynamic of 0.1 Hz component of the heart rate variability spectrum may be considered an independent index of dynamic stability of the heart autonomic control in CHF patients.
Objective: The aim of this work, and under the context of the GREECS study, was to evaluate the association between sweets consumption and the 10 year (2004-2014) incidence of Acute Coronary Syndrome (ACS), among cardiac patients. Methods: From October 2003 to September 2004, 2,172 ACS consecutive patients from 6 major Greek hospitals were enrolled; during 2013-2014, the 10-year follow-up was performed in 1,918 patients (88% participation rate); development of fatal or non-fatal ACS was the outcome of interest and recorded through medical records or registries. Among others, sweets (i.e., cakes, chocolate, traditional pastries, Lenten sweets, pies and other common Greek sweet treats) consumption at baseline examination was assessed using a semi-quantitative food frequency questionnaire. Results: A positive association was observed between sweets consumption (at least one portion per week vs. other) and ACS incidence after taking into account various potential confounders, including diabetes mellitus and obesity [OR=1.23, 95% CI (0.99, 1.53) p=0.060]. However, after stratified the analysis by education status (i.e., ≤ 9 vs. >9 years of school) the above association remained significant only among patients with higher educational status [OR=1.50, 95%CI (0.93, 2.40), p=0.095]; moreover, no significant interaction effect was observed between patients’ financial status and sweets consumption, on the tested outcome (p for interaction =0.56). Conclusion: Moderation or even avoidance of sweets consumption, in the context of healthier dietary habits, seems to be of high importance to reduce the risk of re-current cardiac events and improve disease prognosis among cardiac patients.
Background: Improving HIV disclosure status is significant for reducing HIV prevalent by promoting safer sexual practices, PMTCT, better treatment retention, partner testing and partners to make informed reproductive health choices.
Objective: To explore HIV disclosure and associated factors among reproductive age women in health facilities of Jimma Town.
Methods: Conducting a facility based cross-sectional design at three health facilities of Jimma town among women on ART from March 5-April 1, 2017. Finally, 338 women were selected by using systematic random sampling technique and interviewed with interviewer administered questionnaire. Epi data version 3.1 was used to enter data then transferred to SPSS to version 20 for analysis of explanatory variables.
Results: Out of 337 women responded to the questionnaire, ever disclosure of women to someone was only 290 (86.1%). Still, 47 (13.9%) of them did not disclose. Having free discussion on safer sex [AOR=6.621, 95% CI (1.719-25.498)], being peer counselor [AOR=3.624, 95% CI (1.049-12.522)], being member’s anti-HIV association [AOR=3.171; 95% CI (1.183-8.501)] and being on ART [AOR=4.559, 95% CI (1.586-13.103)] were predictors of HIV disclosure.
Conclusion: The overall magnitude of HIV disclosure was relatively good but nondisclosure is still high in this study. This will be a great fear on HIV transmission. This will continue as major public health burdens in the districts unless future interventions focuses on the factors that enhance disclosure through peer counselor, free discussion, members of anti-HIV association and on ART.
Keywords: Disclosure; HIV; Reproductive women age; Determinants
Introduction: Coronary artery bypass grafting is one of the primary treatment for coronary artery disease and is referred as one of the most common surgical procedure. This surgery has an impact on quality of life. Factors that affected it in patients underwent this kind of surgery are psychosocial, demographic factors and patient related characteristics. Purpose: The aim of the present study was to investigate the quality of life of patients underwent coronary artery bypass graft after six months of it and to determine the factors influencing the quality of life of these patients. Material-Method: The sample was convenience and consisted of 84 patients underwent coronary artery bypass grafting surgery before six months in one hospital of a major city in Northern Greece. Data were collected with a questionnaire that included the SF-36 and socio-demographic characteristics. Data analysis was performed with the Statistical Package SPSS vers.15. Results: The sample was predominately male (n= 61, 72, 6%) and a high percentage of them is above 50 years (85, 7%). The domains of quality of life that have higher means are: role emotional (68, 25 ± 40, 71), role physical (55 ± 33, 13), vitality (53, 99 ± 20, 97) and social functioning (45, 09 ± 22, 71). Some of the factors that are significantly correlated with various domains of quality of life were patients’ sex, nationality, occupational status smoking, family status, educational status and comorbities. Conclusions: The main domains of quality of life that affected are physical functioning, bodily pain, social functioning and mental health, so health care professionals have to plan interventions to improve it.
Background: Oral health-related illness is among serious public-health problems and the fourth most expensive diseases to treat in developing country. According to WHO estimates in Ethiopia 71% of the population are affected by oral health-related illness. Although oral health-related illness is affecting the majority of Ethiopian, much is not known about the extents and the factors influencing the occurrence of oral health-related illnesses; oral care practices and health care seeking behaviors.
Objective: To determine the magnitude of oral health-related illness and its associated factors among Bank employees and Teachers in Addis Ababa, Ethiopia.
Methods: Data collected for Non-Communicable Diseases Survey among Bank employees and Teacher in Addis Ababa was used for this study. After carefully cleaning for completeness of data, 2144 study participants were considered for the study. The data were analyzed using SPSS version 20.0.
Results: The magnitude of oral health-related illness among study participants was 16.40%. Age (i.e., 55 years and older) (AOR=1.70; 95% CI: 1.01–2.87), workplace (Commercial Bank of Ethiopia) (AOR= 1.46; 95% CI: 1.07– 2.01), poor/fair general health condition (AOR=1.31; 95% CI: 1.01–1.67) and Mental Distress (AOR=1.47; 95% CI: 1.03–2.10) were determined as associated factors for Oral health-related illness.
Conclusion: Magnitude of self-reported oral health-related illness among the study participants was 16.40%. And the factors associated with oral health-related illness were age, workplace, general health illness and Mental Distress. This finding was relatively similar and comparable to other studies conducted in other places and still remained a public health important issue.
Keywords: Oral health-related illness; Cross-sectional study; Bank workers
Background: Students in Ghana and other developing countries remain the major vulnerable group most likely to have abortions and suffer abortion stigma. However there is a dearth of empirical information on the experiences of Higher Education students on abortion needed for evidence based policies and interventions.
Background: flow cytometry is a technique of quantitative single cell analysis. It can process measurements on thousands cells in a few seconds. Since different cell types can be distinguished by quantization structural features, flow cytometry can be used to count cells of different types in a mixture. Cord blood samples, has posed additional challenges over the years particularly due to the presence of varying number of nucleated red blood cells (RBC) and the extended age of the samples at the time of CD34+ cells enumeration. Method: the aim in our study was to prove that time has no effect in CD34+ cells storage, efficacy and viability using flow cytometry as a quantitative single cell analysis. To enhance further our study, post-freeze white blood cells (WBC) counts from an automated haematology analyzer were compared with WBC derived after cytometric analysis. Results: four-thousands cord blood samples were analyzed for absolute viable CD34+ cells, WBC and their viability. Viable CD34+ cells were enumerated using single platform flow cytometry and the molecular exclusion dye 7-amino actinomycin D (7- AAD). Conclusion: cryopreservation and processing of autologous stem cells collection, assessing CD34+ cell viability and absolute counts, found to remain the same during periods of time. Measuring CD34 +cell viability allows us the quality of control assessments of stem cells processing.
Background: Drug addiction during pregnancy and postpartum period is undoubtedly connected to maternal and fetal morbidity. Accordingly, there is a great need of proper approach, support and health care provision of addicted women during this special phase of their lives. Aim: The aim of this review was to explore evidence based practices for caring for substance abuse pregnant women by midwife. Methods: A thorough literature research was performed in different nursing and medical databases such as Medline, Embase, Cinahl and Cochran Library, using relevant with this review keywords. Results: Motherhood concerns health professionals of various specialities, who require special training and studies regarding drug addiction and its consequences for the mother-to-be as well as the fetus. A sufficient supporting network aiming to addicted women's care and treatment throughout pregnancy and postpartum period can be created only with the state's contribution. Conclusion: The creation of sufficiently organized health care centers, which are made especially for addicted pregnant women's support and are staffed with interdisciplinary teams, is more than necessary.
Background: Studies and surveys show that sexual abuse and exploitation of children is becoming bigger, and now there is not a problem involving only developing countries in Asia and Africa. The phenomenon of sexual abuse and exploitation of children is a very old global phenomenon that is perpetuated. Nurses, in cooperation with a multidisciplinary team, can provide important services to children who are victims of sexual abuse. Aim: The presentation based on international literature review, of the role of nurses in child sexual abuse in USA. Material and Methods: Method was used is to search electronic databases (MEDLINE, CINAHL) for a review of international literature until 2009 and became selection of books, articles and studies from libraries. Results: Nurses meet abused children and their families in emergency departments, urgent care centers, clinics and offices. Nurses can play a vital role in helping these children and their families by activating a team of people who will respond to the child's disclosure. The most important role for a nurse is to ensure the health and safety of the child. At times, nurse with proper training can also collect and preserve forensic evidence. Conclusion: Nurse can play a very important role in the health and welfare of children who have experienced sexual abuse. All cases of suspected child abuse should be reported to the appropriate authorities.
Introduction: Adolescent sexual abuse is one of the major problems of adolescent that affect their health and security. Specifically, as various (regional, national and global) studies indicate the prevalence of the problem in primary and secondary school environment as caused by different individual and contextual factors. But due to different reasons in Limmu Genet high school the problem of adolescent sexual abuse specifically its prevalence, type and determinant factors are not yet well stated and studied. Objective: The main objective of this study is to explore the prevalence, type and identify major determinant factors associated with adolescent sexual abuse of students in Limmu Genet high school. Methodology: The study was conducted and a quantitative research method was used to collect data about the prevalence, type and major factors associated with adolescent sexual abuse from 354 randomly selected high school students in Limmu Genet high school by sampling procedure in the school compound. The data collection was done by self-administered questionnaire that was analyzed with descriptive and explanatory statistics. Results: The result of this study revealed that sexual abuse is prevalent in the study area in the form of exposing adolescent to verbal sexual advances (32.4%) kissing adolescent in a socially unacceptable manner (29.1%), the combination of touching and fondling adolescent sexually (25.9%), making adolescent to look at somebody's genitals (22.7%), forcing to expose their genitals (18.3%) and other forms like discussing about sexual practices (16.5%). Conclusion: In conclusion, the result of this study revealed that the problem is prevalent (34.9%) in Limmu Genet high school. Also Marital status and monthly family income, factors associated with sexual abuse like alcohol drinking and chewing chat have statistically significance with sexual abuse (P<0.05). Recommendation: As a result of the abuse students may become emotionally disturbed, absence/shortage of education, etc. Therefore, measures should be taken against the abusers, by counseling services, gender club, student maladaptive behavior and others by school teachers.
Sexual; Violence; Factor; Student
Background: Vaginal microbicides, is a potentially important toolkit to stem the tide of sexually transmitted infection including HIV/AIDS globally. It is being presented as a female-initiated prevention method. Although it is still undergoing clinical trials, an acceptability research is critical in its developmental process. Aim:This study was conducted to determine the willingness to accept vaginal microbicides amongst students of the University of Ilorin. Material and Method: A descriptive cross sectional study in which multi-stage sampling technique was used to select respondents. Self-administered questionnaire was used as data collection instrument amongst 400 respondents that were recruited into the study. Results: About 232 (60%) of the respondents indicated interest in the use vaginal microbicides amongst which 104 (66%) perceived that it could be used without their partner's knowledge while 209 (64%) felt it would help women be in control of protecting themselves. Factors identified to influence the interest and acceptability of vaginal microbicides include the past use of a protective measure during sexual activity 82 (77.4%), if the cost of vaginal microbicides is similar to that of condoms' 168 (83%) and its availability over the counter 84 (87%). Conclusions: The study observed an above average willingness to accept and use vaginal microbicides and the factors that influenced its acceptability and use amongst students of University of Ilorin are affordable costs and availability.
Background: The hazards to which are exposed the labor force in the restaurant sector vary since they are performing different types of work. Aim: The aim of this study is to estimate the prevalence of occupational accidents in restaurants of the Piraeus municipality of Attica and to investigate risk factors to being injured. Method and material: For collecting data, a questionnaire for demographic, health and work environment data was used. Our sample consisted of 180 randomly selected current workers in the restaurants of the Piraeus municipality. Pre-testing was carried out on 20 subjects to screen for potential problems in the questionnaire. Univariate and multivariate logistic models have been used to investigate the covariates of occupational accident occurrence. Results: Among current workers, 44.3% reported injuries in their current job. Risk factors for work injuries with statistically significant odds ratio >2.0 included having conflicts with supervisors/colleagues, permanent stress and body pains, being kitchen staff, as well as lifting heavy loads. Results showed that psychosocial, health and physical working environment factors constitute strong predictors of the prevalence of work accidents. Conclusions: A useful measure would be the draft of guidelines addressed to enterprises as to the way they should handle health and safety at work issues.
Accountability and collaborative care are two meanings often mentioned in the health professionals' code of practice. Aim: The aim of the present literature review was to explore the meaning of accountability, collaboration and collaborative care. Method and Material: Pubmed and Scholar Google were searched for relevant studies by using the words "accountability", "collaborative care" and "midwifery" as key words, as well as the South Bank University Library for relevant books. Results: The research revealed 21 studies, mainly British and American. Five studies were referring to the contemporary situation in midwifery practice, seven of them were exploring how accountability obliges health professionals to work collaboratively with other professionals and nine of them were seeking how interprofessional education promotes collaborative care. Conclusions: Health professionals have to work in a collaborative manner not only with other professionals, but also with patients and their families, while interprofessional education plays a significant role in the formation of an effective team.
Background: Globally, more than 40% of all under-five child deaths occur during the neonatal period. Neonatal mortality in Nepal is 33 per 1,000 live births, eight times that of developed regions. So there is an urgent need for neonatal care to prevent these deaths, in order to achieve the fourth Millennium Development Goal by 2015. Objective: The objective of this article was to review the major challenges in improving neonatal health in Nepal and to identify possible keys to achieving Millennium Development Goal 4. Methodology: Key literature searches were conducted of electronic databases and relevant web-sites. Furthermore, personal contact with the local population in Nepal and hand searching of key journals was performed. Results: In Nepal, there exist harmful cultural practices during pregnancy and after childbirth. Under utilization of basic maternal and neonatal healthcare, limited health infrastructure with a shortage of trained health care professionals, poverty, illiteracy, women's low status in the society and political instability are major challenges facing neonatal health in Nepal. Conclusions: In order to improve neonatal health in Nepal, it is imperative to focus on biomedical, nursing and social interventions, in addition to family centred care. Health promotion regarding the practices to be adopted during pregnancy and after childbirth, improving health infrastructure and integrating skilled delivery personnel into local health services are important measures. Longer-term solutions could include: improving mother's nutrition and women's position in society, increasing the proportions of girls attending school, as well as involving men in neonatal health matters.
Background: The incidence density, the risk factors and the attributable mortality of carbapenem-resistant Acinetobacter baumannii (CR-AB) infections are rarely investigated. Aim: The aim of the present study was to determine the risk factors for CR-AB infection and to investigate whether CR-AB infection significantly increases the 28-day ICU mortality rate. Methods: A matched case-control study was conducted at the Medical/Surgical intensive care unit (ICU) of "SOTIRIA" general hospital in Athens, Greece from January 2009 to March 2010. Out of 156 ICU-admitted patients, 50 case-control pairs were selected. Cases were patients who acquired microbiologically documented CR-AB infection, while control patients without A. baumannii infection and were matched to the cases on APACHE II score, age, and length of ICU stay. Results: The incidence density of CR-AB infections was 16.8 /1000 ICU days. Multivariate conditional logistic regression analysis showed that the previous exposure to more than three different antibiotic classes was the only independent risk factor for the development of CR-AB (OR=34.0, 95% CI=2.22-522, P=0.01). The 28-day ICU mortality rates for cases and controls were 54% and 52%, respectively. Thus, the crude attributable mortality for CR-AB infections was 0.02 (95% CI=-0.18-0.22, P=0.84). Multivariate logistic regression analysis showed that CR-AB infection was not an independent predictor for 28-day ICU mortality rate (OR=1.40, 95% CI=0.46-4.22,P=0.55). Conclusions: Previous exposure to more than three different antibiotic classes was independently and significantly associated with the development of CR-AB. CR-AB infection was not associated with 28-day ICU mortality.
Introduction: ICU acquired weakness(ICUAW) is a common complication of critical illness presenting with muscle weakness. The aim of the present study was the assessment of muscle strength and functional ability after ICU discharge. Methods: 37 consecutive critically ill patients were evaluated(28M, 9F). ICUAW was diagnosed clinically at ICU discharge with the medical research council (MRC) scale for muscle strength by two independent investigators (cut off <48/60). The patients were evaluated with MRC and Hand-Grip dynamometry (HG) every 10 days until their discharge from the hospital. The functional ability was assessed with the Functional Independence Measure (FIM) score at ICU discharge and after 8 months in a subgroup of patients. Results: 37 patients were evaluated (n=13 with ICUAW). Patients with ICUAW had a longer ICU and Hospital stay (26 vs 11, 28 vs 13 days). Patients with ICUAW had lower MRC (34±8 vs 56±3) score and HG (9 vs 23 kg) at ICU discharge and 10 days after ICU discharge (41±11 vs 57±3, 6 vs 12 kg). The FIM score improved significantly 8 months after hospital discharge. Conclusions: Patients with ICUAW had significantly longer ICU and hospital stay. They also had significantly lower muscle strength at their discharge from the ICU which remained compromised during hospital stay. The functional ability as assessed with the FIM score improved after 8 months. It seems that the development ICUAW affects the mobility of the patients, even after their discharge from the ICU, with negative impact to their functionality and the duration of their hospitalization.
Background: Traditional Medicine remains widespread in developing countries, while use of complementary and alternative medicine is increasing rapidly in developed countries. Nowadays, there is an explosion of various forms of traditional healing that seem to meet an increasing favour on the part of the population in Europe. In Greece, there is little information gathered around traditional medicine, and is mostly related to herbs. Aim: The research aimed at developing a Virtual Platform and a Thematic Network to facilitate share and exchange of information using the new opportunities offered by the Information and Communication Technologies (ICTs) in order to carry out historical-ethnographic study on traditional medicine in the Euro-Asian countries. The current paper focuses on the Greek findings. Method and Material: The research conducted in Greece, Italy, Nepal, Thailand, India and Philippines. Target groups include primarily the general population, elderly and young people, men and women, traditional healers and Primary Health Care doctors. Activities include a number of surveys and quali/quantitative investigations at community level on population beliefs of the causes of the most common illnesses/symptoms and on their choices of popular remedies to improve their conditions. Results: The paper presents the Greek findings, after a 2.5 years study, on traditional medicine using the developed Virtual Platform and Thematic Network as well as the usefulness of Information and Communication Technologies (ICTs) in the specific sector and for the specific target groups. Five main symptoms were examined (spontaneous abortion, fever, diarrhea, headache and joint pains) and the respondents' answers (traditional healers, primary health care doctors and general population) are analyzed. Conclusions: In conclusion, TM exists in regional Greece without being documented properly and gradually vanishes. Thus, more efforts are needed to preserve the heritage of TM in Greece. The ICTs proved to play a key role in the success of the dissemination of the acquired knowledge between all interesting parties.
Introduction: This paper outlines a European collaborative research Project between the Nursing Departments of Bournemouth University, of Technological Educational Institute of Athens and of Technological Educational Institute of Crete, which explores the changes that Greek people with HIV experience in their life after diagnosis of HIV. It further attempts to identify how they adapt to those changes and what might help this process. The research network also involves “Andreas Syggros” Hospital of Athens. Aim: The aim of this research Project is to explore the lived experience of adaptation for Greek individuals who have been diagnosed as having HIV. Method: A qualitative interpretative phenomenological research design will be used to interpret experiences as described by the participants, and will also guide data collection and data analysis. Local procedures for gaining ethical approval will be followed. Expected Results and Conclusion: The findings of the study will be used to test and strengthen the Perrett and Biley Negotiating Uncertainty Theory (PB-NUT) and to improve services ensuring they are patient-focused and therefore cost-effective. The Project will also present a theoretical understanding of adaptation to HIV that may assist health professionals in caring effectively for those with HIV and possibly other long term conditions. Finally, the Project will provide an opportunity to develop a solid research network among European and Greek Academic Institutions, regarding HIV and AIDS, with useful results for practice and policy.
Background: High-risk intravenous injection errors are fatal to patients and bring great harm. Thus, it is of vital importance to identify the causes of such errors and establish a preventive system and safety culture among the health care professionals to prevent systematic injection errors in the hospital. Objective:The purpose of the present study was to identify the causes of and problems associated with high-risk intravenous injection errors from the perspective ofhealthcare providers. Methods and Material:A focus-group interview was carried out with 13 health care professionals (7 nurses, 3 doctors, 3 pharmacists) who work at a university hospital in Daejeon City and have work experience in and knowledge of high-risk intravenous injection. Results: Three causal categories responsible for errors emerged: human-related, injection procedure-related, and environmental factors. Specifically, lack of knowledge and awareness of high-risk medications, carelessness in controlling the speed and drip of fluids, injecting the wrong fluid, unclear verbal prescriptions from doctors, inappropriate medication management, a shortage of medicators, and a lack of injection experience were identified as the most common problems responsible for nurses' errors when administering high-risk intravenous injections. Conclusion: Our results may serve as baseline data for establishing a safety culture around high-risk intravenous injection administration.
Introduction: Intravenous administration of metallic mercury (Hg) is a rare occurance that is usually reported in association with suicide attempts, with accidental injection, and with attempt of drug addicts to develope new ways to become intoxicated.
Introduction: Adolescence presents a range of physical, mental, psychosexual and social changes. Teenagers influenced by endogenous or exogenous psychosocial factors, resort to using hard drugs or other addictive substances. The nicotine intake of cigarettes is the most common form of addictive substance among teenagers. Material and Method: The sample of the study consisted of high school students aged 13-18 years old, from two cities of central Greece (Lamia-Larisa). Data were collected during the period 01/10/2011-25/02/2012. The questionnaire includes questions on the demographic data of participants and their smoking habits as well as 20 questions relating to social influence, as expressed through and shaped by the social environment and the media. Results: From data analysis the frequency of smoking was 19.2%.The regular smoking of the sample was 10%. The friends of students who smoke are mostly girls (22%) with the percentage of boys standing at 2.6%. The Pearson correlation between the number of cigarettes and number of friends who smoke tested positive for both boys and girls. Conclusion: In conclusion the social influence of tobacco, emerging as one of the most decisive factors promoting smoking activity. The study results indicate that a careful design and a comprehensive smoking policy (and not simply informing young people) about the dangers of smoking are needed.