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"Some of my colleagues had been here before, so I had good recommendations for the University of Washington, Seattle and the Hutchinson Center," he says. "I think it's wonderful that he's here, and that we can get a perspective on the smoking problem in another country," says Dr. Art Peterson, who heads HSPP. "The area of his research is very interesting and very important. "I think research from around the world has a role to play in helping us gain an understanding of why different people are motivated to smoke." HSPP is nearing the end of an effort to determine if an anti-tobacco curriculum from the elementary to the high-school level can deter children from smoking or using chewing tobacco and Haug praises the work of his new-found colleagues. "I'm very impressed by the group I'm working with," he says. "I think they're doing a very good job, and I think the work they are doing will be a classical study in the future." Working with the Norwegian Cancer Society, Haug has helped organize intervention programs for doctors and midwives to help pregnant women quit smoking. While overall smoking rates for Norwegian women have remained constant over the years, Haug's programs helped reduce the rate of smoking among pregnant women, which has declined to 21 percent in 1996, from 35 percent in 1987. Unfortunately, Haug says, the majority of women who quit smoking while they're pregnant start up again after they give birth. This poses long-term health risks for their children, especially if the mothers breast-feed. A study of 25,000 families showed that six months after giving birth, women who smoked were able to breast-feed only half as often as their non-smoking counterparts. Studies suggest that educational programs should be aimed at discouraging women from smoking while they breast-feed, Haug says. "There is a chain of arguments against smoking from pregnancy until the child has grown up," he says, citing the risks apparent during pregnancy, breast-feeding, and exposure to secondhand smoke. And as the child gets older, the parents serve as a role model. "Research in Norway shows that if both parents are non-smokers and best friends are non-smokers, only 5 percent of children smoke at age 15," he says. Conversely, he says, if both parents and best friends do smoke, a child has a 60 percent chance of being a smoker by age 15. For the past three years, Haug has helped plan a large cohort study called "Better Health for Mother and Child." The National Institute of Public Health in Oslo and the National Birth Registry in Bergen wish to enroll all pregnant women in Norway, a total of some 100,000 women, for the two-year study. A corresponding study organized in Denmark will bring the total number of subjects to 250,000. The comprehensive study will follow women throughout their pregnancies with medical data, blood samples and questionnaires covering a wide range of socioeconomic data, medical histories and other information. Questions will bring out participants' exposure to infections and toxins, use of alcohol, tobacco and drugs, and occupational and environmental factors. The study also will follow the children through school age and beyond. Haug's home base, the University of Bergen, plays a key role in such research, because the National Birth Registry is located there. That makes Bergen the place to be for any research on pregnancies and births, as the registry includes all children born in Norway since 1967 1.6 million in all. "I think Scandinavia has a high responsibility for doing research in this area," Haug says. In some ways, he points out, the region is ideal for epidemiological research. "The population is rather small, 25 million to 30 million, the health care system is well organized, and the population is very homogenous, since most have lived there for generations," he says. The population also is much less mobile than that of the United States, which facilitates follow-up work on long-range studies. "We can plan a study and follow people for generations into the future," Haug says. In some ways, he observes, the United States is ahead of Europe in efforts to combat smoking, especially in making airports and other facilities smoke-free. He also praises U.S. efforts to enforce laws against underage smoking by requiring young people to show proof of their age when buying tobacco. Norway recently raised the legal age for buying tobacco from 16 to 18, he says, but there is no effort to check the IDs of purchasers. And while advertising is widely blamed for hooking young Americans on smoking, Haug notes that Norway has had a total ban on cigarette advertising for many years, and still has a relatively high smoking rate. Tobacco prices that are among the world's highest haven't seemed to affect smoking rates, either, he adds. Smoking is also much more prevalent among European women, he says. Norway ranks behind only Denmark in smoking rates for women, Haug says. What's more, Norway's smoking rate is the same for men and women. But while smoking among men has declined from 50 percent to 33 percent over the past 20 years, the rate for women has stayed constant. Haug says his role as a visiting scholar offers a unique opportunity. "I can see the university system, meet people, discuss problems and learn about their experiences," he says, "and there are marvelous possibilities to sit down and work with your own data no meetings, no telephone." Actually, Haug does have a telephone, and he says he would be happy to talk about his research with interested Center faculty and staff. Contact him first by e-mail. "Perhaps we can develop some common projects in the future because of our common interests," he says. "We can see what works in Norway, what works in the States and what works in both places." | ||||||
