Authors place of work:
Masarykova univerzita v Brně, Lékařský fakulta, Ústav preventivního lékařství a Výzkumné pracoviště preventivní a sociální pediatrie
Published in the journal:
Čas. Lék. čes. 2010; 149: 591-597
Theoretical background: The goal of this work is to assess various factors of young men’s lives among smokers and non-smokers. A sample of young men, volunteers, conscripts (servicemen) at that time, was studied within the presented work.
Methods: A questionnaire – screening protocol – was filled in by 104 young men, 83 of them subsequently underwent a clinical examination. The participants expressed their interest in the research and the chosen form of primary prevention during directed talks; 64 participants took part in these talks.
Results: The analysis of the results showed that more than a half of young men smoke. There was a strong statistically significant association between smoking and incomplete households. 39.5 % of the research sample was addicted to nicotine. Smokers consume more coffee and those who smoke also drink more alcoholic beverages. Highly statistically significant association was demonstrated between smoking and especially wine-drinking, while a statistically significant association was also proven between smoking and drinking beer and liquors. It was also verified that smokers drink larger quantities of alcoholic beverages and inebriate more often. Greater use of marijuana and hashish along with using drugs even in the military was proven in smokers.
No link was discovered between smoking and BMI, but it was demonstrated that smokers have an average amount of physical activity and their weekly frequency of physical activity is lower than in non-smokers.
A strongly statistically significant association between smoking and lower age of first sexual intercourse and the number of sexual partners (smokers had 5.69 partners, non-smokers 3.29 partners on average).
Conclusions: Smoking significantly affects the lifestyle of an individual in all aspects of life and lifestyle. The chosen method of work including the assessment and the possibility of making use of primary prevention should be reproducible and usable for a wide range of our young population.
Keywords: young men, lifestyle, primary prevention, smoking
The state of health of a
population can be monitored and evaluated for various purposes. This
paper is focused on verifying and obtaining deeper knowledge in terms
of interrelationship among the health state, life conditions and
lifestyle of young men. Many people, especially young population, are
not aware of or disparage the impact of smoking, life conditions,
eating habits and other factors on their health. On a selected group
of young men, this paper presents an evaluation of many negative
factors and their significant influence on health, which is primarily
focused on the lifestyle of young male generation and its care of
The health state can be
monitored and evaluated by a plethora of methods. Many studies (1-9)
advert to frequent negative influences (e.g. smoking, drinking
alcohol, eating habits, lack of exercises) that are considerably
related to the lifestyle of young generation. Even though they are
supplied with relatively sufficient and available information, young
people mostly need clear recommendations and advice, which would in a
simple manner summarize and sort out this information and provide
them with guidance for using it in their life.
Primary care plays a key
and irreplaceable role in the health care system.
Prevalence of selected health indicators was
found in a group of Czech young men. Our measurement is based on
individual anamnestic and clinical examinations of volunteers –
military conscripts. The method applied for this analysis is
descriptive epidemiological study with use of anamnestic and simple
This study is based on the research sample of 104
young volunteers - male military conscripts
at that time. Their selection was carried out with respect to
organizational capabilities and specific methods. The following
aspects were taken into consideration: military conscripts
(hereinafter referred to as MC) are young men from the whole
territory of the Czech Republic (which enables us to obtain the
population sample of the entire country), their military service
takes place at one unit and one location so as to minimize research
costs. The study was implemented among the volunteering servicemen,
as a part of their instruction on preventing undesirable social,
health care and pathological phenomena. Voluntary participation and
cooperation can also be obtained and respected at present.
Military service is physically and mentally
challenging, therefore it requires a good physical and mental state.
Within their recruitment process, all young
men had to undergo medical examinations evaluated by a commission,
which led to the assumption that only young healthy men were drafted
to the Armed Forces.
The study is based on 1) the questionnaire
(Preventive Examination Report) and 2) clinical examination itself,
including the report that was elaborated with respect to the
monitored signs, causes and relations.
The questionnaire (Preventive Examination Report)
consisted of 71 questions and was subdivided by our individual
research interests into the following parts: personal data, family
information, family medical history, lifestyle, personal medical
history, eating habits, sex life, psychical state and experiences.
Lessons learned from similar studies, our
practical experience and set research goals were used as ground
materials for elaborating the questionnaire (10-16).
Prior to starting the examination, the needed amounts of
questionnaires, instruction sheets, statements on approval and record
sheets had been prepared. Examinations took place in study rooms of
the military unit within three days.
At the beginning, the purpose of this study was
explained to the participating volunteers chosen from military
conscripts. Before commencing the
examination, all MCs received oral introductory instruction to be
followed by administering the statements on approval for reading and
filling out, on the basis of which the cooperation with volunteers
could continue. The questionnaire record sheets were handed out,
followed by the filling out of the questionnaire (anonymous and in
word formulations) - each participant could ask questions anytime
about unclear items. Examinations were connected with filling out the
questionnaire, which means that those who filled out the
questionnaire underwent voluntarily the clinical examination on the
As regards to time and
organization, the clinical examination, which included measurement of
anthropometric data, blood pressure, deficiency of vitamins, and
respiratory functions, is more demanding. 3 stations headed by 3
medical specialists were established.
All the prepared and elaborated materials and the
entire study were submitted for approval to
the Ethical Commission of Brno Masaryk University that subsequently
endorsed them. All the anonymously measured values of the
participants were recorded in the form Clinical Examination –
Preventive Examination Report.
part of the study, the primary intervention was subsequently and
fully separately (in other days) running in the form of a voluntary
discussion that took 3 hours and was aimed at possible decreasing (or
at least influencing) the prevalence of smoking among young men and
enhance their knowledge about risk factors and healthy lifestyle. The
educational publication titled “Vyber si zdraví a svobodu“
(Choose Health and Freedom), provided by the Institute of Preventive
Medicine, MF MU Brno, was used for discussion (17).
questions were answered and the aforementioned publication was given
to each participant. In addition to that, debaters received booklets
and guidance for keeping healthy lifestyle.
- Preventive Examination Report.
All answers recorded in individual questionnaires
were thoroughly rewritten into the coding
sheets, and then transferred to the computer and subsequently to the
statistic software as input data. Dependence on nicotine (Fagerström
Test) was analyzed in the questionnaire items and consequently
calculated and evaluated (18).
The records from
individual sheets of clinical examination filled out by participants
were also rewritten into the coding sheets, and then transferred to
the computer and subsequently to the statistic software as input
Mass Index – BMI (19, 15), Waist-Hip Ratio – WHR (15), blood
values (measured, static mmHg) (20), Kasch Step Test, physical
fitness test (21), respiratory functions (investigation of pulmonary
functions, spirometry) (22), and deficiency of vitamins were
evaluated by clinical symptoms (11).
All the results were evaluated en bloc, i.e. fully
anonymously for the tested individuals.
Evaluations were carried out in cooperation with the
Research Center of Preventive and Social Pediatrics, FM MU Brno, and
with use of their software. The below-stated results were obtained
from questionnaires and clinical examination.
Regarding the large scope of the work, the following part includes a
comparison of smokers and non-smokers and evaluation of statistically
The Questionnaire - Preventive
Examination Report was filled out by 104 young men ¨ (military
conscripts at that time), of which 83 underwent clinical examination
and 64 (more than 50 %) voluntarily took part in the follow-up
Smoking statistic data of our research sample are shown in Table 1.
First cigarette smoking experience by age categories and beginning of
regular smoking by age categories are included in Table 2.
Out of all smokers (i.e. 63) or ex-smokers (16),
39 (ca. 50%) regard themselves as nicotine-dependent, and 40
nicotine-independent. As results from the Fagerström Test for
Nicotine Dependence, 51.3% respondents are nicotine-dependent of
which 1.3 % strongly dependent, 17.5% medium dependent, and 32.5%
slightly dependent, see Table 3. These data show that both subjective
estimates and evaluation based on the Fagerström Test for Nicotine
Dependence provide very close results.
smokers and 100% non-smokers share joint households with parents,
which is a statistically significant difference, see Table 4.
for drinking coffee, we divided our respondents into two groups. The
first one consisted of those who drank daily one and more cups of
coffee, whereas the second one included those who drank less than one
cup daily. Having compared these two groups, we have found an
unambiguous statistically significant difference (see Table 5).
Smokers drink much more coffee than non-smokers.
show strong dependence on drinking wine, beer and liquors, see Table
fact revealing that smokers consume considerably more alcoholic
beverages has been proven both in frequency and quantities of
consumed alcohol. Moreover, statistics show that smokers inebriate
much more frequently than non-smokers. Absolutely clear and
statistically highly significant difference between smokers and
non-smokers is also apparent in using drugs. 14.3 % of smokers, in
contrast with only 2.5 % of non-smokers, refused to answer the
question on using drugs in the military service. 19.5 % of smokers
and 7.5 % of non-smokers admitted using drugs in the military
service. Smokers indicate statistical significance in using drugs in
the Armed Forces (see Table 7).
Statistical analysis has not proven any link
between smoking and BMI.
show a high physical activity (62.5 %), whereas smokers indicate only
average physical activity (50.8 %). Statistical significance has been
proven. In a week non-smokers reveal a considerably higher frequency
of physical activity than smokers, as evidenced by the statistic
significance shown in Table 8.
strongly statistically significant relation between smoking and a
lower age of the first sexual intercourse and the number of sexual
partners (smokers - 5.69 partners, non-smokers - 3.29 partners at
average) has been proven, see Table 9.
than fifty percent of the surveyed young men, in spite of a
widespread preventive campaign and high prices for cigarettes, still
smoke. Nonetheless, 15.4 % of ex-smokers quit smoking, which is a
positive sign indicating that the young generation is thinking of the
harmful effects of cigarettes. However, 75.4 % of the sample has some
smoking experience, which is a high number. The comment to this
problem stated by Kučerová et al. (6) is that “the percentage of
smokers among the second grade students and apprentices was 40.2 % in
2005, which is a significant difference from 38.8 % recorded in
1995”; similarly Csémy et al. (1) highlights the proven fact that
“in 2002 the proportion of regular smokers practically doubled, as
contrasted with the percentage recorded in 1994. The steepest
increase of smoking was noted in the category of fifteen-year old
teenagers, revealing 30 % of smokers in 2002. Based on our findings,
we can state with certainty that smoking has an increasing tendency
among our adolescents.” Sovinová (24) claims that “the adult
population of the Czech Republic includes almost thirty percent of
smokers”. The Action Plan (24) summarizes that “in 1985 our
country registered 45.4 % of regular smokers, but recent data show
continuous, albeit slight, decrease of smoking, which is more
apparent among men, as evidenced by only 32.2 % of male regular
smokers in 1993. In the same spirit, Pecha (7) states “that even
among athletes are 31 % of smokers, which is an alarming number”.
Sovinová et al. (9) also writes that “by the research results from
2008, 24.0% of Czech citizens can be regarded as regular smokers, and
4.2% as irregular smokers. It means that 28.2% of 15 – 64 year-old
Czech citizens, as found from their own statement in 2008, smoked and
can be regarded as smokers. Furthermore, Hrubá (25) points out that
“in the Czech Republic, similarly as in other developed countries,
smoking of machine-produced cigarettes absolutely prevails. Based on
recent surveys in the Czech Republic, 31% of men and 21% of women are
regular smokers, and these numbers are augmented by a further 4% of
occasional smokers. We can expect that more than 30% of our surveyed
young men will smoke in their adult age.
of our young male smoking respondents (50%) are addicted to nicotine,
but their addiction is different and also influenceable by a level
self-knowledge, self-discipline and targeted prevention. Over fifty
percent of active smokers (55.8%, independent and slightly dependent
on nicotine) would be able to quit smoking without big problems or
stress. Králíková et al. (26) adds that “a young smoker goes
through the following three stages: 1. children smoke first
cigarettes together (experimenting stage); 2. this group
progressively narrows (stage of acquiring the habit); 3. individuals
reach the final stage (addiction). Machová et al. similarly says
that “the effort to release from the tobacco addiction is an
extremely arduous process, as witnesses by a low efficiency of
contemporary therapies. Therefore, it is better
not to start smoking at all”. Hrubá (25) also states that “the
first smoking experience has shifted to a lower age categories, which
is a serious trend resulting in a higher risk of falling into
addiction, developing diseases and early death. Since young organism
has not yet developed fully efficient detoxifying mechanisms, it is
more sensitive to harmful effects of smoking. In the Czech Republic
around 20% of boys and 15% of girls in the 15 – 19 years age
category are daily smokers. Most of young smokers indicate some level
of addiction”. However, the chance to visit smoking treatment
centers and take their advice remains unused, since they do not
regard smoking as a problem and high risk to be solved right away.
results also confirm that smoking is a significant risk factor and
the number of smokers is not decreasing. Hrubá in her publication
(28) writes that “smoking is the most significant preventable risk
factor of morbidity and mortality. 50% of smokers die of diseases
associated with smoking, of which a half dies untimely in their
middle age and loses 20 – 25 years of life. The mortality rate
difference between smokers and non-smokers is epidemiologically
visible already after 20 years of smoking, thus smoking is a chronic
progressive and recurrent disease (diagnosis F17). It is not a social
bad habit, but a strong addiction having pharmacological (to
nicotine) and social-behavioral aspects.” Furthermore, Hrubá (25)
states that “smoking is the most significant individual preventable
factor connected with many diseases, including damage to ENT organs.
A cigarette is the only kind of consumable goods which, if used as
instructed, harms and kills, and is the only weapon that kills in its
both ends, as smokers are dangerous to both themselves and
In our work we have proven another well-known fact
that smokers drink more alcoholic
beverages. Nicotine and alcohol are still the most consumed and
available drugs in the Czech Republic. Csémy et al. (1) confirms
that “the result corresponds with those findings revealing that
daily smokers are more often consumers of excessive quantities of
alcohol; 31% of daily smokers admitted recurrent alcohol
intoxication, which is in striking contrast with 5% of other
respondents”. Pecha (7) discovered that the category of excessive
alcohol drinkers was made of 13-20 year-old students and, according
to results, three quarters of alcohol consumers did not reach 18
years of age. The research has also proven that athletes (probably
not only them) show an increasing tendency to alcohol consumption in
proportion to their age.” Kučerová et al. (6) highlights that
“equally alarming situation, as found in 2005, is excessive alcohol
consumption among pupils (16.2%), students and apprentices (68.8%).
Bílek (29) also brings up the fact that “approximately 30% of
young male respondents are excessive alcohol drinkers and, as for the
preference to beverages, consumption of beer considerably prevails
among Czech and Moravians as well. University students show a lower
percentage of excessive alcohol drinkers, but the level of education,
based on the research results, does not have a significant influence
on consumption of alcohol. Foret et al. (3) states that “the
consumption of alcohol in the Czech Republic remains almost unchanged
and amounts to 188 liters per each citizen, which exceeds the average
of the EU countries by 75 liters. The average consumption of beer,
the field where we have achieved the world supremacy, makes up 87% of
the total consumption of all alcoholic beverages. The data on
consumption of alcohol in the Czech Republic have not even indicated
any changes towards healthy lifestyle yet.”
statistical significance in using drugs in the Armed Forces has been
proven among smokers. Sovinová et al. (8) adds that “in 2002, 21%
of 15-year-old respondents were daily smokers, which strikingly
contrasts with only 8.8% in 1994”. Similarly, based on the latest
research, the Sananim team confirms the fact that “the sooner
people come into contact with alcohol and cigarettes, the higher
probability is that they will later obtain illegal drugs” and Csémy
et al. (2) says that “a higher occurrence of smoking was connected
with the factors of incomplete or restructured family and smoking by
close people (parents, peers). On a bigger scale, smokers were prone
to psychosomatic symptoms, excessive consumption of alcohol, smoking
marijuana and using ecstasy.” Kalina et al. (31) highlights the
fact, which is stated in the EU Action Plan, that “risks of health
damage are not merely limited to illegal drugs. Therefore, higher
attention should be paid to other undesired phenomena, such as
smoking tobacco products, consumption of alcoholic beverages in an
early age, and first experiments with banned drugs”.
results from our research, smokers show only an average physical
activity with even lower weekly frequencies, lower age of their first
sexual intercourse, and a higher number of sexual partners. These
findings just confirm the well-known unhealthy lifestyle of smokers,
which has a progressive tendency affecting the young generations of
century, in spite of all medial, educational and medical preventive
efforts. According to Fiala (32), “an intensive physical activity
is, together with a healthy diet (including non-smoking), the most
important thing what can be done in the field of sickness prevention
and health support. However, its potential is used absolutely
insufficiently. A huge part of our population shows too low physical
activity. The true meaning and effect of exercising is unfortunately
underestimated by medical specialists, who do not appropriately apply
it in their nonpharmacologic therapy.” Hrubá (25) also claims that
“smoking is a separate independent risk factor adversely affecting
sensory perception (hearing, smell, taste) and contributing to
development of acute and chronic inflammatory diseases and mainly
malign tumors in their locations. Adverse effects of smoking are
potentiated primarily by consumption of alcohol. Smoking is
accompanied with other unhealthy lifestyle phenomena (excessive
consumption of alcohol, incorrect diet), which augment its harmful
men, even though they were offered medical examinations, did not use
this opportunity; however, more than fifty percent of our research
sample took part in the discussions held in the form of an
intervention as a part of primary prevention. Komárek et al. (33)
also states that “the public interest in prevention is perfectly
evidenced by a relatively high attendance at all group activities and
demand for consulting. More people visit doctors to request
preventive medical examinations.”
In order to improve this situation, some measures
shall be taken. Campaigns running via media, billboards and internet
would certainly be more efficient, if they were closely accompanied
with individual and collective primary
prevention. Žaloudíková et al. (34) says that “their study has
proven that the program “Normální je nekouřit” (Non-smoking is
Normal) presents an effective educational primary-preventive method
for pupils at first grades of elementary schools.” Sovinová et al.
(35) highlights the project “Přestaň a vyhraj” (Stop and Win),
which is aimed at mitigating the tobacco pandemic. This competition
is held regularly, and because of its effects it was included among
the recommended steps of the “National Health Program” run by the
CR Ministry of Health. In 2006 this project attracted mostly people
from the category of 25 – 34 years of age. In order to check its
efficiency, the verification study was launched in 2007, showing that
one year after the competition at least 14 % of participants provably
do not smoke. The competition gives a good reason for doing away with
the addiction to tobacco products. Most of applicants joined the
competition with the intention to use its period as the beginning of
their new non-smoking life.” Zachovalová (36) writes in the same
spirit that “their survey based on anonymous questionnaires
revealed that the program successfully influenced behavior of
children: the program participants noted a significant drop in the
number of smokers during six months (from 18.7 % to 10.4 %), while
the number of smokers in the reference group remained unchanged.”
Pecha (7) states that “alcohol consumption and smoking are still
big problems in our society. While developed countries show a
striking tendency to protecting young people against alcohol and
nicotine, our society seems to be too tolerant.” Csémy et al. (2)
points out that “decreasing prevalence of smoking among children
and adolescents after 2002 was influenced by regulatory measures
pertaining to the availability of tobacco products (lawful age shift
from 16 to 18 years, higher taxation of tobacco products),
restrictions on promotion (ban on billboards and advertisement in
journals), and improved preventive programs in schools”.
We suppose that this study, can provide valuable
information, including ground materials for adopting preventive
measures, and could become an initial stage for making more complex
analyses (e.g. longitudinal).
List of Abbreviations
MC – military conscripts
CR – Czech Republic
FM MU – Faculty of
Medicine, Masaryk University
BMI – Body Mass Index
WHR – Waist-Hip
EU – European
Submitted for publication:
August 4, 2010
Iveta Marková M.D. LF MU Brno e-mail: email@example.com Address
(work): Nemocnice Milosrdných bratří Brno Polní 3 Brno 639 00
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