Factors for the high prevalence of tobacco use in Bulgaria

Introduction: Within the boundary of Europe the epidemic of tobacco use is in different stages of development. Western countries report reduced consumption of tobacco products, while in the low and middle income countries it is increasing.
Aim: To discuss the main factors causing the widespread use of tobacco in Bulgaria and the difficulties in controlling it.
Material and methods: This study is based on national statistical data and the European database “Health for all”. Also, a cross-sectional study was carried out among 228 pupils (88 boys and 140 girls), aged 14-19.
Results: Bulgaria has one of the highest proportions of smokers and the highest consumption of cigarettes per capita. Several factors determine this public health problem. Bulgarians start smoking at a very young age. More than 80% of the16-year adolescents have tried tobacco, 32.6% are regular smokers. Tobacco use is widespread and has become more frequent among Bulgarian women – from 16.7% in 1986 to 29.8% in 2001. Smoking is a common habit among the highly-educated people like physicians, nurses, teachers, politicians, who are supposed to be positive role models. About a half (46.8%) of the physicians and 44% of the teachers in the capital city of Sofia are smokers versus 42.9% in the general population. Cigarette consumption is increasing simultaneously with increase in income of the family. In 2003 households with a monthly income below 300 Euros consumed on the average 792.1 cigarettes per person, and those with an income over 300 Euros per month – 1406,9 cigarettes per person.
Predisposing factors for tobacco use are also low prices of cigarettes, ineffective legislation, social tolerance of smoking.
Conclusion: Tobacco smoking is a major risk factor for the health of Bulgarian population. The widespread use of tobacco and its hazardous health effects require the implementation of proven public policies.