Tobacco Control : From North Karelia to the National Level

•The North Karelia Project reduced smoking first regionally and later in all of Finland.•Regional campaigning against tobacco in North Karelia became nationwide.•National tobacco control legislation was inspired by the North Karelia Project.•Tobacco endgame target is now written in the Finnish Tobacco Act.

After World War II, smoking among men was very common in Finland, and especially in North Karelia, contributing to the high rates of cardiovascular diseases and cancer. Thus, the North Karelia Project, from its very start in 1972, took reduction in smoking as one of its main targets. After 1977, the project actively contributed to national tobacco control work, including comprehensive legislation and many other activities. Smoking in North Karelia declined initially much more than in the rest of Finland, but thereafter there has been a steady national decline, resulting in a prevalence of daily smoking among adults of approximately 15% and contributing to the big reduction in the rates of heart disease and tobacco-related cancers, especially among men.