Changes in smoking prevalence among Finnish physicians 1990-2001

BACKGROUND: The aim of the study was to investigate the changes in smoking habits among physicians in Finland between 1990 and 2001. METHODS: Three independent cross-sectional surveys using a self-administered questionnaire regarding smoking behaviour as well as knowledge, skills and attitudes in smoking were carried out by mail among physicians in Finland in 1990, 1995 and 2001. RESULTS: The prevalence of daily smoking decreased in both men and women between 1990 and 1995, but did not decrease any further between 1995 and 2001. In 2001, 7% of male and 4% of female physicians reported smoking daily. Daily smoking was highest (8-12%) among male physicians in the oldest age group. Occasional smoking was more prevalent at a younger age (22-24% in males and 7-10% in females). CONCLUSION: Smoking prevalence among physicians in Finland is relatively low and has not changed since 1995. A further reduction in daily and occasional smoking requires a different, specially adjusted and physician-targeted approach.     

Prevalence of type 2 diabetes and physical activity status in elderly men and women from Cyprus (the MEDIS Study)

Our aim is to investigate the association of being physically active on the prevalence of Type 2 diabetes mellitus among elderly people. We enrolled 53 men and 97 women, aged 65 to 100, from various areas of Cyprus. Physical activity was evaluated through a validated questionnaire (the short International Physical Activity Questionnaire, IPAQ). Prevalence of diabetes was 26% in men and 18% in women, while 55% of men and 50% of women were reported as being moderately or vigorously active. Furthermore, 5% of the participants reported that they smoked, 4% had stopped smoking, and 8% reported alcohol consumption. People in the upper tertile of the IPAQ score were 0.26 times less likely to have diabetes (p < 0.05); on the other hand people in the lower tertile of the score were 1.7 times more likely to have diabetes (p < 0.05). Our findings support the notion of a beneficial effect of physical activity on the burden of diabetes in the elderly.     

Obesity,diabetes and associated cardiovascular risk factors among Torres Strait Islander people

OBJECTIVE: To describe the lifestyle-related chronic disease and risk factor prevalence among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area Health Service District and to compare this information with that available for the general Australian population. METHODS: Voluntary community-based screening for persons aged 15 years and older, including oral glucose tolerance test, anthropometry, health questionnaire, measurement of lipids and lipoprotein levels, blood pressure and urinary albumin to creatinine ratio. RESULTS: Nine communities participated in screening between 1993 and 1997. Five hundred and ninety-two participants (286 male and 306 female) identified as Torres Strait Islander. There were high prevalences of overweight (30%), obesity (51%), abdominal obesity (70%), diabetes (26%), hypercholesterolaemia (33%), albuminuria (28%), hypertension (32%) and tobacco smoking (45%). Only 8.5% of men and 6.5% of women were free of any cardiovascular risk factors (abdominal obesity, hypercholesterolaemia, hypertension, dyslipidaemia, smoking, diabetes, albuminuria). Comparisons of this information for Torres Strait Islander people with results from the AusDiab survey show rates of obesity three times higher and diabetes six times higher than for other Australians. CONCLUSIONS: There is a very high prevalence of preventable chronic disease and associated risk factors among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area. Implications: Effective interventions to prevent and manage obesity, diabetes and associated cardiovascular risk factors are essential if the health of the Torres Strait Islander people is to improve. Such interventions could inform initiatives to stem the burgeoning epidemic of obesity and diabetes among all Australians.     

Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000

PURPOSE: Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. DESIGN: Stratified cross-sectional design. SETTING: United States. SUBJECTS: 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. MEASURES: Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. RESULTS: Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). CONCLUSION: The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.     

The role of education for current,former and never-smoking among non-western immigrants in Norway. Does the pattern fit the model of the cigarette epidemic?

Objectives. The aim was (1) to investigate the association between education and smoking status (current, former and never-smoking) among non-western immigrants in Norway and (2) examine if these associations fit the pattern predicted by the model of the cigarette epidemic.

Design. Data came from the Oslo Health Study and the Oslo Immigrant Health study (2000–2002). The first included all Oslo citizens from seven selected birth cohorts. The second included all Oslo citizens born in Turkey, Iran, Pakistan, Vietnam and Sri Lanka. 14,768 respondents answered questions on smoking, education and relevant background variables (over-all response rate 43.3%). Two gender specific multinomial logistic regression models with smoking status [current, former or never-smoker (reference)] as dependent variable were computed and predicted probabilities of smoking status among groups with different levels of education were calculated.

Results. Smoking prevalence among men ranged from 19% among Sri Lankans to 56% among Turks. Compared to the smoking prevalence among Norwegian men (27%), smoking was widespread among Iranians (42%) and Vietnamese (36%). Higher education was associated with lower probability of current smoking among all male immigrant groups except Sri Lankans. Never having smoked was positively associated with education among Pakistani and Norwegian men. Among women, <5% smoked among Pakistanis, Vietnamese and Sri Lankans. Smoking prevalence among Turkish (28%) and Iranian (23%) women were comparable to Norwegian women (30%). The probability of smoking among Turkish and Iranian women with secondary education was higher than for other levels of education. The probability of being a never-smoker was high among Turkish and Iranian women with primary education.

Conclusions. High smoking prevalence among Turkish and Iranian men highlights the importance of addressing smoking behaviour in subgroups of the general population. Smoking was almost non-existent among Pakistani, Vietnamese and Sri Lankan women and indicates strong persistent social norms against smoking.     

Prevalencia,detección,tratamiento y grado de control de los factores de riesgo cardiovascular en la población de Extremadura (España). Estudio HERMEX

ObjectiveTo estimate the prevalence, detection, treatment and degree of control of cardiovascular risk factors in Extremadura.DesignCross-sectional study.SettingPopulation study in Don Benito-Villanueva de la Serena health area (Badajoz).ParticipantsA random sample of the people between 25 and 79 years, who lived in this area, was selected.MethodsHistory of cardiovascular risk factors and its treatment were obtained by questionnaire. Blood pressure and blood sample were obtained for all participants. We calculated the prevalence of each variable standardized for age and gender for the population of Extremadura.ResultsOf the 3521 eligible, 2833 (80.5%) participants were included, mean age 51.2 years, male 46.5%. Adjusted prevalence of current smoking in men: 40.5% (37.8-43.2), hypertension 39.5% (37.3-41.7), hypercholesterolemia, 37.9% (35.4-40.4), obesity 36.5% (33.9-39.1), diabetes 13.7% (12.1-15.4). Adjusted prevalence of hypercholesterolemia in women: 35,0% (32.9-37.2), hypertension 33,0% (31.3-34.7), obesity 30.7% (28.6-32.8), current smoking 26,6% (24.5-28.7), diabetes 12,0% (10.5-13.5). The detection level of each factor was above 70%, and the degree of control among those treated of 51, 62.3 and 74.7% for hypertension, diabetes and hypercholesterolemia, respectively.ConclusionsExtremadura's population is highly exposed to major cardiovascular risk factors, especially men. Smoking, obesity and diabetes stand in the national context as the most prevalent in our community.     

Cigarette smoking and exposure to environmental tobacco smoke in China: the international collaborative study of cardiovascular disease in Asia

OBJECTIVES: We estimated the prevalence of cigarette smoking and the extent of environmental tobacco smoke exposure (ETS) in the general population in China. METHODS: A cross-sectional survey was conducted on a nationally representative sample of 15540 Chinese adults aged 35-74 years in 2000-2001. Information on cigarette smoking was obtained by trained interviewers using a standard questionnaire. RESULTS: The prevalence of current cigarette smoking was much higher among men (60.2%) than among women (6.9%). Among nonsmokers, 12.1% of men and 51.3% of women reported exposure to ETS at home, and 26.7% of men and 26.2% of women reported exposure to ETS in their workplaces. On the basis of our findings, 147358000 Chinese men and 15895000 Chinese women aged 35-74 years were current cigarette smokers, 8658000 men and 108402000 women were exposed to ETS at home, and 19072000 men and 55372000 women were exposed to ETS in their workplaces. CONCLUSIONS: The high prevalence of cigarette smoking and environmental tobacco smoke exposure in the Chinese population indicates an urgent need for smoking prevention and cessation efforts.     

Cigarette smoking and erectile dysfunction among Chinese men without clinical vascular disease

The authors examined the association between cigarette smoking and risk of erectile dysfunction among 7,684 Chinese men aged 35-74 years without clinical vascular disease. Cigarette smoking and erectile dysfunction were assessed by questionnaire. Vascular risk factors were measured according to standard methods. After adjustment for age, education, alcohol consumption, physical inactivity, diabetes, hypertension, overweight, and hypercholesterolemia, the odds ratio of erectile dysfunction was 1.41 (95% confidence interval (CI): 1.09, 1.81) for cigarette smokers compared with never smokers. There was a statistically significant dose-response relation between cigarette smoking and risk of erectile dysfunction (p(trend) = 0.005). Multivariate-adjusted odds ratios of erectile dysfunction were 1.27 (95% CI: 0.91, 1.77), 1.45 (95% CI: 1.08, 1.95), and 1.65 (95% CI: 1.08, 2.50) for those who smoked 1-10, 11-20, and more than 20 cigarettes per day, respectively, compared with never smokers. The association was stronger in participants with diabetes (odds ratio = 3.29, 95% CI: 1.49, 7.27) than in participants without diabetes (odds ratio = 1.33, 95% CI: 1.03, 1.73). If the association is causal, an estimated 22.7% of erectile dysfunction cases (11.8 million cases) among Chinese men are attributable to cigarette smoking. This 2000-2001 study of Chinese men documented an independent and dose-response relation between cigarette smoking and risk of erectile dysfunction.     

Comparing smoking and smoking cessation process in the Republic of Karelia, Russia and North Karelia, Finland

STUDY OBJECTIVE: The aims of this study were to assess and validate self reported smoking prevalence and to assess smoking cessation related process variables in the Republic of Karelia, Russia and in North Karelia, Finland. DESIGN: Comparative population surveys of random population samples from both areas in spring 1992. The study included a self administered questionnaire, physical measurements and laboratory tests. The validity of self reported smoking prevalence was assessed by serum cotinine analyses. SETTING: The district of Pitkaranta in the Republic of Karelia, Russia and province of North Karelia, Finland. PARTICIPANTS: The study population was a 25 to 64 year old population in both areas. A stratified random sample of 1000 people in Pitkaranta and 2000 people in North Karelia was drawn from the population registers. In Pitkaranta 380 men and 455 women, and in North Karelia 673 men and 803 women, participated in the survey. RESULTS: The self reported prevalence rates of daily smoking in Pitkaranta were 65% among men and 10% among women. In North Karelia the respective rates were 29% and 13%. Women in Pitkaranta greatly underreported their smoking status, which was assessed by comparing the self reported data to the serum cotinine measurements. The smoking prevalence among women in Pitkaranta would rise from 10% to 21% if all participants with high cotinine values would be regarded as smokers. Compared with smokers in North Karelia, a higher percentage of smokers in Pitkaranta expressed their wish to quit and believed that they would succeed. However, on average they had fewer previous smoking cessation attempts than smokers in North Karelia. In addition, the health personnel in North Karelia were more active in advising smokers to quit. CONCLUSIONS: High smoking prevalence among men in Pitkaranta obviously contributes much to the high premature death rate in the Republic of Karelia. There is considerable underreporting of smoking in Pitkaranta, especially among women, which is probably attributable to the cultural unacceptability of female smoking in Russia. The common wish to quit, few previous cessation attempts and much lower rates of ex smokers, together with less smoking cessation counselling from health personnel, need to be considered in tailoring antismoking interventions in the area.       

Prevalence of a set of risk factors for chronic diseases in the city of São Paulo, Brazil

OBJECTIVE: To estimate the prevalence of a set of risk factors for non-transmissible chronic diseases and compare it to that found 15-16 years ago in a similar survey. METHODS: A cross-sectional household survey was carried out comprising a random sample of people aged 15-59 years in the city of S?o Paulo between 2001 and 2002. The total of 2,103 people answered a questionnaire and had their blood pressure, weight, height, waist and hip circumferences measured. For a third of these participants, their total cholesterol, HDL-cholesterol, triglycerides and glucose levels were determined. RESULTS: The total age-adjusted prevalences in the study age group were as follows: smoking, 22.6%; uncontrolled blood pressure, 24.3%; obesity, 13.7%; increased waist circumference, 19.7%; total cholesterol >or =240 mg/dL, 8.1%; HDL-cholesterol <40 mg/dL, 27.1%; triglycerides > or =200 mg/dL, 14.4%; and blood glucose > or =110 mg/dL, 6.8%. Smoking, uncontrolled blood pressure, high total cholesterol, low HDL-cholesterol and high triglycerides were significantly more prevalent in men than women. CONCLUSIONS: The prevalences of a set of risk factors for chronic diseases showed men to have a poorer condition than women. In comparison to the previous survey, the prevalence of uncontrolled blood pressure remained unchanged but the prevalence of smoking has significantly lowered.     

中国10个地区30~79岁成年人被动吸烟行为特征分析

目的 描述中国慢性病前瞻性研究（CKB）项目10个地区非吸烟人群被动吸烟行为特征的地区和人群分布差异。方法 分析10个地区317 486名30~79岁非吸烟者在基线调查时的被动吸烟行为信息,描述其被动吸烟行为特征的地区和人群分布差异。结果 按照全国人口普查结果进行标化,我国成年人被动吸烟率为56.7%,与吸烟者共同居住率为66.5%,其中农村高于城市。周被动吸烟频率、周被动吸烟累计时长、日均被动吸烟时长具有明显的地区差异,城市地区的周被动吸烟累计时长随周被动吸烟频率的增加而增加,女性中湖南省的周被动吸烟频率较高,但周被动吸烟累计时长较低,日均被动吸烟时长最低,河南省却与之相反;与吸烟者共同居住者的被动吸烟率是从未共同居住者的2.27倍（95% CI：2.24~2.29）,且在女性中关联更强（OR=2.61,95% CI：2.58~2.64）,而在男性中二者无关（OR=1.01,95% CI：0.95~1.06）。女性除日均被动吸烟时长小于男性外,其余指标均大于男性;且年龄较小、文化程度较低者的多数被动吸烟指标较高;家庭年收入较低者的被动吸烟率和与吸烟者共同居住率较低,但日均被动吸烟时长较高;女性在婚者的被动吸烟率、与吸烟者共同居住率较高,男性与之相反。结论 CKB项目10个地区非吸烟人群的被动吸烟率、周被动吸烟频率、周被动吸烟累计时长和日均被动吸烟时长以及与吸烟者共同居住率、共同居住年限均存在明显的地区和人群分布差异。     

Food habits, physical activity and body mass index in relation to smoking status in 40-42 year old Norwegian women and men

BACKGROUND: The aim of the study was to examine the associations between smoking habits, and dietary habits, physical activity and body mass index (BMI) in Norway in 1997-1999. METHODS: The study was cross-sectional. Data on smoking habits, consumption of selected foods and physical activity were collected by questionnaire while body height and weight were measured in 59,361 subjects 40-42 years in 11 Norwegian counties. RESULTS: In both genders, nearly twice as many never smokers than current smokers had fruit or vegetables at least twice a day; 25.5% versus 13.3% for women and 10.5% versus 4.6% for men. The proportion of non-smoking women with a high intake of fish and fruit/vegetables was considerably higher than that of non-smoking men. Mean BMI (95% confidence interval (CI)) was higher for never smokers than for current smokers; 25.2 (25.1-25.3) versus 24.7 (24.6-24.8) kg/m2 for women and 26.6 (26.5-26.7) versus 26.1 (26.0-26.2) kg/m2 for men. The prevalence of obesity (BMI > or =30 kg/m2) (mean and 95% CI) was 12.5% (11.9-13.1%) and 14.4% (13.7-15.1%) among never-smoking women and men, respectively, whereas in smokers, the prevalence of obesity was 10.3% (9.8-10.8%) in women and 12.3% (11.7-12.9%) in men. The prevalence of performing strenuous physical activity at least 1 h a week was approximately 10% lower among current smokers than among non-smokers for both men and women. CONCLUSION: We found that non-smokers had healthier eating habits and higher levels of physical activity than did smokers, whereas the prevalence of obesity was lower in smokers. On the other hand, there were considerable gender differences, and female smokers' eating habits were as healthy as non-smoking males' eating habits.     

Effects of nativity, age at migration, and acculturation on smoking among adult Houston residents of Mexican descent

OBJECTIVES: We investigated differences in smoking behaviors between US-and Mexican-born ever smokers and examined the influence of US culture on smoking initiation. METHODS: Participants were 5030 adults of Mexican descent enrolled in an ongoing population-based cohort in Houston, Tex. RESULTS: More men than women reported current smoking; rates among US-born women were higher than those among Mexican-born women. Smoking rates among US-born men were higher than earlier published rates among Hispanics and non-Hispanic Whites but similar to rates among African Americans. Current smoking rates among Mexican-born women were lower than published rates for Hispanics, non-Hispanic Whites, and African Americans. Older age, male gender, a higher level of acculturation, more than a high school education, and residing in a census tract with a higher median age predicted history of smoking among US-born participants. Among Mexican-born participants, older age, male gender, a higher level of acculturation, and younger age at migration predicted history of smoking. CONCLUSIONS: Smoking interventions for people of Mexican descent should be tailored according to gender, nativity, and acculturation level and should target all ages, not just young people.     

Changes in Smoking Prevalence in 8 Countries of the Former Soviet Union Between 2001 and 2010

Objectives. We sought to present new data on smoking prevalence in 8 countries, analyze prevalence changes between 2001 and 2010, and examine trend variance by age, location, education level, and household economic status.Methods. We conducted cross-sectional household surveys in 2010 in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. We compared smoking prevalence with a related 2001 study for the different countries and population subgroups, and also calculated the adjusted prevalence rate ratios of smoking.Results. All-age 2010 smoking prevalence among men ranged from 39% (Moldova) to 59% (Armenia), and among women from 2% (Armenia) to 16% (Russia). There was a significantly lower smoking prevalence among men in 2010 compared with 2001 in Belarus, Kazakhstan, Kyrgyzstan, and Russia, but not for women in any country. For all countries combined, there was a significantly lower smoking prevalence in 2010 than in 2001 for men aged 18 to 39 years and men with a good or average economic situation.Conclusions. Smoking prevalence appears to have stabilized and may be declining in younger groups, but remains extremely high among men, especially those in lower socioeconomic groups.Rates of smoking among men in countries of the former Soviet Union have traditionally been high as reflected in the very high premature mortality from smoking-related causes.1 In the Soviet era, cigarettes were easily available and cheap, and heavy smoking (among men) became the norm in a setting where male leisure-time activities centered around negative health behaviors such as heavy drinking and smoking.2,3The cigarette market was transformed in the early 1990s when borders opened to the transnational tobacco companies who soon engaged in aggressive and highly sophisticated marketing campaigns coupled with the creation of a domestic manufacturing presence and enhanced distribution systems.4 Much of this marketing effort was aimed at women who traditionally had low rates of smoking, as well as young people.5 The Russia Longitudinal Monitoring Survey, which, among other things, has tracked changes in health behavior among the Russian population during the transition period, reported a small but significant rise in the prevalence of tobacco smoking among men from 57% in 1992 to 63% in 2003, whereas rates among women more than doubled from 7% to 15% in the same period and the age of smoking uptake among both genders fell.6 These findings were consistent with data from other surveys in Russia and also in Ukraine.7,8These data suggest that the tobacco epidemic is following a somewhat different pattern in the former Soviet Union than it took in the West. Smoking rates in men have failed to decline as the Western model would predict and as a result the accumulated burden of tobacco-related disease among men younger than 75 years in the former Soviet Union is the highest in the world,9 whereas smoking rates in women did not increase significantly until the transition.6,10 Research indicates that younger women appear more likely to smoke than older ones, whereas among men rates are high at all ages until late middle age when they begin to fall.7,10 However, research on changing patterns of smoking in this region has been largely concentrated in Russia and Ukraine, with little evidence about what has been happening elsewhere.A key source of comparable data on smoking across the former Soviet Union has been the Living Standards, Lifestyles, and Health (LLH) survey undertaken in 2001 in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine (http://www.llh.at).10,11 In March 2010, a new series of follow-up surveys, the Health in Times of Transition (HITT) surveys (http://www.hitt-cis.net), were undertaken by the same research teams (the civil disturbance in Kyrgyzstan in 2010 delayed the survey there until April 2011). Both series of surveys sought to compare a wide range of social conditions, lifestyles, and health in the adult populations in the countries of the former Soviet Union.Our objectives were to (1) present new data on smoking prevalence in 8 countries of the former Soviet Union in 2010, (2) analyze changes in smoking prevalence between 2001 and 2010 for each country, and (3) examine how trends in smoking prevalence over this period vary by age group, area of residence, level of education, and household economic status. Determining rates and trends in smoking prevalence plus the factors associated with smoking in these countries are important first steps in efforts to address the public health impacts of tobacco in the countries of this region. We hypothesized that we would observe a leveling-off of the extremely high rates of smoking among men, whereas rates of smoking among women would continue to rise with the previously documented increases in smoking among women now spreading to rural areas. This hypothesis was based on studies such as that by Perlman et al. in Russia, which observed only a small rise in smoking among men over the study period,6 but a more marked rise in women, particularly those in large cities, a trend attributed to the targeting of women by the transnational tobacco companies.     

Does job strain mediate the effect of socioeconomic group on smoking behaviour? The impact of different health policies in Denmark and Sweden

AIMS: The aim was to compare the impact of socioeconomic groups (SEG) on the risk of being a daily smoker or quitter, and to investigate whether the potentially mediating effect of psychosocial working conditions was similar in the Danish and the Swedish populations. METHODS: The study populations consisted of 10,049 employed participants, aged 18-64 years, 51% women, randomly selected from the general populations in the Oresund region, 1999-2000. Odds ratios (OR) for daily-smokers and "non-quitters' were computed for two age-groups and two SEGs in gender specific models, stratified by country. The association between SEG, current smoking, quitting, and influence at work, job demand and jobstrain, respectively, was tested by means of logistic regression. RESULTS: The contextual determinants defined by country had a different effect on smoking prevalence among men and women and among age groups. Low influence and job strain seemed to have an effect on smoking among Danish women, but not among Swedish women. The OR of being a daily smoker were higher in men than women among younger Danes, but higher in women than men among Swedes. The prevalence of low influence, high demand and job strain was higher and more socially skewed among the Swedes, but did not mediate the effect of SEG on smoking behaviour. CONCLUSIONS: The smoking prevalence was lower and the quit-rates higher among Swedes than Danes. Both countries had social differences in smoking that in absolute terms were rather similar, but in relative terms were higher in Sweden. The mediating effect of psychosocial working conditions was lacking. The determinants of smoking behaviours must be found somewhere else in the social and cultural context.     

Risk of smoking and body mass index for incidence of diabetes mellitus in a rural Japanese population

Objective

To assess the risk of smoking, body mass index (BMI), and both for incidence of diabetes in a rural Japanese population.

Method

This study was a 10.1-year cohort study of 2070 men and 3802 women aged 40-69 years without diabetes at baseline who underwent a health check-up at one central hospital in Nagano Prefecture. Participants were classified according to a combination of smoking status and BMI. Participants were followed from 1990 to 2006. The incidence of diabetes was determined from fasting and random levels of plasma glucose, HbA_1c levels or being under medical treatment for diabetes.

Results

Diabetes developed in 595 of the participants during 59,111 person-years of follow-up. In men, the multivariable-adjusted hazard ratios for incidence of diabetes compared with non-smokers of normal weight were as follows: 3.36 (2.02-5.60) in current smokers with normal weight and 1.70 (0.87-3.34) and 3.93 (2.22-6.96) in obese non-smokers and obese current smokers, respectively. In men the population-attributable fraction of diabetes onset due to current smoking, obesity and both were 22.0%, 2.5% and 11.2%, respectively.

Conclusion

Regardless of BMI, smoking is an important risk factor for diabetes in male populations with a high prevalence of smoking.     

Effect of smoking on the paradox of high waist-to-hip ratio and low body mass index

OBJECTIVE: Research on diabetes mellitus (DM) indicates that people with a low body mass index (BMI) but a high waist-to-hip ratio (WHR) are in a particularly high-risk group. The purpose of this study was to investigate the prevalence of and the effect of smoking on this paradoxical relationship. RESEARCH METHODS AND PROCEDURES: Our study sample consisted of 3450 men and 4250 women who had participated in the Korean Nationwide Health Examination Survey. We divided the study sample into tertiles (low, medium, and high), according to the level of WHR and of BMI, which yielded nine different combinations. Individuals exhibiting so-called paradox A had the highest WHR and the lowest BMI. RESULTS: The prevalence of paradox A was 4.7% for men and 3.8% for women. The overall agreement of WHR and BMI groups was poor [for men: kappa = 0.31 and 95% confidence interval (CI) = 0.29 to 0.34; for women: kappa = 0.39 and 95% CI = 0.37 to 0.42 for women]. The odds ratios for subjects having paradox A were estimated using a logistic regression model after adjusting for age, age(2), height, education, smoking, use of alcohol, and exercise. The risk for paradox A among current smokers was 2.1-fold (95% CI, 1.5 to 3.0) higher for men and 2.5-fold (95% CI, 1.6 to 3.9) higher for women than for nonsmokers, after adjusting for age and covariates. DISCUSSION: Cigarette smoking may increase the risk of paradox A. The findings of this study should be crossvalidated to different populations.     

Prevalence of cardiovascular disease risk factors in a southwestern Native American tribe.

A cross-sectional study was conducted among the Pascua Yaqui Indian tribe in Tucson, AZ, in 1990 to document the prevalence of cardiovascular disease risk factors. Cardiovascular disease is the leading cause of mortality for Native Americans and for members of the Pascua Yaqui tribe specifically. A total of 230 randomly selected adults, ages 25-65 years, who were listed as members on the tribal roll, participated, resulting in a 73-percent participation rate for those contacted. The five risk factors studied included diabetes, hypertension, hypercholesterolemia, obesity, and smoking. Only 14 percent of participants had none of the risk factors; 52 percent had two or more factors. Obesity was the most prevalent, being present in 69 percent of the women and 40 percent of the men, followed by diabetes, 35 percent of men and 39 percent of women. Twenty-six percent of the population had hypertension, and 43 percent of men were smokers, compared with 24 percent of women. Hypercholesterolemia was present in 19 percent of men and 14 percent of women. The rates of diabetes, obesity, hypertension, and smoking documented in this tribe are relatively high and can serve as a baseline for evaluating future prevention efforts.     

The Lifestyle Profile of Individuals with Cardiovascular and Endocrine Diseases in Cyprus: A Hierarchical,Classification Analysis

The study aims to explore the lifestyle profile of adult individuals with cardiovascular and endocrine diseases in Cyprus. Age and sex-specific analyses were applied. A representative sample of the general adult population was recruited during 2018–2019 using stratified sampling among the five government-controlled municipalities of the Republic of Cyprus. Data on Mediterranean diet adherence, quality of sleep, smoking status, physical activity, Body Mass Index, and the presence of cardiovascular and endocrine diseases were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, Tenth Revision (ICD-10). A total of 1140 men and women over 18 years old (range: 18–94) participated in the study. The prevalence of cardiovascular and endocrine diseases among the adult general population of Cyprus was 24.8% and 17.2%, respectively, with a higher prevalence of cardiovascular diseases in men, and a higher prevalence of endocrine diseases in women. Among individuals with cardiovascular disease, 23.3% were aged between 18–44 years old, while the corresponding percentage among endocrine disease individuals was 48%. The prevalence of smoking, physical activity, a low adherence to the Mediterranean diet, poor quality of sleep and obesity among the study population was 35.5%, 48.0%, 32.9%, 39.0% and 13.6%, respectively. Individuals with cardiovascular and endocrine diseases were characterized by poor quality of sleep, inadequate physical activity, and a higher BMI. This is the first study in Cyprus exploring the profile of individuals with cardiovascular and endocrine diseases in Cyprus. Health promotion and educational programs focusing on the importance of sleep quality, healthier dietary habits, physical activity, and lower BMIs among people with cardiovascular and endocrine diseases should be developed.