Smoking status and health-related quality of life: as findings from the 2001 Behavioral Risk Factor Surveillance System data

PURPOSE: To examine the relationship between smoking status and health-related quality of life (HRQOL). DESIGN: Our study used a cross-sectional analysis with self-reported data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). SETTING: United States. SUBJECTS: Subjects were a representative sample of noninstitutionalized adults aged 18 years and older. After excluding respondents who reported being pregnant and for whom smoking status could not be determined, we included 209,031 respondents. MEASURES: Multiple logistic regressions were performed to examine the associations of smoking status with the four HRQOL items, controlling for demographic and health-related characteristics. RESULTS: Current smokers had a higher likelihood of reporting poor general health status compared with nonsmokers and ex-smokers. Compared with nonsmokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.51-1.77), poor mental health (OR = 1.99, 95% Cl = 1.84-2.16), and activity limitations (OR = 1.80, 95% Cl = 1.63-2.00). Similarly, compared with ex-smokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (OR = 1.30, 95% CI = 1.19-1.42), poor mental health (OR = 1.65, 95% CI = 1.50-1.81), and activity limitations (OR = 1.48, 95% CI = 1.32-1.65). Age, income, and presence of comorbidities also significantly explained variation in HRQOL. CONCLUSIONS: Our study reaffirms the significant association between smoking and HRQOL in a large nationally representative sample. Poor health associated with smoking persists as a major public health problem, and effective preventive and smoking cessation efforts should be undertaken.     

广州工厂职工健康自评和吸烟者戒烟意愿研究

目的 调查工厂职工的健康状况和戒烟意愿,为开展控烟工作提供科学依据.方法 采用横断面调查方法对668名广州不同工作类型工厂职工的吸烟行为、自评健康状况和戒烟意愿进行问卷调查,吸烟者尼古丁依赖性用fTND问卷进行调查,自评健康和戒烟难度与某些因素的关系用logistic回归模型分析.结果 (1)男性工人吸烟者348人,吸烟率为65.0%;女性工人吸烟者4人,吸烟率为3.0%.与朋友或其他吸烟者在一起、在家或休闲时以及饭后吸烟最常见,占男性经常吸烟者的90.6%.(2)男性经常吸烟和戒烟者自评健康状况比普通同龄人差者占10.7%,高于偶吸和从不吸烟者(5.1%),调整年龄和文化程度后,OR值为2.22(95%CI 1.08～4.59).(3)男性经常吸烟者想过戒烟的占50.5%,其中自评健康状况比同龄人差、差不多和好者分别占73.3%、50.0%和37.2%,差异有统计学意义(P=O.009).自评戒烟难度≤30分、31～60分和60分以上的分别占26.9%、24.9%和48.2%,自评戒烟难度(≤30分和＞30分)比数比随周围同事吸烟人数和尼古丁依赖性的增加而增大.结论 男性职工经常吸烟或戒烟者自评健康较偶吸或从不吸烟者差,自评健康较差者多数想过戒烟,戒烟难度主要与周围同事吸烟和尼古丁依赖有关.     

Smoking among a cohort of Spanish university graduates. The SUN Project

OBJECTIVE: The objective of this study was to assess the association between employment, educational level, marital status, and smoking in a large cohort of Spanish university graduates (3- and 5-year degrees), with a predominance of health professionals. METHODS: A cross-sectional analysis of the baseline data of the first 7,508 participants in the follow-up study of the University of Navarre (SUN Project) was performed. The subjects were classified according to their smoking status. Independent variables were: employment, marital status, highest educational level attained, number of children, alcohol consumption (g/day), body mass index, and age. In the multivariate analysis, 3 non-conditional logistic regression models were built using the following outcomes: a) smokers vs never-smokers plus ex-smokers; b) smokers vs never-smokers; c) smokers of 15 or more cigarettes a day vs smokers of less than 15 cigarettes a day plus never-smokers and ex-smokers. RESULTS: Among men, no association was found between employment and smoking status in any of the comparisons. In contrast, among women, being a nurse was associated with a higher prevalence of smoking. The prevalence of current smokers among nurses was 48.5%. Female students were also more likely to smoke and had a higher risk of being heavy smokers (OR = 1.81; 95% CI, 1.28-2.57). A lower prevalence of smoking was found among participants of both sexes who had completed a doctorate. CONCLUSIONS: Among a large Spanish collective with higher education, the prevalence of smoking was higher in women with a shorter college degree. The prevalence of smoking among nurses was higher than the average among women graduates, which is a cause for concern.     

The association between amount of cigarettes smoked and overweight, central obesity among Chinese adults in Nanjing, China

OBJECTIVES: To examine the association between overweight, central obesity and cigarette smoking (total amount of cigarettes smoked [TACS] and status). DESIGN: Population-based cross-sectional study. Setting: Administrative villages and neighborhoods (n=45) randomly selected from three urban districts and two rural counties in Nanjing City, China. SUBJECTS AND METHODS: A representative sample (n=13,463) of permanent local male residents aged 35 years or older; 66.5% were urban residents. The response rate was 90.1%. Overweight (BMI>=24) and central obesity (waist circumference>=85 in men) were defined according to the new Chinese standard. The association between smoking (amount and status) and obesity was examined using logistic and linear regression analysis. RESULTS: The overall prevalence of overweight was 36.1% (29.7% with 24<=BMI<28 and 6.4% with BMI>=28). After adjusted for age, residence, education, occupation, family income, alcohol drinking, dietary intake, occupational and leisure-time physical activity, the prevalence was significantly lower among current smokers (33.0%) than in non-smokers (39.9%) and ex-smokers (39.2%), respectively (p<0.05). The amount of cigarette smoked was reversely associated with BMI (compared to non-smokers, ORs and 95%CIs for smokers with low-, medium- and high-TACS were 0.88 [0.79, 0.98], 0.77 [0.69, 0.86], and 0.77 [0.69, 0.86], respectively). The prevalence of central obesity was 35.9%. Compared to nonsmokers, only male ex-smokers were at increased risk of central obesity (OR=1.38, 95%CI=1.10, 1.74), while there was no significant association with current- smokers (OR=1.02 [0.92, 1.12]). The amount of cigarette smoked was not significantly associated with central obesity. CONCLUSIONS: Cigarette smoking was negatively associated with body weight indicated by BMI but not with central obesity indexed by waist circumference in Chinese men. Cessation of smoking may increase the risk of gaining overall body weight and developing central obesity. Cigarette smoking prevention and cessation should be a public health priority in China.     

Association between smoking and alcohol use in the general population: stable and unstable odds ratios across two years in two different countries

AIMS: The main objective of this article was to compare alcohol and tobacco consumption in the US and the Basque Country (the North of Spain) with particular attention to the association between alcohol and tobacco use. The consistency of findings was considered by analyzing data from two different years. These comparisons may provide a rational basis for exploring the associations between alcohol and cigarette use that are influenced by changes in use prevalences. METHODS: Two epidemiological samples from the US, obtained in 1992 and 1996, and two from the Basque Country, obtained in the same years, were used. Sampling methodologies were similar. Questionnaires were self-administrated with the help of interviewers, and were used to define ever smokers, ex-smokers, current smokers, heavy smokers, ever drinkers, ex-drinkers, current drinkers and weekly drinkers. The associations between smoking and alcohol drinking were explored through logistic regressions. RESULTS: The associations between current smoking and current drinking in the general population, and between ever smoking and weekly drinking among current drinkers appear very stable. In 1992 and 1996, US subjects who decided to try alcohol tended to try smoking and vice versa. In US Caucasians (particularly in 1996), heavy smoking was strongly associated with ever drinking among current smokers. In the Basque Country in 1992, there was a significant association between smoking cessation and drinking cessation among ever drinkers who also were ever smokers. CONCLUSIONS: Our analyses suggest that some associations between alcohol drinking and smoking behaviours are likely to be detected in Western countries where alcohol and nicotine are legal and easily available. On the other hand, other associations may be detected only in certain social contexts. These social contexts make the associations in subpopulations who are vulnerable to addiction, influence the results in the general population. In social contexts that exert considerable social pressure to quit smoking, such as in US Caucasians (particularly in 1996), heavy smoking was strongly associated with ever drinking among current smokers. When a social environment strongly discourages smoking and alcohol initiation (as in the US in 1992 and 1996), subjects who decide to try alcohol tend to try smoking and vice versa. The lack of social stigmatization of smoking and drinking in the Basque Country in 1992 may help to explain the significant association between smoking cessation and drinking cessation among ever drinkers who also were ever smokers.     

Impact of reproductive experience on women's smoking behaviour in Japanese nurses

OBJECTIVES: The objectives of this study were to describe current and past smoking behaviour of female Japanese nurses, to examine factors associated with developing and stopping a smoking habit, and to examine how their reproductive experiences affect their smoking behaviour. Study design: A cross-sectional study. This study was a baseline survey of a prospective occupational cohort study. METHODS: A self-administered survey of 1748 female Japanese nurses aged over 20 years was conducted in Gunma prefecture, Japan, in 1999. RESULTS: Overall, 27.2% developed a smoking habit (current smokers, 19.8%; ex-smokers, 7.4%) and 72.2% were never smokers. Logistic regression analysis showed that the type of nursing certificate was statistically associated with developing a smoking habit. It also showed that the type of nursing certificate, work place, marital status and current pregnancy were statistically associated with smoking cessation. Currently pregnant women were more likely to stop smoking than non-pregnant women (adjusted odds ratio, 3.18; 95% confidence intervals, 1.25-8.06). For women aged 20-29 years, the proportions of current smokers, ex-smokers and never smokers among pregnant women were 11.5, 23.1 and 65.4%, respectively; among non-pregnant women of this age, the values were 22.3, 4.3 and 73.4%, respectively. There was a statistically significant difference in such proportions between the two groups (chi2=19.27; P<0.0001). More than half of the ex-smokers who were currently pregnant had stopped smoking in the last 12 months. Smoking behaviour showed no statistically significant difference between women who had had at least one delivery and women who had not. CONCLUSIONS: The results suggest that pregnancy provides a good opportunity for smoking cessation, but a large proportion of women who successfully quit smoking during pregnancy relapse after delivery.     

How soon after quitting smoking does risk of heart attack decline?

A population-based case-control study (involving 1282 cases and 2068 controls) was conducted to examine the risk of myocardial infarction or coronary death after cigarette smokers quit smoking. The odds ratios for current smokers were significantly elevated compared to non-smokers (OR = 2.7 for men and OR = 4.7 for women). For ex-smokers odds ratios declined rapidly after quitting and after about 3 years they were not significantly different from unity. Fibrinogen concentrations measured in the controls only were higher in current smokers and ex-smokers up to 2 years after quitting than in non-smokers and after that time were similar to levels in non-smokers; however, most of the differences among categories of smokers were not statistically significant. These results support the hypothesis that risk of a coronary event in ex-smokers declines rapidly after quitting and within 2-3 years is similar to the risk for non-smokers.     

Subjective health of male ex-smokers: relationship with time since smoking cessation,intensity and duration of tobacco consumption

BACKGROUND: To examine the relationship of subjective health with time since smoking cessation and amount and duration of tobacco consumption among male ex-smokers. METHODS: Pooled analysis of three household interview surveys conducted in 1993 (n = 8,494), 1995 (n = 2,556), and 1997 (n = 2,624) on samples representative of the noninstitutionalized population aged 16 and over in Spain. RESULTS: After controlling for the main confounders, ex-smokers with smoking burden < or =13 pack-years had a lower frequency of suboptimal health (fair, poor, or very poor) than current smokers (OR, 0.59; 95% Cl, 0.38-0.91) during the first year after cessation; thereafter, it reached a value similar to that of never-smokers 11 years or more after cessation. Among those with burden >13 pack-years, frequency of suboptimal health during the first year after cessation was higher than in current smokers (OR, 1.28; 95% CI, 1.00-1.63). Afterwards, it fell progressively, approaching the value of never-smokers 11 years or more after cessation. Frequency of suboptimal health in ex-smokers increased with duration (years) of smoking (P linear trend = 0.045), but did not vary with the number of cigarettes smoked. CONCLUSIONS: Suboptimal health declined with time since smoking cessation, to reach the frequency of never-smokers. Longer duration of tobacco consumption is associated with worse subjective health.     

Association of Smoking Status With Quality of Life in a Cross-sectional Population-Based Sample of Iranian Adults: Isfahan Healthy Heart Program

This study aimed to examine the association between smoking status and quality of life (QOL) in a population-based sample of Iranian adults. The study used data from the Isfahan Healthy Heart Program (IHHP). A total of 5830 participants were included. They were categorized as current, former, or never smokers. QOL was evaluated using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Persian version. Data entry was performed using SPSS (SPSS Inc, Chicago, IL) software version 13.0. QOL was associated with marital status (P = .014), education (P = .001), occupation (P = .007), and income (P < .000) among current smokers. After adjusting for sociodemographic characteristics, smoking decreased QOL among current (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.97-0.99) and past (OR = 0.97; 95%CI = 0.95-0.98) smokers relative to never smokers. QOL is lower among Iranian current and past smokers, and the relation is independent of underlying sociodemographic factors.     

Social correlates of cigarette smoking cessation: findings from the 1995 microcensus survey in Germany

BACKGROUND: An increasing percentage of smokers are quitting this unhealthy behavior during their life course. The aim of this study is to analyze which social factors play an important role regarding ex-smoking in Germany. METHODS: Data were derived from the 1995 German Microcensus, which is a representative survey for the population in Germany. Included in the analysis were 44,553 current smokers and 23,780 ex-smokers. The independent variables were education, occupational status, family status, unemployment/social welfare, household income, and community size. A two-stage statistical modeling procedure was used, initially to assess the most important effects of the independent variables on smoking cessation and secondly, to analyze the cumulative effects of the independent variables. RESULTS: The most striking effects observed for smoking cessation were family status and education. For example, in males aged 30 to 49 years, the percentages of ex-smokers of all ever smokers were 44.7% for married males with high education compared with only 14.6% for males with low education. The corresponding percentages for females were 44.0% and 17.6%. CONCLUSIONS: Such striking differences in the social polarization of smoking cessation in Germany demonstrate the importance of anti-smoking policies and new strategies that avoid a further increase in the social inequality of smoking behavior.     

The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers.

BACKGROUND: Health related quality-of-life is recognized as an important health outcome measure; how ever, it may also have a significant application in smoking reduction and cessation programs. METHODS: Representative population data (n = 3010) was used to compare the quality-of-life status of differ ent smoking categories with never smokers. RESULTS: Statistically significant differences in mean quality-of-life scores, as measured by the SF-36 health status questionnaire, were observed between never smokers, as the reference group, ex-smokers, all smokers, and light, moderate, and heavy smokers. Heavy smokers also scored significantly lower than both other groups of smokers, scoring as low as the 29th percentile of the population on the general health dimension and lower than the 36th percentile of the population on all the mental health dimensions. CONCLUSIONS: The design of public health smoking cessation programs should consider the varying characteristics of different segments of the smoking population. The advantages of improved quality-of-life may strengthen the argument for encouraging heavier smokers to become light smokers as a precursor to total cessation.     

A randomized controlled trial of group intervention based on social cognitive theory for smoking cessation in China

BACKGROUND: New training programs need to be developed to help Chinese smokers achieve quitting. The objective of this study was to assess the effectiveness of a group smoking cessation intervention based on social cognitive theory among Chinese smokers. METHOD: A total of 225 smokers were eligible for the study and were randomly assigned to an intervention group (n=118) and a control group (n=107). The intervention group received the course soon after a baseline survey, whereas the control group received routine training in the first 6 months, and then took the same course. Effectiveness was evaluated at 6-month and 1-year follow-up from baseline. RESULTS: After 6 months, 40.5% (47/116) in the intervention group and 5.0% (5/101) in the control group quit smoking (absolute risk reduction: 35.5% [95% confidence interval (CI): 24.2-46.8%]). The 6-month continuous abstinence rate was 28.4% (33/116) in the intervention group and 3.0% (3/101) in the control group (absolute risk reduction 25.4% [95% CI: 15.6-35.2%]). At 1-year follow-up, the proportion of quitting and the 6-month abstinence rate in the intervention group were 35.8% and 22.0%, respectively. The factors associated with smoking cessation during the 6 month period were intervention (adjusted odds ratio [OR]=6.42 [95% CI: 2.46-13.28]), as well as anticipation of quitting (adjusted OR=1.46 [95% CI: 1.12-1.91]) and skill self-efficacy score in the baseline (adjusted OR=1.04 [95% CI: 1.01-1.07]). The same intervention was conducted in the control group after the 6-month study, in which a similar intervention effect was observed. CONCLUSION: A smoking cessation intervention based on social cognitive theory among Chinese smokers is highly effective.     

Smoking during pregnancy and preterm birth according to obstetric history: French national perinatal surveys

The relation between smoking and preterm delivery is not totally known. Our aim was to determine whether smoking during pregnancy was associated with preterm birth among women at different risk according to their obstetric history. The study was based on data from the 1998 French national perinatal survey. Of the 13073 singleton live births, 4.7% were preterm; 15% of the pregnant women were moderate (one to nine cigarettes per day) and 10% heavy smokers (at least 10 cigarettes per day). Smoking heavily was related to preterm birth (crude odds ratio [OR] = 1.35, 95% confidence interval [95% CI]: [1.04, 1.74]). Multivariable logistic regression showed a relation between smoking and preterm birth among multiparae without previous adverse pregnancy outcomes; the associated adjusted ORs (AORs) were 1.25 [95% CI 0.83, 1.87] among moderate smokers and 1.46 [95% CI 0.98, 2.20] among heavy smokers. The corresponding AORs were 0.69 [95% CI 0.46, 1.05]) and 0.96 [95% CI 0.59, 1.56] for primiparae and 1.11 [95% CI 0.63, 1.93] and 0.50 [95% CI 0.25, 0.98] for multiparae with previous adverse pregnancy outcomes. Our study showed a relation between heavy smoking during pregnancy and preterm birth mostly for women with low obstetric risk.     

Dietary patterns and smoking in Northern Irish men: a population at high risk of coronary heart disease

This study evaluated dietary habits of Northern Irish men who are at high risk of cardiovascular disease, stratified as never-, ex-, moderate-, or heavy-smokers. Participants were male volunteers (30 - 49 years) from a single workforce in Belfast (n = 765). Dietary information was collected using a validated food frequency questionnaire. For 'a priori' diet scores, never- and ex-smokers had a significantly higher fruit and vegetable score, Mediterranean diet score, and alternative Mediterranean diet score than moderate or heavy-smokers (all p < 0.05). For 'a posteriori' patterns, scores for the healthy, sweet tooth, and traditional dietary patterns, derived from principal component analysis, differed significantly by smoking status, being lower among smokers for the healthy and sweet tooth patterns, and higher in ex-smokers for the traditional pattern (all p < 0.05). When the 'a posteriori' patterns were included in models predicting likelihood of being in a particular smoking category with the 'a priori' patterns, the results for the fruit and vegetable score lost significance (p = 0.13). Both 'a priori' and 'a posteriori' dietary patterns identified smokers, particularly heavy smokers, as exhibiting fewer healthy dietary habits than never- or ex-smokers, but 'a posteriori' dietary patterns appeared to be more strongly associated with smoking status.     

Tobacco smoking in relation to pain in a national general population survey

BACKGROUND: We examined whether smoking status including heavy smoking (20 or more cigarettes per day) is related to the number of pain locations and intensity of pain. METHODS: A probability sample of the German national population aged 18 to 79 including 7124 participants (response proportion: 61.4%) was used. All individuals underwent a health examination between 1997 and 1999. Ordinal logistic regression analyses were performed with number of pain locations and pain intensity as dependent variables which had been assessed by questionnaire. RESULTS: Former and current heavy smokers had higher odds for greater numbers of pain locations and for moderate and intense pain than never smokers after adjustment for analgesic medicament use and behavior-related risk factors. Female former heavy smokers had an adjusted odds ratio (OR) of 1.6 (95% confidence interval, CI, 1.2-2.2) and male former heavy smokers had an adjusted OR of 1.4 (CI 1.1-1.8) for higher numbers of pain locations compared to never smoking women and men respectively (female current smokers: OR 1.4, CI 1.0-1.9; male current smokers: OR 1.3, CI 1.1-1.7). CONCLUSION: The findings suggest that former and current heavy smokers are more likely to report more pain locations and more intense pain than never smokers.     

Cognitive factors associated with smoking initiation in adolescents

OBJECTIVE: To study the association between cognitive factors of the behavioral change model "Attitude Self Efficacy" (ASE) at different phases of smoking initiation among adolescents. METHODS: We carried out a cross-sectional survey among students in the second grade of Compulsory Secondary Education (13-14 years old) from Cornellà de Llobregat (Barcelona, Spain) in 2000 to obtain information on cognitive factors and smoking. Logistic regression analysis was used to investigate the variables associated with smoking (odds ratio [OR] of experimenters vs. non-smokers and of smokers vs. experimenters). RESULTS: The prevalence of daily smoking was 22.9% (95% CI, 16.5%-29.3%) among boys and 36.2% (95% CI, 29.7%-42.6%) among girls. Factors associated with experimenting (vs. non-smoking) were: attitudes to smoking (disagreement with smoke-free areas [OR = 3.46; 95% CI, 1.65-7.24], agreement with smoking promotion [OR = 3.42; 95% CI, 1.42-8.28]), and subjective norms (perceiving friends as smokers [OR = 2.50; 95% CI, 1.17-5.35]). The variables associated with regular smoking (vs experimenting) belong to: self-efficacy and attitudes to smoking. CONCLUSIONS: Focussing on subjective norms and smoking attitudes with programs targetted younger ages seems appropriate, since these factors are more closely associated with the experimenting phase. Encouraging skills to refuse cigarettes offered by friends is appropriate at a more advanced age, since this determinant is associated with the change from experimenting to regular smoking.     

Determinants of developmental delay in infants aged 12 months

The aim of this study was to determine which demographic, maternal, obstetric and postnatal variables were associated with achievement of developmental milestones at the age of 12 months in term infants. Mothers and babies were enrolled in the Auckland Birthweight Collaborative Study shortly after birth. All infants were full term (gestation >or= 37 weeks). Approximately half of the sample were small for gestational age (SGA = birthweight 10th percentile). A maternal interview was conducted soon after birth. Phase 2 of the study occurred 12 months later when mothers were sent a postal questionnaire requesting information about the child's health and development during the first year of life using the Denver Prescreening Developmental Questionnaire. Seven hundred and forty-four (85.4%) European mothers returned the postal questionnaire. SGA children were not at increased risk of developmental delay at 12 months of age. In a sample representative of New Zealand European children, after adjustment for the effects of potential confounders, maternal smoking during pregnancy (OR = 2.1 [95% CI 1.1, 4.0]), maternal smoking during the first year of life (OR = 1.9 [95% CI 1.0, 3.8]) and low levels of satisfaction with parenting (OR = 2.4 [95% CI 1.1, 5.2]) were associated with significantly increased risk of developmental delay. In the subgroup of SGA children, maternal smoking during pregnancy (OR = 2.9 [95% CI 1.4, 6.2]), high levels of stress associated with parenting (OR = 2.2 [95% CI 1.2, 4.0]), and low levels of satisfaction with parenting (OR = 4.3 [95% CI 1.3, 13.5]) were significantly associated with developmental delay after adjustment for the effects of potential confounders. In conclusion, maternal and postnatal factors were better predictors of developmental delay than demographic variables.     

Disparities in hypertension control advice according to smoking status

ObjectivesHypertension is the most common modifiable cardiovascular risk factor. Blood pressure (BP) reduction, particularly among smokers, is highly effective at preventing cardiovascular diseases. We examined the association between patient smoking status and hypertension management advice.MethodsAdults who participated in the 2007 Behavioral Risk Factor Surveillance System with self-reported hypertension were examined (n = 51,063). Multivariable logistic regression analysis controlling for age, gender, race/ethnicity, education, marital status, insurance status, body mass index, alcohol use, self-reported general health and survey design were conducted to examine the association between smoking status (never, former, or current) and receipt of hypertension control advice.ResultsAfter controlling for potential confounders, being a current smoker was significantly associated with lower odds of receiving advice to lower salt intake (Adjusted Odds Ratio, AOR, 0.91 [95% confidence interval = 0.84–0.99]), exercise (AOR 0.89 [0.80–0.98]), and to take hypertensive medication (AOR 0.80 [0.66–0.98]) compared to never smokers. However, hypertensive smokers had greater odds of receiving advice to reduce alcohol consumption (AOR 1.23 [1.10–1.45]).ConclusionsAlthough healthcare providers are in an optimal position to provide patient education to improve BP control, hypertensive smokers may be less likely to receive important BP control lifestyle modification messages from their healthcare provider than non-smokers.     

Effect of smoking cessation and tobacco type on the risk of cancers of the upper aero-digestive tract in Brazil.

Tobacco smoking has long been identified as the most important risk factor for upper aero-digestive tract cancers. To investigate the effect of different tobacco types and the benefit of smoking cessation, we analyzed data from a case-control study of 784 cases of mouth, pharynx, and larynx cancers and 1,578 non-cancer controls in three metropolitan hospital areas in Brazil. Subjects were interviewed as to their smoking and drinking habits, demographics, environmental exposures, occupational history, health characteristics, and diet. Controlling for total tobacco and alcohol consumption, risks for ex-smokers compared with current smokers decreased substantially with time since cessation of the habit. Compared with never smokers, ex-smokers of >20 years had a relative risk (RR) of 1.98 [95% confidence interval (CI) = 1.0-3.8] for all upper aerodigestive tract cancers. RRs for long-term (>20 years) ex-smokers tended to be lower for mouth (RR = 1.61) and pharynx (RR = 1.52) than for larynx (RR = 3.63) cancers. The benefit of quitting was strongest for commercial cigarettes (RR = 1.45, 95% CI = 0.7-3.0) for ex-smokers of >10 years, as compared with smoking of black tobacco (RR = 2.57, 95% CI = 1.4-4.6), cigars (RR = 2.59, 95% CI = 0.6-11.6), and pipe tobacco (RR = 3.40, 95% CI = 1.3-8.8).     

Smoking and SF-36 health functioning

OBJECTIVE: To examine the association between smoking and general health as measured by the Short-Form Health Survey (SF-36) questionnaire. METHODS: Data derived are from three cross-sectional surveys conducted in 2000, 2001 and 2002. Respondents to the postal surveys were middle-aged employees of the City of Helsinki (1799 men and 7171 women, response rate 67%). Smoking status was divided into current heavy and moderate smokers, ex-smokers and never smokers. Health status was measured by the eight SF-36 subscales and the physical and mental component summaries. RESULTS: On the physical subscales, current smokers reported poorer health than non-smokers on general health and physical functioning in men. On the mental subscales, current smokers had consistently poorer health than non-smokers. However, often only heavy smokers differed from non-smokers. No differences were found between ex-smokers and never smokers on any subscale or the component summaries of the SF-36. CONCLUSIONS: Differences between smoking categories were found on some physical and all mental subscales of the SF-36. The differences were slightly larger among men. As heavy smokers more often report limitations with daily activities as well as loss of well-being, these impairments potentially provide valuable incentives for non-smoking to be used in health education messages and interventions.