Smoking status and relative weight by educational level in Finland, 1978-1995

Work participation and physicality of work in young adulthood and the development of unhealthy lifestyle habits and obesity later in life: a prospective cohort study

OBJECTIVE

To determine the effects of early entry into the labour market and physicality of work in young adulthood on the development of obesity and unhealthy lifestyle habits later in life.

METHODS

This study is a part of the Young Finns Study. Entry into the labour market and physicality of work were measured at baseline, when participants were aged 18, 21, or 24 years in 1986 or 18 years in 1989. Follow-up of lifestyle habits were conducted in 2001, 2007 and 2011. The outcomes were obesity (n=5558 observations), abdominal obesity (n=4060 observations), daily smoking (n=5628) and leisure time physical activity (n=5946) and analysed with generalised estimating equation.

RESULTS

Compared with sedentary work, physicality of work in young adulthood increased the odds of future obesity (adjusted OR=1.32, 95% CI 1.01 to 1.74 for light/moderate work and OR=1.44, 95% CI 0.99 to 2.08 for heavy manual work (particularly in women OR=2.03, 95% CI 1.07 to 3.84)) and future smoking (OR=1.79, 95% CI 1.39 to 2.30 for light/moderate work and OR=2.01, 95% CI 1.47 to 2.76 for heavy manual work (particularly in women OR=2.81, 95% CI 1.60 to 4.91)). For those who entered the labour market at ages 18-21 or younger, the odds of smoking was 1.85 times (95% CI 1.26 to 2.73) and that of obesity 1.45 times (95% CI 1.01 to 2.10) higher, and the rate of leisure time physical activity was 0.73 times (95% CI 0.58 to 0.93) lower compared with those who entered the labour market at ages 22-24 years.

CONCLUSION

Early entry into the labour market and physicality of work in young adulthood shape the development of obesity and unhealthy behaviours in later adulthood.

Application of the Marginal Beta-Binomial Model in Estimation the Overall Odds of Obesity Among Iranian Adults: Meta-Analysis Method

CONTEXT

To obtain accurate and reliable estimation of overall obesity odds ratio (OR) a statistical method is needed to be designed to account for heterogeneity among studies. The marginal beta-binomial model is a new method with attractive features that make it robust for meta-analysis.

OBJECTIVES

The aim of this study is the estimation of overall obesity OR among Iranian adults with particularly attention to age, sex, place of residence, and smoking status.

DATA SOURCES

We systematically reviewed all studies regarding obesity in Iranian adults in national and international journals that are published between 1990 and 2017, including PubMed, Scopus, SID, Google Scholar, Magiran, and IranMedex. The R software was used for data analysis and obtaining overall obesity OR using the marginal beta-binomial model.

RESULTS

A total of 18 studies, with a sample size of 258283, were included in our analysis. Results showed that increasing age, female sex, and residence in urban areas increases the odds of obesity. Using the age group 20 - 30 years as the reference, the overall obesity ORs for 30 - 40, 40 - 50, 50 - 60, and 60+ years were 2.13, 3.33, 3.15, and 2.33, respectively. The overall obesity OR for women was 2.35, compared with men. The estimated odds of obesity were 53% higher for urban adults. Smoking has a negative effect on obesity; the OR of obesity for smokers was 0.48 compared with non-smokers.

CONCLUSION

Consistent results in our research can be used as a basis to reinforce health programs for prevention and treatment of obesity in Iran.

Smoking Habits and Body Weight Over the Adult Lifespan in Postmenopausal Women

INTRODUCTION

The inter-relationships between smoking habits and weight gain are complex. However, few studies have examined the association of smoking habits with weight gain over the life course.

METHODS

Major smoking parameters and weight gain over time were examined in a large cohort of postmenopausal women aged 50-79 years at enrollment between 1993 and 1998 (N=161,808) and followed through 2014 (analyses conducted in 2016). Cross-sectional analyses were used to assess the association of smoking and body weight at baseline. Retrospective data were used to correlate smoking status with body weight over a 45-year period prior to enrollment. In addition, the association of smoking with weight gain over 6 years of follow-up was examined.

RESULTS

At baseline, women who had quit smoking prior to enrollment weighed 4.7 kg more than current smokers and 2.6 kg more than never smokers. Former, never, and current smokers all gained weight over the 45-year period from age 18 years to time of enrollment (average age, 63 years): 16.8, 16.4, and 14.6 kg, respectively. In prospective analyses, women who were current smokers at baseline but who quit smoking during follow-up gained more than 5 kg by Year 6 compared with current smokers at baseline who continued to smoke. Among long-term quitters, greater intensity of smoking and more recent quitting were associated with greater weight gain.

CONCLUSIONS

These results suggest that excess weight gain associated with smoking cessation occurs soon after quitting and is modest relative to weight gain in never smokers over the adult lifespan.

Twenty-five-year trends in lifestyle and socioeconomic characteristics in Eastern Finland

Aims: Little is known about changes in lifestyle and socioeconomic characteristics among physical activity subgroups over time. This study aimed at assessing whether the lifestyle and the socioeconomic profile of people with either low total physical activity (TPA) or high TPA changed during 1972—97. Methods: Six independent cross-sectional surveys were carried out among a middle-aged population at five-year intervals in Eastern Finland, 1972—97. The participation rates varied from 71% to 95% (n=33,712). Physical activity during leisure time (LTPA) and occupational physical activity (OPA) were determined by a self-administered questionnaire. TPA was calculated by combining LTPA and OPA. Results: Men with low TPA were older, smoked more, and had a higher BMI than men with high TPA. The increase in BMI was almost fourfold in sedentary men (trend 0.4%/5 years, p=0.023 for trend) than in highly active men (trend 0.1%/5 years, p=0.044 for trend). Education no longer accounted for the socioeconomic difference after 1977. Sedentary women had a higher BMI and smoking prevalence than those with high TPA. The difference in age, education, and marital status disappeared between those two groups after 1977. Conclusions: The lifestyle and the socioeconomic profiles of people with both low TPA and high TPA have changed during 1972—97.

Smoking is associated with abdominal obesity, not overall obesity, in men with type 2 diabetes

Objectives

Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes.

Methods

Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI).

Results

Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively.

Conclusions

Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.

Longitudinal changes in weight in relation to smoking cessation in participants of the EPIC-PANACEA study

PURPOSE

We assessed the association between smoking cessation and prospective weight change in the European population of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home And obesity (EPIC-PANACEA) project.

METHODS

The study involved more than 300,000 healthy volunteers, recruited between 1992 and 2000 in 9 European countries, who provided data on anthropometry and smoking habits at baseline and after a follow-up of 5 years on average. Adjusted mixed-effects linear regression models were used to obtain sex-specific summary estimates of the association between the change in smoking status and the annual change in weight.

RESULTS

Smoking cessation tends to be followed by weight gain; when compared to stable smokers, annual weight gain was higher in men (0.44 kg (95%CI: 0.36; 0.52)) and women (0.46 kg (95%CI: 0.41; 0.52)) who stopped smoking during follow-up. When smokers who stopped smoking at least 1 year before recruitment were compared to never smokers, no major differences in annual weight gain were observed. The excess weight gain following smoking cessation appears to mainly occur in the first years following the cessation.

CONCLUSIONS

When considering the benefits of smoking cessation, such findings strengthen the need for promoting cessation offering information on weight gain control and support to weight-concerned smokers in order to remove a barrier to quitting.

Changes in Body Mass Index across Age Groups in Iranian Women: Results from the National Health Survey

Background. To investigate the associations between some factors with weight gain across age groups in Iranian women. Methods. Proportional odds model was used to estimate the probability of BMI categorized as a function of education, economic index, workforce, smoking, marital status, and place of residence adjusted for age, using data from the “National Health Survey in Iran” database. It included 14176 women aged 20–69 years. Results. For all covariates, age was directly associated with overweight and obesity before 60 years of age. Among women aged 20–40 years, the rates of change in probabilities of overweight and obesity were highest. Among women, being inactive, with high economic index, married, being nonsmoker, in an urban residence, with lower educational attainment, all increased the probabilities of overweight and obesity. Conclusions. Women aged 20–40 years gained weight faster than other groups. They may need additional information and more support on how to reduce their risk for weight gain through positive health behaviors.

Factors related to obesity among Iranian men: results from the National Health Survey

OBJECTIVE

To our knowledge, only a few Iranian studies have investigated factors associated with obesity among men. The aims of the present study were to explore the associations between sociodemographic factors, smoking and obesity in Iranian men and compare these associations between Iranian men and women.

DESIGN

We used data from the National Health Survey in Iran. A generalised estimating equations model included 11,697 men and 14,854 women aged 20-69 years (12,850 households). Body weight and height were objectively measured. BMI was calculated as kg/m2, and subjects were classified into obese (BMI >or= 30 kg/m2) and non-obese (BMI < 30 kg/m2).

RESULTS

Among men, adjusted obesity OR were 0.62 (95 % CI 0.52, 0.74), 1.09 (95 % CI 0.90, 1.32), 1.003 (95 % CI 1.00, 1.007) and 0.57 (95 % CI 0.40, 0.81) for smokers, married, economic index and active workforce groups, respectively. Using low education as the reference group, the obesity OR for men were 1.06 (95 % CI 0.89, 1.26) and 0.75 (95 % CI 0.57, 0.99) for the moderate and high education groups, respectively. Using rural as the reference group, the obesity OR was 1.87 (95 % CI 1.56, 2.26) for urban men.

CONCLUSIONS

Our findings may point towards a better understanding of the social and cultural mechanisms of obesity in Iranian men. The above sociodemographic factors are large contributors to obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.

Smoking and body fatness measurements: a cross-sectional analysis in the EPIC-PANACEA study

OBJECTIVE

The present study investigates the cross-sectional relationship between tobacco smoking and body fatness.

METHODS

This cross-sectional study consisted of 469,543 men and women who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study between 1992 and 2000 providing anthropometric measurements and information on smoking. Adjusted multilevel mixed-effects linear regression models were used to assess the association between smoking and body fat mass.

RESULTS

The analyses showed that BMI and WC were positively associated with smoking intensity in current smokers but negatively associated with time since quitting in former smokers. When compared to never smokers, average current smokers (17 and 13 cig/day for men and women, respectively) showed a lower BMI. When average former smokers (men and women who had stopped smoking for 16 and 15 years, respectively) were compared to never smokers, higher BMI and WC were observed in men, whereas no significant associations were observed in women.

CONCLUSIONS

This cross-sectional study suggests that smoking may be associated with body fatness and fat distribution. Although our findings cannot establish cause and effect, they suggest that providing information and support to those who want to stop may help in preventing weight gain and therefore weaken a barrier against stopping smoking.

A comparison of two methods for estimating odds ratios: results from the National Health Survey

Background

The practice of dichotomizing a continuous outcome variable does not make use of within-category information. That means the loss of information. This study compared two approaches in the modelling of the association between sociodemographic and smoking with obesity in adult women in Iran.

Methods

We conducted a comparative study between two methods via an illustrative example, using data from the "National Health Survey in Iran (NHSI)" database. It included 14176 women aged 20–69 years. At first, body mass index(BMI) was treated as a continuous variable, OR_s and 95 per cent confidence intervals were calculated using the "without dichotomizing" method. Then subjects were classified into obese (BMI ≥ 30 kg/m²) and nonobese (BMI < 30 kg/m²) and logistic regression model was used to estimate OR_s and 95 per cent confidence intervals.

Results

The odds ratio estimates changed only slightly over the two methods. But the "without dichotomizing" method provided shorter confidence intervals on the odds ratio parameters than dichotomizing method. All relative confidence interval lengths were greater than 1.15.

Conclusion

If responses are continuous then the "without dichotomizing" method is certainly more useful than the "dichotomizing" method and leads to more precise estimation of odds ratios.

Lifestyle factors associated with BMI in a Spanish graduate population: the SUN Study

OBJECTIVE

To study the association between BMI and lifestyle factors such as alcohol consumption, smoking habits, education level and marital status in a Spanish graduate population.

METHOD

Cross-sectional analysis of 8,706 participants (3,643 men and 5,063 women) from the Seguimiento Universidad de Navarra (SUN) Study, an ongoing dynamic cohort study in Spain. Data on body weight, height and sociodemographic characteristics, and lifestyle habits were collected with self-administered validated questionnaires.

RESULTS

Among older participants (above sex-specific median age), educational level was a factor independently associated with BMI. University graduates with a lower educational level (3-year college degree or 5-year university degree) had a significantly higher BMI than those with doctorate which requires, at least, 8 years of university studies in Spain. Mean BMI was significantly higher among past smokers than among never smokers. Alcohol consumption, marital and smoking status were associated with BMI only among men.

CONCLUSION

In a study whose members were all university graduates, several factors were independently associated with a higher BMI, such as less years of higher education, past smoking, marital status and higher alcohol consumption.

Serum adiponectin levels and lifestyle factors in Japanese men

Adiponectin plays an important role in the development of various lifestyle-related diseases such as obesity, hypertension, type II diabetes mellitus, hyperlipidemia, and metabolic syndrome, leading to the development of heart and vascular diseases. However, the determinants that affect circulating adiponectin levels, including lifestyle factors, have still not been thoroughly investigated, in a general male population in particular. A total of 109 healthy Japanese male subjects (mean age, 55 +/- 14 years) with constant lifestyles were enrolled. All were on no medication. Fasting serum adiponectin levels were measured with an enzyme-linked immunosorbent assay. Each subject's lifestyle was assessed by the self-administered Breslow Questionnaire (a well-established method to estimate various lifestyles) with minor modifications. Partial correlation analysis for serum adiponectin levels, after controlling age and all lifestyle factors, revealed a significant and independent negative correlation between serum adiponectin levels and body mass index (BMI) (r = -0.222, P = 0.025), and a significant and independent positive correlation between serum adiponectin levels and sleep duration (r = 0.252, P = 0.011). No significant correlations were observed between adiponectin and other lifestyle factors. These data suggest that increased BMI and shorter sleep duration may be significant independent risks for low serum adiponectin levels in healthy males. Therefore, these factors may be intervention targets to modulate adiponectin to its proper levels for the prevention of cardiovascular disorders.

Recurrent dieting and smoking among Finnish men and women

OBJECTIVE

To examine the association of smoking with recurrent dieting and BMI among Finnish adults.

RESEARCH METHODS AND PROCEDURES

We used questionnaire data from 1990 on 11,055 subjects from the Finnish Twin Cohort who were 33 to 61 years of age. Multinomial logistic regression analysis was carried out using lifetime dieting as the outcome variable and smoking as the main explanatory variable, adjusted for BMI and age. Twin pairs discordant for dieting and smoking were studied to examine the effect of environmental and genetic factors.

RESULTS

Among women, current smokers [odds ratio (OR), 1.09 to 1.41 at different ages] and former smokers (OR, 1.52 to 2.82) were more likely to have dieted recurrently than never smokers. Among men, current smokers were less likely (OR, 0.69; 95% confidence interval, 0.55, 0.87) and former smokers were more likely (OR, 1.30; 95% confidence interval, 1.05, 1.61) to have dieted recurrently at different ages. The differences between the discordant pairs were consistent with this, although not statistically significant.

DISCUSSION

Recurrent dieting was associated with former smoking in both sexes and with current smoking in women.

Socio-economic and lifestyle factors associated with overweight in Flemish adult men and women

BACKGROUND

Changes in lifestyles and in the environment over the last decades are probably the most important cause of the overweight epidemic, but the findings are inconsistent among studies. The purpose of this study was to investigate the association of several socio-economic and lifestyle factors with overweight in Flemish adults, using BMI > or = 25 kg/m2, waist circumference (WC) > or = 94 cm (men) or > or = 80 cm (women) and the combination of BMI and WC for identifying overweight.

METHODS

This cross-sectional epidemiological study was conducted by the Flemish Policy Research Centre Sport, Physical Activity and Health between October 2002 and February 2004 in 46 Flemish communities. A total of 4903 Flemish adults (2595 men and 2308 women), aged 18 to 75 years, from a population-based random sample were included in the analysis. Body weight, height and WC were measured, and socio-economic and lifestyle factors were reported by means of validated questionnaires.

RESULTS

The results of the logistic regressions revealed that age is positively associated with overweight in both genders. Alcohol consumption is associated with overweight only in men. Men smoking in the past and watching TV >11 h/week have significantly higher OR's for overweight, while men who participate in health related sports >4 h/week have significantly lower OR's for overweight. In women, watching TV >9 h/week was positively associated with overweight. Women who are current smokers or participate in health related sports >2.5 h/week or with a higher educational level have significantly lower odds for overweight. Different results are observed between the first (BMI) and the second model (WC) in both genders. In men, the models differ for education and health related sports, while in women they differ for smoking status and leisure time physical activity.

CONCLUSION

The present study confirms the contention that overweight is a multifactorial problem. Age and TV viewing are positively associated with overweight, while educational level and health related sports are negatively related to overweight in both genders. In men, alcohol consumption and smoking in the past are also among the lifestyle factors associated with overweight. This study also indicates that BMI and WC do not have the same discriminative function regarding different lifestyle factors.

A longitudinal study of the influence of smoking on the onset of obesity at a telecommunications company in Japan

OBJECTIVE

To clarify the influence of smoking on the onset of obesity. METHODS.: A 5-year follow-up study was carried out on 25,312 workers at the time of their annual health check-up from 1992 to 1997. Pooled logistic regression analyses by sex were performed with age, working conditions and lifestyle as independent variables and the onset of obesity (BMI> or =26.4) as a dependent variable adjusted for the time period.

RESULTS

In males, the following factors increased the risk of the onset of obesity: smoking equal to or more than 20 cigarettes per day (versus nonsmokers), monthly holidays fewer than 5 days (versus >7 days), one-way commute more than 90 min (versus< or =60 min), sleeping less than 5 h, moderate and high preference for fatty meals (versus little preference). In females, 30-39 years, 40-49 years and 50-59 years (versus 20-29 years), being an ex-smoker, smoking fewer than 20 cigarettes per day, smoking equal to or more than 20 cigarettes per day (versus nonsmokers, respectively) and high preference for fatty meals (versus little preference) increased the risk of the onset of obesity.

CONCLUSION

This study revealed that smoking independently increases the risk of the onset of obesity regardless of sex.

Association between tobacco use and body mass index in urban Indian population: implications for public health in India

BACKGROUND

Body mass index [BMI, weight (kg)/height (m2)], a measure of relative weight, is a good overall indicator of nutritional status and predictor of overall health. As in many developing countries, the high prevalence of very low BMIs in India represents an important public health risk. Tobacco, smoked in the form of cigarettes or bidis (handmade by rolling a dried rectangular piece of temburni leaf with 0.15-0.25 g of tobacco) or chewed, is another important determinant of health. Tobacco use also may exert a strong influence on BMI.

METHODS

The relationship between very low BMI (< 18.5 kg/m2) and tobacco use was examined using data from a representative cross-sectional survey of 99,598 adults (40,071 men and 59,527 women) carried out in the city of Mumbai (formerly known as Bombay) in western India. Participants were men and women aged > or = 35 years who were residents of the main city of Mumbai.

RESULTS

All forms of tobacco use were associated with low BMI. The prevalence of low BMI was highest in bidi-smokers (32% compared to 13% in non-users). For smokers, the adjusted odds ratio (OR) and 95% confidence interval (CI) were OR = 1.80(1.65 to 1.96) for men and OR = 1.59(1.09 to 2.32) for women, respectively, relative to non-users. For smokeless tobacco and mixed habits (smoking and smokeless tobacco), OR = 1.28(1.19 to 1.38) and OR = 1.83(1.67 to 2.00) for men and OR = 1.50(1.43 to 1.59) and OR = 2.19(1.90 to 3.41) for women, respectively.

CONCLUSION

Tobacco use appears to be an independent risk factor for low BMI in this population. We conclude that in such populations tobacco control research and interventions will need to be conducted in concert with nutrition research and interventions in order to improve the overall health status of the population.

Determining lifestyle correlates of body mass index using multilevel analyses: the Tromsø Study, 1979-2001

Increases in overweight and obesity have been observed globally in both developed and developing countries. The authors assessed the relation between lifestyle factors and body mass index (BMI) (weight (kg)/height (m)2) in a population-based longitudinal study, using BMI and its subsequent change as responses in a multilevel model. The authors included 11,115 men and women aged 20-61 years at baseline who were living in the municipality of Tromsø, Norway, and who participated in three or four consecutive health surveys between 1979-1980 and 2001. Baseline age, physical activity at work, coffee consumption, and desired BMI (i.e., the BMI that the subjects reported they would like to have) were positively associated with baseline BMI, whereas height, alcohol consumption, leisure-time physical activity, and level of education were inversely associated. Most relations were found to be stronger in women than in men. Clinically relevant effect sizes were observed for most of the significant associations, especially in women. For instance, on an ordinal scale, a one-category increase in educational level would decrease the mean baseline BMI among women by 0.30 kg/m2. Significant associations between several lifestyle factors and subsequent BMI change revealed that observed baseline associations were strengthened over time, especially in women.

Smoking status, cigarettes per day, and their relationship to overweight and obesity among former and current smokers in a national adult general population sample

BACKGROUND

Weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The goal was to analyze overweight and obesity depending on smoking status and number of cigarettes per day (cpd) among former and current smokers.

METHODS

The sample included 7124 residents of Germany aged 18-79 y from a national health examination survey (participation rate: 61.4%). Body weight and height were objectively measured; smoking status and cpd were assessed by a questionnaire administered in a health examination center.

RESULTS

The number of cpd was positively related to being overweight and more so to obesity among former smoking men, but not women. The results were adjusted for age, school education, exercise and alcohol consumption. Men who formerly had smoked more than 30 cpd had an adjusted odds ratio (OR) of 5.0 for obesity compared to men who had never smoked.

CONCLUSION

With an increasing number of cpd more psychological and physiological processes of compensation of nicotine supply after smoking cessation may be expected. Male smokers should be provided with information on how to prevent weight gain after smoking cessation. To foster smoking cessation, female smokers should be informed that women who stop smoking manage to have no increase in the rates of overweight or obesity when considered at the general population level.

No considerable long-term weight gain after smoking cessation: evidence from a prospective study

The aim of the study was to analyse predictors of the body mass index (BMI) after smoking cessation. The sample included 4075 residents aged 18-64 years in a northern German area (participation rate 70.2%), drawn randomly from the resident registration files, among them 1545 current and 903 former daily smokers. The current smokers were followed up 36 months after baseline. Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) including questions about body weight and height at baseline and postal questionnaires at follow-up were employed. The data reveal that the number of cigarettes smoked at time of peak consumption in life contributed substantially, and years of abstinence from daily smoking contributed marginally to the BMI in a general linear model. It is concluded that the contribution of smoking cessation to the BMI increase was practically negligible. Efforts to prevent weight gain after smoking cessation should focus especially on heavy smoking.

Cooccurrence of lifestyle risk factors and the explanation of education inequalities in mortality: results from the GLOBE study

BACKGROUND

To investigate whether the cooccurrence of two lifestyle risk factors (smoking, excessive alcohol consumption, physical inactivity in leisure time) has an additional contribution to the explanation of education inequalities in mortality, over and above the contribution of single risk factors.

METHODS

Prospective cohort study, 1991-1998, in the South East of the Netherlands. Participants were 16,980 men and women aged 15-74 years at baseline.

RESULTS

Education differences in the cooccurrence of risk factors were of a similar magnitude as education inequalities seen for single risk factors. A significant (P = 0.04) interaction effect on mortality was found between smoking and physical inactivity. Adjustment for both smoking and inactivity reduced the mortality hazard ratio of the lowest level of education by 30% (from 1.66 to 1.46). Further adjustment for the interaction between the two risk factors did not change the hazard ratio significantly.

CONCLUSION

The cooccurrence of lifestyle risk factors did not provide any additional contribution to the explanation of education inequalities in mortality, over and above that of single risk factors. However, because risk factors tend to cooccur and have a higher prevalence among lower-educated people, it is still useful to focus interventions on more than one risk factor.

Intentional weight loss and smoking in young adults

OBJECTIVE

To investigate whether current smoking and lifetime snuff use are associated with a lifetime history of major (>/=5 kg) intentional weight loss in young adults, and to examine the dependence of this association on familial factors.

DESIGN

Cross-sectional population-based questionnaire survey of young adult Finnish twins participating in the fourth wave of the longitudinal FinnTwin-16-study in 2000-2002.

SUBJECTS

A total of 4521 young adult Finnish twins aged 23-27 y.

MEASUREMENTS

Questionnaire data on the number of intentional weight-loss episodes and on body mass index (BMI), cigarette smoking and snuff use, educational level, and number of subjects' own children.

RESULTS

Current daily smoking was strongly associated with a history of two or more intentional major weight-loss episodes (lost >/=5 kg twice or more lifetime) both in women odds ratio (OR 1.87; 95%; confidence interval (CI) 1.39-2.50) and in men (OR 2.00; 95% CI 1.37-2.90). Frequent lifetime snuff use was statistically significantly associated with recurrent intentional weight loss episodes in men (OR 1.51; 95% CI 1.08-2.13). Among the twin pairs discordant for daily smoking, the smoking twin was more likely than the nonsmoking co-twin to have recurrent intentional weight-loss episodes (OR 1.57; 95% CI 1.03-2.41). These episodes were also strongly associated with high BMI. Education was inversely related to recurrent intentional weight-loss episodes in men.

CONCLUSION

Tobacco use is strongly associated with a lifetime history of recurrent intentional major weight-loss episodes in early adulthood. This represents a major challenge to existing attitudes on smoking prevention and the promotion of healthful weight control.

Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk)

OBJECTIVES

To investigate the independent association between individual and area based measures of socioeconomic status and cigarette smoking habit.

DESIGN AND SETTING

Cross sectional, population based study.

PARTICIPANTS AND METHODS

12 579 men and 15 132 women aged 39-79 years living in the general community participating in the EPIC-Norfolk Study in 1993-1997. The association between social class, educational status, Townsend residential deprivation level, and cigarette smoking status was examined.

MAIN OUTCOME MEASURES

Cigarette smoking status at baseline survey.

RESULTS

Social class, educational level, and residential deprivation level independently related to cigarette smoking habit in both men and women. Multivariate age adjusted odds ratios for current smoking in men were 1.62 (95% CI 1.45 to 1.81) for manual compared with non-manual social class, 1.32 (95% CI 1.17 to 1.48) for those with educational level less than O level compared with those with O level qualifications or higher and 1.84 (95% CI 1.62 to 2.08) for high versus low area deprivation level. For women, the odds ratios for current smoking for manual social class were 1.14 (95% CI 1.03 to 1.27); 1.31 (95% CI 1.18 to 1.46) for low educational level and 1.68 (95% CI 1.49 to 1.90) for high residential deprivation respectively.

CONCLUSIONS

Residential deprivation level using the Townsend score, individual social class, and educational level all independently predict smoking habit in both men and women. Efforts to reduce cigarette smoking need to tackle not just individual but also area based factors. Understanding the specific factors in deprived areas that influence smoking habit may help inform preventive efforts.

Obesity: epidemiology and possible prevention

Obesity can be defined as the excessive accumulation of fat in adipose tissue, to the extent that health may be impaired. The most widely used measures of total and abdominal adiposity are the body mass index and waist circumference. Obesity is now a global public health problem, with about 315 million people world-wide estimated to fall into the WHO-defined obesity categories with a body mass index (BMI) of 30 or above. The primary causes of the rapid global rise in obesity rates lie in the profound environmental and societal changes now affecting large parts of the world and creating societies in which physical activity is low and the availability of high-fat, energy-dense foods has increased. Strategies aimed at preventing weight gain and obesity have not been successful to date but are likely to be more cost effective, and to have a greater positive impact on long-term control of body weight than treating obesity once it has developed.

Associations of body mass index and obesity with physical activity, food choices, alcohol intake, and smoking in the 1982-1997 FINRISK Studies

BACKGROUND

Recent increases in the prevalence of obesity worldwide are suggested to be caused largely by an environment that promotes sedentariness and excessive food intake.

OBJECTIVE

We investigated associations of body mass index (BMI) and obesity with physical activity, food choices, alcohol consumption, and smoking history. In addition, we examined the consistency of these associations over time, with the aim of assessing whether the significance of lifestyle variables as correlates of obesity increased over a 15-y period.

DESIGN

Independent cross-sectional surveys were carried out in 1982, 1987, 1992, and 1997. Altogether, 24604 randomly selected men and women (aged 25-64 y) participated in these surveys. The subjects' weights and heights were measured, and data on lifestyle were collected with self-administered questionnaires.

RESULTS

In men and women, perceived general health, leisure-time physical activity, and daily vegetable consumption were inversely associated with obesity, as were bread consumption in women and activity at work in men. Consumption of sausages, milk, and sour milk and heavy work (in women only) were positively associated with obesity. Obesity was also associated with alcohol consumption and smoking history. Most associations were constant over the 15-y period. However, the inverse associations of BMI with physical activity in women and with perceived health in men seemed to strengthen over time.

CONCLUSIONS

A physically active lifestyle with abstention from smoking, moderate alcohol consumption, and consumption of healthy foods maximizes the chances of having a normal weight. The significance of avoiding sedentariness increases over time as a factor associated with normal weight.