Relation between awareness of circulatory disorders and smoking in a general population health examination

BMC Public Health BioMed Central Open Access Research article Relation between awareness of circulatory disorders and smoking in a general population health examination Ulrich John*, Christian Meyer†, Monika Hanke†, Henry Völzke† and Anja Schumann† Address: University of Greifswald, Institute of Epidemiology and Social Medicine, Walther-Rathenau-Str. 48, D-17487, Germany Email: Ulrich John* - ; Christian Meyer - ; Monika Hanke - ; Henry Völzke - ; Anja Schumann - * Corresponding author †Equal contributors Published: 27 February 2006 BMC Public Health2006, 6:48 doi:10.1186/1471-2458-6-48 Received: 09 November 2005 Accepted: 27 February 2006 This article is available from: http://www.biomedcentral.com/1471-2458/6/48 © 2006John et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Little is known about proportions of smokers who maintain smoking after they are aware of a circulatory disorder. The goal was to analyze the extent to which the number of circulatory disorders may be related to being a current smoker. Methods: Cross-sectional survey study with a probability sample of residents in Germany investigated in health examination centers. Questionnaire data of 3,778 ever smoking participants aged 18 – 79 were used, questions included whether the respondent had ever had hypertension, myocardial infarction, other coronary artery disease, heart failure, stroke, other cerebrovascular disease, peripheral vascular disease, and venous thrombosis. Logistic regression was calculated for circulatory disorders and their number with current smoking as the dependent variable, and odds ratios (OR) are presented adjusted for physician contact, inpatient treatment, smoking cessation counseling, heavy smoking, exercise, overweight and obesity, school education, sex and age. Results: Among ever smokers who had 1 circulatory disorder, 52.1 % were current smokers and among those who reported that they had 3 or more circulatory disorders 28.0 % were current smokers at the time of the interview. The adjusted odds of being a current smoker were lower for individuals who had ever smoked in life and had 2 or more central circulatory disorders, such as myocardial infarction, heart failure or stroke, than for ever smokers without central circulatory disorder (2 or more disorders: adjusted OR 0.6, 95 % confidence interval, CI, 0.4 to 0.8). Conclusion: Among those with central circulatory disorders, there is a substantial portion of individuals who smoke despite their disease. The data suggest that only a portion of smokers among the general population seems to be discouraged from smoking by circulatory disorders or its accompanying cognitive or emotional processes. Background Circulatory disease prevention includes smoking cessation [1]. Although awareness of having circulatory disease prima facie should be assumed to function as a threat to the smoker sufficient in strength to stimulate smoking cessation [2] there is evidence that diseased smokers are even less likely to quit than non-diseased smokers [3]. Page 1 of 7 (page number not for citation purposes) BMC Public Health 2006, 6:48 Among individuals with circulatory disorders, there are considerable proportions of current smokers. In a general population survey carried out in 1997 in different areas of Finland [4], there appeared to be no differences in smoking status by awareness of hypertension. Among male ever smokers aged 25 to 64 with hypertension (> 160 mm Hg systolic or > 95 mm Hg diastolic blood pressure) who were aware of hypertension but untreated, there were 55.6 % current smokers and among male ever smokers who had been unaware of hypertension and untreated, there were 54.2 % current smokers. Among those male ever smokers who reported current antihypertensive medication, the proportion of current smokers was 29.3 %. Among women, the current smoker proportions were 58.1 % of those aware but untreated, 61.1 % of those unaware and untreated, and 57.1 % of those with hypertensive medication. In a national survey carried out among the general population aged 16 or older living in England 1994, lower odds for awareness of hypertension were found for current smokers compared to never smokers [5]. Awareness of a tobacco-attributable disease might support smoking cessation depending on the degree the smoker feels vulnerable by a disease compared to nonsmokers and the strength of threat, i. e. perceiving the disease to be life-threatening [2]. The number and type of circulatory disorders might be major determinants of the strength of threat. According to type, one might argue that in the lay view diseases of organs close to the body site of tobacco smoke intake are considered more affected from smoking than peripheral organs [2,6]. Altogether, little detail is known about how many individuals smoke although they are aware of a circulatory disorder and about associations between the number and type of circulatory disorders with smoking status from general population studies. The goals of the present paper were, first, to describe how many individuals are current smokers among those who are aware of circulatory disorder, second, to analyze relations of the number of circulatory disorders with smoking status and to account for variables potentially relevant in smoking cessation: physician contact, smoking cessation counseling, exercise, BMI, school education, age and gender in a probability sample representative of the general population aged 18 – 79 of Germany, a country for which data show little intention to quit among the smoking population [7]. Third, we analyzed whether having central circulatory disorders, such as myocardial infarction or stroke, predicted lower odds of being a current smoker among ever smokers whereas this might not be the case for peripheral circulatory disorders, such as peripheral vascular disease. We hypothesized that among ever smokers those with central circulatory disorders have lower odds of being a current smoker than ever smokers without these circulatory disorders. http://www.biomedcentral.com/1471-2458/6/48 Methods Sample A national sample of the German civilian, noninstitutionalized population aged 18 – 79 was used [8]. A random sample (N = 13,222) stratified by the 16 German Federal States was drawn from the German residents' registration files in which every resident's address, age and gender is included by law. On contact of the target persons, 1,621 (12.3 %) had been deceased, moved, were unknown under the registered address or did not speak German. Of the remaining 11,601 individuals, 7,124 (61.4 %) participated in the study [9]. They had been invited to take part in a health examination that was conducted in a (...truncated)