Quitting smoking: why, how, and what might help

OBJECTIVE: To examine reasons for quitting smoking, methods used in quitting, reasons for continuing smoking and potential aids to quitting in the population of Ontario, Canada. DESIGN: Two population-based, telephone interview surveys, conducted by random-digit dialing. SUBJECTS: Adults aged 18 years of age and older in 1983 (n = 1383) and 1991 (n = 1421). MAIN OUTCOME MEASURES: Information was obtained from former smokers on why and how they quit smoking, and from continuing smokers on why they smoked and what might help them quit. RESULTS: The proportion of current smokers in the population decreased from 35.5% in 1983 to 27.2% in 1991. In both surveys, former smokers cited a variety of reasons for quitting, including personal health concerns, social and environmental factors, personal attitude factors, cost, and health education messages. Responses concerning the most important reason also revealed a range of factors; "advice of a physician" was not prominent among them. When questioned about methods used in quitting, most former smokers in both surveys responded that they "just decided to quit". Very few reported using other aids such as cessation clinics or nicotine gum. More smokers in 1991 than in 1983 reported that they continued smoking for enjoyment, to satisfy a craving or addiction, and for relaxation. With regard to what might help them quit, continuing smokers in both surveys cited a wide variety of potential aids, including information on harmful effects, more restrictions on smoking and on sales, cessation clinics, programmes on radio/TV, and higher taxes. CONCLUSIONS: These findings support a multifaceted approach to tobacco control.


     

Passive smoking as well as active smoking increases the risk of acute stroke

OBJECTIVE: To estimate the relative risk of stroke associated with exposure to environmental tobacco smoke (ETS, passive smoking) and to estimate the risk of stroke associated with current smoking (active smoking) using the traditional baseline group (never-smokers) and a baseline group that includes lifelong non-smokers and long-term (> 10 years) ex-smokers who have not been exposed to ETS. DESIGN AND SETTING: Population-based case-control study in residents of Auckland, New Zealand. SUBJECTS: Cases were obtained from the Auckland stroke study, a population-based register of acute stroke. Controls were obtained from a cross-sectional survery of major cardiovascular risk factors measured in the same population. A standard questionnaire was administered to patients and controls by trained nurse interviewers. RESULTS: Information was available for 521 patients with first-ever acute stroke and 1851 community controls aged 35-74 years. After adjusting for potential confounders (age, sex, history of hypertension, heart disease, and diabetes) using logistic regression, exposure to ETS among non-smokers and long-term ex-smokers was associated with a significantly increased risk of stroke (odds ratio (OR) = 1.82; 95% confidence interval (95% CI) = 1.34 to 2.49). The risk was significant in men (OR = 2.10; 95% CI = 1.33 to 3.32) and women (OR = 1.66; 95% CI = 1.07 to 2.57). Active smokers had a fourfold risk of stroke compared with people who reported they had never smoked cigarettes (OR = 4.14; 95% CI = 3.04 to 5.63); the risk increased when active smokers were compared with people who had never smoked or had quit smoking more than 10 years earlier and who were not exposed to ETS (OR = 6.33; 95% CI = 4.50 to 8.91). CONCLUSIONS: This study is one of the few to investigate the association between passive smoking and the risk of acute stroke. We found a significantly increased risk of stroke in men and in women. This study also confirms the higher risk of stroke in men and women who smoke cigarettes compared with non-smokers. The stroke risk increases further when those who have been exposed to ETS are excluded from the non-smoking reference group. These findings also suggest that studies investigating the adverse effects of smoking will underestimate the risk if exposure to ETS is not taken into account.     

The effects of household and workplace smoking restrictions on quitting behaviours

OBJECTIVE: To assess the association of household and workplace smoking restrictions with quit attempts, six month cessation, and light smoking. DESIGN: Logistic regressions identified the association of household and workplace smoking restrictions with attempts to quit, six month cessation, and light smoking. SETTING: Large population surveys, United States. SUBJECTS: Respondents (n = 48,584) smoked during the year before interview in 1992-1993, lived with at least one other person, and were either current daily smokers or were former smokers when interviewed. MAIN OUTCOME MEASURES: The outcome measures were an attempt to quit during the last 12 months, cessation for at least six months among those who made an attempt to quit, and light smoking (< 15 cigarettes a day). RESULTS: Smokers who lived (odds ratio (OR) = 3.86; 95% confidence interval (CI) = 3.57 to 4.18) or worked (OR = 1.14; 95% CI = 1.05 to 1.24) under a total smoking ban were more likely to report a quit attempt in the previous year. Among those who made an attempt, those who lived (OR = 1.65, 95% CI = 1.43 to 1.91) or worked (OR = 1.21, 95% CI = 1.003 to 1.45) under a total smoking ban were more likely to be in cessation for at least six months. Current daily smokers who lived (OR = 2.73, 95% CI = 2.46 to 3.04) or worked (OR = 1.53, 95% CI = 1.38 to 1.70) under a total smoking ban were more likely to be light smokers. CONCLUSIONS: Both workplace and household smoking restrictions were associated with higher rates of cessation attempts, lower rates of relapse in smokers who attempt to quit, and higher rates of light smoking among current daily smokers.     

Smoking in the workplace: do smoking patterns and attitudes reflect the legislative environment?

OBJECTIVE: With regard to the workplace, to examine restrictions on smoking, smoking at work, attitudes toward and reactions to restrictions, and workplace programmes in the context of the legislative environment. DESIGN: Population-based telephone interview survey of adult residents of the jurisdictions of Metropolitan Toronto, Ontario, Canada. SUBJECTS: Workers within the City of Toronto (n = 374) were compared with other workers (n = 536), because their legislative environments with regard to workplace smoking were markedly different, with workplaces in the City of Toronto being covered by a much more stringent bylaw. RESULTS: In comparison with other workers, City of Toronto workers reported workplace restrictions to be more common and widespread. These workers were also less likely to smoke at work, and more likely to smoke less at work and to have cut down on smoking at work. Quit-smoking rates, however, were similar. There was evidence of some compensatory smoking outside work, but additional compensation in association with more stringent restrictions was not found. City workers and other workers were similar in their support for smoke-free workplaces, in their attitudes to the role of governments in regulating workplace smoking, and in their perceptions of conflict between smokers and non-smokers. Reports of quit-smoking programmes and educational interventions in the workplace were similarly uncommon, although both groups of workers indicated strong support for the role of business and industry in helping people quit. CONCLUSIONS: Restrictions on smoking and smoking patterns reflected the legislative environment; a more stringent environment was associated with more restrictions and less smoking at work.


     

Correlates of home smoking restrictions among rural smokers.

The prevalence of smoking is greater and smoking restrictions are less common in rural areas in comparison to urban areas. Consequently, rural smokers and their families are at increased risk for adverse health consequences from smoking. The presence of home smoking restrictions (i.e., limiting or banning cigarette smoking in the home) can be a mediator for smoking cessation and can reduce health risks for those who live with smokers. The purpose of the present study was to identify correlates of home smoking restrictions among rural smokers. We surveyed 472 smokers from 40 rural Kansas primary care practices who were enrolled in a smoking cessation intervention study. We assessed the prevalence of home smoking restrictions and examined the relationship between such restrictions, demographic variables, comorbid diagnoses, and psychosocial measures of smoking abstinence self-efficacy and motivation to quit. Complete home smoking restrictions were found among 25.4% of rural smokers with an additional 28.3% reporting some restrictions. Restrictions were associated with younger age, higher controlled motivation to quit (i.e., motivation from external pressure), the presence of children under age 6 years living in the home, fewer friends who smoke, and a partner who does not smoke. Smokers with a comorbid diagnosis of high cholesterol, chronic lung disease, or heart disease were less likely to have restrictions. Most smokers in rural primary care practices do not have home smoking restrictions, particularly those without children or a nonsmoking partner and those with significant risk factors for smoking-related illnesses. These patients may be critical targets for broaching issues of home smoking restrictions.     

The impact of workplace smoking bans: results from a national survey

OBJECTIVE: To estimate the impact of workplace smoking restrictions on the prevalence and intensity of smoking among all indoor workers and various demographic and industry groups. DESIGN: Detailed cross sectional data on worker self reported characteristics, smoking histories, and workplace smoking policies were used in multivariate statistical models to examine whether workplace smoking policies reduce cigarette consumption. After analysing the distribution of policies, four main types of workplace programme were defined: (1) 100% smoke-free environments, (2) work area bans in which smoking is allowed in some common areas, (3) bans in some but not all work and common areas, and (4) minimal or no restrictions. SETTING: After environmental tobacco smoke was identified as a health hazard in the mid-1980s, workplace smoking restrictions became more prevalent. By 1993, nearly 82% of indoor workers faced some restriction on workplace smoking and 47% worked in 100% smoke-free environments. PARTICIPANTS: The database included a nationally representative sample from the tobacco use supplements to the September 1992, January 1993, and May 1993 Current Population Surveys of 97,882 indoor workers who were not self employed. MAIN OUTCOME MEASURES: Prevalence of smoking and number of cigarettes smoked daily by smokers. RESULTS: Having a 100% smoke-free workplace reduced smoking prevalence by 6 percentage points and average daily consumption among smokers by 14% relative to workers subject to minimal or no restrictions. The impact of work area bans was lessened by allowing smoking in some common areas. Smoke-free policies reduced smoking for all demographic groups and in nearly all industries. CONCLUSIONS: Requiring all workplaces to be smoke free would reduce smoking prevalence by 10%. Workplace bans have their greatest impact on groups with the highest rates of smoking.     

Associations between parental smoking restrictions and adolescent smoking.

The purpose of this study was to examine the cross-sectional relation between reported levels of parental smoking restriction and several behavioral and cognitive variables in a sample of 757 (363 males, 394 females) adolescent smokers. Experimenters administered surveys to students in the homerooms of three Florida high schools. After controlling for student age, gender, and parental smoking status, results revealed that more restrictive parental smoking policies were significantly associated with less smoking on weekdays and weekend days, greater latency to smoking the first cigarette of the day, greater motivation to quit smoking, greater confidence in ability to quit smoking, and higher estimated risk perception regarding the health consequences of smoking. Results also revealed that 44% of adolescent smokers reported that their parents or legal guardians did not know that they smoked tobacco. These findings suggest that parental smoking restrictions may have the potential to impede adolescent progression to adult smoking behavior by reducing smoking rates and nicotine dependence, and increasing motivation to quit, self-confidence to quit, and health risk perception. Parental restrictions on smoking may present obstacles and inconveniences to adolescent smoking behavior that make smoking cessation a more attractive option.     

Passive smoking in the home: plasma cotinine concentrations in non-smokers with smoking partners

BACKGROUND: Risks of lung cancer and of heart disease attributable to passive smoking have been evaluated mainly in non-smokers married to smokers, but there has been little quantitative assessment of the extent of exposure in marriage partners as indicated by markers of inhaled smoke dose. OBJECTIVE: To relate plasma cotinine concentrations in non-smoking English adults to the smoking behaviour of their partners and to demographic and other factors. DATA: Population survey. Data from two years (1994 and 1996) of the Health Survey for England. MAIN OUTCOME MEASURES: Plasma cotinine concentrations in non-smoking adults married to or cohabiting with a partner. RESULTS: There was a strong dose-response relation between cotinine concentrations in non-smoking adults and the smoking behaviour of their partners, rising from a geometric mean of 0.31 ng/ml in those with non-smoking partners to 1.99 ng/ml in those whose partners smoked 30 or more cigarettes per day. In addition, exposure was greater in men, in the autumn and winter, and in those living in more disadvantaged circumstances, and there was an increasing gradient of exposure from the south to the north of the country. On average, cotinine concentrations in non-smokers with a smoking partner were 0.6-0.7% of those in cigarette smokers. CONCLUSIONS: If cotinine is taken as a measure of risk relevant dose, the implied increase in risk of lung cancer in non-smokers with smoking partners is consistent with the risk observed in epidemiological studies. Smoking by partners in the home is a major source of non-smoking adults' exposure to passive smoking.     

The wealth effects of smoking

Objective: To investigate the impact of smoking on the wealth of US young baby boomers.

Methodology: The research analyses self reported responses of both smoking habits and wealth holdings from a nationally representative sample of US individuals born between 1957 to 1964 (n = 8908). Data are from four waves (1984, 1992, 1994, 1998) of the National Longitudinal Survey of Youth 1979 cohort, a random survey of individuals conducted by the US Department of Labor using a stratified multistage area sample design.

Results: Regression results show lower net worth is associated with smoking, after holding constant a variety of demographic factors. Respondents who were ever heavy smokers are associated with a reduction in net worth of over $8300 while light smokers are $2000 poorer compared to non-smokers. Beyond this reduction, each adult year of smoking is associated with a decrease in net worth of $410 or almost 4%.

Conclusions: While a causal relation cannot be proven, smokers appear to pay for tobacco expenditures out of income that is saved by non-smokers. Hence, reductions in smoking will boost wealth, especially among the poor.

     

Out of the Smokescreen: does an anti-smoking advertisement affect young women's perception of smoking in movies and their intention to smoke?

Objective: To evaluate the effect of an anti-smoking advertisement on young women's perceptions of smoking in movies and their intention to smoke.

Subjects/setting: 2038 females aged 12–17 years attending cinemas in New South Wales, Australia.

Design/intervention: Quasi-experimental study of patrons, who were surveyed after having viewed a movie at their local cinema. The control group was surveyed during week 1 and the intervention group, during week 2. Before seeing the movie in week 2, a 30 second anti-smoking advertisement was shown, which featured a well known female actor drawing attention to the prevalence of smoking in movies.

Outcomes: Attitude of current smokers and non-smokers to smoking in the movies; intention of current smokers and non-smokers to be smoking in 12 months time.

Results: Among non-smokers, 48.2% of the intervention subjects thought that the smoking in the movie they viewed was "not OK" compared with 28.3% of the control subjects (p < 0.0001). However, there was no difference among smokers in the intervention (26.4%) and control (16.9%) groups (p = 0.28). A higher percentage of current smokers in the intervention group indicated they were unlikely to smoke in 12 months time (47.8%) than smokers in the control condition (31.9%) (p = 0.03). For non-smokers, there was no difference in smoking intentions between conditions, with 95% saying they would be unlikely to be smoking in 12 months time.

Conclusions: This "real world" study suggests that placing an anti-smoking advertisement before movies containing smoking scenes can help to "immunise" young women against the influences of film stars smoking.

     

Smoking behavior among hospital staff still influences attitudes and counseling on smoking.

Smoking among health professionals has been shown to influence smoking-related knowledge and counseling in clinical practice. The evidence regarding smoking as a risk factor has increased in the past decade. The present study was carried out in 2000 and investigated the associations between individual smoking behavior among hospital staff and (a). smoking-related knowledge, (b). attitudes toward counseling on smoking, and (c). self-reported smoking-related counseling provided by the staff. The study was based on a survey using self-administered questionnaires given to all hospital staff in a large university hospital in Denmark. Altogether, 82% of staff (2561) returned a completed questionnaire. Analyses focused on a subsample consisting of health professionals in the clinical wards (1429). Multivariate analyses were performed in which smoking-related knowledge, attitudes toward smoking-related counseling, smoking-related counseling practices, and self-rated qualifications for counseling were main outcome measures. Health professionals who were current smokers systematically underestimated the health consequences of smoking and differed significantly from nonsmokers in their assessments of smoking as a risk factor. Nonsmokers might overestimate smoking as a risk factor. Nonsmokers gave patients advice on smoking cessation significantly more often than did current smokers (ex-smokers, OR=2.5, 95% CI=1.8-3.4; never-smokers, OR=1.5, 95% CI=1.1-2.0). Ex-smokers and smokers felt significantly more qualified to counsel patients about smoking than did never-smokers (ex-smokers, OR=1.8, 95% CI=1.3-2.5; smokers, OR=1.4, 95% CI=1.0-1.9). Individual smoking behavior among hospital staff was strongly associated with smoking-related knowledge, attitudes, and counseling practices. Lack of self-rated qualifications was a major barrier to professional counseling on smoking in a hospital framework.     

Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers

OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerstrom Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.


     

Influence of physician and patient gender on provision of smoking cessation advice in general practice

OBJECTIVE: To examine the association between physician and patient gender and physicians' self-reported likelihood of providing smoking cessation advice to smokers using hypothetical case scenarios in primary care. DESIGN: Cross-sectional analysis of a self-administered questionnaire. SUBJECTS: National random sample of Australian general practitioners (GPs). MAIN OUTCOME MEASURES: Self-reported likelihood of advising hypothetical male and female smokers to stop smoking during a consultation for ear-syringing ("opportunistic" approach) or a dedicated preventive health "check up". RESULTS: 855 GPs returned questionnaires (67% response rate). Significantly more respondents indicated they would be "highly likely" to initiate an opportunistic discussion about smoking with a male smoker (47.8% (95% confidence intervals (CI) = 44.5 to 51.2)) than a female smoker (36.3% (95% CI = 33.1 to 39.5]). Older, male GPs were less likely to adopt an opportunistic approach to smoking cessation for patients of either sex. Respondents were more likely to recommend that a male patient return for a specific preventive health check up. Furthermore, in the context of a health check up, a greater proportion in total of respondents indicated they would be "highly likely" to discuss smoking with a man (86.9%, 95% CI = 84.5 to 89.0) than a female smoker (82.5%, 95% CI = 79.8 to 84.9). CONCLUSIONS: As measured by physician self-report, the likelihood of advising smokers to quit during primary care consultations in Australia appears to be influenced by gender bias. Gender-sensitive strategies to support cessation activities are recommended.     

Homelessness and smoking cessation: insights from focus groups.

Smoking prevalence among homeless persons is approximately 70%, yet little is known about tobacco use patterns or smoking cessation practices in this population. We assessed smoking attitudes and behaviors, psychosocial and environmental influences on smoking, barriers to and interest in quitting, and preferred methods for cessation among some homeless smokers. Six 90-min focus groups of current smokers (N = 62) were conducted at homeless service facilities. Participants had a mean age of 41.5 years (SD = 9.3), were predominantly male (69.4%) and African American (59%), and smoked an average of 18.3 cigarettes/day. Although most reported that they were motivated to quit, a number of barriers to quitting were identified. Participants reported that the pervasiveness and social acceptance of tobacco use in homeless settings contributed to smoking more cigarettes per day, adopting alternative smoking behaviors such as smoking cigarette butts and making their own cigarettes, and experiencing difficulty in quitting. High levels of boredom and stress also were cited as reasons for continued smoking. Smoking frequently occurred in combination with alcohol or illicit drug use or to achieve a substitute "high." Most participants (76%) reported that they planned to quit smoking in the next 6 months. Many were interested in using pharmacotherapy in combination with behavioral treatments. Results suggest that, although motivated to quit smoking, homeless smokers are faced with unique social and environmental barriers that make quitting more difficult. Interventions must be flexible and innovative to address the unique needs of homeless smokers. Smoking restrictions at homeless service facilities and funding for smoking cessation assistance in this underserved population may help to reduce prevalence.     

Socially cued smoking in bars,nightclubs, and gaming venues: a case for introducing smoke-free policies

OBJECTIVE: To assess smokers' perceived effects of smoking bans in bars, nightclubs, and gaming venues on their smoking behaviour. DESIGN: Cross sectional structured interview telephone survey of a random sample of smokers. SETTING: Population survey in Victoria, Australia. PARTICIPANTS: The sample comprised 597 smokers and analyses were conducted on 409 smokers who reported patronising bars, nightclubs or gaming venues at least monthly. OUTCOME MEASURES: Two outcomes studied were socially cued smoking and readiness to quit as a result of restrictions on smoking in social venues. Respondents were identified as socially cued smokers if they reported attending bars, nightclubs or gaming venues at least monthly and said that they smoke more in these venues. The potential influence of bans in social venues on readiness to quit was measured by asking respondents if they would be more or less likely to quit smoking if smoking were banned in hotels, licensed bars, gaming venues, and nightclubs. RESULTS: Of all adult smokers, 69% attended bars, nightclubs or gaming venues at least monthly. Of these smokers, 70% reported smoking more in these settings (socially cued smokers) and 25% indicated they would be likely to quit if smoking were banned in social venues. Compared to smokers not likely to quit if there were bans, smokers likely to quit were more likely to be socially cued (odds ratio (OR) 2.64), to be contemplating or preparing to quit (OR 2.22), to approve of bans in social venues (OR 2.44), and to be aged under 30 years (OR 1.73). Compared with smokers not socially cued, socially cued smokers were more likely to be under the age of 30 years (OR 6.15), more likely to believe that there is a safe level of cigarette consumption (OR 2.25), and more likely to have previously made a quit attempt (OR 2.60). CONCLUSIONS: These findings suggest that bans on smoking in bars, nightclubs, and gaming venues could reduce cigarette consumption and increase quitting among smokers who frequently patronise these settings. These beneficial effects are likely to be strongest among younger smokers.     

Costs of employee smoking in the workplace in Scotland

BACKGROUND: Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies. Few policies include provision of smoking cessation intervention. OBJECTIVE: To estimate the cost to employers of smoking in the workplace in Scotland to illustrate the potential gains from smoking cessation provision. Costs vary with type of smoking policy in place; therefore, to estimate these costs results from a survey were combined with evidence drawn from a literature review. STUDY DESIGN: A telephone survey of 200 Scottish workplaces, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 1996. Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects. RESULTS: 167 completed responses were received, of which 156 employers (93%) operated a smoking policy, 57 (34%) operated smoke free buildings, and 89 (53%) restricted smoking to a "smoke room". The research literature shows absenteeism to be higher among smokers when compared to non-smokers. The estimated cost of smoking related absence in Scotland is pound40 million per annum. Total productivity losses are estimated at approximately pound450 million per annum. In addition, the resource cost in terms of losses from fires caused by smoking materials is estimated at approximately pound4 million per annum. In addition, there are costs from smoking related deaths and smoking related damage to premises. CONCLUSION: This study shows how smoking cessation interventions in the workplace can yield positive cost savings for employers, resulting in gains in productivity and workplace attendance which may outweigh the cost of any smoking cessation programme.     

Smoking-related knowledge and attitudes of senior Australian medical students

OBJECTIVE: To assess the smoking-related knowledge and attitudes of senior medical students and to compare knowledge and attitude changes in students exposed to four different smoking cessation skills training interventions. DESIGN: A survey questionnaire, assessing knowledge and attitudes, was administered pre- and post-intervention for each of the four intervention conditions. SUBJECTS: A cohort of 219 fifth-year medical students at the University of Sydney. INTERVENTIONS: Students were randomised into one of four intervention conditions: (1) a traditional didactic lecture mode (control group); (2) the use of role plays and audiotaped feedback; (3) role plays with peer feedback; and (4) video feedback. MAIN OUTCOME MEASURES: Knowledge on morbidity and mortality associated with smoking, intervention strategies, intervention effectiveness, and cessation practices; anticipated clinical behaviour related to smoking; and attitudes towards medical practitioner involvement in smoking cessation. RESULTS: Smoking knowledge was significantly greater at post-test (mean unweighted scores of 69% before and 74% after intervention). All groups had improved knowledge levels at post-test. However, after controlling for pre-test differences, the control group, video feedback, and peer feedback groups were found to have improved significantly over the audio feedback group. Scores were higher on items related to morbidity and mortality and intervention effectiveness than for items on intervention strategies and cessation practices. Positive student attitudes towards their role in smoking cessation were also found. There was an almost universally held view that doctors can have a significant impact on reducing smoking levels. Although most students perceived smoking intervention to be a worthwhile activity, they remained pessimistic about the ease with which patients' smoking behaviour could be changed. CONCLUSIONS: Positive smoking cessation knowledge changes can be readily achieved through training. However, specific smoking cessation training is needed for medical trainees to develop appropriate skills and strategies. Attention to particular weaknesses related to specific intervention strategies and cessation practices is required to develop competence in this area and to maximise the chances of new medical graduates fully using the opportunities available to them.


     

Cigarette smoking weakens exercise habits in healthy men.

To investigate the longitudinal impact of smoking cessation and relapse on the exercise habits of apparently healthy Japanese men, 750 subjects presenting for a checkup at a metropolitan health center were surveyed annually for 7 years. Exercise was dichotomously classified as none or any. Subjects were grouped in two categories: 98 smokers who ceased smoking during the second year of the study, matched with 196 continuing smokers and 196 men who had never smoked; and 52 relapsed smokers (including 2 new smokers) who did not smoke at baseline or at Year 1 but smoked from Year 2 to final follow-up, matched with 104 continuing smokers and 104 never-smokers. Based on self-reported responses to questionnaires, exercise was consistently less prevalent among smokers who did not quit than among never-smokers throughout the study. Habitual exercise in subjects who had quit smoking increased during the follow-up (any exercise: 42.9% at baseline increased to 51% at final follow-up, p for longitudinal trend = .115). Habitual exercise in matched never-smokers did not change during the study and decreased significantly among persistent smokers (p = .025). Habitual exercise in relapsed smokers decreased during the follow-up (any exercise: 50.0% at baseline declined to 32.7% at final follow-up, p = .007), but habitual exercise in matched persistent smokers and never-smokers did not change. We conclude that smoking and sedentary lifestyle coexist continuously, that smoking cessation is associated with increased habitual exercise among healthy men, and that relapse is associated with reduced habitual exercise, suggesting that cigarette smoking weakens exercise habits.