Trends in cigarette smoking among US adults with diabetes: findings from the Behavioral Risk Factor Surveillance System
Introduction
Since at least 1964, the detrimental health effects of smoking have been well characterized [1], [2]. Between the landmark report of the Surgeon General and the end of the 20th century, the burden of smoking-attributable morbidity and mortality led to aggressive efforts to reduce the prevalence of smoking in the US population, and impressive reductions were eventually achieved [3].
People with chronic conditions who smoke may be at especially high risk for poor health outcomes, as they are at risk for complications from their disease while still experiencing the adverse outcomes associated with smoking. People with diabetes are one such group. Their risk for future heart disease is equivalent to that of people with coronary heart disease [4]. Consequently, diabetes is recognized as a risk equivalent for coronary heart disease [5]. Even if the relative risks for morbidity and mortality associated with smoking were the same for people with diabetes and those without this disorder, the attributable risk might be much greater among people with diabetes because of their higher baseline risk for various complications including cardiovascular disease. However, smoking and diabetes may interact in terms of increasing a person's risk for cardiovascular disease [6], [7]. Smoking has also been associated with various forms of microvascular disease such as nephropathy and neuropathy in addition to macrovascular disease and mortality among people with diabetes mellitus [8].
Given these considerations, one might assume that people with diabetes would be less likely to smoke than people without this disorder, but this is not the case. In the United States, people with diabetes are about as likely as those without diabetes to be current smokers [9], [10], [11]. However, little is known about trends in the prevalence of smoking among people with diabetes since 1990. To examine such trends, we analyzed data from the Behavioral Risk Factor Surveillance System from 1990 to 2001.
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Subjects and methods
The BRFSS is the largest telephone survey of health behaviors in the United States [12], [13], [14]. Health agencies in all states and the District of Columbia selected for interview an independent probability sample from adult residents aged ≥18 years in households with telephones by using a multistage sampling design. All states used an identical core questionnaire administered over the telephone by trained interviewers.
In all the survey years (1990–2001), respondents were asked, “Have you
Results
Participants in the surveys ranged from 81,557 in 1990 to 212,510 in 2001, and participants with diabetes ranged from 4183 in 1990 to 14,457 in 2001. Among all participants with diabetes, the unadjusted prevalence of smoking was 18.9% (SE, 0.9%) (men, 20.9%; women, 17.6%) in 1990 and 17.0% (SE, 0.5%) (men, 18.3%; women, 15.8%) in 2001. The age-adjusted prevalence of smoking was 23.6% (SE, 1.4%) (men, 25.4%; women, 22.2%) in 1990 and 23.2% (SE, 0.2%) (men, 24.8%; women, 21.9%) in 2001 Table 1.
Discussion
Even though smoking has been found to worsen several diabetic complications, the prevalence of smoking among people with diabetes continues to be very similar to that among people without this disorder We estimate that 1.6 million persons with diabetes smoked in 1990. By 2001, this number had risen to 2.4 million due to population growth and the increase in the prevalence of diabetes. Particularly disconcerting is the high rate of smoking among younger adults with diabetes. In most years, young
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2015, Diabetes Research and Clinical PracticeCitation Excerpt :Also, patients who continued smoking benefitted from the intervention because of the reduction in the number of cigarettes smoked per day. The prevalence of cigarette smoking in diabetic patients in our environment is around 15%, which is in the range between 12.4% and 21% reported by other authors [32,33,13,34], although a decreasing trend as compared with previous studies is observed (22% in the study of Canga et al. [18] and 23.6% in the Behavioral Risk Factor Surveillance System for 1990–2001 found by Ford et al. [35]). Recent studies carried out in Spain have shown a reduction in the prevalence of smoking in people with diabetes to 13% [35].
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