Elsevier

Preventive Medicine

Volume 39, Issue 6, December 2004, Pages 1238-1242
Preventive Medicine

Trends in cigarette smoking among US adults with diabetes: findings from the Behavioral Risk Factor Surveillance System

https://doi.org/10.1016/j.ypmed.2004.04.039Get rights and content

Abstract

Background. Smoking substantially increases morbidity and mortality rates in people with diabetes. Previous studies have shown that the prevalence of smoking among people with diabetes is similar to that among people without diabetes. We sought to examine temporal trends in the prevalence of smoking among people with diabetes since 1990.

Methods. We analyzed data from the Behavioral Risk Factor Surveillance System for 1990–2001.

Results. The age-adjusted prevalence of smoking among adults with diabetes was 23.6% (men, 25.4%; women, 22.2%) in 1990 and 23.2% (men, 24.8%; women, 21.9%) in 2001. In comparison, the prevalence among participants without diabetes was 24.2% (men, 25.7%; women, 22.8%) in 1990 and 23.2% (men, 24.8%; women, 21.5%) in 2001. Thus, the prevalence of cigarette smoking was similar and remained stable from 1990 through 2001. Among participants with diabetes, significant decreases in the prevalence of smoking occurred among African Americans and those aged ≥65 years.

Conclusions. New efforts and commitments to promote smoking cessation among people with diabetes are needed.

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.

Section snippets

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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