Swedish snuff and incidence of cardiovascular disease. A population-based cohort study

<p>Abstract</p> <p>Background</p> <p>The relationship between smoking and an increased incidence of cardiovascular diseases is well known. Whether smokeless tobacco (snuff) is related to myocardial infarction (MI) or stroke is still controversial. Aim of this study was to explore whether snuff users have an increased incidence of MI or stroke.</p> <p>Methods</p> <p>A total of 16 754 women and 10 473 men (aged 45–73 years), without history of cardiovascular disease (CVD), belonging to the population-based "Malmö Diet and Cancer" study were examined. Incidence of MI and stroke were monitored over 10.3 years.</p> <p>Results</p> <p>Snuff was used by 737 (7.0%) men and 75 (0.4%) women, respectively. Among men, snuff was significantly associated with low occupation level, single civil status, high BMI and with current and former smoking. In women, snuff was associated with lower systolic blood pressure. A total of 964 individuals (3.5%), i.e.544 men (5.3%) and 420 (2.5%) women suffered a MI during the follow-up period. The corresponding numbers of incident stroke cases were 1048, i.e. 553 men (5.3%) and 495 (3.0%) women, respectively. Snuff was not associated with any statistically significant increased risk of MI or stroke in men or women. The relative risks (RR) in male snuff users compared to non-users were 1.05 (95% confidence interval (CI): 0.8–1.4, p = 0.740) for incident MI and 0.97 (0.7–1.4, p = 0.878) for stroke, after taking age and potential confounders into account. In women none of the 420 (2.5%) women who were snuff users had a MI and only one suffered a stroke during the follow-up.</p> <p>Conclusion</p> <p>Several life-style risk factors were more prevalent in snuff-users than in non-users. However, the present study does not support any relationship between snuff and incidence of cardiovascular disease in men.</p

Women, smoking and myocardial infarction

The aim of this thesis has been to explore factors associated with smoking and smoking cessation in women and the relation between smoking and incidence of myocardial infarction (MI). The time trends in incidence of MI 1986-2002 in the city of Malmö (pop. 250.000) were explored. It showed declining incidences in men and older women, but not in women below 65 years of age. The high prevalence of smokers could possibly explain the absence of decline. In a cohort study of 10 902 middle-age women followed over 14 years, it was concluded that many of the MI events in smokers and ex-smokers can be attributed to other cardiovascular risk factor e.g. hypertension, diabetes and high cholesterol. There was a significant interaction between smoking and hypertension on risk of MI. This illustrates the need of a global risk factor assessment in smokers. Within the city of Malmö there are marked differences between residential areas with regard to the socio-economic circumstances. A cross-sectional study of 17 319 women showed marked differences of the area-specific prevalence of smoking. The prevalence of smoking was related to several unfavourable socio-economic circumstances. The area specific incidence of MI among women was strongly related to the prevalence of smoking, particularly in younger age groups. Fear of weight gain after smoking cessation is an obstacle for many female smokers who consider to quit. A cross-sectional study of 3 931 women showed that smokers on average have lower body weight and lower blood pressure than have non-smokers. During nine years follow-up, the weight increase was 3-4 kg higher in women who quit than it was in those who had never smoked. Smoking cessation was also associated with a moderate increase of both the systolic and diastolic blood pressure and a higher incidence of hypertension. A number of socio-economic and psycho-social circumstances e.g. civil status, educational level, annual income, availability of emotional support, exposure to passive smoking, body weight and self perceived health were in a cross-sectional study associated with women's ability to quit smoking. It is concluded that by using epidemiological methods it is possible to identify target groups for tobacco preventive measures

Obesity in Somali migration women due to post migration dietary changes and decreasing self-esteem : a qualitative interview study on diet, knowledge ab out risk of heart disease, inactivity, body image and self-esteem

The last-decade incidence of myocardial infarction (MI) has diminished dramatically in most age groups but not in middle-aged women in Sweden. There has been a large influx of immigrants and it has been shown that immigrant wom en have a higher BMI and are less physically active than Swedish women. Thereby they have a higher risk for heart disease. The aim of the study was to examine post-migration diet ary changes, and knowledge about risks for heart diseases among Somali women. Furthermore, to examine the women’s perceptions of body image, self-esteem, and their knowledge about the positive effect of physical activity. The qualitative research method was used and eight Soma li women aged 40 years or more, who have lived in Sweden longer than ten years, were in terviewed with the help of a semi- structured questionnaire. The study revealed that S omali migrated women in Sweden had changed their diet and experienced weight increase. They reported low self-esteem and little motivation for physical activity. They understood t hat they had a higher risk for heart disease as compared to Swedish women and they had, in gener al, a preference for big body size. The women of this study are, in combination with other risk factors, at a high risk of myocardial infarction. They all revealed a general knowledge a bout the relationship between obesity and inactivity and enhanced risks for heart disease. Th ey had a preference for a larger female body image. They expressed low self-esteem, loneliness, and alienation from society. It is important to address the health issue among migrant Somali wo men in Sweden, but since this study had few informants, larger studies and more science is needed to further investigate the problem

Social capital, institutional (vertical) trust and smoking: A study of daily smoking and smoking cessation among ever smokers.

Objectives: The associations between vertical ( institutional) trust in the healthcare system and the mass media ( newspapers and television), and daily smoking and smoking cessation were investigated. Methods: The 2004 public-health survey in Scania is a cross-sectional study. A total of 27,757 persons aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the associations between institutional trust in the healthcare system and the mass media, and daily smoking and smoking cessation. A multivariate analysis was performed to investigate the importance of possible confounders ( age, country of origin, education, economic stress, generalized trust in other people) on the differences in daily smoking and smoking cessation according to trust in the healthcare system and the mass media. Results: 14.9% of the men and 18.1% of the women were daily smokers. Middle-aged respondents were daily smokers to a significantly higher extent than the young. Respondents with low trust in the healthcare system had significantly higher odds ratios of daily smoking, 1.88 ( 95% CI 1.38-2.57) among men and 2.05 ( 95% CI 1.51-2.78) among women, while respondents with low trust in the mass media had no significant odds ratios of daily smoking, 1.01 ( 0.67-1.52) among men and 1.55 ( 0.97-2.47) among women, after multiple adjustments. Conclusions: Institutional ( vertical) trust in the healthcare system but not the mass media was significantly associated with lower odds of daily smoking and higher odds of having quit smoking if ever smoker. The healthcare system seems to be a potent arena for tobacco prevention

Smoking as a determinant of the geographical pattern of cardiac events among women in an urban population

Background: Smoking is the major risk factor for cardiac events in younger women and is most common in groups with the least favourable socioeconomic circumstances. Objective: To assess to what extent geographical differences in the female incidence of myocardial infarction in the city of Malmo in Sweden can be accounted for by smoking and to what extent intra-urban variances of smoking are related to socioeconomic circumstances. Method: Area specific prevalences of smokers is based on a sample of 17,319 women, aged 45 - 73 years. A comprehensive score was used to rank the 17 residential areas in terms of socioeconomic circumstances. Incidence of myocardial infarction and death is based on official statistics 1989 - 97. Results: The area-specific prevalence of female smokers, which ranged from 17.5 to 32.5%, was inversely related to the socioeconomic score in 45- to 54 and 55- to 64-year-olds, r=-0.65 ( p < 0.05) and 20.59 ( p < 0.05). No correlation was found for women above 65 years of age. The annual age-adjusted incidence of cardiac events in the residential areas, which ranged from 151 to 414 per 100,000 person years, was strongly related to the prevalence of smokers, r=0.75 ( p < 0.001). Conclusion: Between 50% and 60% of the intra-urban variance of the female incidence of myocardial infarction was accounted for by smoking in this urban population. The geographical pattern of smoking was strongly related to inferior socioeconomic circumstances

Attitudes to and Experiences of Physical Activity among Migrant Women from Former Yugoslavia : a qualitative interview study about physical activity and its beneficial effect on heart health, in Malmo, Sweden.

Background: Many risk factors for heart disease can be reduced by lifestyle modifications such as physical activity, but the attitude to and the knowledge about the beneficial effect of physical activity vary among the population. Migrant women are reported to have a higher BMI and to be less physically active than the Swedish-born women. In order to motivate them to participate in physical activity it is necessary to understand that they are not a homogenous group, and thus their knowledge about, needs for, and attitude to physical activity have to be examined. Aim: The aim of the study was to explore structural and individual factors working either as barriers against or as motivation for a change towards higher levels of physical activity and a healthy lifestyle. Furthermore, the aim was to investigate if the migration had changed the women's level of physical activity and what would be required to increase it. Method: Seven women from Bosnia living in Malmo, Sweden, were interviewed by means of a semi-structured interview guide. The data was analyzed using Burnard's content analysis method. Results: The findings were presented in two categories, namely, "barriers against physical activity" and "motivational factors for physical activity". With regard to the category "barriers against physical activity", the move to Sweden had led to losses and shifts in lifestyles for the women. The greatest lifestyle changes were reported among women who had moved from rural areas in Bosnia to urban areas in Sweden. They found it troublesome to reach the same activity level in Sweden and expressed a greater need to do so. Earlier negative experiences or no experiences at all, of performing physical activity, as well as the winter climate, were seen as obstacles to being active. All the women prioritized family, work, school, and club activities above physical activity. With respect to the category "motivational factors for physical activity", it was found that physical activity could help improve their mental balance, and the women also considered the possibility of losing weight. Conclusion: The study showed that although these migrant women had difficulties finding appropriate and realistic physical activities, and prioritized family activities, they desired to be more physically active, even if the climate was seen as a hindrance. They also reported that physical activity could be a means to achieve better mental health as well as weight loss. Politicians ought to allocate funding, and public health worker to focus more on and enable this high risk group of immigrant women to become more physical active. They should also be informed about their increased risk of myocardial infarction. This, to stimulate increased physical activity among them and in ought to be in co-working with their own immigrant organization

Can physical activity be used as a tool to reduce depression in patients after a cardiac event? What is the evidence? A systematic literature study.

A reduction in the incidence of cardiovascular diseases (CVD) has been reported in the Western world, but post-infarction depression often occurs and is related to poor medical outcomes. The aim of this study was to examine the scientific literature by a systematic review, in order to find evidence for whether physical activity can be a tool to reduce depression in patients who have suffered a cardiac event. Three databases were systematically searched (PubMed, CINAHL, and Cochrane), and the GRADE protocol was used in combination with a revised Amstar-protocol for the systematic review. Scientific reports fitting the area were scarce. Finally, ten studies were included in this study: one meta-analysis, five randomized controlled trials, and four clinical trials. The results showed low to moderate evidence for the use of low to moderate levels of exercise as a tool to reduce depression in post-coronary artery event patients. This study concluded positive effects of physical activity as a tool to reduce depression in post-coronary artery event patients. Physiotherapists could be further involved in increasing physical activity after cardiac events. More studies are needed in the area

Attitudes to and Experiences of Physical Activity among Migrant Women from Former Yugoslavia : a qualitative interview study about physical activity and its beneficial effect on heart health, in Malmo, Sweden.

Background: Many risk factors for heart disease can be reduced by lifestyle modifications such as physical activity, but the attitude to and the knowledge about the beneficial effect of physical activity vary among the population. Migrant women are reported to have a higher BMI and to be less physically active than the Swedish-born women. In order to motivate them to participate in physical activity it is necessary to understand that they are not a homogenous group, and thus their knowledge about, needs for, and attitude to physical activity have to be examined. Aim: The aim of the study was to explore structural and individual factors working either as barriers against or as motivation for a change towards higher levels of physical activity and a healthy lifestyle. Furthermore, the aim was to investigate if the migration had changed the women's level of physical activity and what would be required to increase it. Method: Seven women from Bosnia living in Malmo, Sweden, were interviewed by means of a semi-structured interview guide. The data was analyzed using Burnard's content analysis method. Results: The findings were presented in two categories, namely, "barriers against physical activity" and "motivational factors for physical activity". With regard to the category "barriers against physical activity", the move to Sweden had led to losses and shifts in lifestyles for the women. The greatest lifestyle changes were reported among women who had moved from rural areas in Bosnia to urban areas in Sweden. They found it troublesome to reach the same activity level in Sweden and expressed a greater need to do so. Earlier negative experiences or no experiences at all, of performing physical activity, as well as the winter climate, were seen as obstacles to being active. All the women prioritized family, work, school, and club activities above physical activity. With respect to the category "motivational factors for physical activity", it was found that physical activity could help improve their mental balance, and the women also considered the possibility of losing weight. Conclusion: The study showed that although these migrant women had difficulties finding appropriate and realistic physical activities, and prioritized family activities, they desired to be more physically active, even if the climate was seen as a hindrance. They also reported that physical activity could be a means to achieve better mental health as well as weight loss. Politicians ought to allocate funding, and public health worker to focus more on and enable this high risk group of immigrant women to become more physical active. They should also be informed about their increased risk of myocardial infarction. This, to stimulate increased physical activity among them and in ought to be in co-working with their own immigrant organization

Who are the "quitters"? a cross-sectional study of circumstances associated with women giving up smoking.

Background: Smoking is an important preventable risk factor for cardiovascular disease, cancer, and many other diseases. Even though tobacco consumption is declining in Sweden, it is not declining in all groups. This study explored socioeconomic and psychosocial circumstances hindering or facilitating smoking cessation in three birth cohorts of women from the general population. Methods: Between 1991 and 1996 a comprehensive questionnaire was administered to 17,319 women, 45–73 years old, from the Malmo¨ Diet and Cancer cohort. Smoking habits were compared in relation to socioeconomic and psychosocial circumstances in three birth cohorts. Results: Of these women, 44% were never smokers, 28% were ex-smokers, and 28% were smokers (regular or occasional). When compared with smokers, ex-smokers were more often married, had a higher socioeconomic position, a longer education, more smoke-free surroundings, better emotional support, higher BMI, and better self-perceived health. Ex-smokers reported less work-related stress and less shift work. A history of cardiovascular disease was not associated with smoking cessation. The socioeconomic differences between current and former smokers were higher for young women as compared with older birth cohorts. Conclusions: Continuing smokers and quitters differ with regard to socioeconomic and psychosocial circumstances and factors related to working life and environmental tobacco exposure. By determining who the quitters are through continued follow-up, useful insights can be gained to develop strategies to achieve successful cessation of smoking