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Smokers in Västerbotten County, Sweden. What contributes to increased cardiovascular risk among heavy smokers?
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0003-3025-2690
2003 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 4, 237-241 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To analyse risk factor levels and risk factor patterns among heavy smokers compared to never smokers. DESIGN: An incident case-referent study.

SETTING: The study was nested within the Västerbotten Intervention Programme (VIP).

SUBJECTS: 286 people (62 women and 224 men) claimed to be heavy smokers, i.e. smoked 25 cigarettes or more per day. For each of them, two referents (who reported never to have been smokers) were matched on age and gender (572 referents).

MAIN OUTCOME MEASURES: Differences in biomedical variables and social and lifestyle factors were confirmed.

RESULTS: S-cholesterol, s-triglycerides, fasting blood glucose, body weight and body mass index were all significantly elevated among the heavy smokers. Some gender differences were also found. Social and lifestyle factors differed significantly between heavy smokers and never smokers, but without gender differences.

CONCLUSIONS: Heavy smokers carry a risk factor pattern corresponding to an increased risk of developing cardiovascular disease. Unfavourable changes in serum lipids and in glucose metabolism can exacerbate other deleterious effects of tobacco smoke on the cardiovascular system. Obviously, heavy smokers and never smokers differ not only in regard to biomedical variables but also to lifestyle and social health determinants. These are important factors to consider in public health efforts aimed at reducing the increased risk for cardiovascular diseases among smokers.

Place, publisher, year, edition, pages
2003. Vol. 21, no 4, 237-241 p.
URN: urn:nbn:se:umu:diva-38353PubMedID: 14695075OAI: diva2:375640
Available from: 2010-12-08 Created: 2010-12-08 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Tobaksvanor i medelåldern: riskfaktormönster, rökstoppsattityder och erfarenheter av att sluta röka
Open this publication in new window or tab >>Tobaksvanor i medelåldern: riskfaktormönster, rökstoppsattityder och erfarenheter av att sluta röka
2011 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tobacco use, mostly smoking, has been a deeply rooted habit for many people for centuries. However, it was not until the second half of last century that the risks with smoking became obvious. Today when the bad consequences of smoking are recognized by almost all people, it is important to discuss why smokers choose to continue smoking. The main aim of this thesis is to try to better explain why some middle aged smokers choose to continue smoking in spite of knowledge of the huge mass of information that is gathered about the serious side effects of smoking. Many of these people cannot by any means stop smoking while others succeed in their attempt to quit.

Since 1990 all inhabitants in Västerbotten County are invited to a health survey the year they become 40, 50 and 60 years: the Västerbotten Intervention Programme (VIP). The VIP health survey consists of risk markers for cardiovascular diseases (blood pressure, blood sugar and blood lipids), a questionnaire on socioeconomic, psychosocial and life style factors, supplemented by a health counselling discussion with a district nurse.

The thesis is based on five papers. Four of them use VIP data. In Paper I tobacco habits are related to different levels of age, gender and education and are analyzed in a 18 year perspective, based on 112 920 VIP participants. As it has been suggested that women might have more difficulties than men to stop smoking, Paper II elucidates women’s perceptions about smoking, based on interviews with nine smoking and ex-smoking women. Paper III identify metabolic consequences of heavy smoking and relate these to social and life style factors that might accompany smoking behaviour. Paper IV analyzes the individual pattern of changes in tobacco use over a ten year period among 16 492 subjects, while Paper V, a questionnaire study, addresses 513 respondents own assessments of what was especially important for them in their attempts to become smoke-free and what was positive and what was negative when they stopped to smoke. Their knowledge and attitudes about smoking issues were also analyzed.

The thesis shows that heavy smokers seem to have a metabolic profile heading towards the metabolic syndrome, and that this pattern could be reinforced by some social and life style factors. Smoking women expressed their concern over weight gain, if quitting. They provided a series of different hinders and barriers against smoking cessation as well as some explanations of why it was reasonable to continue smoking. Feeling of shame and fatalism played a major role but also influence from friends, relatives and media was regarded as important factors. For both men and women the decision to quit smoking was supported from relatives and from a wish for a healthier lifestyle. Support from the health care providers was perceived to be rare. Snus use and nicotine replacement therapy in the attempts to stop smoking were also discussed.

In summary the thesis stresses that the use of tobacco products in Västerbotten is slowly decreasing in the middle aged population in general. For people with shorter school education and at somewhat younger age the dual use of tobacco products, cigarettes and snus, are slowly increasing. However, after ten years, half of the smokers in these age cohorts still smoke. It is possible that the more addicted smokers remain, why a major challenge is to find new ways to support these individuals. Health care providers have to do more, but also schools, media, societal organizations and governmental bodies on local, regional and national levels. One proposal is to look upon nicotine dependence, especially smoking, as a chronic condition that needs various multifactorial treatment and long time follow up, and that it is important to organize the support accordingly. Special antitobacco or life style centres outside the established health care organization where focus could be on different healthy life style matters is suggested. The thesis also suggest different ways to handle smoking cessation at the primary health care level.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 113 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1344
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
urn:nbn:se:umu:diva-38402 (URN)978-91-7459-000-5 (ISBN)
Public defence
2011-01-21, Sal 135, Allmänmedicin, Byggnad 9 A, ingång X5, Umeå, 09:00 (Swedish)
Available from: 2011-01-04 Created: 2010-12-13 Last updated: 2015-04-29Bibliographically approved

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