Health promotion and disease prevention in the education of health professionals: a mapping of European educational programmes from 2019.

BACKGROUND: Health professionals face barriers in carrying out effective health promotion and disease prevention. To indicate what are the needs for curriculum development in educational programmes, this study aims to provide an overview of how various health professionals are currently trained in health promotion and disease prevention at different educational levels. METHODS: In 2019, a descriptive mapping exercise was performed focusing on European programmes for different health and healthcare professionals at the three levels of education (undergraduate, postgraduate, and continuous professional development [CPD]). Data were collected by a self-developed online survey that was distributed using a modified snowball method. RESULTS: A total of 186 educational programmes of 17 different health professionals were analysed, implemented in 31 countries (60% were undergraduate, 30% postgraduate and 10% CPD programmes). Nearly all programmes indicated that expected outcomes were defined on knowledge (99%), skills (94%) and behaviours/attitudes (89%) regarding health promotion and disease prevention. A multidisciplinary approach was reported to be applied by 81% of the programmes. Traditional teaching methods such as lectures (97%) and assignments (81%) were dominant, while e-learning was less frequently used (46%). Digitalization in health promotion and digital health coaching were the least addressed topics in most programmes. CONCLUSIONS: Health promotion and disease prevention are reported at all surveyed levels of education for a broad spectrum of health professionals. Educational programmes cover contents on knowledge, skills, and behaviours. There is a need for capacity building and joint development in health promotion education. Specifically, there is a need to include digitalisation and novel teaching in the educational programmes of health promotion and disease prevention.

Eight-year post-trial follow-up of morbidity and mortality of telephone health coaching.

BACKGROUND: Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF).. METHODS: 1535 T2D, CAD and CHF patients with unmet treatment targets were randomly allocated into an intervention group (n = 1034) and control group (n = 501). Intervention group received monthly individual strength-based, autonomy supportive THC sessions (average 30 min) for behavior change with a specially trained nurse for 12 months additional to usual health care. Control group received usual health care services. The primary outcome was a composite of death from cardiovascular causes or non-fatal stroke or non-fatal myocardial infarction (AMI) or unstable angina pectoris (UAP) during a follow-up of 8 years Three other composite endpoints with distinct combinations of fatal and non-fatal cardiovascular events and death from any cause were used as secondary outcomes. Other outcomes followed were the most relevant components of the composite endpoints. Randomized controlled trial (RCT) data was linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year evaluation was conducted using intention-to-treat (ITT) and per-protocol (PP) analysis. RESULTS: The composite primary outcome event rate per 100 person years was lower in the intervention group (3.45) than in control group (3.88) in ITT -analysis, but the difference was not statistically significant (hazard ratio in the intervention group 0.87; 95% CI, 0.71 to 1.07; P = 0.19). In the subgroup (T2D, CAD/CHF) analysis, there were no statistically significant effects. The secondary PP-analysis showed statistically significant benefits for those who participated in the study. CONCLUSIONS: No statistically significant effect of health coaching on mortality and morbidity was found in intention to treat analysis. The per protocol results suggest, however, that the intervention may be effective among patients who are willing and able to participate in health coaching. More research is needed to identify patients most likely to benefit from low-intensity health coaching. TRIAL REGISTRATION: NCT00552903 (registration date: the 1st of November 2007, updated the 3rd of February 2009).

Associations of Weight Concerns With Self-Efficacy and Motivation to Quit Smoking: A Population-Based Study Among Finnish Daily Smokers.

INTRODUCTION: Concerns about weight gain occurring after smoking cessation may affect motivation and self-efficacy towards quitting smoking. We examined associations of smoking-specific weight concerns with smoking cessation motivation and self-efficacy in a population-based cross-sectional sample of daily smokers. METHODS: Six-hundred biochemically verified (blood cotinine) current daily smokers comprising 318 men and 282 women aged 25-74 years, were studied as part of the National FINRISK (Finnish Population Survey on Risk Factors on Chronic, Noncommunicable Diseases) study and its DIetary, Lifestyle and Genetic factors in the development of Obesity and Metabolic syndrome (DILGOM) sub-study that was conducted in Finland in 2007. Self-reported scales were used to assess weight concerns, motivation and self-efficacy regarding the cessation of smoking. Multiple regression analyses of concerns about weight in relation to motivation and self-efficacy were conducted with adjustments for sex, age (years), body mass index (BMI, [kg/m(2)]), physical activity (times per week), and further controlled for nicotine dependence (Fagerström Test for Nicotine Dependence). RESULTS: Higher levels of weight concerns were associated with lower self-efficacy (ß = -0.07, p < .001) after adjusting for sex and age. The association remained after additional adjustment for BMI and physical activity (ß = -0.07, p < .001). After further controlling for nicotine dependence the association became weaker but remained significant (ß = -0.04, p = .02). There were no statistically significant associations between concerns about weight and motivation for smoking cessation (ß = 0.02, p = 0.16). CONCLUSIONS: These cross-sectional population-based data do not support earlier findings that suggest that smokers with high levels of weight concerns are less motivated to quit smoking. Our data suggest that daily smokers who are highly concerned about weight may have lower self-efficacy for cessation of smoking.

Smoking and attitudes towards it and its cessation among dental students in Latvia.

BACKGROUND: The prevalence of smoking is higher in Latvia than in most EU countries. This study aimed to determine the level of knowledge of dental students in Latvia about the effects of smoking on oral health and their attitudes toward smoking and its cessation. METHODS: A cross-sectional survey among all the dental students in Latvia was conducted in 2011. Students at the Riga Stradins University were asked to participate in this anonymous, voluntary survey. The questionnaire included items concerned with the students' own smoking habits, their knowledge of smoking as an addiction and its health effects and their attitudes towards its prevention and cessation in a dental setting. The response rate was 87% (173/200). The Chi-square test and logistic regression were used for the statistical analyses. RESULTS: About one quarter of the students (24%) were daily or occasional smokers and almost half of the male students (46%) had smoked at least 100-times in their lifetime. The students revealed a lack of knowledge about the addictive nature of smoking, in that about half of the students did not consider smoking physically or socially addictive. About one fifth (21.4%) didn't consider environmental tobacco smoke (ETS) harmful to one's health. Although the students' awareness of smoking improved during their studies, the most significant factor related to their knowledge was their own smoking history (OR=2.7; p=0.021). CONCLUSIONS: Smoking was frequent among undergraduate dental students and they lacked knowledge of its addictiveness. More emphasis ought to be placed on education with regard to smoking and on cessation services.

[New challenges for the medical professionalism]. / Muuttuva ja muuttumaton professionalismi: lääkärin ammatillisuuden uudet haasteet.

The right of a doctor to conduct her/his profession consists of the patients' confidence in the doctor's professionalism and competence as well as the confidence of the medical profession in the doctor's commitment to act in a professional manner. Professionalism maintains and defines the interaction between the medical profession and the society. It functions on three levels: choices and behavior of individuals, activities between people, and functioning of organizations. While it can be taught, it is difficult to measure. Changing values and esteem of the society modifies professionalism and sets new challenges for it.

Weight concerns among Finnish ever-smokers: a population-based study.

INTRODUCTION: Concern over weight gain after smoking cessation has been hypothesized to discourage quit attempts and consequently reduce smoking cessation rates. The aim of this study was to examine the association between smoking status and weight concerns among a population-based sample of Finnish ever-smokers. METHODS: Data were collected in conjunction with the National FINRISK 2007 Study from a population-based sample of 25- to 74-yearold Finns. These analyses were based on a subsample of 1,614 ever-smokers. Participants were divided into 4 groups (daily smokers, occasional smokers, recent quitters, and former smokers) based on the self-reported smoking status. Weight concerns were analyzed as a sum score including 6 items (range 0-24). Regression analyses were used to examine the association between smoking status and weight concerns, while adjusting for multiple confounders. RESULTS: Smoking status was significantly associated with weight concerns, current daily smokers reporting the highest levels of weight concerns. After adjusting for potential confounders (age, gender, body mass index, socioeconomic status, and health behavior), the weight concerns of daily smokers remained significantly higher in comparison with all other groups. Although women were more concerned about their weight than men, no gender-specific associations were found between weight concerns and smoking status. CONCLUSIONS: Current daily smokers are more concerned about their weight than recent quitters, as well as former and occasional smokers. Weight concerns should be taken into account in tobacco dependence treatment.

Age, marital status and changes in dietary habits in later life: a 21-year follow-up among Finnish women.

OBJECTIVE: To examine 21-year longitudinal changes in dietary habits and their associations with age and marital status among women aged 50-60 years at baseline. DESIGN: Prospective, longitudinal study of a cohort in the FINMONICA population-based risk factor survey with clinical assessments in 1982, 1992 and 2003. Dietary habits were assessed via self-reported consumption of foods typically contributing to SFA, cholesterol and sugar intakes in the Finnish diet. A dietary risk score based upon five items was used. SETTING: Kuopio region, Finland. SUBJECTS: Complete data from all three assessments for 103 women of the original cohort of 299 were included for two age groups: 50-54 and 55-60 years at baseline. RESULTS: Dietary habits improved between 1982 and 1992 and showed continued but less pronounced improvement between 1992 and 2003: within the younger age group, 78 % of the women reduced the number of dietary risk points from the 1982 to 2003 scores, whereas 3 % increased them and 19 % reported no change. In the older age group these percentages were 61 %, 23 % and 16 %, respectively. Women who remained married showed a steadier decline in dietary risk points than single women or women who were widows at the beginning of the follow-up. CONCLUSIONS: Older women make positive changes to their dietary habits but the consistency of these changes may be affected by the ageing process, marital status and changes in the latter.

Physicians' knowledge of and adherence to improving oral health.

BACKGROUND: Integration of oral health promotion into general health care has been highly recommended by the World Health Organization. Primary-care physicians can as part of their general health care promote and contribute to improved oral health care. Our aim was to investigate primary-care physicians' knowledge of oral health, their attitudes toward delivering oral health care (OHC), and their willingness to obtain more education in this field. METHODS: We conducted a cross-sectional survey of all primary-care physicians working in the public health centers of Tehran city. An anonymous self-administered questionnaire queried their knowledge in pediatric- and general medicine-related areas of dentistry, providing knowledge scores to be calculated for three domains. The physicians' attitudes toward OHC and willingness to pursue continuous education underwent evaluation with statements utilizing a 5-point Likert scale. Totally, 220 physicians took part in the survey (response rate: 92%). Chi-square test, linear and logistic regression, and t-test served for statistical analyses. RESULTS: The physicians' knowledge score was significantly lower in the pediatric domain than in the dental and medical domains (p < 0.001). The number of physicians answering correctly to the pediatric questions was less than 40%. Almost all physicians (95%) reported it necessary for a physician to know about OHC and admitted (78%) that physicians' general knowledge in this field is inadequate. Further, 77% of the physicians expressed a will to implement preventive oral health activities in their practice, and almost two-thirds (62%) of them showed a willingness to pursue further education about OHC. Those with higher knowledge scores had a greater willingness to deliver oral health care to their patients. CONCLUSIONS: Physicians' lack of knowledge of OHC and their generally positive attitudes toward it revealed a great need for planning of a continuous medical education program in primary care.

Health coaching by telephony to support self-care in chronic diseases: clinical outcomes from The TERVA randomized controlled trial.

BACKGROUND: The aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes. METHODS: An open-label cluster-randomized parallel groups trial. Pre- and post-intervention anthropometric and blood pressure measurements by trained nurses, laboratory measures from electronic medical records (EMR). A total of 2594 patients filling inclusion criteria (age 45 years or older, with type 2 diabetes, coronary artery disease or congestive heart failure, and unmet treatment goals) were identified from EMRs, and 1535 patients (59%) gave consent and were randomized into intervention or control arm. Final analysis included 1221 (80%) participants with data on primary end-points both at entry and at end. Primary outcomes were systolic and diastolic blood pressure, serum total and LDL cholesterol concentration, waist circumference for all patients, glycated hemoglobin (HbA1c) for diabetics and NYHA class in patients with congestive heart failure. The target effect was defined as a 10-percentage point increase in the proportion of patients reaching the treatment goal in the intervention arm. RESULTS: The proportion of patients with diastolic blood pressure initially above the target level decreasing to 85 mmHg or lower was 48% in the intervention arm and 37% in the control arm (difference 10.8%, 95% confidence interval 1.5-19.7%). No significant differences emerged between the arms in the other primary end-points. However, the target levels of systolic blood pressure and waist circumference were reached non-significantly more frequently in the intervention arm. CONCLUSIONS: Individualized health coaching by telephony, as implemented in the trial was unable to achieve majority of the disease management clinical measures. To provide substantial benefits, interventions may need to be more intensive, target specific sub-groups, and/or to be fully integrated into local health care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00552903.

Does the need for professional competencies change during the physician's career?--A Finnish national survey.

BACKGROUND: Competence consists of a range of skills, knowledge and attitudes that physicians utilize in their work. Different models for defining physician competency areas have been used in medical organizations. The goal of this study was to explore how Finnish physicians perceive the need for different competency areas in their work. METHODS: The data for this study were collected in a national questionnaire administered by the Finnish Medical Association (response rate = 63%; N = 10,624). The competency framework was derived from the CanMEDS framework (seven areas) and detailed into 11 items focusing on different aspects of physicians' work. The participants were asked to evaluate how much they needed different items in their work. RESULTS: Factor analysis identified three broad competency dimensions: (1) medical knowledge, (2) management skills and (3) interpersonal skills. There were differences in the need for these competency dimensions according to work assignment and age, reflecting occupational status and amount of work experience and specialty. CONCLUSIONS: The results were in agreement with the theoretical framework, but the factor analysis compressed the competency areas into three broader dimensions. This study suggests that different positions require different competencies from physicians. Therefore, if physicians are assessed, they should be assessed in accordance with their work.

[Evaluation of tobacco addiction among adolescents and its treatment within the health care]. / Nuorten tupakkariippuvuuden arviointi ja hoito terveydenhuollossa.

Evaluation and treatment of tobacco addiction among adolescents require partly different means than those for adults. Some adolescents are hooked already from the first cigarettes. Indicators of dependence designed for adults and based on regular smoking are suitable for daily smoking adolescents. Indicators providing a more sensitive detection of the appearance of the first signs of dependence are suitable for the less smoking. Regular meetings enabling an open discussion within personal or group councelling constitute the main components in the treatment of tobacco addiction in adolescents. Preliminary evidence exists also on the efficacy of supplementary nicotine patches and bupropion.

Eight-year post-trial follow-up of health care and long-term care costs of tele-based health coaching.

OBJECTIVE: To evaluate the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients. DATA SOURCES/STUDY SETTING: Randomized controlled trial (RCT) data were linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year economic evaluation was conducted. STUDY DESIGN: A total of 1,535 patients (≥45 years) were randomized to the intervention (n = 1034) and control groups (n = 501). The intervention group received monthly telephone health coaching for 12 months. Usual health care and LTC were provided for both groups. PRINCIPAL FINDINGS: Intention-to-treat analysis showed no significant change in total health and long-term care costs (intervention effect €1248 [3 percent relative reduction], CI -6347 to 2217) in the intervention compared to the control group. There were also no significant changes among subgroups of patients with T2D or CAD. CONCLUSIONS: Health coaching had a nonsignificant effect on health care and long-term care costs in the 8-year follow-up among patients with T2D or CAD. More research is needed to study, which patient groups, at which state of the disease trajectory of T2D and cardiovascular disease, would best benefit from health coaching.

Adult smoking as a proxy for environmental tobacco smoke exposure among children - comparing the impact of the level of information in Estonia, Finland and Latvia.

OBJECTIVE: International comparability of environmental tobacco smoke (ETS) exposure levels is difficult. This study assesses whether estimating children's exposure from information on adult smoking and exposure to ETS makes international comparisons more reliable. METHODS: The exposure among children was estimated using three different combinations (models) based on different sets of information on adult smoking, household composition or adult exposure to ETS at home in three cross-sectional nationally representative samples drawn from data sets from Estonia (n=2650), Finland (n=2829) and Latvia (n=5440) in the years 2002 and 2004. The first two models were based on adult smoking and the third also included ETS exposure. RESULTS: The parental smoking rate was similar to the general smoking prevalence. ETS exposure in non-smoking parents ranged from 22% in Finland to 60% in Latvia. All models gave rather comparative ranges except in Latvia, where the proportion of children with exposure varied from 67% with the simplest model to 81% with the most complex one. CONCLUSIONS: Adult exposure at home or adult smoking prevalence, preferably among people with children, could be used as a proxy for children's exposure to ETS. It is recommended that population questionnaires include detailed information on exposure and household composition.

[Competence in the medical profession: a need for a wider perspective?]. / Lääkärin ammatillisen osaamisen laajentaminen.

Working as a physician requires versatile competence, which has been dissected by using various models. Most of these include medical knowledge, patient work, interactive skills, multiprofessional collaboration, management of operational processes within medical and health care, and information technology skills. Without feedback, the ability of physicians to evaluate their developmental needs is poor, whereby the development of competence should be tied on the basis of needs to on-the-job learning and functionality. Different perspectives should be used in its planning and evaluation. After the evaluation, a development plan should be devised and resources created for its implementation.

Did the Tobacco Control Act Amendment in 1995 affect daily smoking in Finland? Effects of a restrictive workplace smoking policy.

BACKGROUND: This study examined changes in adult daily smoking in 1981-2005 in Finland, in order to evaluate the impact of the 1995 Tobacco Control Act Amendment (TCAA) and accompanying measures on the proportion of daily smokers. The main focus of the TCAA was to prohibit smoking at workplaces (designated rooms excluded) in order to protect workers from environmental tobacco smoke. METHODS: The study was based on data from annual postal surveys among 15- to 64-year-olds in 1981-2005 (average response rate 73%). The data set for this study comprised men and women aged 25-64 years (n = 73 471). Logistic models were used to test the effect of the 1995 TCAA across employment status while controlling for the effect of changes in the real price of tobacco and in gross domestic product per capita, and adjusting for age, education, secular trend and prevalence of ever-smokers in each birth cohort. RESULTS: Controlling for confounding factors, the odds ratio (OR) for daily smoking after 1995 among employed men was 0.83 (95% CI 0.73-0.94) compared with the OR (1.0) for the period ending 1994. The corresponding figure for employed women was 0.78 (95% CI 0.68-0.91). The results can be interpreted as a positive effect of the 1995 TCAA on employees' daily smoking. Moreover, a similar decrease in daily smoking was not seen among those not targeted by the TCAA (including farmers, students, housewives, pensioners and the unemployed). CONCLUSION: Smoking behaviour was and can be influenced by national tobacco policy measures.

Smoking and related factors of the social environment among adolescents in the Republic of Karelia, Russia in 1995 and 2004.

BACKGROUND: To investigate changes in smoking prevalence associated with social factors and existing health policies among adolescents in Russia from 1995 to 2004. METHODS: In 1995 and 2004 a confidential questionnaire was distributed to every 9th grade student of all 10 comprehensive schools of the Pitkäranta in Republic of Karelia, Russia. In 1995, 385 children participated in the survey (response rate 95%) and 395 children (response rate 85%) in 2004. RESULTS: Twenty-nine percent of boys smoked daily in 1995 and 31% in 2004. Daily smoking doubled from 7% to 15% for girls. Smoking in the schoolyard increased among girls. The proportion of girls who reported smoking at home with their parents' knowledge increased. Both genders cited the ease of purchasing tobacco as a minor. Knowledge about the fast development of tobacco addiction increased statistically significantly among boys. Fewer numbers of respondents of either gender thought that young smokers look 'cool' and more grown up. Having a best friend who smoked was the strongest predictor for smoking for both genders. CONCLUSION: Smoking has increased among girls. Social environment is a predisposing factor. Anti-smoking legislation was implemented weakly. Minors purchase tobacco relatively easily. Knowledge about tobacco's harmfulness has somewhat increased but is not sufficient to deter starting smoking, especially among non-smoking girls. Adequate education of adolescents on the hazards of tobacco consumption is needed, accompanied by a more determined enforcement of health policies. The potent influence of peers should be considered when planning preventive interventions.

Social climate on tobacco control in an advanced tobacco control country: A population-based study in Finland.

AIMS: Finland has implemented a gradually tightening tobacco control policy for decades. Recently the objective of a tobacco-free Finland was introduced. Still, the population's acceptance of tobacco control policy has not been measured. More knowledge is needed on differences in attitudes and factors associated with tobacco control opinions for future policy-making. METHODS: A population-based study with quantitative analysis. Attitudes on smoking and tobacco control policy were assessed within the National FINRISK 2012 Study in Finland involving 25-74-year-old adults (N = 4905). In analyses, smoking status groups were compared. RESULTS: In general, attitudes differed systematically by smoking status. Differences increased or decreased when moving from never smokers to other smoking groups. Similarities in attitudes were found particularly on youth smoking, while differences between smoking groups were notable on statements regarding smoking on balconies and availability of tobacco products. The adjusted analysis showed that smoking status was most strongly associated with attitudes on different tobacco control policy measures. Daily smokers viewed stricter tobacco control policy and workplace smoking bans more negatively than others, though they viewed societal support for quitters and sufficiency of tobacco control policy more positively compared with others. Differences were vast compared with non-smokers, but also occasional smokers differed from daily smokers. CONCLUSIONS: Tightening tobacco control and workplace smoking bans were supported by the Finnish adult population, but societal support for quitters to a lesser extent. Attitude change, where smokers are seen as deserving help to quit smoking, is important.

Weight concerns as a predictor of smoking cessation according to nicotine dependence: A population-based study.

BACKGROUND: Nicotine-dependent smokers find it difficult to quit smoking. Additionally, smoking-specific weight concerns may affect smoking cessation although the evidence is controversial. We investigated whether smoking-specific weight concerns predict the probability of cessation and, if so, whether the effect varies according to the level of nicotine dependence. METHODS: The study was conducted with a population-based sample of 355 adult daily smokers who participated in the baseline examination in 2007 and in the 2014 follow-up. Baseline nicotine dependence was classified as low or high (Fagerström Test for Nicotine Dependence; 0-3 vs. 4-10 points). Within these groups, we examined whether baseline weight concerns predict smoking status (daily, occasional, ex-smoker) at follow-up by using multinomial logistic regression with adjustment for multiple covariates. RESULTS: Among low-dependent participants at baseline, 28.5% had quit smoking, while among highly dependent participants 26.1% had quit smoking. The interaction between weight concerns and nicotine dependence on follow-up smoking status was significant. Among participants with low nicotine dependence per the fully adjusted model, greater weight concerns predicted a lower likelihood of both smoking cessation (relative risk ratio 0.93 [95% CI 0.87-1.00]) and smoking reduction to occasional occurrence (0.89 [95% CI 0.81-0.98]). Weight concerns were not associated with follow-up smoking status among participants with high nicotine dependence. CONCLUSIONS: Weight concerns are associated with a smaller likelihood of quitting among smokers with low nicotine dependence. Weight concerns should be addressed in smoking cessation interventions, especially with smokers who have low nicotine dependence.

Carotid intima-media thickness and cognitive function in elderly women: a population-based study.

OBJECTIVE: Several vascular risk factors have been linked to cognitive decline. However, little is known about the association between the atherosclerotic process and cognitive impairment. We investigated whether carotid intima-media thickness (IMT) predicts the risk of cognitive impairment and whether the putative impairment is specific for some cognitive domains. METHODS: A 12-year population-based follow-up study was performed for a total of 91 women, aged 60-70 years at baseline. Ultrasonographically assessed carotid artery IMT and the Mini-Mental State Examination test were performed at baseline and 12-year follow-up. A detailed cognitive evaluation for memory and cognitive speed was performed in 2003. The mean of left and right carotid bifurcation IMT was used in the analyses for association with the risk for poor cognitive speed and memory. RESULTS: Increased IMT at baseline was an independent predictor for poor memory (beta = -5.004, 95% confidence interval = -7.74 to -2.27; p = 0.001) and cognitive speed (beta = 2.562, 95% confidence interval = 1.19-4.94; p = 0.035) at 12-year follow-up after adjustment for age, education, depression, plasma LDL cholesterol, systolic blood pressure, cardiovascular disease, hormone replacement therapy, smoking, alcohol consumption and physical activity. The risk for poor memory (p = 0.023 for linear trend) and cognitive speed (p = 0.070 for linear trend) increased with increasing IMT tertiles. CONCLUSIONS: Carotid IMT predicts an increased risk for cognitive impairment, particularly poor memory and cognitive speed, in elderly women.

Smoking status and abdominal obesity among normal- and overweight/obese adults: Population-based FINRISK study.

Several studies have reported direct associations of smoking with body mass index (BMI) and abdominal obesity. However, the interplay between them is poorly understood. Our first aim was to investigate the interaction between smoking status and BMI on abdominal obesity (waist circumference, WC). Our second aim was to examine how the association of smoking status with WC varies among normal and overweight/obese men and women. We examined 5833 participants from the National FINRISK 2007 Study. The interactions between smoking and BMI on WC were analyzed. Participants were categorized into eight groups according to BMI (normal weight vs. overweight/obese) and smoking status (never smoker, ex-smoker, occasional/light/moderate daily smoker, heavy daily smoker). The associations between each BMI/smoking status -group and WC were analyzed by multiple regressions, the normal-weight never smokers as the reference group. The smoking status by BMI-interaction on WC was significant for women, but not for men. Among the overweight/obese women, ex-smokers (ß = 2.73; 1.99, 3.46) and heavy daily smokers (ß = 4.90; 3.35, 6.44) had the highest estimates for WC when adjusted for age, BMI, alcohol consumption and physical activity. In comparison to never smoking overweight/obese women, the ß-coefficients of ex-smokers and heavy daily smokers were significantly higher. Among men and normal weight women the ß -coefficients did not significantly differ by smoking status. An interaction between smoking status and BMI on abdominal obesity was observed in women: overweight/obese heavy daily smokers were particularly vulnerable for abdominal obesity. This risk group should be targeted for cardiovascular disease prevention.