Behavior-related risk factors and time to death among persons with alcohol consumption versus persons without: a general population study with mortality follow-up after 20 years.

BACKGROUND: Evidence shows that low to moderate alcohol consumers seem to live longer than abstainers. Insufficient consideration of subgroups among abstainers and of further behavior-related risk factors for death might be reasons. The aim of this study was to compare alcohol lifetime abstainers, former drinkers and current consumers with regard to mortality considering tobacco smoking, body overweight, and physical inactivity. METHODS: A general adult population sample of residents aged 18 to 64 had been drawn at random in northern Germany. Among eligible persons, 4093 (70.2 %) participated. Assessments include alcohol consumption by the Alcohol Use Disorders Identification Test Consumption in addition to lifetime alcohol abstinence and former drinking. A score of behavior-related risk factors was built from tobacco smoking, body overweight, and physical inactivity. Twenty years later, a mortality follow-up was conducted. Data of 4,028 study participants were analyzed. RESULTS: At baseline, former alcohol consumers but not current low to moderate alcohol -drinkers had more behavior-related risk factors than lifetime abstainers. At follow-up, former alcohol drinkers with two or more behavior-related risk factors had a shorter time to death than lifetime abstainers with 0 or one behavior-related risk factor (hazard ratio 3.43, 95 % confidence interval: 1.63-7.20). Low to moderate alcohol drinkers did not survive longer than lifetime alcohol abstainers with 0 or one behavior-related risk factor. CONCLUSION: The results provide evidence against the assumption that alcohol consumption has a beneficial effect on health and longevity.

Alcohol and Nicotine Dependence and Time to Death in a General Adult Population: A Mortality Cohort Study.

INTRODUCTION: Findings from general population studies are lacking in regard to the co-occurrence of alcohol and nicotine dependence in relation to later mortality. The aim of this study was to analyze potential interactions of risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and time until the first cigarette is smoked in the morning after awakening in the prediction of mortality. METHODS: This study analyzed a random sample of the general population in Northern Germany, which comprised adults aged 18-64 years. Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning after awakening were assessed for the period of 1996-1997 by applying the Munich-Composite International Diagnostic Interview. Data about all-cause mortality were gathered for the period of 2017-2018 and analyzed using Cox proportional hazards models. RESULTS: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning were associated with each other and predicted the time to death. Among participants with a former alcohol dependence, 29.59% had a current nicotine dependence. Participants who had ever been dependent on alcohol at some point in their life before and currently smoked their first cigarette in the morning within 30 min or less after awakening had a hazard ratio of 5.28 (95% confidence interval: 3.33-8.38) for early death compared to low-risk alcohol consumers who had never smoked. CONCLUSION: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning may have a cumulative impact on time to death. The findings suggest that it could be beneficial to provide support for quitting both risky alcohol drinking and tobacco smoking among nondependent individuals in addition to supporting remission from dependence.

Behavior-related health risk factors, mental disorders and mortality after 20 years in a working aged general population sample.

Mortality is predicted by the sum of behavior-related health risk factors (BRFs: tobacco smoking, alcohol drinking, body overweight, and physical inactivity). We analyzed degrees and combinations of BRFs in their relation to mortality and adjusted for mental disorders. In a random sample of the general population in northern Germany aged 18-64, BRFs and mental disorders had been assessed in 1996-1997 by the Munich Composite International Diagnostic Interview. A sum score including eight ranks of the behavior-related health risk factors was built. Death and its causes were ascertained 2017-2018 using residents' registration files and death certificates. Relations of the sum score and combinations of the BRFs at baseline with all-cause, cancer, and cardiovascular mortality 20 years later were analyzed. The sum score and combinations predicted all-cause, cardiovascular and cancer mortality. The odds ratio of the sum score was 1.38 (95% confidence interval 1.31-1.46) after adjustment for age, gender, and mental disorder. In addition to the BRFs, mood, anxiety or somatoform disorders were not related to mortality. We concluded that the sum score and combinations of behavior-related health risk factors predicted mortality, even after adjustment for mental disorders.

Severity of alcohol dependence and mortality after 20 years in an adult general population sample.

OBJECTIVES: To estimate mortality on grounds of the severity of alcohol dependence which has been assessed by two approaches: the frequency of alcohol dependence symptoms (FADS) and the number of alcohol dependence criteria (NADC). METHODS: A random sample of adult community residents in northern Germany at age 18 to 64 had been interviewed in 1996. Among 4075 study participants at baseline, for 4028 vital status was ascertained 20 years later. The FADS was assessed by the Severity of Alcohol Dependence Scale among the 780 study participants who had one or more symptoms of alcohol dependence or abuse and vital status information. The NADC was estimated by the Munich Composite International Diagnostic Interview among 4028 study participants with vital status information. Cox proportional hazard models were used. RESULTS: The age-adjusted hazard ratio for the FADS (value range: 0-79) was 1.02 (95% confidence interval, CI: 1.016-1.028), for the NADC (value range: 0-7) it was 1.25 (CI: 1.19-1.32). CONCLUSIONS: The FADS and NADC predicted time to death in a dose-dependent manner in this adult general population sample.

Automated provision of clinical routine data for a complex clinical follow-up study: A data warehouse solution.

A deep integration of routine care and research remains challenging in many respects. We aimed to show the feasibility of an automated transformation and transfer process feeding deeply structured data with a high level of granularity collected for a clinical prospective cohort study from our hospital information system to the study's electronic data capture system, while accounting for study-specific data and visits. We developed a system integrating all necessary software and organizational processes then used in the study. The process and key system components are described together with descriptive statistics to show its feasibility in general and to identify individual challenges in particular. Data of 2051 patients enrolled between 2014 and 2020 was transferred. We were able to automate the transfer of approximately 11 million individual data values, representing 95% of all entered study data. These were recorded in n = 314 variables (28% of all variables), with some variables being used multiple times for follow-up visits. Our validation approach allowed for constant good data quality over the course of the study. In conclusion, the automated transfer of multi-dimensional routine medical data from HIS to study databases using specific study data and visit structures is complex, yet viable.

Knowledge, attitudes, behaviors, and serological status related to Chagas disease among Latin American migrants in Germany: A cross-sectional study in six German cities.

Background: Little is known about knowledge, attitudes and behaviors concerning Chagas disease (CD) among Latin American migrants in Germany to inform public health decision making. Methods: A cross-sectional, questionnaire-based study was conducted between March 2014 and October 2019 among Latin American migrants in six cities in Germany to obtain information on migration history, socioeconomic and insurance status, knowledge about CD, potential risk factors for Trypanosoma cruzi infection, and willingness to donate blood or organs. Results: 168 participants completed the questionnaire. The four countries with the highest proportion of participants contributing to the study population were Colombia, Mexico, Peru and Ecuador. Before migrating to Europe, the majority of the study population resided in an urban setting in houses made of stone or concrete, had higher academic education and was integrated into the German healthcare and healthcare insurance system. The majority of all study participants were also willing to donate blood and organs and a quarter of them had donated blood previously. However, many participants lacked basic knowledge about symptoms and modes of transmission of Chagas disease. One out of 56 serologic tests (1.8%) performed was positive. The seropositive female participant born in Argentina had a negative PCR test and no signs of cardiac or other organ involvement. Conclusions: The study population does not reflect the population structure at risk for T. cruzi infection in endemic countries. Most participants had a low risk profile for infection with T. cruzi. Although the sample size was small and sampling was not representative of all persons at risk in Germany, the seroprevalence found was similar to studies previously conducted in Europe. As no systematic screening for T. cruzi in Latin American blood and organ donors as well as in women of child-bearing age of Latin American origin is implemented in Germany, a risk of occasional transmission of T. cruzi remains.

Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study.

BACKGROUND: Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later. METHODS AND FINDINGS: A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018. We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption. The Cox proportional hazard ratio (HR) was 2.44 (95% confidence interval (CI), 1.68 to 3.56) for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 (CI 0.72 to 3.77) compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking. Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption. CONCLUSIONS: The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.

Mental disorders and total mortality after 20 years in an adult general population sample.

BACKGROUND: General population data on associations between mental disorders and total mortality are rare. The aim was to analyze whether the number of mental disorders, single substance use, mood, anxiety, somatoform or eating disorders during the lifetime and whether treatment utilization may predict time to death 20 years later in the general adult population. METHODS: We used data from the Composite International Diagnostic Interview, which includes DSM-IV diagnoses for substance use, mood, anxiety, somatoform, and eating disorders, for a sample of 4,075 residents in Germany who were 18-64 years old in 1996. Twenty years later, mortality was ascertained using the public mortality database for 4,028 study participants. Cox proportional hazards models were applied for disorders that existed at any time in life before the interview. RESULTS: The data revealed increased hazard ratios (HRs) for number of mental disorders (three or more; HR 1.4; 95% confidence interval [CI] 1.1-1.9) and for single disorders (alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis), with the reference group being study participants who had not suffered from any of the mental disorders analyzed and with adjustments made for age, sex, and education. Among individuals with any mental disorder during their lifetimes, having been an inpatient in treatment for a mental disorder was related to a higher HR (2.2; CI 1.6-3.0) than was not having been in any treatment for a mental disorder. CONCLUSIONS: In this sample of adults in the general population, three or more mental disorders, alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis were related to premature death.

Health Risk Behavior Patterns in a National Adult Population Survey.

Background: The aim of this paper is to analyze the co-occurrence of health risk behaviors (HRBs), namely, tobacco smoking, alcohol risk drinking, overeating, and physical inactivity, as well as their 16 combinations (patterns), which are stratified by age and gender. Methods: The data of 19,294 study participants, from a telephone survey among the adult general population of Germany that was conducted in 2012, were analyzed. Results: In adults, two or more of the four HBRs were found among 51.5% of females and 61.9% of males. The single most prevalent HRB pattern among all of the female (20.7, 19.6⁻21.8%) and male participants (18.2, 17.1⁻19.3%) was being overweight combined with a lack of physical activity, and its prevalence increased by 4% with each year of life. A multinomial regression analysis revealed that education was inversely associated with 11 of the 15 HRB patterns. The risk of having four, compared to zero, HRBs was 3.3 (2.5⁻4.4) for males relative to females. Conclusion: Similar to the findings from other western countries, the majority of the participants in this adult national sample from Germany had two or more HRBs. The most common of all possible HRB patterns was overweight and inactivity. The data confirm inverse relations between education and most HRB patterns.

[Trends of Tobacco and Alcohol Consumption over 65 Years in Germany]. / Trends des Tabak- und Alkoholkonsums über 65 Jahre in Deutschland.

AIM: No estimation was available for tobacco and for alcohol consumption in Germany based on sales data that were provided for public use and suited for time trend analysis. OBJECTIVES: To estimate trends of tobacco and alcohol consumption rates for the years 1950-2014. METHODS: Data on tobacco and alcohol consumption in the nation were retrieved from reports made by producers of beer, wine, or spirits to the Federal Statistics Office of Germany. Time trends over the 65 years were calculated using the program Joinpoint. RESULTS: Tobacco consumption rose from 1950 to 1972. Thereafter it decreased, mostly by 1.2-6.9 percentage points per year. Alcohol consumption rose until the year 1974 and decreased thereafter by 1.0 percentage points annually until the end of the time period under analysis in 2014. CONCLUSIONS: The findings may be explained, among others, by changes of social norms according to smoking and alcohol consumption after tax increases, nonsmoker and youth protection laws, and legislative measures against driving under the influence of alcohol. A steepening of the decrease in tobacco consumption occurred after laws including tax increases had come into effect. However, the tobacco and alcohol consumption levels were still high at the end of the observation period in 2014.

Age- and Sex-Specific Trends in Lung Cancer Mortality over 62 Years in a Nation with a Low Effort in Cancer Prevention.

BACKGROUND: A decrease in lung cancer mortality among females below 50 years of age has been reported for countries with significant tobacco control efforts. The aim of this study was to describe the lung cancer deaths, including the mortality rates and proportions among total deaths, for females and males by age at death in a country with a high smoking prevalence (Germany) over a time period of 62 years. METHODS: The vital statistics data were analyzed using a joinpoint regression analysis stratified by age and sex. An age-period-cohort analysis was used to estimate the potential effects of sex and school education on mortality. RESULTS: After an increase, lung cancer mortality among women aged 35-44 years remained stable from 1989 to 2009 and decreased by 10.8% per year from 2009 to 2013. CONCLUSIONS: Lung cancer mortality among females aged 35-44 years has decreased. The potential reasons include an increase in the number of never smokers, following significant increases in school education since 1950, particularly among females.

Liver cirrhosis mortality, alcohol consumption and tobacco consumption over a 62 year period in a high alcohol consumption country: a trend analysis.

BACKGROUND: The relationship between alcohol consumption and liver cirrhosis mortality has been revealed by data from several different countries. However, the impact of tobacco smoking on liver cirrhosis has not been considered. The aim of this study was to estimate trends in liver cirrhosis mortality and alcohol and tobacco consumption from 1952 to 2013 as well as more recent trends in substance use disorder treatments and hospital treatments of liver diseases in Germany. METHODS: Data from the National Statistics Office were used. Liver cirrhosis was diagnosed according to the International Classification of Diseases (ICD-6 to ICD-10). Alcohol beverages and tobacco products were estimated according to tax or governmental data. Substance use disorder treatment and hospital treatment data were used. Trends were calculated using Joinpoint regression analyses. RESULTS: Liver cirrhosis mortality among men increased annually by 8.4% from 1952 to 1960 and increased annually by 2.8% from 1961 to 1976. From 1976 to 1982, liver cirrhosis mortality decreased annually by 4.8%, from 1982 to 2013 liver cirrhosis mortality decreased annually by 1.2%. Among females, liver cirrhosis mortality increased annually by 8.9% from 1952 to 1959 and by 4.3% from 1959 to 1968, but then decreased 1.0% annually from 1968 to 1995. After 1995, liver cirrhosis mortality decreased 1.9% annually through 2013. These reductions in liver cirrhosis mortality were accompanied by decreases in alcohol consumption beginning in 1976. These findings were also accompanied by decreases in the consumption of cigarette equivalents since 1971. Meanwhile, the number of substance use disorder treatments and hospital treatments of liver diseases increased. CONCLUSIONS: The decrease in liver cirrhosis mortality may have been caused by a decrease in alcohol drinking and tobacco smoking. Smoking may have exerted indirect effects via alcohol consumption as well as direct effects. These trends existed despite largely missing preventive efforts to reduce alcohol consumption and tobacco smoking. Increases in educational attainment in the general population may have contributed to the reductions in alcohol and tobacco consumption. Convincing evidence that the increased provision of substance use disorder treatment significantly contributed to the decrease of liver cirrhosis was not found.

Lung cancer mortality and years of potential life lost among males and females over six decades in a country with high smoking prevalence: an observational study.

BACKGROUND: Little is known about sex-specific trends in lung cancer mortality and years of potential life lost (YPLL) attributable to lung cancer over more than five decades. The aim of the present study was to describe mortality and YPLL due to lung cancer over 61 years of observation in a country with a high smoking prevalence. METHODS: We obtained data on trends in lung cancer mortality, population-level vital statistics, sales of taxed tobacco products, and survey data on smoking behavior among the German population. We then undertook joinpoint regression analyses to determine sex-specific trends in lung cancer mortality and YPLL. RESULTS: Rates of lung cancer mortality and rates of lung cancer among all causes of death increased more among females than among males. Although YPLL among females increased from 6.6 in 1952 to 11.3 in 2012, this figure was found to have decreased from 7.3 to 4.4 among males in the same period. Sales of tobacco subject to tax increased from 1,509 cigarette equivalents per resident aged 15 or older in 1952 to 2,916 in 1976 - after which there was a decline. The prevalence of current smoking among females aged 35 years or older remained stable between 17.9 and 18.9 % in the period from 1989 to 2009. Among males in the same age group, however, prevalence decreased from 36.7 % in 1989 to 27.5 % in 2009. CONCLUSIONS: Lung cancer mortality and YPLL among females increased over the six decades studied. Women should be more considered in smoking policies.

Excess mortality of alcohol-dependent individuals after 14 years and mortality predictors based on treatment participation and severity of alcohol dependence.

BACKGROUND: Little is known about excess mortality and its predictors among alcohol-dependent individuals in the general population. We sought to estimate excess mortality and to determine whether alcohol dependence treatment utilization, alcohol dependence severity, alcohol-related problems, and self-rated health may predict mortality over 14 years. METHODS: A random sample of the general population between the ages of 18 and 64 in 1 region in Germany was drawn. Among 4,070 respondents with valid data, 153 alcohol-dependent individuals were identified. For 149 of these 153, vital status information was provided 14 years later. Baseline data from the Composite International Diagnostic Interview (German version M-CIDI) included a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) of the American Psychiatric Association, alcohol dependence treatment utilization, alcohol dependence severity based on the number of DSM-IV alcohol dependence diagnostic criteria fulfilled and a symptom frequency questionnaire, alcohol-related problems, self-rated general health, cigarettes smoked per day, and the number of psychiatric disorders according to the DSM-IV at baseline. RESULTS: Annualized death rates were 4.6-fold higher for women and 1.9-fold higher for men compared to the age- and sex-specific general population. Having participated in inpatient specialized alcohol dependence treatment was not related with longer survival than not having taken part in the treatment. Utilization of inpatient detoxification treatment predicted the hazard rate ratio of mortality (unadjusted: 4.2, 90% confidence interval 1.8 to 9.8). The severity of alcohol dependence was associated with the use of detoxification treatment. Alcohol-related problems and poor self-rated health predicted mortality. CONCLUSIONS: According to the high excess mortality, a particular focus should be placed on women. Inpatient specialized alcohol dependence treatment did not seem to have a sufficient protective effect against dying prematurely. Having been in detoxification treatment only, the severity of alcohol dependence, alcohol-related problems, and self-rated health may be predictors of time-to-death among this general population sample.

Serological and virological analysis of maternal and fetal blood samples in prenatal human parvovirus b19 infection.

BACKGROUND: Intrauterine parvovirus B19 (B19V) infection can be asymptomatic or may cause severe fetal complications. Information on serological and virological findings of infection in the fetus is scarce. METHODS: We determined B19V-DNA and anti-B19V antibodies in maternal and fetal blood samples obtained from 41 pregnancies that were complicated by prenatal B19V infection. Most fetuses presented with moderate to severe anemia or hydrops. RESULTS: At the time of fetal blood sampling, all mothers were B19V-DNA positive and B19V-IgG positive. B19V-IgM was detected in 95% of maternal blood samples. B19V-DNA, B19V-IgM, and B19V-IgG were detected in 100%, 28%, and 24% of fetal blood samples, respectively. The probability of a positive B19V-IgG or B19V-IgM finding in fetal blood increased with gestational age. B19V-IgG levels in maternal blood did not correlate with the likelihood of a positive B19V-IgG test in the fetus. The presence of B19V-IgG in fetal blood was accompanied by lower B19V-DNA levels and less severe clinical findings. CONCLUSIONS: The lack of B19V-IgG in fetuses with B19V-derived anemia or hydrops is most likely due to a limited materno-fetal transfer of IgG and a poor fetal antibody response. Fetal B19V infection is poorly controlled in the absence of specific antibodies.

Overestimation of drinking norms and its association with alcohol consumption in apprentices.

AIMS: To investigate associations of normative misperceptions and drinking behaviors in apprentices, complementing the previous literature on university students. METHODS: A survey in a defined region of northern Germany was carried out among 1124 apprentices attending vocational schools. Using items from the short form of the Alcohol Use Disorders Identification Test (AUDIT-C), drinking behaviors and normative perceptions of drinking in the reference group of same-gender apprentices were assessed. Demographic, smoking- and drinking-related predictors for normative misperceptions were explored. RESULTS: Personal drinking behavior was positively correlated with perceived norms, both for drinking frequency (males: Kendall's τ = 0.33, P < 0.01; females: τ = 0.22, P < 0.01) and drinking quantity (males: Kendall's τ = 0.39, P < 0.01; females: τ = 0.25, P < 0.01). Alcohol use disorders according to AUDIT-C cut-offs were more prevalent in subjects who overestimated drinking quantity in their reference group than in those who correctly estimated or underestimated drinking quantity (male: P < 0.01; relative risk (RR) 1.78; female: P < 0.01; RR 1.65). Concerning drinking frequency, this difference was only found in males (P < 0.01; RR 1.49). Male gender and higher alcohol use were positively associated with normative misperceptions of both drinking quantity and frequency. CONCLUSION: Interventions correcting alcohol use misperceptions might be effective in reducing problem drinking in adolescents with heterogeneous educational levels.

Tobacco smoking in relation to pain in a national general population survey.

BACKGROUND: We examined whether smoking status including heavy smoking (20 or more cigarettes per day) is related to the number of pain locations and intensity of pain. METHODS: A probability sample of the German national population aged 18 to 79 including 7124 participants (response proportion: 61.4%) was used. All individuals underwent a health examination between 1997 and 1999. Ordinal logistic regression analyses were performed with number of pain locations and pain intensity as dependent variables which had been assessed by questionnaire. RESULTS: Former and current heavy smokers had higher odds for greater numbers of pain locations and for moderate and intense pain than never smokers after adjustment for analgesic medicament use and behavior-related risk factors. Female former heavy smokers had an adjusted odds ratio (OR) of 1.6 (95% confidence interval, CI, 1.2-2.2) and male former heavy smokers had an adjusted OR of 1.4 (CI 1.1-1.8) for higher numbers of pain locations compared to never smoking women and men respectively (female current smokers: OR 1.4, CI 1.0-1.9; male current smokers: OR 1.3, CI 1.1-1.7). CONCLUSION: The findings suggest that former and current heavy smokers are more likely to report more pain locations and more intense pain than never smokers.

Tobacco smoking in relation to analgesic drug use in a national adult population sample.

BACKGROUND: Nicotine is known to produce pain-inhibitory effects. Here, we examine whether there is a relation between tobacco smoking and analgesic drug use (ADU). METHODS: A probability sample of the German national population aged 18-79 with 7124 participants (participation rate: 61.4%) was used. All individuals underwent a health examination and ADU was assessed as part of an interview conducted by a study physician. RESULTS: Current and former smokers had higher odds for ADU than never smokers. Current heavy smokers (>20 cigarettes per day) had an odds ratio (OR) of 1.8 (95% confidence interval, CI, 1.4-2.3) for ADU three times per month or less and an OR of 3.1 (CI 2.0-4.8) for ADU once a week to daily, with never smokers as the reference group. Former heavy smokers had an OR of 2.0 (CI 1.3-3.2) for ADU once a week to daily compared to never smokers. CONCLUSION: The findings suggest that current and former smokers, particularly current and former heavy smokers, are more likely to use analgesic drugs than never smokers.

Relation between awareness of circulatory disorders and smoking in a general population health examination.

BACKGROUND: Little is known about proportions of smokers who maintain smoking after they are aware of a circulatory disorder. The goal was to analyze the extent to which the number of circulatory disorders may be related to being a current smoker. METHODS: Cross-sectional survey study with a probability sample of residents in Germany investigated in health examination centers. Questionnaire data of 3,778 ever smoking participants aged 18-79 were used, questions included whether the respondent had ever had hypertension, myocardial infarction, other coronary artery disease, heart failure, stroke, other cerebrovascular disease, peripheral vascular disease, and venous thrombosis. Logistic regression was calculated for circulatory disorders and their number with current smoking as the dependent variable, and odds ratios (OR) are presented adjusted for physician contact, inpatient treatment, smoking cessation counseling, heavy smoking, exercise, overweight and obesity, school education, sex and age. RESULTS: Among ever smokers who had 1 circulatory disorder, 52.1 % were current smokers and among those who reported that they had 3 or more circulatory disorders 28.0 % were current smokers at the time of the interview. The adjusted odds of being a current smoker were lower for individuals who had ever smoked in life and had 2 or more central circulatory disorders, such as myocardial infarction, heart failure or stroke, than for ever smokers without central circulatory disorder (2 or more disorders: adjusted OR 0.6, 95 % confidence interval, CI, 0.4 to 0.8). CONCLUSION: Among those with central circulatory disorders, there is a substantial portion of individuals who smoke despite their disease. The data suggest that only a portion of smokers among the general population seems to be discouraged from smoking by circulatory disorders or its accompanying cognitive or emotional processes.

Gender and age differences among current smokers in a general population survey.

BACKGROUND: Evidence suggests a higher proportion of current smokers among female than among male ever smokers at the age above 50. However, little is known about the proportion of current smokers among ever smokers in old age groups with consideration of women in comparison to men from general population samples. The goal was to analyze the proportions of current smokers among female and among male ever smokers including those older than 80. METHODS: Cross-sectional survey study with a national probability household sample in Germany. Data of 179,472 participants aged 10 or older were used based on face-to-face in-home interviews or questionnaires. The proportions of current smokers among ever smokers were analyzed dependent on age, age of onset of smoking and cigarettes per day including effect modification by gender. RESULTS: Proportions of current smokers tended to be larger among female than among male ever smokers aged 40 or above. Women compared to men showed adjusted odds ratios of 1.7 to 6.9 at ages 40 to 90 or older in contrast to men. No such interaction existed for age of onset of smoking or cigarettes per day. CONCLUSION: Special emphasis should be given to current smokers among the female general population at the age of 40 or above in public health intervention.