Discussion
The study provides two main findings: First, for each of the single circulatory disorders, there were 29.7 % or more current smokers among those with a disease. With respect to the number of circulatory disorders, even among those who reported 3 or more, 28.0 % were current smokers. Second, lower odds to be a current smoker were found for individuals with central, but not with peripheral circulatory disease. The hypothesis was confirmed except that those with one central circulatory disorder did not show a relation with current smoking. Altogether, our data confirm former research that had found high proportions of current smokers among hypertensive individuals.[4] Our Results were controlled for overweight and obesity and for exercise which were related to current smoking, supporting former findings.[14,15]
Three approaches may explain the result of substantial proportions of smokers even among those who have suffered from diseases attributable to smoking: First, cognitive processes, such as denial, may be used by smokers to minimize or rationalize the health threat, i. e. finding a justification for the maintenance of smoking. The threat of disease might be related to further other psychological factors such as expectations to succeed in quitting smoking.[2] The reason is plausible also in the light of the finding that central, but not peripheral circulatory disease was related to the odds of being a current smoker. This finding supports former research.[2,6] The data support that threat from disease to the individual and its perception of vulnerability for disease might be used in prevention. Second, current smokers may have insufficient knowledge about the smoking-disease relationship. This is supported by the finding that only 3.4 % (127) of the ever smokers reported that they had received smoking cessation counseling from a physician during the last 12 months prior to the health examination. There could be a recall bias among the smokers, i. e. denying counseling which in fact has been provided. If it had not been provided this would indicate a shortcoming of health care. The majority had had contact to a physician in the last 12 months prior to the interview, and ever smokers who had consulted a physician during the last 12 months prior to the health examination were less likely to be current smokers than subjects who did not consult a physician during the last 12 months prior to the health examination. This result may indicate that having contact alone with a physician might add to stopping. However, those subjects who stated that they had received smoking cessation counseling had threefold odds to smoke at the time of the interview compared to those who mentioned that they did not have received cessation counseling. This might indicate that there is a subpopulation of hard core smokers who seem to have particular difficulty to stop. Nicotine dependence or single aspects of it, such as particularly strong craving for nicotine, might be factors that could be part of the resistance to smoking cessation. Evidence revealed that physician advice may increase the likelihood of stopping smoking.[16] However, it appears that much more may be done in the medical field to improve smoking cessation intervention. Third, a person may decide to smoke, fully aware of the smoking-disease relationship and hazarding the consequences.
A strength of the study is its representativeness for one nation although the country showed only very little activity in the prevention of tobacco-attributable death and disease at the time of the data collection. On the other hand, there are several limitations to the findings. First, this is a cross-sectional study, and the data do not allow any conclusions about causal relations. Second, our data do not reveal whether the threat from illness or vulnerability or a combination of these might be an origin of the smoking cessation. Third, the questionnaire did not include psychiatric comorbidity and nicotine dependence that may add to the maintenance of smoking in spite of the awareness of disease. Fourth, except for the BMI, data were based on self-statements only, and no validation according to smoking and according to circulatory disorders was used. However, evidence shows that the proportion of smokers who deny or minimize smoking in survey studies may be negligible because they do not significantly change the Results with respect to smoking status.[17] According to circulatory disorders, only the awareness to have a specified circulatory disorder was of interest. We assumed this to be relevant for the intention to stop smoking.
BMC Public Health. 2006;6 © 2006 John et al., licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this: Relation Between Awareness of Circulatory Disorders and Smoking in a General Population Health Examination - Medscape - Feb 01, 2006.
