title: Cigarette smoking and the risk of diabetes in women.
abstract: OBJECTIVE
  Noninsulin-dependent diabetes mellitus, a major risk factor for cardiovascular disease, is prevalent in more than 12 million Americans. A voluminous amount of data demonstrates that cigarette smoking is an important cause of cancer and coronary heart disease. However, the association between cigarette smoking and the risk of diabetes is virtually unexplored, especially in women.
  
  
  METHODS
  We examined the association between smoking and the incidence of noninsulin-dependent diabetes mellitus among 114,247 female nurses who were free of diabetes, cardiovascular disease, and cancer in 1976. We collected exposure information and disease status prospectively for 12 years from biennially self-administered questionnaires.
  
  
  RESULTS
  Current smokers had an increased risk of diabetes, and we observed a significant dose-response trend for higher risk among heavier smokers. During 1,277,589 person-years of follow-up, 2333 women were clinically diagnosed with diabetes. The relative risk of diabetes, adjusted for obesity and other risk factors, was 1.42 among women who smoked 25 or more cigarettes per day compared with nonsmokers.
  
  
  CONCLUSIONS
  These data suggest that cigarette smoking may be an independent, modifiable risk factor for noninsulin-dependent diabetes mellitus.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115.
authors.forename: E B
authors.initials: EB
authors.lastname: Rimm
authors.forename: J E
authors.initials: JE
authors.lastname: Manson
authors.forename: M J
authors.initials: MJ
authors.lastname: Stampfer
authors.forename: G A
authors.initials: GA
authors.lastname: Colditz
authors.forename: W C
authors.initials: WC
authors.lastname: Willett
authors.forename: B
authors.initials: B
authors.lastname: Rosner
authors.forename: C H
authors.initials: CH
authors.lastname: Hennekens
authors.forename: F E
authors.initials: FE
authors.lastname: Speizer
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*