title: Heavy Smoking Is More Strongly Associated with General Unhealthy Lifestyle than Obesity and Underweight.
abstract: BACKGROUND
  Smoking and obesity are major causes of non-communicable diseases. We investigated the associations of heavy smoking, obesity, and underweight with general lifestyle to infer which of these risk groups has the most unfavourable lifestyle.
  
  
  METHODS
  We used data from the population-based cross-sectional Swiss Health Survey (5 rounds 1992-2012), comprising 85,575 individuals aged≥18 years. Height, weight, smoking, diet, alcohol intake and physical activity were self-reported. Multinomial logistic regression was performed to analyse differences in lifestyle between the combinations of body mass index (BMI) category and smoking status.
  
  
  RESULTS
  Compared to normal-weight never smokers (reference), individuals who were normal-weight, obese, or underweight and smoked heavily at the same time had a poorer general lifestyle. The lifestyle of obese and underweight never smokers differed less from reference. Regardless of BMI category, in heavy smoking men and women the fruit and vegetable consumption was lower (e.g. obese heavy smoking men: relative risk ratio (RRR) 1.69 [95% confidence interval 1.30;2.21]) and high alcohol intake was more common (e.g. normal-weight heavy smoking women 5.51 [3.71;8.20]). In both sexes, physical inactivity was observed more often in heavy smokers and obese or underweight (e.g. underweight never smoking 1.29 [1.08;1.54] and heavy smoking women 2.02 [1.33;3.08]). A decrease of smoking prevalence was observed over time in normal-weight, but not in obese individuals.
  
  
  CONCLUSIONS
  Unhealthy general lifestyle was associated with both heavy smoking and BMI extremes, but we observed a stronger association for heavy smoking. Future smoking prevention measures should pay attention to improvement of general lifestyle and co-occurrence with obesity and underweight.
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
authors.forename: Tina
authors.initials: T
authors.lastname: Lohse
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Faeh
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D005260:Female; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D012044:Regression Analysis; D012907:Smoking / Q000453:epidemiology*; D013851:Thinness / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult