Background-Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women. Methods and Results-A total of 1927 men and 2495 women Ն40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men Յ70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of any age. Among men 40 to 70 years old, those with AHI Ն30 were 68% more likely to develop coronary heart disease than those with AHI Ͻ5.Obstructive sleep apnea predicted incident heart failure in men but not in women (adjusted hazard ratio 1.13 [95% confidence interval 1.02 to 1.26] per 10-unit increase in AHI). Men with AHI Ն30 were 58% more likely to develop heart failure than those with AHI Ͻ5. Conclusions-Obstructive sleep apnea is associated with an increased risk of incident heart failure in communitydwelling middle-aged and older men; its association with incident coronary heart disease in this sample is equivocal. (Circulation. 2010;122:352-360.)Key Words: epidemiology Ⅲ sleep apnea Ⅲ coronary disease Ⅲ heart failure O bstructive sleep apnea (OSA), characterized by recurrent partial or complete collapse of the upper airway during sleep, is a common chronic condition that affects an estimated 9% of adult women and 24% of adult men. 1 A number of cross-sectional studies have reported an association of OSA with coronary heart disease (CHD), 2-6 although most were small hospital or clinic-based case-control studies that often lacked adjustment for important cardiovascular risk factors. Recent longitudinal studies have found an association of untreated OSA with incident or recurrent cardiovascular disease events. [7][8][9][10] Because untreated OSA generally reflected refusal or voluntary discontinuance of continuous positive airway pressure (CPAP) therapy, a healthy-user effect might be an important source of confounding bias in these studies. Moreover, women were absent from or underrepresented in these studies. Clinical Perspective on p 360Several cross-sectional studies indicate a high prevalence of OSA of 11% to 37% in patients with heart failure. [11][12][13] One study found echocardiographic evidence of left ventricular diastolic dysfunction in 56% of newly diagnosed OSA patients but in only 20% of control subjects; diastolic dysfunction improved with CPAP therapy. 14 Small clinical trials Continuing me...

U.S. health professionals report not fully performing the 5 A's. The common barriers and facilitators identified may help inform strategies for increasing the involvement of all health professionals in conducting tobacco dependence treatments.

Objective To examine the association between smoking and risk of invasive breast cancer using quantitative measures of lifetime passive and active smoking exposure among postmenopausal women.

Background-China has the most smokers in the world. Physicians play a key role in smoking cessation but little is known about Chinese physicians and smoking.

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Background Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world’s largest number of smokers and a high male smoking prevalence rate. Objective To compare exposure to SHS among rural and urban Chinese non-smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration Setting Sichuan province, China. Population In all 1181 non-smoking pregnant women with smoking husbands recruited from eight district/county Women and Children’s hospitals. Methods The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self-reported SHS exposure (total and at home); linear regression was conducted for the sub-sample of hair nicotine concentrations. Main outcome measures Secondhand smoking exposure rates, hair nicotine levels. Results About 75.1% of the non-smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke-free home rules. Conclusions The high prevalence rate of SHS exposure suggests that it is important for non-smoking pregnant women, especially rural women, to establish smoke-free home rules and increase knowledge and negative attitudes towards SHS.

Background Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic Whites. Hmong Americans have limited socioeconomic resources and literacy. This randomized controlled trial (RCT) was conducted to determine if bilingual/bicultural lay health educator (LHE) education can increase CRC screening among Hmong Americans Methods We conducted a cluster RCT among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by a LHE. The control group received education about nutrition and physical activity delivered by a health educator. The outcomes were change in self-reported ever and up-to-date CRC screening after 6 months. Results All participants (n=329) were foreign-born with mostly no formal education, limited English proficiency, and no employment. Most were insured and had a regular place for care. The intervention group had greater changes after the intervention than the control group for ever screening (p=0.068) and being up-to-date (p<0.0001). In multivariable regression analyses, the intervention group had a greater increase than the control group in reporting ever screening (AOR = 1.73, 95% CI: 1.07–2.79) and being up-to-date (AOR = 1.71, 95% CI: 1.26–2.32). Having health insurance had > 4 times the odds for receiving screening, both ever and up-to-date. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. Conclusions A culturally and linguistically appropriate educational intervention delivered by trained LHEs increases colorectal cancer screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Trial Registration Clinicaltrials.gov # NCT01904890

Recent studies reported that smoking cessation leads to higher short-term risk of type 2 diabetes than continuing to smoke. However, the duration of increased diabetes risk following smoking cessation needs further investigation. We followed 135,906 postmenopausal women aged 50-79 years enrolled in the Women's Health Initiative between September 1, 1993, and December 31, 1998, over an average of 11 years to examine the association between smoking cessation and risk of diabetes using Cox proportional hazard multivariable-adjusted regression models. Compared with that for never smokers, the risk for diabetes was significantly elevated in current smokers (hazard ratio = 1.28, 95% confidence interval: 1.20, 1.36) but was even higher in women who quit smoking during the first 3 years of follow-up (hazard ratio = 1.43, 95% confidence interval: 1.26, 1.63). Among former smokers, the risk of diabetes decreased significantly as the time since quitting increased and was equal to that of never smokers following a cessation period of 10 years. In new quitters with low cumulative exposure (<20 pack-years), diabetes risk was not elevated following smoking cessation. In conclusion, the risk of diabetes in former smokers returns to that in never smokers 10 years after quitting, and even more quickly in lighter smokers.