Tobias Martin, Yeh Li-Chia, Jackson Gary
New Zealand Ministry of Health, Wellington, New Zealand.
Aust N Z J Public Health. 2007 Feb;31(1):19-22.
To describe the co-occurrence and clustering/aversion of tobacco use and obesity in New Zealand.
Data were sourced from the 2002/03 New Zealand Health Survey, a nationally representative household survey that included measured body mass index (BMI) and self-reported smoking status. The association of cigarette smoking, obesity, and the combination of these risk factors with socio-demographic variables was analysed by multiple logistic regression. Clustering/aversion (defined as observed prevalence of [smoking + obesity] > or < expected prevalence, where expected prevalence = prevalence of [smoking] x prevalence of [obesity]) was also estimated.
The joint prevalence of smoking plus obesity in the adult population (15+ years) was 4.5%. However, this was 10% for Maori and 8.5% for deprivation quintile 5. Adjusting for relevant covariates, Maori were twice as likely to have both risk factors as non-Maori. A smooth deprivation gradient was found, with deprivation quintile 1 (least deprived) only one-fifth as likely to have both risk factors as quintile 5 (most deprived). There was no evidence of clustering, and aversion (negative clustering) was demonstrated only for middle-aged adults and for Maori.
Since smoking cessation is associated with weight gain, substantial aversion might have been expected across all subgroups, yet this was not found. The most likely explanations are that the extent of weight gain associated with smoking cessation has been overestimated or is often not sustained. Even so, health promotion and clinical interventions need to take the dually exposed population into account, addressing not only the unhealthy behaviours themselves but also the social context in which dual exposure occurs.
描述新西兰烟草使用与肥胖的共现情况以及聚集/相斥情况。
数据来源于2002/03年新西兰健康调查，这是一项具有全国代表性的家庭调查，其中包括测量的体重指数（BMI）和自我报告的吸烟状况。通过多元逻辑回归分析吸烟、肥胖以及这些风险因素的组合与社会人口统计学变量之间的关联。还估计了聚集/相斥情况（定义为[吸烟+肥胖]的观察患病率>或<预期患病率，其中预期患病率=[吸烟]的患病率×[肥胖]的患病率）。
成年人口（15岁及以上）中吸烟加肥胖的联合患病率为4.5%。然而，毛利人的这一患病率为10%，最贫困五分位人群的患病率为8.5%。在对相关协变量进行调整后，毛利人同时具有这两种风险因素的可能性是非毛利人的两倍。发现了一个平滑的贫困梯度，最不贫困的五分位1人群同时具有这两种风险因素的可能性仅为最贫困的五分位5人群的五分之一。没有聚集的证据，仅在中年成年人和毛利人中表现出相斥（负聚集）。
由于戒烟与体重增加有关，预计在所有亚组中都会出现大量相斥情况，但实际并未发现。最可能的解释是，与戒烟相关的体重增加程度被高估了，或者这种增加往往无法持续。即便如此，健康促进和临床干预仍需考虑双重暴露人群，不仅要解决不健康行为本身，还要解决双重暴露发生的社会背景问题。
