Predicting exercise and smoking behaviors in diabetic and hypertensive patients. Age, race, sex, and psychological factors
J. G. Spangler and J. C. Konen
Department of Family and Community Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.
OBJECTIVE: To predict exercise and smoking behaviors in primary care
patients with chronic diseases (insulin-dependent diabetes mellitus [IDDM],
non-insulin-dependent diabetes mellitus [NIDDM], and hypertension) using
standardized measures of stress, affect, and family function. DESIGN:
Survey by a self-administered health risk appraisal and the Family APGAR
Scale (measuring family function), the Brief Encounter Psychosocial
Instrument (measuring coping with psychological stress), and the Affect
Balance Scale (measuring positive and negative affect). SETTINGS: Large
family practice center, university medical center pediatrics clinic, and
community health center. PARTICIPANTS: Volunteers meeting World Health
Organization criteria for IDDM (n = 83) or NIDDM (n = 322), and volunteers
with documented hypertension (n = 140). MAIN OUTCOME MEASURES: Exercise
levels at or above 2510 kJ/wk; smoking status; and number of cigarettes
consumed per day. RESULTS: Smoking status in all groups was lower than that
measured nationally. Stepwise logistic regression showed a correlation
between positive affect and higher exercise levels among patients with IDDM
and NIDDM, but lower levels among hypertensives. Psychological stress
correlated with current smoking among patients with IDDM. In pooled models,
whites were much more likely than blacks to exercise at higher levels and
to be former or nonsmokers; however, among smokers, whites consumed more
cigarettes per day. Among smokers with IDDM, males were much more likely to
be moderate to heavy smokers. CONCLUSIONS: Among patients with IDDM, NIDDM,
and hypertension, psychosocial stress, affect, age, race, and sex
differentially predict exercise and smoking behaviors. The
lower-than-national prevalence of smoking in these groups may indicate
increased responsiveness to the stop-smoking message. Black diabetic and
hypertensive patients, in particular, may require increased health
promotion efforts.
