The effect of a smoking cessation program for patients in cancer treatment: a quasi-experimental intervention study.

BACKGROUND: Compared to non-smokers, smokers have reduced effects of cancer treatment, and increased risk of treatment-related toxicity. Quitting smoking can improve treatment effects and reduce side effects. This study reports on the potential impact of a smoking cessation program on smoking cessation rates among patients in cancer treatment. MATERIAL AND METHODS: Cancer patients 18 years and older who smoked, with survival prognosis ≥12 months, not suffering dementia or other mental illness, and who were referred to cancer treatment at six Norwegian hospitals were invited to participate. The study took place from 2017 to 2020 and used a pre-test-posttest non-equivalent control group design. The intervention group received structured smoking cessation guidance based on Motivational Interviewing combined with cost-free nicotine replacement products, while the control group received standard smoking cessation treatment. Self-reported smoking status were registered at baseline and at 6 months' follow up. RESULTS: 76% of patients smoked at baseline and 44% at follow-up in the intervention group, correspondingly 72% and 49% in the control group. In an analysis of differences in within-person change, the reduction in the intervention group was 13 percentage points larger (95% CI = (0.25, -0.005), p = 0.041). Adjusting for gender, age, education, labour market participation and partnership status did not attenuate the estimated effect (18 percentage point difference, 95% CI = (-0.346, -0.016), p = 0.032). Demographic factors and dropout rate differed somewhat between the groups with a higher dropout rate in the intervention group, 54% vs. 51%, respectively). CONCLUSION: Offering a structured smoking cessation program based on Motivational Interviewing and cost-free nicotine replacement products to cancer patients can increase cessation rates in comparison to standard smoking cessation care.

Methods Used in Smoking Cessation and Reduction Attempts: Findings from Help-Seeking Smokers.

In addition to traditional smoking cessation methods like nicotine replacement therapy (NRT), new methods such as mobile applications and e-cigarettes have been added to the toolbox. The purpose of this study was to examine which methods smokers currently use in quit or reduction attempts and map characteristics of users of the various methods. In this study, participants were smokers who visited a website or called a quit line for smoking cessation and who were currently in quit or reduction attempts (N = 740). Data were collected in Norway in 2013-2017 through a web survey. Most smokers were currently trying to quit, and the most frequently used methods were a smoking cessation app for mobile phones, nicotine replacement therapies (NRTs), and e-cigarettes. Logistic regression analyses identified older daily smokers with high cigarette consumption as NRT users, while the users of a cessation app were younger females. The use of e-cigarettes was associated with older, low educated smokers with low cigarette consumption. The use of the mobile phone app was associated with having made several recent quit attempts. The study provides insight into help-seeking smokers' preferences for smoking cessation methods and user characteristics. This knowledge is relevant for further work in smoking cessation planning and policies.

Biomarker-assessed passive smoking in relation to cause-specific mortality: pooled data from 12 prospective cohort studies comprising 36 584 individuals.

AIMS: While investigators have typically quantified the health risk of passive (secondhand) smoking by using self-reported data, these are liable to measurement error. By pooling data across studies, we examined the prospective relation of a biochemical assessment of passive smoking, salivary cotinine, with mortality from a range of causes. METHODS: We combined data from 12 cohort studies from England and Scotland initiated between 1998 and 2008. A total of 36 584 men and women aged 16-85 years of age reported that they were non-smoking at baseline, provided baseline salivary cotinine and consented to mortality record linkage. RESULTS: A mean of 8.1 years of mortality follow-up of 36 584 non-smokers (16 792 men and 19 792 women) gave rise to 2367 deaths (775 from cardiovascular disease, 779 from all cancers and 289 from smoking-related cancers). After controlling for a range of covariates, a 10 ng/mL increase in salivary cotinine was related to an elevated risk of total (HRs; 95% CI) (1.46; 1.16 to 1.83), cardiovascular disease (1.41; 0.96 to 2.09), cancer (1.49; 1.00 to 2.22) and smoking-related cancer mortality (2.92; 1.77 to 4.83). CONCLUSIONS: Assessed biomedically, passive smoking was a risk factor for a range of health outcomes known to be causally linked to active smoking.

Monitoring young lifestyles (MyLife) - a prospective longitudinal quantitative and qualitative study of youth development and substance use in Norway.

PURPOSE: The Monitoring Young Lifestyles (MyLife) project was initiated as an integrated quantitative and qualitative prospective investigation of correlates, causes, and consequences of adolescent substance use and other addictive behaviours in Norway. PARTICIPANTS: The MyLife cohort was recruited from middle schools in Norway, which were selected from low, medium and high standard of living areas in both rural and urban regions of the country. A total of 3512 eighth, ninth and tenth graders (55% girls) from 33 schools were enrolled in the quantitative project arm (QT), while a total of 120 eighth graders (52% girls) from six schools were enrolled in the qualitative project arm (QL). FINDINGS TO DATE: QT baseline was conducted in the fall of 2017, when 2975 adolescents completed an online questionnaire at school during a regular class time. A total of 2857 adolescents participated in the first QT follow-up 1 year later. QL baseline was conducted across the fall semesters of 2014 (one class) and 2015 (five classes), when a total of 118 eighth graders completed face-to-face interviews. QL follow-ups were conducted in the spring of 2015 and fall of 2017 (n=98) for group interviews, and in the spring of 2017 and 2018 (n=95) for individual interviews. In terms of additional data sources, a total of 3035 parents consented to own participation, of which 1899 completed a brief online questionnaire at QT baseline in late 2017. School principals completed brief surveys at the same time. FUTURE PLANS: Both QT and QL arms have planned follow-ups through 2021. Consents were obtained for individual-level linkages of adolescent and parental quantitative surveys to each other, as well as to the information available in multiple national registries and databases. These supplemental data sources will provide key information on additional putative exposures as well as on the long-term health, educational, and social outcomes of the MyLife participants.

Biomarker assessment of tobacco smoking exposure and risk of dementia death: pooling of individual participant data from 14 cohort studies.

BACKGROUND: While there is a suggestion that self-reported tobacco smoking may be a risk factor for dementia, to date, it has not been possible to explore the thresholds at which this exposure elevates risk. Accordingly, our aim was to relate cotinine, a biomarker of tobacco smoking, to risk of dementia death. METHODS: We pooled 14 prospective cohort studies that held data on cotinine (plasma or saliva), covariates and death records. RESULTS: In the 33 032 study members (17 107 women) with salivary cotinine data, a mean duration of 8.3 years of follow-up gave rise to 135 deaths ascribed to dementia; while in 15 130 study members (7995 women) with plasma cotinine data, there were 119 dementia deaths during 14.3 years of mortality surveillance. After multiple adjustment, both plasma cotinine (per 1 SD higher cotinine; 95% CI 1.29; (1.05 to 1.59)) and salivary cotinine (1.10 (0.89 to 1.36)) were positively related to dementia risk, with stronger effects apparent for plasma. CONCLUSION: Our finding that plasma cotinine was related to an elevated risk of dementia death warrants testing in studies with measures of disease onset as opposed to just mortality.

Associations between snus use, body mass index and general health in a cross-sectional population-based sample of women.

BACKGROUND: In Norway, snus use among women has increased substantially over the last decade, particularly in younger age groups. Snus use is associated with increased morbidity among men, but few studies have addressed health consequences of snus use among women. AIM: To investigate the associations between body mass index (BMI) and female snus use, and between self-rated general health and female snus use. METHODS: A nationally representative net sample of 13,756 women in Norway, aged 18-45 years, participated in a survey on lifestyle and health. Ordinal logistic regression was applied to address associations between snus use and BMI/general health, adjusting for age and lifestyle factors. RESULTS: Compared to never users of snus, daily snus users had a lower likelihood of high BMI (OR: 0.83, 95% CI: 0.68-1.00), a higher likelihood of low BMI (OR: 1.63, 95% CI: 1.14-2.33), and a higher likelihood of poor/fair health (OR: 1.43, 95% CI: 1.08-1.90). Former and occasional snus users did not differ from never users in terms of BMI or general health in multiply adjusted models. Daily smokers had the highest likelihood of reporting poor/fair health (OR: 2.18, 95% CI: 1.8-2.63) relative to never smokers. CONCLUSIONS: Daily female snus use was associated with a lower likelihood of being overweight, and a higher likelihood of being underweight. Moreover, daily snus use was associated with a higher likelihood of worse general health. Former and occasional female snus use was not associated with BMI or general health.

Social Media Use and Episodic Heavy Drinking Among Adolescents.

Objectives Little is known about the consequences of adolescent social media use. The current study estimated the association between the amount of time adolescents spend on social media and the risk of episodic heavy drinking. Methods A school-based self-report cross-sectional study including 851 Norwegian middle and high school students (46.1% boys). MEASURES: frequency and quantity of social media use. Frequency of drinking four or six (girls and boys, respectively) alcoholic drinks during a single day (episodic heavy drinking). The MacArthur Scale of Subjective Social Status, the Barratt Impulsiveness Scale - Brief, the Brief Sensation Seeking Scale, the Patient Health Questionnaire-9 items for Adolescents, the Strengths and Difficulties Questionnaire Peer Relationship problems scale, gender, and school grade. Results Greater amount of time spent on social media was associated with greater likelihood of episodic heavy drinking among adolescents ( OR = 1.12, 95% CI (1.05, 1.19), p = 0.001), even after adjusting for school grade, impulsivity, sensation seeking, symptoms of depression, and peer relationship problems. Conclusion The results from the current study indicate that more time spent on social media is related to greater likelihood of episodic heavy drinking among adolescents.

Accumulation of material and lifestyle problems among daily smokers in Norway 1999 to 2013 - a cross-sectional analysis.

BACKGROUND: International studies have found that smoking is increasingly concentrated among lesser-privileged individuals and marginalised groups, indicating a possible rise in daily smokers' accumulated problem burden. The study asks whether material shortages and occurrence of behaviours related to poor health are increasing among daily smokers in Norway, and whether the time trends differ between daily smokers on the one hand, and occasional and non-smokers on the other. METHOD: The study used data acquired by biennial cross-sectional surveys from 1999 to 2013 of the adult (i.e. over 15) Norwegian population. Time trends in individual and accumulated material and lifestyle problems among daily smokers and non-daily and non-smokers combined were assessed using logistic regression analyses for men and women separately. RESULTS: The accumulation of problems in any isolated survey is higher among daily smokers than other respondents. Over the longer term, however, there are few signs of decline in any group, except in regards to frequent alcohol drinking, which increased in all studied groups. The only problem factor differentiating daily smokers from occasional smokers/non-smokers that did change during the period was quality of diet. While problem accumulation declined in all but one group, i.e., male daily smokers, the difference between them and the group of occasional smokers and non-smokers was not significant. CONCLUSION: Daily smokers are generally worse off than occasional smokers and non-smokers combined. However, the accumulation of material problems and health-risk behaviours by daily smokers and occasional smokers/non-smokers did not change significantly and all groups had fewer problems in 2013 than in 1999.

Lifestyle Correlates of Female Snus Use and Smoking: A Large Population-Based Survey of Women in Norway.

INTRODUCTION: While smoking in Norway has become less prevalent, snus use has increased, including among women. The aims of this study were to describe female snus use and its correlates, and to contrast patterns of snus use and smoking. METHODS: In 2011-2012, data on tobacco use, age, education, alcohol consumption, sexual behaviors, and physical activity were collected from a population based sample of 13 756 Norwegian women aged 18-45 years, using a self-administered questionnaire. RESULTS: Ever-use prevalence of snus ranged from 29.6% to 4.5% among those aged 18-19 years and 40-45 years, respectively. In contrast, the corresponding figures for smoking were 24.1% and 44.1%. Among snus users, 54.1% and 22.8% of 18-19 and 40 to 45-year-olds had never smoked, respectively. Debut age for snus use increased markedly with age, and was higher than debut age for smoking. Female snus use was positively associated with intermediate education, alcohol consumption, number of sexual partners, and hard physical activity. Smoking was also positively associated with alcohol consumption and number of sexual partners, but negatively associated with physical activity and education. CONCLUSION: While most snus users among older women were former or current smokers, this was not the case among younger women. Low snus debut age and extensive snus use among younger women suggest that measures to reduce snus use should be targeted at young adolescents. The correlates of female snus use and smoking were not identical, and were similar to those previously documented for men.

Passive smoking assessed by salivary cotinine and self-report in relation to cause-specific mortality: 17-year follow-up of study participants in the UK Health and Lifestyle Survey.

BACKGROUND: Evidence that passive smoking is a risk factor for cardiovascular disease and selected cancers is largely derived from studies in which this exposure is self-reported. Objective assessment using biochemical techniques may yield a more accurate estimate of risk, although each approach has its strengths and weaknesses. We examined the association of salivary cotinine, a widely utilised biomarker for passive smoking, and self-reported passive smoking in the home, with mortality from all causes, cardiovascular disease and all cancers combined. METHODS: In 1992, investigators on the UK Health and Lifestyle Survey collected data on salivary cotinine, self-reported smoking (direct and passive) and a range of covariates in 3731 men and women aged 25 years and over. Mortality was ascertained using linkage to national death records. RESULTS: Analyses were based on 2523 individuals (1433 [57%] women) who classified themselves as non-smokers (never and former). Seventeen years of follow-up gave rise to 588 deaths (253 from cardiovascular disease and 146 from cancer). In men, adjusted hazard ratios (HR) for the association between cotinine levels (1.3-15.0 [high] vs ≤0.3 [low] ng/mL) and the various mortality outcomes were weak for total mortality (HR; 95% CI: 1.22; 0.91 to 1.64) and cardiovascular disease (1.25; 0.78 to 1.99) and absent for all cancers combined (1.10; 0.61 to 2.00). Corresponding associations were generally stronger when self-reported passive smoking (some vs none) was the exposure of interest: 1.53 (1.12 to 2.08), 1.88 (1.20 to 2.96) and 1.58 (0.85 to 2.93). The pattern of association for women in both sets of analyses was less consistent. CONCLUSIONS: In men in the present study, compared with our biochemical marker of passive smoking, cotinine, mortality was generally more consistently associated with self-reported passive smoking.

Nondaily smoking: a population-based, longitudinal study of stability and predictors.

BACKGROUND: Nondaily smoking appears to have remained stable in Western countries in recent years, alongside a steep decline in daily smoking. Nondaily smoking increases the risk of several diseases and premature mortality, but our knowledge about nondaily smoking is limited. The present study was designed to examine the stability of nondaily smoking during young adulthood, and to identify adolescent factors predictive of nondaily smoking compared with nonsmoking and non-nicotine-dependent and nicotine-dependent daily smoking. METHODS: A population-based sample (n = 942) of Norwegians was followed up by surveys for 13 years, from adolescence to young adulthood. Information about smoking patterns, nicotine dependence, school achievement, parents' and peers' smoking, and parental monitoring was collected. Data on parental and participants' education were obtained from a national register. RESULTS: Of all nondaily smokers at age 21 years, 26% were still nondaily smokers at 27 years, while 17% had become daily smokers and 57% had quit. Bivariate analyses revealed that young adult nondaily smokers did not differ from nonsmokers on any of the included variables, while a number of differences in parental, peers' and individual characteristics were observed between nondaily smokers and the two categories of smokers in young adulthood. Longitudinal analyses revealed that unorganized leisure time activities and peers' smoking differentiated nondaily smoking from nonsmoking. Higher educational achievement and less parental binge drinking predicted nondaily smoking and differentiated it from both categories of daily smoking. CONCLUSIONS: The degree of nondaily smoking-stability from 21 to 27 years of age was modest, and most nondaily smokers quit smoking in the course of young adulthood. Young adult nondaily smokers were quite similar to nonsmokers, but differed substantially from both nicotine-dependent and nondependent daily smokers. The study suggests that nondaily smoking--at least in the absence of traditional risk factors for smoking--is usually a transitory behavior, with most people returning to nonsmoking.

[Occasional smoking in Norway]. / Av-og-til-røyking i Norge.

BACKGROUND: In recent decades, daily smoking has become less common, while occasional smoking has stayed at the same level. The purpose of the study is to describe occasional smokers on the basis of their smoking behaviour and socio-demographic characteristics. MATERIAL AND METHOD: Data from Statistics Norway's quarterly surveys of tobacco use in 2010 and 2011 were used. Information on smoking habits, smoking-related behaviour and the respondents' attitudes to their own smoking was collected in telephone interviews. RESULTS: Of the 8,700 men and women aged 16-74 (response rate 57%) who were included, altogether 1,583 were daily smokers and 907 occasional smokers. The occasional smokers were younger, more frequently lived in large cities and had a higher level of education and income than the daily smokers. Twenty-nine of 174 (17%) occasional smokers used snus on a daily basis, compared to 10 of 394 (3%) of the daily smokers. The occasional smokers had great confidence in their ability to quit: 95% responded that they would be smoke-free in five years, compared to 55% of the daily smokers (n = 2,158). Fifty-five (35%) of the occasional smokers lit up several times weekly (16 cigarettes per week on average), while the remaining (65%) smoked only once per week as a maximum (five cigarettes per week on average). Those who smoked several times each week had attitudes to their own smoking and usage pattern for tobacco that were similar to those of the daily smokers. Nearly half of the occasional smokers defined themselves as non-smokers. INTERPRETATION: Norwegian occasional smokers are a heterogeneous group in terms of their smoking pattern and frequency, and many define themselves as non-smokers.

Do smoking and fruit and vegetable intake mediate the association between socio-economic status and plasma carotenoids?

BACKGROUND: The aim was to study whether the association between educational attainment and antioxidant status is mediated by smoking and fruit and vegetable intake. METHODS: Cross-sectional analyses of the Oslo Youth Study 2006 wave were carried out. Information about education, smoking habits and diet was collected by questionnaire for 261 subjects (142 women and 119 men aged 38-42 years). Blood samples, height and weight measurements were taken by the participants' General Practitioner. Blood were analysed for plasma carotenoids. Linear regression analyses were used to examine whether smoking and fruit and vegetable intake mediate the association between education and plasma carotenoids. RESULTS: Educational level was positively associated with ß-cryptoxanthin, α-carotene and lutein/zeaxanthin, but not with total carotenoids, ß-carotene or lycopene. Education was negatively associated with smoking and positively associated with fruit and vegetable intake. Smoking was negatively associated with ß-cryptoxanthin, and fruit and vegetable intake was positively associated with ß-cryptoxanthin (adjusted for educational level). Moreover, cigarette consumption mediated the association between education and ß-cryptoxanthin by 37%, while fruit and vegetable intake mediated this association by 18%. The total mediation effect was 55%. CONCLUSION: Smoking seemed to be more important as a mediator between education and plasma levels of ß-cryptoxanthin than the intake of fruit and vegetables, but more studies are needed to establish the relative importance of smoking and diet as mediators of the association between education and antioxidant status.

How do impulsivity and education relate to smoking initiation and cessation among young adults?

OBJECTIVE: This study examined the predictive value of impulsivity for starting and quitting smoking and whether education had an independent effect on smoking careers or moderated the impulsivity-smoking association. METHOD: Two waves of the cohort study Young in Norway were used in the present study (third wave: 1999, age range: 19-32 years; fourth wave: 2005, age range: 25-38 years). Postal questionnaires were used for data collection. Subjects participating in 1999 and 2005 were eligible (N = 2,562). Stable smokers (daily smokers in 1999 and 2005) and nonsmokers (never smokers in 1999 and 2005), quitters (daily smokers in 1999, nonsmokers in 2005), and starters (never smokers in 1999, daily smokers in 2005) constituted the analytical sample (1,776 men and women). The associations between self-reported impulsivity and education and smoking were investigated using logistic regression analyses. RESULTS: The odds ratio (OR) for a 1-unit increase in the impulsivity score was 2.16 (95% CI [1.09, 4.30]) for smoking initiation, whereas the OR [95% CI] for low compared with high education was 2.55 (95% CI [1.36, 4.77]). Education, but not impulsivity, emerged as a significant determinant for smoking cessation compared with continued smoking. The OR for quitting smoking by low compared with high education was 0.61 (95% CI [0.42, 0.90]). Mutual adjustment for education and impulsivity did not change any of the results. The interaction term between impulsivity and education was not significantly related to smoking. CONCLUSIONS: Because impulsivity emerged as important for smoking initiation regardless of educational level, it should be considered when planning and implementing smoking prevention programs for both low and high socioeconomic groups.

Parental education as a predictor of offspring behavioural and physiological cardiovascular disease risk factors.

BACKGROUND: Childhood socio-economic disadvantage has been shown to be associated with an elevated rate of cardiovascular disease (CVD) events in adulthood. The objective of this study is to examine associations between mothers' and fathers' education and offspring CVD risk factors. METHODS: The Oslo Youth Study (n = 498) was initiated in 1979. Children (age 11-15 years) attending six schools and their parents were included. Information on education was collected for parents and participants. Participants were followed through 2006 (age 40 years). Information about physical activity, diet, smoking, binge drinking, body mass index (BMI), s-cholesterol, s-triglycerides and blood pressure was collected in 1981, 1991 and 2006. RESULTS: Fathers' education was inversely associated with participants' BMI at 15 and 25 years, cholesterol at 25 and 40 years, triglycerides at 25 years and systolic blood pressure at 15 and 25 years (regression coefficients -0.18 to -0.11; P < 0.05 for all). The effects were weakened after adjusting for participants' own education. Maternal education showed no association with these risk factors. After controlling for participants' own education, associations between parental education and behavioural risk factors in adulthood were few. CONCLUSION: Any impact of parental education on offspring CVD risk factors seemed to be mediated via subject's own education. Parental education offered little predictive capacity for offspring CVD risk factors.

Hardcore smokers in Norway 1996-2009.

INTRODUCTION: The aim of this study was to investigate changes in the relative proportion of hardcore smokers (HCS) in Norway for the years 1996-2009. METHODS: Data were derived from Statistics Norway's annually cross-sectional representative samples of the adult population. The total sample size of smokers each year was between 250 and 500. The outcome measure was HCS, defined by their intention not to quit smoking and absence of attempts to quit during the last 12 months. Logistic regression analysis was conducted to estimate the association between time (survey year) and the number of HCS. RESULTS: We identified three groups of smokers: occasional smokers, daily non-HCS, and HCS. The relative proportion of HCS declined in the period 1996-2009, from 30% to 23%. A model adjusted for gender, age, educational level, and the use of snus (smokeless tobacco) showed the same downward trend. CONCLUSIONS: Within this sample of Norwegian smokers, the relative share of HCS is not increasing. This knowledge is important for tobacco prevention policy. The result does not support a hardening hypothesis regarding changes in the size of the group of HCS. Further analysis is needed to investigate individual resistance to smoking cessation.

Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey.

BACKGROUND: Physical activity, diet, smoking, and alcohol consumption have been shown to be related to mortality. We examined prospectively the individual and combined influence of these risk factors on total and cause-specific mortality. METHODS: The prospective cohort study included 4886 individuals at least 18 years old from a United Kingdom-wide population in 1984 to 1985. A health behavior score was calculated, allocating 1 point for each poor behavior: smoking; fruits and vegetables consumed less than 3 times daily; less than 2 hours physical activity per week; and weekly consumption of more than 14 units of alcohol (in women) and more than 21 units (in men) (range of points, 0-4). We examined the relationship between health behaviors and mortality using Cox models and compared it with the mortality risk associated with aging. RESULTS: During a mean follow-up period of 20 years, 1080 participants died, 431 from cardiovascular diseases, 318 from cancer, and 331 from other causes. Adjusted hazard ratios and 95% confidence intervals (CIs) for total mortality associated with 1, 2, 3, and 4 poor health behaviors compared with those with none were 1.85 (95% CI, 1.28-2.68), 2.23 (95% CI, 1.55-3.20), 2.76 (95% CI, 1.91-3.99), and 3.49 (95% CI, 2.31-5.26), respectively (P value for trend, <.001). The effect of combined health behaviors was strongest for other deaths and weakest for cancer mortality. Those with 4 compared with those with no poor health behaviors had an all-cause mortality risk equivalent to being 12 years older. CONCLUSION: The combined effect of poor health behaviors on mortality was substantial, indicating that modest, but sustained, improvements to diet and lifestyle could have significant public health benefits.

Physical fitness and physical activity at age 13 years as predictors of cardiovascular disease risk factors at ages 15, 25, 33, and 40 years: extended follow-up of the Oslo Youth Study.

OBJECTIVE: Few studies have examined the association of childhood physical activity and physical fitness with cardiovascular disease risk factors in adulthood. Furthermore, interpretation of these findings is hampered by methodologic shortcomings. In a population-based cohort study, we explored the influence, if any, of childhood physical activity and physical fitness on later cardiovascular disease risk factors. METHODS: Data were taken from the Oslo Youth Study, a prospective cohort study that began in 1979, when 1016 students (mean age: 13 years; range: 11-15 years) who were attending 6 schools were invited to participate in a health education intervention. Cardiovascular disease risk factor data were collected at baseline and again in 1981 (mean age: 15 years; range: 13-17 years), 1991 (mean age: 25; range: 23-27 years), 1999 (mean age: 33; range: 31-35 years), and 2006 (mean age: 40; range: 38-42 years). RESULTS: At baseline, physical fitness was inversely related to BMI, triceps skinfold thickness, and blood pressure (systolic and diastolic; N = 716). These associations were also present in prospective analyses at ages 15 (N = 472), 25 (N = 280; except for systolic blood pressure), and 33 years (N = 410, only BMI measured)-albeit with progressively diminishing magnitude-but were lost at 40 years (N = 294). There were fewer relationships with cardiovascular disease risk factors when physical activity was the exposure of interest. Controlling for educational attainment of both the parent and the study member had little impact on these associations. CONCLUSIONS: Although childhood physical fitness seems to reveal some inverse associations with obesity and blood pressure in early adulthood, these effects diminished markedly into middle age.