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Predicting exercise and smoking behaviors in diabetic and hypertensive patients. Age, race, sex, and psychological factors.

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.