The development of family alliance from pregnancy to toddlerhood and child outcomes at 5 years.

This article presents a longitudinal study of the development of "family alliance" from pregnancy to toddlerhood in a community sample, as well as its links with the emotional and cognitive development of the child at age 5 years. Family alliance is defined as the quality of the interactive coordination between family members. We consider that the alliance constitutes a context for the child to learn emotion regulation and to develop an understanding of inner states. Family interactions (N = 38) were observed at the 5th month of pregnancy and at 3, 9, and 18 months after birth in a standardized situation of observation (Lausanne Trilogue Play). Marital satisfaction and child temperament were assessed through self-reported questionnaires. Several outcomes of the child at age 5 years were measured: theory of mind performances, predominant emotional themes in pretend play, internalized and externalized symptoms. Results show that (a) three patterns of evolution of family alliance occur: "high stable" (n = 19), "high to low" (n = 10), and "low stable" (n = 9); (b) a high stable alliance is predictive of better outcomes in children at age 5 years, especially regarding theory of mind; (c) the temperament of the child is predictive of child outcomes; and (d) an interaction effect occurs between family alliance and temperament. These results highlight the importance of both family-level and individual-level variables for understanding individual differences in the social and cognitive development of children.

Psychophysiological activation during preparation, performance, and recovery in high- and low-anxious music students

The present study provides a comprehensive view of (a) the time dynamics of the psychophysiological responding in performing music students (n = 66) before, during, and after a private and a public performance and (b) the moderating effect of music performance anxiety (MPA). Heart rate (HR), minute ventilation (VE), and all affective and somatic self-report variables increased in the public session compared to the private session. Furthermore, the activation of all variables was stronger during the performances than before or after. Differences between phases were larger in the public than in the private session for HR, VE, total breath duration, anxiety, and trembling. Furthermore, while higher MPA scores were associated with higher scores and with larger changes between sessions and phases for self-reports, this association was less coherent for physiological variables. Finally, self-reported intra-individual performance improvements or deteriorations were not associated with MPA. This study makes a novel contribution by showing how the presence of an audience influences low- and high-anxious musicians' psychophysiological responding before, during and after performing. Overall, the findings are more consistent with models of anxiety that emphasize the importance of cognitive rather than physiological factors in MPA.

Les gangs en Suisse : délinquance, victimisation et facteurs de risque

Abstract Gang membership constitutes one of the strongest risk factors of delinquency. Research on this topic found that gang members commit more offences in general and are particularly more prone to violent offences than other juveniles. Indeed, they are responsible for approximately 50 to 86% of the total offences perpetrated by juvenile offenders. In Switzerland, as in other European countries, there is a reluctance to use the term of gang to talk about delinquent youth groups. However, this term implies many stereotypes that do not apply to the majority of juvenile American gangs. Thus, it appears that some delinquent youth groups in European countries can be described as gangs. This manifestation of juvenile delinquency is increasingly studied by European researchers, whose studies demonstrate the high level of delinquency committed by gang members. This research assesses the proportion of gangs in Switzerland and their level of involvement in delinquency. Victimization of gang members as well as risk factors of gang membership are also analyzed. For this research, data of two self-reported juvenile delinquency surveys were used, namely the survey of "les jeunes et l'insécurité" and the second wave of the International Self-Reported Delinquency Survey (ISRD-2). The first survey took place in the canton of Vaud among 4'690 teenagers, and the second one was conducted across Switzerland by interviewing 3'648 teenagers aged 12 to 16. The results from the ISRD-2 survey show that 4.6% of young Swiss belong to a gang, whereas this is the case for 6.5% of teenagers in the canton of Vaud. About a third of the gang members ara girls. A strong link between the commission of offences and gang membership was found in both surveys. A teenager who does not belong to a gang commits on average 1.9 offences per year, whereas this number increases to 7.2 offences for teenagers who have delinquent peers and to 16 offences for gang members. The risk of victimization is also stronger for a gang member than for a non-gang member, as it is 4 to 5 times higher for assaults and robberies. International comparisons based on the ISRD-2 survey have been conducted, highlighting the high level of delinquency of gang members and their vulnerability to victimization. Risk factors of gang membership include the influence of accessibility to drugs in the neighbourhoods, the lack of self-control of the teenagers and their consumption of cannabis. Résumé Un des facteurs de risque les plus importants de la délinquance juvénile est l'appartenance à un gang. Les recherches faites sur cette problématique indiquent que les membres de gangs commettent plus de délits et des délits plus violents que les autres jeunes et qu'ils sont responsables d'environ 50 â 86% des actes délinquants perpétrés. En Suisse, tout comme dans d'autres pays européens, une réticence existe à utiliser le terme de gang pour parler des bandes de jeunes délinquants. Pourtant, ce terme implique de nombreux stéréotypes qui ne correspondent toutefois pas à la majorité des gangs américains. Ainsi, il apparaît que certaines bandes de jeunes délinquants présentes dans des pays européens peuvent être qualifiées de gangs. Cette manifestation de ta délinquance juvénile est de plus en plus étudiée par les chercheurs européens qui démontrent également la sur-criminalité de leurs membres. I La présente recherche évalue dans quelle proportion tes membres de gangs existent en Suisse et Quel est leur niveau d'implication dans la délinquance. Leur victimisation ainsi que les facteurs de risque de l'affiliation à de tels groupes y sont également analysés. Pour ce faire, les données de deux enquêtes ont été utilisées, à savoir l'enquête des jeunes et de l'insécurité portant sur 4'690 élèves de 8'? et 9*? année scolaire du canton de Vaud, ainsi que la deuxième vague du sondage de délinquance auto-reportée portant sur 3'648 jeunes suisses ayant entre 12 et 16 ans (ISRD-2 -International Self Reported Delinquency-). Ainsi, 4.6% des jeunes suisses, selon la recherche de l'ISRD-2, et 6.5% des jeunes vaudois, selon l'enquête des jeunes et de l'insécurité, appartiennent à un gang ; un tiers des membres étant de sexe féminin. Un lien fort entre la commission de délits et l'affiliation à un gang a été mis en évidence dans les deux enquêtes. Un adolescent qui ne fait pas partie d'un gang commet en moyenne 1.9 délits par année, un jeune qui a des pairs délinquants en commet en moyenne 7.2, alors que la moyenne annuelle des jeunes qui appartiennent à un gang s'élève à 16. Le risque de devenir victime est également plus important lorsqu'un jeune fait partie de tels groupes, puisqu'il est 4 à 5 fois plus élevé pour les agressions et les brigandages. Des comparaisons internationales, basées sur l'enquête de l'lSRD-2, ont pu être effectuées, mettant en exergue la sur-criminalité des membres de gangs ainsi que leur vulnérabilité face à la victimisation. Des facteurs de risque de l'affiliation è un gang, tels que l'influence de l'accessibilité à la drogue dans les quartiers où habitent les jeunes, le manque d'autocontrôlé de ces derniers ou leur consommation de cannabis ont été relevés

Secular trends in legal and illegal substance use among 16 to 20 year old adolescents in Switzerland.

BACKGROUND: Data targeting trends in legal and illegal substance use by adolescents are scarce. Using the data from two similar large national surveys run in 1993 and 2002, this paper assesses secular trends in rates of substance use among 16-20-year-old Swiss adolescents. METHODS: Self-reported regular use of tobacco, alcohol misuse, regular cannabis use (01 occasion over last 30 days) and lifetime use of psychoactive medication, LSD, ecstasy, cocaine and heroine were assessed through identical questions using an anonymous self-administered questionnaire. 9268 (1993) and 7428 (2002) high school students and apprentices were included in the analyses. RESULTS: There is a higher proportion of regular smokers among apprentices than among students (p <0.001). Between 1993 and 2002 the increase in regular tobacco consumption was significant among both female and male apprentices (p <0.001) but not among students. Between 1993 and 2002 alcohol misuse significantly increased in all four groups (p <0.001). It is more prevalent among males than among females (p <0.001) and higher among apprentices than among students (p <0.001). Regular use of cannabis has increased in the four groups (p <0.0001). It is higher among males than among females (p <0.001), while it is largely the same among students and apprentices. While the increase in ecstasy use is highly significant in all four groups (p <0.001), the increase in LSD and cocaine use is significant among apprentices only (p <0.001). Use of LSD, ecstasy and cocaine is more prevalent among males than among females (<0.001) and higher among apprentices than among students (p <0.001). CONCLUSION: The secular increase in psychoactive substance use among older Swiss adolescents calls for the implementation of effective strategies both from individual and public health viewpoints.

A high proportion of users of low-threshold facilities with needle exchange programmes in Switzerland are currently on methadone treatment: implications for new approaches in harm reduction and care.

BACKGROUND: Increasingly, patients receiving methadone treatment are found in low threshold facilities (LTF), which provide needle exchange programmes in Switzerland. This paper identifies the characteristics of LTF attendees receiving methadone treatment (MT) compared with other LTF attendees (non-MT). METHODS: A national cross-sectional survey was conducted in 2006 over five consecutive days in all LTF (n=25). Attendees were given an anonymous questionnaire, collecting information on socio-demographic indicators, drug consumption, injection, methadone treatment, and self-reported HIV and HCV status. Univariate analysis and logistic regression were performed to compare MT to non-MT. The response rate was 66% (n=1128). RESULTS: MT comprised 57.6% of the sample. In multivariate analysis, factors associated with being on MT were older age (OR: 1.38), being female (OR: 1.60), having one's own accommodation (OR: 1.56), receiving public assistance (OR: 2.29), lifetime injecting (OR: 2.26), HIV-positive status (OR: 2.00), and having consumed cocaine during the past month (OR: 1.37); MT were less likely to have consumed heroin in the past month (OR: 0.76, not significant) and visited LTF less often on a daily basis (OR: 0.59). The number of injections during the past week was not associated with MT. CONCLUSIONS: More LTF attendees were in the MT group, bringing to light an underappreciated LTF clientele with specific needs. The MT group consumption profile may reflect therapeutic failure or deficits in treatment quality and it is necessary to acknowledge this and to strengthen the awareness of LTF personnel about potential needs of MT attendees to meet their therapeutic goals.

Generational effects on adult height in individual heterogeneity

As adult height is a well-established retrospective measure of health and standard of living, it is important to understand the factors that determine it. Among them, the influence of socio-environmental factors has been subjected to empirical scrutiny. This paper explores the influence of generational (or environmental) effects and individual and gender-specific heterogeneity on adult height. Our data set is from contemporary Spain, a country governed by an authoritarian regime between 1939 and 1977. First, we use normal position and quantile regression analysis to identify the determinants of self-reported adult height and to measure the influence of individual heterogeneity. Second, we use a Blinder-Oaxaca decomposition approach to explain the `gender height gap¿ and its distribution, so as to measure the influence on this gap of individual heterogeneity. Our findings suggest a significant increase in adult height in the generations that benefited from the country¿s economic liberalization in the 1950s, and especially those brought up after the transition to democracy in the 1970s. In contrast, distributional effects on height suggest that only in recent generations has ¿height increased more among the tallest¿. Although the mean gender height gap is 11 cm, generational effects and other controls such as individual capabilities explain on average roughly 5% of this difference, a figure that rises to 10% in the lowest 10% quantile.

'Biased' Risk Perceptions of Longevity and Disability in Old Age

Rational learning theories postulate that information channels and cognitive biases such as individual optimism may influence an individual¿s assessment of the risk of undesired events, especially with regard to those that have a cumulative nature. This is the case with disability in old age, which may take place upon survival to an advanced age, and such factors have been regarded as responsible for certain individual behaviours (for example, the limited incidence of insurance purchase). This paper examines the determinants of individual perceptions with regard to disability in old age and longevity. The cumulative nature of such perceptions of risk is tested, and potential biases are identified, including `optimism¿ and a set of information determinants. Empirical evidence from a representative survey of Catalonia is presented to illustrate these effects. The findings from this research suggest a significant overestimation of disability in old age, yet this is not the case with longevity. Furthermore, individual perceptions with regard to disability in old age, unlike those with regard to longevity, exhibit on aggregate an `optimistic bias¿ and, are perceived as `cumulative risks¿. Gender influences the perceived risk of disability in old age at a population level but not at the individual level, and the opposite holds true for age. Finally, self-reported health status is the main variable behind risk perceptions at both the individual and population level.

Socioeconomics status and quality of care in a population-based sample of swiss diabetic patients

Introduction: Low socioeconomic status (SES) is associated with higher prevalence of diabetes and worse outcomes; it has also been shown to be associated with worse quality of care. We aimed to explore the relationship between SES and quality of care in the Swiss context. Methods: We used data from a population-based survey including 519 adult diabetic patients living in the canton of Vaud. Self-reported data on patients' and diabetes characteristics, indicators of process and outcomes of care and quality of life were collected. Dependent variables included 6 processes of care (PoC) received during the last 12 months (HbA1C, lipid, microalbuminuria, fundoscopy, feet examination and influenza vaccination) and selected clinical outcomes (blood pressure, LDL, HbA1C, diabetes-specific (ADDQoL) and generic quality of life (SF-12)). Regression analyses were performed to assess the relationship between education and income, respectively, and quality of care as measured by PoC and clinical outcomes. Adjustment was made for age, gender and comorbidities. Results: Mean age was 64.5 years, 40% were women; 19%, 56% and 25% of the patients reported primary (I), secondary (II) and tertiary (III) education. Fundoscopy was the only PoC significantly associated with education, with III education patients more likely to get the exam than those with primary education (adjOR 1.8, 95% CI 1.0-3.3). Use of composite indicators of PoC showed that compared to patients with primary education, patients with III education were more likely to receive ≥5/6 PoC (adjOR 1.9, 95% CI 1.1-3.4), and that those with II or III education were more likely to receive 4/4 PoC (adjOR 1.9, 95% CI 1.0-3.3; adjOR 2.1, 95% CI 1.1-4.1, respectively). Quality of life was the only clinical outcome significantly associated with education, with II and III education patients reporting better quality of life compared to primary education patients, as measured by the ADDQoL (β 0.6, 95% CI 0.3-1.0, β 0.6, 95% CI 0.2-1.0, respectively) and the physical component score of the SF-12 (β 2.5, 95% CI 0.2-4.8, β 3.6, 95% CI 0.9-6.4, respectively). No associations were found between income and quality of care. Conclusion: Social inequalities have been demonstrated in Switzerland for global health indicators. Our results suggest that similar associations are found when considering quality of care measures in individuals with diabetes, but only for a few indicators.

Diabetic patients who report receiving processes of diabetic care do not express a better quality of life

Background: Chronic disease management initiatives emphasize patient-centered care, and quality of life (QoL) is increasingly considered a representative outcome in that context. In this study we evaluated the association between receipt of processes of diabetic care and QoL. Methods: This cross-sectional population-based study (2011) used self-reported data from non-institutionalized, adult diabetics, recruited from randomly selected community pharmacies in Vaud. Outcomes included the physical and mental composites of the SF-36 (PCS, MCS) and the disease-specific Audit of Diabetes-Dependent QoL (ADDQoL). Main exposure variables were receipt of six diabetes processes-of care in the past 12 months. We also evaluated whether the association between care received and QoL was congruent with the chronic care model, when assessed by the Patient Assessment of Chronic Illness Care (PACIC). We used linear regressions to examine the association between process measures and the three composites of health-related QoL. Analyses were adjusted for age, gender, socioeconomic status, living companion, BMI, alcohol, smoking, physical activity, co-morbidities and diabetes mellitus (DM) characteristics (type, insulin use, complications, duration). Results: Mean age of the 519 diabetic patients was 64.4 years (SD 11.3), 60% were male and 73% had a living companion; 87% reported type 2 DM, half of respondents required insulin treatment, 48% had at least one DM complication, and 48% had DM over 10 years. Crude overall mean QoL scores were PCS: 43.4 (SD 10.5), MCS: 47.0 (SD 11.2) and ADDQoL: -1.56 (SD 1.6). In bivariate analyses, patients who received the influenza vaccine versus those who did not, had lower ADDQoL and PCS scores; there were no other indicator differences. In adjusted models including all processes, receipt of influenza vaccine was associated with lower ADDQoL (β= - 0.41, p=.01); there were no other associations between process indicators and QoL composites. There was no process association even when these were reported as combined measures of processes of care. PACIC score was associated only with the MCS (β= 1.57, p=.004). Conclusions: Process indicators for diabetes care did not show an association with QoL. This may represent an effect lag time between time of process received and quality of life; or that treatment may be related with inconvenience and patient worry. Further research is needed to explore these unexpected findings.

Can routine offering of influenza vaccination in office-based settings reduce racial and ethnic disparities in adult influenza vaccination?

BACKGROUND: Influenza vaccination remains below the federally targeted levels outlined in Healthy People 2020. Compared to non-Hispanic whites, racial and ethnic minorities are less likely to be vaccinated for influenza, despite being at increased risk for influenza-related complications and death. Also, vaccinated minorities are more likely to receive influenza vaccinations in office-based settings and less likely to use non-medical vaccination locations compared to non-Hispanic white vaccine users. OBJECTIVE: To assess the number of "missed opportunities" for influenza vaccination in office-based settings by race and ethnicity and the magnitude of potential vaccine uptake and reductions in racial and ethnic disparities in influenza vaccination if these "missed opportunities" were eliminated. DESIGN: National cross-sectional Internet survey administered between March 4 and March 14, 2010 in the United States. PARTICIPANTS: Non-Hispanic black, Hispanic and non-Hispanic white adults living in the United States (N = 3,418). MAIN MEASURES: We collected data on influenza vaccination, frequency and timing of healthcare visits, and self-reported compliance with a potential provider recommendation for vaccination during the 2009-2010 influenza season. "Missed opportunities" for seasonal influenza vaccination in office-based settings were defined as the number of unvaccinated respondents who reported at least one healthcare visit in the Fall and Winter of 2009-2010 and indicated their willingness to get vaccinated if a healthcare provider strongly recommended it. "Potential vaccine uptake" was defined as the sum of actual vaccine uptake and "missed opportunities." KEY RESULTS: The frequency of "missed opportunities" for influenza vaccination in office-based settings was significantly higher among racial and ethnic minorities than non-Hispanic whites. Eliminating these "missed opportunities" could have cut racial and ethnic disparities in influenza vaccination by roughly one half. CONCLUSIONS: Improved office-based practices regarding influenza vaccination could significantly impact Healthy People 2020 goals by increasing influenza vaccine uptake and reducing corresponding racial and ethnic disparities.

Association between smoking and total energy expenditure in a multi-country study.

BACKGROUND: The association between smoking and total energy expenditure (TEE) is still controversial. We examined this association in a multi-country study where TEE was measured in a subset of participants by the doubly labeled water (DLW) method, the gold standard for this measurement. METHODS: This study includes 236 participants from five different African origin populations who underwent DLW measurements and had complete data on the main covariates of interest. Self-reported smoking status was categorized as either light (<7 cig/day) or high (≥7 cig/day). Lean body mass was assessed by deuterium dilution and physical activity (PA) by accelerometry. RESULTS: The prevalence of smoking was 55% in men and 16% in women with a median of 6.5 cigarettes/day. There was a trend toward lower BMI in smokers than non-smokers (not statistically significant). TEE was strongly correlated with fat-free mass (men: 0.70; women: 0.79) and with body weight (0.59 in both sexes). Using linear regression and adjusting for body weight, study site, age, PA, alcohol intake and occupation, TEE was larger in high smokers than in never smokers among men (difference of 298 kcal/day, p = 0.045) but not among women (162 kcal/day, p = 0.170). The association became slightly weaker in men (254 kcal/day, p = 0.058) and disappeared in women (-76 kcal/day, p = 0.380) when adjusting for fat-free mass instead of body weight. CONCLUSION: There was an association between smoking and TEE among men. However, the lack of an association among women, which may be partly related to the small number of smoking women, also suggests a role of unaccounted confounding factors.

Cardiovascular risk factors attributable to obesity and overweight in Switzerland.

BACKGROUND AND AIMS: Obesity increases the risk for cardiovascular risk factors (CVRFs), including hypertension, dyslipidaemia and type 2 diabetes. In this study, we assessed the burden of overweight and obesity on CVRFs in Switzerland, using Swiss-specific population attributable fractions (PAFs). METHODS AND RESULTS: The number of cases of CVRFs that could have been prevented if the increase in overweight and obesity in Switzerland had been contained was estimated using gender-specific, age- and smoking-adjusted PAFs for overweight and obesity. PAFs were estimated from the Swiss Health Survey 2007 (self-reported) and the CoLaus study (measured) data. PAFs from self-reported were lower than from measured data. Using measured data, overweight and obesity contributed to 38% of hypertension cases in men (32% in women). In men, overweight had a larger impact than obesity (22.2% and 15.6%, respectively), while the opposite was observed for women (13.6% and 18.1%, respectively). In men, 37% of dyslipidaemia (30% in women) could be attributed to overweight and obesity; overweight had a higher contribution than obesity in both sexes. In men, 57% of type 2 diabetes (62% in women) was attributable to overweight and obesity; obesity had a larger impact than overweight in both sexes. Overall, approximately 27,000 cases of type 2 diabetes, 63,000 cases of high blood pressure and 37,000 cases of dyslipidaemia could have been avoided if overweight and obesity levels were maintained at 1992 levels. CONCLUSION: A large proportion of CVRFs is attributable to overweight and/or obesity and could have been prevented by containing the overweight/obesity epidemic.

Prevalence of overweight and obesity in the Swiss population

Introduction: The latest data on prevalence of overweight (OW) and obesity (OB) in the general Swiss resident population rely on the Swiss Health Survey (SHS), a telephonic interview performed in 2007. However, body mass index (BMI) is underestimated when self-reported, leading to a misclassification of up to 60% of obese subjects. The last survey with measured BMI performed in the 3 linguistic regions of Switzerland dates back to 1977. We explored the regional prevalences of OW and OB by measured BMI in the general Swiss resident population. Methods: Cross-sectional population-based survey in the 3 linguistic regions of Switzerland in 2010-2011. Data on 1471 participants aged 15-95 years (712 men, 759 women) were available for the analysis. BMI was calculated from measured height and weight and categorized into 3 groups according to WHO classification: lean (<25 kg/m2), overweight (25-30 kg/m2) and obese (>= 30 kg/m2). Data on medication, smoking, education, physical activity and dietary habitudes were collected using a questionnaire. Results: The overall prevalence of OW and OB was 32.1% and 13.9%, respectively. OB prevalence was similar across the 3 linguistic regions (13.5% in German-, 15.6% in French- and 12.0% in Italian-speaking Switzerland, p = 0.40), unlike OW prevalence, which significantly differed in unadjusted analyses (35.4%, 29.1% and 25.4%, respectively, p = 0.005). In analyses including age, sex, smoking, physical activity and education as covariates, living in the Italian-speaking region was associated neither with BMI (linear regression) nor with OW or OB (logistic regressions) . Age (beta coefficient [SE]: 0.064[0.006] kg/m2 per year, p <0.001) and sex (-1.76 [0.23] kg/m2 in women, p <0.001) were significantly associated with BMI. Conclusions: Overweight and obesity affect nearly half of the Swiss population aged >15 years. We observed no significant differences across regions once we accounted for age, sex, education and lifestyle. Public health interventions addressing modifiable behavioral factors to reduce overweight and obesity in Switzerland can be expected to have substantial benefits.

Obesity in Switzerland: a critical assessment of prevalence in children and adults.

The objective was to analyze the situation in Switzerland regarding the prevalence of overweight or obesity in children, adolescents and adults. The data were compared with France, an adjacent much larger country. The results showed that there is a definitive lack of objective information in Switzerland on the prevalence of obesity at different ages. As in other European studies, the fact that many national surveys are classically based on subject interviews (self-reported weights and heights rather than measured values) implies that the overweight/obesity prevalence is largely underestimated in adulthood. For example, in a recent Swiss epidemiological study, the prevalence of obesity (BMI greater than 30 kg/m(2)) averaged 6-7% in young men and women (25-34 y), the prevalence being underestimated by a factor of two to three when body weight was self-reported rather than measured. This phenomenon has already been observed in previous European studies. It is concluded that National Surveys based on telephone interviews generally produce biased obesity prevalence results, although the direction of the changes in prevalence of obesity and its evolution with repeated surveys using strict standardized methodology may be evaluated correctly. Therefore, these surveys should be complemented by large-scale epidemiological studies (based on measured anthropomeric variables rather than declared) covering the different linguistic areas of Switzerland. An epidemiological body weight (BMI) monitoring surveillance system, using a harmonized methodology among European countries, would help to accurately assess differences in obesity prevalence across Europe without methodological bias. It will permit monitoring of the dynamic evolution of obesity prevalence as well as the development of appropriate strategies (taking into account the specificity of each country) for obesity prevention and treatment.

Relationship between cigarette smoking and abdominal obesity

BACKGROUND: Although smokers tend to have a lower body-mass index (BMI) than non-smokers, smoking may affect body fat (BF) distribution. Some studies have assessed the association between smoking, BMI and waist circumference (WC), but, to our knowledge, no population-based studies assessed the relation between smoking and BF composition. We assessed the association between amount of cigarette smoking, BMI, WC and BF composition. METHODS: Data was analysed from a cross-sectional population-based study including 6187 Caucasians aged 32-76 and living in Switzerland. Height, weight and WC were measured. BF, expressed in percent of total body weight, was measured by electrical bioimpedance. Obesity was defined as a BMI>=30 kg/m2 and normal weight as a BMI<25 kg/m2. Abdominal obesity was defined as a WC>=102 cm for men and >=88 cm for women and normal WC as <94 cm for men and <80 cm for women. In men, excess BF was defined as %BF >=28.1, 28.7, 30.6 and 32.6 for age groups 32-44, 45-54, 55-64 and 65-76, respectively; the corresponding values for women were 35.9, 36.5, 40.5 and 44.4. Cigarette smoking was assessed using a self-reported questionnaire. RESULTS: 29.3% of men and 25.0% of women were smokers. Prevalence of obesity, abdominal obesity, and excess of BF was 16.9% and 26.6% and 14.2% in men and 15.0%, 33.0% and 27.5% in women, respectively. Smokers had lower age-adjusted mean BMI, WC and percent of BF compared to non-smokers. However, among smokers,mean age-adjusted BMI,WC and BF increased with the number of cigarettes smoked per day: among light (1-10 cig/day), moderate (11-20) and heavy smokers (>20), mean +/-SE %BF was 22.4 +/−0.3, 23.1+/−0.3 and 23.5+/−0.4 for men, and 31.9+/−0.3, 32.6+/−0.3 and 32.9+/−0.4 for women, respectively. Mean WC was 92.9+/−0.6, 94.0+/−0.5 and 96.0+/−0.6 cm for men, and 80.2+/−0.5, 81.3+/−0.5 and 83.3+/−0.7 for women, respectively. Mean BMI was 25.7+/−0.2, 26.0+/−0.2, and 26.1+/−0.2 kg/m2 for men; and 23.6+/−0.2, 24.0+/−0.2 and 24.1+/−0.3 for women, respectively. Compared with light smokers, the age-adjusted odds ratio (95% Confidence Interval) for excess of BF was 1.04 (0.58 to 1.85) formoderatesmokers and 1.06 (0.57 to 1.99) for heavy smokers in men (p-trend = 0.9), and 1.35 (0.92 to 1.99) and 2.26 (1.38 to 3.72), respectively, in women (p-trend = 0.04). Odds ratio for abdominal obesity vs. normal WC was 1.32 (0.81 to 2.15) for moderate smokers and 1.95 (1.16 to 3.27) for heavy smokers in men (p-trend < 0.01), and 1.15 (0.79 to 1.69) and 2.36 (1.41 to 3.93) in women (p-trend = 0.03). Odds ratio for obesity vs. normal weight was 1.35 (0.76 to 2.41) for moderate smokers and 1.33 (0.71 to 2.49) for heavy smokers in men (p-trend = 0.9) and 0.78 (0.45 to 1.35) and 1.44 (0.73 to 2.85), in women (p-trend = 0.08). CONCLUSIONS: WC and BF were positively and dose-dependently associated with the number of cigarettes smoked per day in women, whereas onlyWC was dose dependently and significantly associated with the amount of cigarettes smoked per day in men. This suggests that heavy smokers, especially women, are more likely to have an excess of BF and to accumulate BF in the abdomen compared to lighter smokers.