Alcohol habits and tobacco use in 70-year-olds—Evaluation of a pilot project of targeted health dialogues

Alcohol habits and tobacco use in 70-year-olds—Evaluation of a pilot project of targeted health dialogues | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Alcohol habits and tobacco use in 70-year-olds—Evaluation of a pilot project of targeted health dialogues Amanda Lahti, Emelie Stenman, Anton Grundberg, Danijel Balcanovic, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6519810/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Targeted Health Dialogues (THDs), an intervention program aimed at improving health behaviors in 40- and 50-year-olds to prevent cardiovascular disease and type 2 diabetes, was piloted to 70-year-olds in Scania County, Sweden. This study evaluates tobacco use and alcohol habits, along with self-estimated impact of the THD after one year. Methods Fourteen primary healthcare centers invited all their registered 70-year-olds to a THD. A total of 155 (30.3%) out of 511 THD-participants also consented to take part in our research project and filled out both the baseline and one-year follow-up questionnaires on health behaviors. In addition to the baseline questionnaire, the participants underwent physical measurements and received a visual health profile with 13 risk factors across four levels: green (lowest risk), yellow, orange and red (highest risk). The one-year follow-up questionnaire assessed changes in tobacco and alcohol use, analyzed using Chi-squared and Wilcoxon signed-rank tests. Results The study participants reported that they had reduced their weekly alcohol consumption from a mean of 3.4 to 2.7 glasses (p < 0.001). Among the participants with the highest consumption of alcohol at baseline, 21.6% reported that they had improved their alcohol habits at follow-up, which was significant compared to those who scored green in the health profile at baseline (p < 0.007). For tobacco use, the results were similar but less consistent. Conclusions THDs may reduce alcohol consumption in older adults. In addition, many study participants with high consumption reported that they had improved their tobacco and alcohol habits, which needs further evaluation. Further research on larger sample sizes is needed to assess the impact of THDs on tobacco and alcohol use in elderly participants. Trial registration: ClinicalTrials.gov, identifier: NCT04912739, registration date: 04/23/2021 Targeted health dialogues Smoking Tobacco use Alcohol Elderly Figures Figure 1 Figure 2 Figure 3 Background Tobacco and excessive alcohol use are risk factors for multiple non-communicable diseases (NCDs) including cancer, cardiovascular diseases, and all-cause of mortality (1-5). Tobacco use and alcohol use typically begins in adolescence and continues through adulthood. Consequently, most research is directed towards younger and adult age groups, leaving the elderly as a relatively neglected subgroup in the population. Tobacco use can be defined as smoking cigarettes or using “snus” (oral tobacco product), e-cigarettes or waterpipes regularly (6). According to the World Health Organization (WHO), cigarette smoking is the most common form of tobacco use worldwide. It has also long been recognized that there is a strong association between excessive alcohol use and cigarette smoking. Approximately 80% of alcohol-dependent patients are reported to also smoke cigarettes (7, 8). The fact that tobacco and alcohol use frequently occur together has an impact on disease development (9). Tobacco and alcohol contribute to an increased incidence of several malignancies, especially head and neck cancers (10). Alcohol consumption and smoking also contribute to pancreatic, esophageal, and hepatocellular cancers (11-13). In contrast to low regular daily alcohol consumption (defined as consuming one standard glass per day), which may potentially have a positive impact on cardiovascular health, excessive drinking, which can be distinguished into high average alcohol consumption and frequent heavy drinking days, has been associated with numerous negative health risks such as increased risk of falls and cardiovascular complications (14). One standard glass corresponds to an amount of 12 g alcohol according to a definition from the National Board of Health and Welfare provided to health care personnel in Sweden. In contrast to the low regular daily alcohol consumption, which is defined as one standard glass per day (equivalent to 12 g of alcohol according to the National Board of Health and Welfare's definition), this is the recommended limit for health care personnel in Sweden. Additionally, it can exacerbate chronic conditions such as hypertension and diabetes, while also interacting negatively with medications commonly used in this patient group (14). Regarding older adults, smoking cessation and reducing alcohol consumption may not undo all harm accumulated from years of these unhealthy behaviors, but can still have significant health implications. For example, smoking cessation among elderly reduces the risk of developing or dying from cancer and other diseases (15, 16). In addition to increased risks for many types of cancer, older adult smokers, in comparison to non-smokers, are more prone to worse management and outcomes of common age-related diseases such as diabetes, osteoporosis, cardiovascular disease, chronic kidney disease, and respiratory problems (2). Smoking also may decrease vaccine efficacy and increase the risk of infections in the older population (17). In addition, older adults that manage to decrease their tobacco and alcohol consumption may experience many positive effects, such as a reduced risk of polypharmacy and medical interactions with alcohol, reduced risk of falls and fractures as well as a decreased risk of cognitive decline (14). According to WHO, between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million, which consequently will increase the healthcare costs. Taken together, efforts to reduce tobacco use and alcohol consumption among the elderly should be considered a public health interest. In Sweden, the screening and intervention program “Targeted Health Dialogues” (THDs) is offered in many regions on a yearly basis to the population of certain age groups to prevent cardiovascular diseases and type 2 diabetes in the society. Previous research that has examined 40- and 50-year-olds has shown a decline in cardiovascular risk markers including cholesterol levels and systolic blood pressure, and some changes in smoking and alcohol habits (18-20). In 2022, a pilot project for 70-year-olds was performed in Scania County. This study aims to examine: 1) self-reported tobacco use and alcohol habits in 70-year-olds at baseline and one year after participating in a THD; and 2) the study participants' beliefs about the impact of the THD on their tobacco use and alcohol habits. Methods This study evaluates a pilot project involving THDs for 70-year-olds with a one-year follow-up. The THD project was initiated and implemented by the Scania County Council, with the Center for Primary Health Care Research involved in conducting the scientific evaluation. Scania County, which has a population of approximately 1.4 million, includes Sweden's third-largest metropolitan area. The county has around 180 primary healthcare centers (PHCC), equally divided between publicly and privately run, all of which are tax-financed and part of Sweden’s universal healthcare system. All residents are registered at a PHCC. All PHCCs were invited to participate in the pilot project targeting 70-year-olds, with the first fourteen centers to respond and agree included in the study. The participating PHCCs came from different parts of the county and represented both urban and rural areas. To estimate representativeness of the participating PHCCs, socioeconomic indicators were collected and compared with the entire county. At the participating PHCCs, 10% of all “listed” persons were born outside the European Union, 5% of the 25-64-year-olds had low education and 9% of the ≥ 65 years-olds were living alone. For the entire county, the corresponding figures were quite similar, i.e., 11%, 6% and 8% respectively. The THDs were conducted during the winter 2022-2023, and the 14 centers were instructed to invite all individuals born in 1952 to participate in a THD. Those 70-year-olds who agreed to participate were also invited to participate in this research study. Participation in the THDs was independent of involvement in the study. Written informed consent was required to participate in the research study, and ethical approval was obtained from the Swedish Ethical Review Authority (registration number 2020-02689 with later amendments). The study is registered at ClinicalTrials.gov, identifier: NCT04912739. The THD method in Scania has been described in detail previously (21). Those who wanted to participate in a THD filled out an electronic questionnaire at home about family situation, place of birth, education, chronic diseases, family history of diseases, general health, and health behaviors. The questionnaire used in the THDs is available as a supplementary file 1. Two visits were booked at the PHCC. On the first visit, the participant took a fasting blood test to measure blood lipids and plasma glucose, and anthropometric measures. The results from the blood samples, measurements and questionnaire were gathered automatically in a visual tool called “the health profile”, containing 13 risk factor categories grouped across four levels: green (lowest cardiovascular risk), yellow, orange and red (highest risk) (Figure 1). On the second visit, the health profile was used as the base for an hour’s THD led by a health dialogue coach, i.e., a registered nurse, dietician, occupational- or physiotherapist, or physician with special education, which comprised a two-day course in the THD method and a three-day course in motivational interviewing. During the THD, lifestyle including tobacco use and alcohol habits were discussed, and health advice was worked out together with the participant according to the participant’s circumstances and preferences. When necessary, follow-up visits were booked or referrals to appropriate specialists were sent. To help the health dialogue coaches with clinical decisions and proper health advice, they were provided with an evidence-based, method support manual. This was produced by the Office for Integrated Care (including general practitioners, nurses, dieticians, and physiotherapists) at the County Council. One year after the THD, another electronic questionnaire was sent to the participants. It contained the same questions on general health, and health behaviors as the baseline questionnaire. The questionnaire was only sent to the participants once, without reminders. There was no visit to the PHCC at follow-up, thus no further blood sampling or anthropometric measurements were performed. Sex, level of education (≤ 9 years, upper secondary school, post-secondary school), and place of birth (Sweden, other European country, non-European country) were collected. Tobacco use was defined as smoking cigarettes or using “snus” (oral tobacco product), e-cigarettes or waterpipe regularly. Those who scored green in the health profile’s tobacco category did not use any kind of tobacco. Those who scored yellow in the health profile did not smoke cigarettes but used other kinds of tobacco. According to the method support manual, they could be offered support for quitting. Those who scored orange or red were daily cigarette smokers with those scoring red smoking a higher number of cigarettes. They were informed about the cardiovascular risks and given advice in a patient-centered manner. They were also offered professional support for quitting and a brochure about risks with tobacco and how to quit using it. The scores for alcohol use were also defined as green, yellow, orange and red and were based on the frequency of alcohol use, the amount of consumed alcohol (standard glasses) and the frequency of heavy drinking. The cutpoints (e.g. number of glasses) were higher for men than for women. Those who scored yellow in the health profile alcohol category were encouraged to decrease their alcohol consumption. Those who scored orange were asked again about their consumption and were given advice in a patient-centered manner. They were offered a brochure about alcohol and, if needed, further professional support for reduced consumption. Those who scored red were offered qualified advice with healthcare professionals specially educated in treatment of alcohol problems. Statistical analysis All collected data in the THDs were stored in a national quality register within the Scania County Council. From there, pseudonymized data for participants in the research project were transferred to our research group. Participant characteristics are presented with numbers and percentages. Differences in characteristics between participants who proceeded with the follow-up versus did not proceed with the follow-up were tested using Chi-squared tests. The health profiles for tobacco use, and alcohol consumption were dichotomized into green versus not green, and the differences between baseline and one year follow up were tested using McNemar’s tests. Questions about tobacco and alcohol consumption were tested using Wilcoxon signed rank test for the continuous variable, and sign tests for the categorical variables. The chosen level of statistical significance was 0.05. All statistical analyses were done in R version 4.4.0 (R Core Team, 2024). Results Baseline characteristics Out of 952 70-year-olds that were invited to a THD, 511 completed a THD at baseline. A total of 294 (58%) THD participants consented to take part in the research project. Of those, 155 (30%) also responded to the follow-up questionnaire and were thus included in this evaluation. Table 1 shows the study population where 59.4% were women, 52.9% had post-secondary education and 9% were born outside Sweden. Aggregated data on all 70-year-old THD participants that responded to the follow-up-questionnaire (regardless of research participation) showed a similar distribution of the sociodemographic characteristics (data not shown). We also compared baseline characteristics between those research participants who filled out both the baseline and follow-up questionnaires with those who only filled out the baseline questionnaire. There were no significant differences in level of education, place of birth, tobacco use, or alcohol consumption. However, more women than men completed the follow-up questionnaire (p = 0.008) (data not shown). On average, the follow-up questionnaire was filled out 319.3 days (approximately 10.5 months) after baseline. Tobacco use Table 2 shows that the difference between those who scored green (no tobacco use) at baseline (n = 140) and at follow-up (n = 138) was non-significant. Among all study participants at baseline, 5.2% (n = 8) participants classified themselves as daily smokers, whereas 42.6% (n = 66) reported that they had never been smokers. At the follow up, 3.9% (n = 6) of the participants reported daily smoking. Among those who classified themselves as daily smokers at baseline, the mean number of cigarettes decreased from 9.4 to 7.1 at follow-up (p = 0.23) (data not shown). A total of 5 out of the 8 daily smokers reported that they had decreased the number of cigarettes per day, 1 consumed a similar number of cigarettes and 2 had increased the number of cigarettes per day between baseline and follow up (Figure 2). Alcohol habits Table 2 shows that the difference between those who scored green at baseline (n = 110) and at the follow-up (n = 112) was non-significant. Figure 3 shows the distribution of participants by number of standard glasses per week at baseline and follow-up. The mean number of standard glasses consumed per week decreased from 3.4 (SD = 3.5) to 2.7 (SD = 2.8) (p < 0.001) at follow-up (Table 2). In addition, the proportion of study participants who drank alcohol four times per week or more decreased from 14 (9.0) to 8 (5.2), though this difference did not reach statistical significance (p = 0.12) (Table 2). No significant differences were found regarding how often the study participants consumed more than four (women) or five (men) standard glasses in one day (p = 0.99) (Table 2). Self-estimated impact of the THD Most study participants, i.e., 130 (83.9%), did not believe that the THD had any impact on their tobacco use. Among those who did not score green at baseline, 33.3% believed that the THD had improved their tobacco habits, which was significant (p < 0.001) compared to those who scored green at baseline (3.6%) (Table 3). Regarding alcohol consumption, most study participants, i.e., 135 (87.1%), did not believe that the THD had any impact on their alcohol habits but 21.6% of participants classified as not green for the alcohol variable in the health profile believed that the THD had positively affected their alcohol habits (p = 0.003) (Table 3). Table 1. Descriptive characteristics of the 155 included 70-year-old study participants who participated in the targeted health dialogue Characteristic Total (n=155) Sex, n (%) Male 63 (40.6) Female 92 (59.4) Level of education, n (%) ≤ 9 years 31 (20.0) Upper secondary school 42 (27.1) Post-secondary school 82 (52.9) Place of birth, n (%) Sweden 141 (91.0) Other European country 9 (5.8) Non-European country 5 (3.2) Data is presented as n (%). Table 2. Tobacco and alcohol use at baseline and follow up according to the health profile and number of standard glasses during a normal week among 155 study participants aged 70-years Baseline Follow-up p-value Tobacco use – health profile, n (%) 0.56 a Green 140 (90.3) 138 (89.0) Not green 15 (9.7) 16 (10.3) Missing 0 (0) 1 (0.6) Alcohol – health profile, n (%) 0.55 a Green 110 (71.0) 112 (72.3) Not green 37 (23.9) 36 (23.2) Missing 8 (5.2) 7 (4.5) Number of standard glasses during a normal week Median (IQR) 2.0 (3.0) 2.0 (3.0) <0.001 b Mean (SD) 3.4 (3.5) 2.7 (2.8) Missing, n (%) 18 (11.6) 2 (1.3) How often do you drink alcohol? Never 14 (9.0) 15 (9.7) 0.12 c 1 time per month or less 24 (15.5 31 (20.0) 2-4 times per month 60 (38.7) 51 (32.9) 2-3 times per week 43 (27.7) 48 (31.0) 4 times per week or more 14 (9.0) 8 (5.2) Do not know/do not want to answer 0 (0) 2 (1.3) How often do you consume more than four (women) or five (men) standard glasses in one day? Never 84 (54.2) 75 (48.4) 0.99 c Less than one time per month 44 (28.4) 49 (31.6) Every month 11 (7.1) 15 (9.7) Every week 10 (6.5) 7 (4.5) Do not know/do not want to answer 6 (3.9) 9 (5.8) a McNemar’s test. b Wilcoxon signed rank test, see figure 3 for distribution. c Sign test. Data is presented as n, (%). Table 3. Self-estimated impact of the targeted health dialogues on tobacco use habits among all 70-year-old study participants and categorized by alcohol consumption status at baseline in the health profile All study-participants n=155 Green health profile at baseline Not green health profile at baseline p-value How do you feel that the targeted health dialogue affected your lifestyle habits regarding tobacco use? <0.001 a Improved 10 (6.5) 5 (3.6) 5 (33.3) Unchanged 130 (83.9) 121 (86.4) 9 (60.0) Worsened 0 (0) 0 (0) 0 (0) Do not know/do not want to answer 15 (9.7) 14 (10.0) 1 (6.7) How do you feel that the targeted health dialogue affected your lifestyle habits regarding alcohol? 0.003 a Improved 14 (9.0) 6 (5.5) 8 (21.6) Unchanged 135 (87.1) 99 (90.0) 28 (75.7) Worsened 1 (0.6) 0 (0) 1 (2.7) Do not know/do not want to answer 5 (3.2) 5 (4.5) 0 (0) a Fisher exact test. Does not know/do not want to answer is excluded from test. Data is presented as n (%). Statistically significant differences are bolded. Discussion In this pilot study of 70-year-olds, we found that participation in a THD was not associated with a higher proportion of participants who scored green on tobacco and alcohol use at the follow-up. However, we found that those participants who did not score green reported that they had improved their tobacco and alcohol habits with, for example, a significantly reduced self-reported number of standard glasses of alcohol per week. We also found that five of the eight daily smokers reported that they had reduced their number of daily cigarettes. Among those who scored not green at baseline for tobacco use and alcohol use, approximately one third and one fifth, respectively, believed that the THDs had improved these behaviors. This study indicates that older adults may be susceptible to lifestyle interventions and that lifestyle habits could be changed at older ages. Previous research that has examined the THDs in 40- and 50-year-olds has shown a decline in cardiovascular risk markers including cholesterol levels and systolic blood pressure, albeit with smaller effects on smoking and alcohol habits (18-20). This study contributes to new knowledge by suggesting that THDs also may impact tobacco and alcohol habits among the elderly, although the results for tobacco were more difficult to interpret, possibly due to small sample sizes. Another interesting finding is that the number of study participants who drank alcohol four times per week or more decreased from 9.0% to 5.2%. Even though this difference was not statistically significant, the finding is noteworthy as frequent drinking, in addition to the total amount of alcohol consumed, is an important risk factor. The small sample size may lie behind our inability to detect a potential difference in excessive drinking. The effect of THDs on the frequency of alcohol consumption per week should be further evaluated in future studies based on larger sample sizes. Although debated, small amounts of alcohol (i.e. one standard glass per day or less), have been associated with improved cardiovascular health and lower dementia risk (22, 23). In contrast, frequent excessive drinking in older adults is associated with several adverse health effects, including an increased risk of falls, cardiovascular complications, and cognitive decline (5, 9, 14, 22, 23). It can also exacerbate chronic conditions such as hypertension and diabetes, while negatively interacting with commonly used medications in this age group. Given these risks, it would be particularly beneficial if THDs could reduce excessive drinking among elderly. However, we found no significant association between THDs and the frequency of “binge” drinking, i.e., consuming more than four standard glasses for women and five for men on one occasion which may be due to the small study population. In a larger perspective, the aim of improving tobacco and alcohol habits among the elderly is primarily to reduce morbidity and mortality in the population but also to reduce the economic burden and load on the healthcare system. Even though most study participants in this study did not feel that the THD had impacted their tobacco and alcohol use, it seems like those with the worst habits, and who subsequently got extensive advice, were most susceptible to the intervention. From a public health perspective, this is an important finding as improving habits among those who have the poorest lifestyle may be associated with the most health benefits. The study strengths include the representative selection of study participants with different socioeconomic backgrounds and from different areas. Another strength is that the follow-up survey was performed one year after baseline, which decreases the risk of seasonal bias. Yet another strength is that our research group was not responsible for the actual implementation of the pilot project in 70-year-olds; we thus had an independent role in the evaluation. However, due to the small sample size, the results should be interpreted with caution. With these limitations in mind, this study also has important strengths as we studied a previously rarely examined age group as well as suggesting that older adults may also be able to change their lifestyle habits even if the results need to be confirmed in larger study populations and other settings. In conclusion, THDs among 70-year-olds may have improved tobacco and alcohol habits among those participants who did not score green at baseline and thus received more extensive health advice. The results suggest that an elderly population may be susceptible to lifestyle interventions. Future studies should examine the impact of THD on tobacco use and alcohol consumption on a larger scale as our findings were based on a quite small pilot study of 70-year-olds. Abbreviations NCD Non-communicable diseases PHCC Primary healthcare centers SD Standard deviations THDs Targeted health dialogues WHO World Health Organization Declarations Human Ethics and Consent to Participate The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Swedish Ethical Review Authority (registration number 2020-02689 with later amendments). Written informed consent was a prerequisite for taking part in the research study. The study is registered at ClinicalTrials.gov, identifier: NCT04912739. Registration date: 04/23/2021. Ethics, Consent to Participate, and Consent to Publish Not applicable. Availability of data and materials The datasets generated and analyzed during the current study are not publicly available due to national regulations but are available from the corresponding author on reasonable request. Competing Interests None. Funding Declaration This work was supported by funding to Kristina Sundquist from the Swedish Heart-Lung Foundation (20210553) and the Swedish Research Council (2021-06456). Authors' contributions A.L, as the corresponding author, was responsible for writing the manuscript, contributing to the intellectual content, developing the methodology, and overseeing the submission process. E.S contributed to writing, revising the manuscript, and the intellectual content. A.G performed the statistical analyses. D.B contributed to the writing of the article. K.S, as professor, provided intellectual input, contributed to the study design, and had overall responsibility for the study. Acknowledgements None. References Peto R, Boreham J, Lopez AD. Mortality from smoking in developed countries. Oxford University Press; 1996. Burns DM. Cigarette smoking among the elderly: disease consequences and the benefits of cessation. Am J Health Promot. 2000;14(6):357–61. Federation WH. World Heart Report 2023; Confronting the World’s Number One Killer. Geneva, Switzerland; 2023. Mons U, Müezzinler A, Gellert C, Schöttker B, Abnet CC, Bobak M, et al. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ. 2015;350:h1551. Halme JT, Seppä K, Alho H, Poikolainen K, Pirkola S, Aalto M. Alcohol consumption and all-cause mortality among elderly in Finland. Drug Alcohol Depend. 2010;106(2):212–8. World Health Organization (WHO). Availiable at: https://www.who.int/news-room/fact-sheets/detail/tobacco . Cited: 25–02. Burling TA, Ziff DC. Tobacco smoking: a comparison between alcohol and drug abuse inpatients. Addict Behav. 1988;13(2):185–90. Miller NS, Gold MS. Comorbid cigarette and alcohol addiction: epidemiology and treatment. J Addict Dis. 1998;17(1):55–66. Blazer DG, Wu L-T. The Epidemiology of At-Risk and Binge Drinking Among Middle-Aged and Elderly Community Adults: National Survey on Drug Use and Health. Am J Psychiatry. 2009;166(10):1162–9. Znaor A, Brennan P, Gajalakshmi V, Mathew A, Shanta V, Varghese C, et al. Independent and combined effects of tobacco smoking, chewing and alcohol drinking on the risk of oral, pharyngeal and esophageal cancers in Indian men. Int J Cancer. 2003;105(5):681–6. Li D, Jiao L. Molecular epidemiology of pancreatic cancer. Int J Gastrointest Cancer. 2003;33(1):3–14. Wang LY, You SL, Lu SN, Ho HC, Wu MH, Sun CA, et al. Risk of hepatocellular carcinoma and habits of alcohol drinking, betel quid chewing and cigarette smoking: a cohort of 2416 HBsAg-seropositive and 9421 HBsAg-seronegative male residents in Taiwan. Cancer Causes Control. 2003;14(3):241–50. Blot WJ, McLaughlin JK. The changing epidemiology of esophageal cancer. Semin Oncol. 1999;26(5 Suppl 15):2–8. Barry KL, Blow FC. Drinking Over the Lifespan: Focus on Older Adults. Alcohol Res. 2016;38(1):115–20. Barengo NC, Antikainen R, Harald K, Jousilahti P. Smoking and cancer, cardiovascular and total mortality among older adults: The Finrisk Study. Prev Med Rep. 2019;14:100875. Doolan DM, Stotts NA, Benowitz NL, Covinsky KE, Froelicher ES. The Women's Initiative for Nonsmoking (WINS) XI: Age-Related Differences in Smoking Cessation Responses Among Women With Cardiovascular Disease. Am J Geriatr Cardiol. 2008;17(1):37–47. Godoy P, Castilla J, Soldevila N, Mayoral JM, Toledo D, Martín V, et al. Smoking may increase the risk of influenza hospitalization and reduce influenza vaccine effectiveness in the elderly. Eur J Pub Health. 2017;28(1):150–5. Hellstrand M, Simonsson B, Engström S, Nilsson KW, Molarius A. A health dialogue intervention reduces cardiovascular risk factor levels: a population based randomised controlled trial in Swedish primary care setting with 1-year follow-up. BMC Public Health. 2017;17(1):669. Eliasson M, Eriksson M, Lundqvist R, Wennberg P, Söderberg S. Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme. Eur J Prev Cardiol. 2018;25(16):1765–72. Lingfors H, Persson LG, Lindström K, Bengtsson C, Lissner L. Effects of a global health and risk assessment tool for prevention of ischemic heart disease in an individual health dialogue compared with a community health strategy only results from the Live for Life health promotion programme. Prev Med. 2009;48(1):20–4. Stenman E, Borgstrom Bolmsjo B, Grundberg A, Sundquist K. Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people. Scand J Prim Health Care. 2024:1–12. Kunzmann AT, Coleman HG, Huang W-Y, Berndt SI. The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study. PLoS Med. 2018;15(6):e1002585. Koch M, Fitzpatrick AL, Rapp SR, Nahin RL, Williamson JD, Lopez OL, et al. Alcohol Consumption and Risk of Dementia and Cognitive Decline Among Older Adults With or Without Mild Cognitive Impairment. JAMA Netw Open. 2019;2(9):e1910319–e. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6519810","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":481828730,"identity":"7da14e31-6dc6-4fe2-8fff-97d2b32d1677","order_by":0,"name":"Amanda Lahti","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYLACHgYGGQYJBoYDHxgYGBvYidTCwyDBzHBwBkgLMylamHmI0cI/7fCzB29qGHj4Z/cfPGybYyPbwMxjwPijArcWidtp5oZzjjHwSNw5zHA4d1uaMUgLM88ZPNbcTjCT5mEDOuxGMkjL4USwFsY23Drkb6d/k+b5x8AjD9Jiue0/WAvjz3+4tRjczjGT5m1j4DEAaWHcdgCshYG3AbcWw9s5ZZJz+yR4DG8kGxzs3ZZs3MbMVnCY5xhuLXK307dJvPlmIyd3I/Hxh5/b7GT72Zs3PvxRg8f7ECCBYLIB8QGCGkbBKBgFo2AU4AUA+OFLNvRtWwAAAAAASUVORK5CYII=","orcid":"","institution":"Lund University","correspondingAuthor":true,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Lahti","suffix":""},{"id":481828731,"identity":"7c7e0011-5046-4dce-b652-a299866829c6","order_by":1,"name":"Emelie Stenman","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Emelie","middleName":"","lastName":"Stenman","suffix":""},{"id":481828732,"identity":"1ed80e86-9669-4f84-8138-34185f7e8727","order_by":2,"name":"Anton Grundberg","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Anton","middleName":"","lastName":"Grundberg","suffix":""},{"id":481828733,"identity":"bebbf772-e503-42aa-ad94-079950a14412","order_by":3,"name":"Danijel Balcanovic","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Danijel","middleName":"","lastName":"Balcanovic","suffix":""},{"id":481828734,"identity":"85cd7eab-43aa-4d29-8600-0cc8b6a8681f","order_by":4,"name":"Kristina Sundquist","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Kristina","middleName":"","lastName":"Sundquist","suffix":""}],"badges":[],"createdAt":"2025-04-24 10:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6519810/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6519810/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86298563,"identity":"110476e8-d821-43fe-8448-d0870b2e4ac2","added_by":"auto","created_at":"2025-07-09 05:55:41","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":631976,"visible":true,"origin":"","legend":"\u003cp\u003eHealth profile used in the targeted health dialogue, categorizing the participant into green, yellow, orange or red dependent on blood tests, lifestyle habits and diseases.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6519810/v1/33d76ef64f8acd2a2d6b2b4a.jpeg"},{"id":86298568,"identity":"1eb2a370-a96e-424e-9eea-06944c426293","added_by":"auto","created_at":"2025-07-09 05:55:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13089,"visible":true,"origin":"","legend":"\u003cp\u003eCigarettes per day at baseline and follow up one year after the targeted health dialog, among those 70-year-old study participants who smoke on a daily basis at baseline.\u003c/p\u003e\n\u003cp\u003ea: The line from 8 to 5 includes two participants. b: The two participants ending at 0 have reported that they still smoke but not daily at follow up.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6519810/v1/3bb38286be84ac7e39e76437.png"},{"id":86299139,"identity":"ba98a2cc-b9d1-4a9d-9832-ca5c1a6a58a9","added_by":"auto","created_at":"2025-07-09 06:03:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":14789,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of number of standard glasses during a normal week. Left panel: distribution at baseline. Right panel: distribution at follow up one year after the THD.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6519810/v1/b9d210881c87b02226ee8e2a.png"},{"id":92963990,"identity":"ede7eaab-2d78-43c7-a5cf-dfe014425444","added_by":"auto","created_at":"2025-10-07 15:24:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1341966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6519810/v1/d58fe82c-edb7-4442-bf4e-96fb22877a7a.pdf"},{"id":86299138,"identity":"310f293f-7463-4776-8484-08c932107be5","added_by":"auto","created_at":"2025-07-09 06:03:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":72450,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6519810/v1/2ff8b3f560ebda16f65bee9b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Alcohol habits and tobacco use in 70-year-olds—Evaluation of a pilot project of targeted health dialogues","fulltext":[{"header":"Background","content":"\u003cp\u003eTobacco and excessive alcohol use are risk factors for multiple non-communicable diseases (NCDs) including cancer, cardiovascular diseases, and all-cause of mortality (1-5). Tobacco use and alcohol use typically begins in adolescence and continues through adulthood. Consequently, most research is directed towards younger and adult age groups, leaving the elderly as a relatively neglected subgroup in the population.\u003c/p\u003e\n\u003cp\u003eTobacco use can be defined as smoking cigarettes or using “snus” (oral tobacco product), e-cigarettes or waterpipes regularly (6). According to the World Health Organization (WHO), cigarette smoking is the most common form of tobacco use worldwide. It has also long been recognized that there is a strong association between excessive alcohol use and cigarette smoking. Approximately 80% of alcohol-dependent patients are reported to also smoke cigarettes \u0026nbsp;(7, 8). The fact that tobacco and alcohol use frequently occur together has an impact on disease development (9). Tobacco and alcohol contribute to an increased incidence of several malignancies, especially head and neck cancers (10). Alcohol consumption and smoking also contribute to pancreatic, esophageal, and hepatocellular cancers (11-13). In contrast to low regular daily alcohol consumption (defined as consuming one standard glass per day), which may potentially have a positive impact on cardiovascular health, excessive drinking, which can be distinguished into high average alcohol consumption and frequent heavy drinking days, has been associated with numerous negative health risks \u0026nbsp;such as increased risk of falls and cardiovascular complications (14). One standard glass corresponds to an amount of 12 g alcohol according to a definition from the National Board of Health and Welfare provided to health care personnel in Sweden.\u003c/p\u003e\n\u003cp\u003eIn contrast to the low regular daily alcohol consumption, which is defined as one standard glass per day (equivalent to 12 g of alcohol according to the National Board of Health and Welfare's definition), this is the recommended limit for health care personnel in Sweden.\u003c/p\u003e\n\u003cp\u003eAdditionally, it can exacerbate chronic conditions such as hypertension and diabetes, while also interacting negatively with medications commonly used in this patient group (14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding older adults, smoking cessation and reducing alcohol consumption may not undo all harm accumulated from years of these unhealthy behaviors, but can still have significant health implications. For example, smoking cessation among elderly reduces the risk of developing or dying from cancer and other diseases (15, 16). In addition to increased risks for many types of cancer, older adult smokers, in comparison to non-smokers, are more prone to worse management and outcomes of common age-related diseases such as diabetes, osteoporosis, cardiovascular disease, chronic kidney disease, and respiratory problems (2). Smoking also may decrease vaccine efficacy and increase the risk of infections in the older population (17). In addition, older adults that manage to decrease their tobacco and alcohol consumption may experience many positive effects, such as a reduced risk of polypharmacy and medical interactions with alcohol, reduced risk of falls and fractures as well as a decreased risk of cognitive decline (14).\u003c/p\u003e\n\u003cp\u003eAccording to WHO, between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million, which consequently will increase the healthcare costs. Taken together, efforts to reduce tobacco use and alcohol consumption among the elderly should be considered a public health interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Sweden, the screening and intervention program \u003cem\u003e“Targeted Health Dialogues”\u003c/em\u003e (THDs) is offered in many regions on a yearly basis to the population of certain age groups to prevent cardiovascular diseases and type 2 diabetes in the society. Previous research that has examined 40- and 50-year-olds has shown a decline in cardiovascular risk markers including cholesterol levels and systolic blood pressure, and some changes in smoking and alcohol habits (18-20). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn 2022, a pilot project for 70-year-olds was performed in Scania County. This study aims to examine: 1) self-reported tobacco use and alcohol habits in 70-year-olds at baseline and one year after participating in a THD; and 2) the study participants' beliefs about the impact of the THD on their tobacco use and alcohol habits. \u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study evaluates a pilot project involving THDs for 70-year-olds with a one-year follow-up. The THD project was initiated and implemented by the Scania County Council, with the Center for Primary Health Care Research involved in conducting the scientific evaluation. Scania County, which has a population of approximately 1.4 million, includes Sweden\u0026apos;s third-largest metropolitan area. The county has around 180 primary healthcare centers (PHCC), equally divided between publicly and privately run, all of which are tax-financed and part of Sweden\u0026rsquo;s universal healthcare system. All residents are registered at a PHCC.\u003c/p\u003e\n\u003cp\u003eAll PHCCs were invited to participate in the pilot project targeting 70-year-olds, with the first fourteen centers to respond and agree included in the study. The participating PHCCs came from different parts of the county and represented both urban and rural areas. To estimate representativeness of the participating PHCCs, socioeconomic indicators were collected and compared with the entire county. At the participating PHCCs, 10% of all \u0026ldquo;listed\u0026rdquo; persons were born outside the European Union, 5% of the 25-64-year-olds had low education and 9% of the \u0026ge; 65 years-olds were living alone. For the entire county, the corresponding figures were quite similar, i.e., 11%, 6% and 8% respectively.\u003c/p\u003e\n\u003cp\u003eThe THDs were conducted during the winter 2022-2023, and the 14 centers were instructed to invite all individuals born in 1952 to participate in a THD. Those 70-year-olds who agreed to participate were also invited to participate in this research study. Participation in the THDs was independent of involvement in the study. Written informed consent was required to participate in the research study, and ethical approval was obtained from the Swedish Ethical Review Authority (registration number 2020-02689 with later amendments). The study is registered at ClinicalTrials.gov, identifier: NCT04912739.\u003c/p\u003e\n\u003cp\u003eThe THD method in Scania has been described in detail previously (21). Those who wanted to participate in a THD filled out an electronic questionnaire at home about family situation, place of birth, education, chronic diseases, family history of diseases, general health, and health behaviors. The questionnaire used in the THDs is available as a supplementary file 1. Two visits were booked at the PHCC. On the first visit, the participant took a fasting blood test to measure blood lipids and plasma glucose, and anthropometric measures. The results from the blood samples, measurements and questionnaire were gathered automatically in a visual tool called \u0026ldquo;the health profile\u0026rdquo;, containing 13 risk factor categories grouped across four levels: green (lowest cardiovascular risk), yellow, orange and red (highest risk) (Figure 1). On the second visit, the health profile was used as the base for an hour\u0026rsquo;s THD led by a health dialogue coach, i.e., a registered nurse, dietician, occupational- or physiotherapist, or physician with special education, which comprised a two-day course in the THD method and a three-day course in motivational interviewing. During the THD, lifestyle including tobacco use and alcohol habits were discussed, and health advice was worked out together with the participant according to the participant\u0026rsquo;s circumstances and preferences. When necessary, follow-up visits were booked or referrals to appropriate specialists were sent. To help the health dialogue coaches with clinical decisions and proper health advice, they were provided with an evidence-based, method support manual. This was produced by the Office for Integrated Care (including general practitioners, nurses, dieticians, and physiotherapists) at the County Council.\u003c/p\u003e\n\u003cp\u003eOne year after the THD, another electronic questionnaire was sent to the participants. It contained the same questions on general health, and health behaviors as the baseline questionnaire. The questionnaire was only sent to the participants once, without reminders. There was no visit to the PHCC at follow-up, thus no further blood sampling or anthropometric measurements were performed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSex, level of education (\u0026le; 9 years, upper secondary school, post-secondary school), and place of birth (Sweden, other European country, non-European country) were collected. Tobacco use was defined as smoking cigarettes or using \u0026ldquo;snus\u0026rdquo; (oral tobacco product), e-cigarettes or waterpipe regularly. Those who scored green in the health profile\u0026rsquo;s tobacco category did not use any kind of tobacco. Those who scored yellow in the health profile did not smoke cigarettes but used other kinds of tobacco. According to the method support manual, they could be offered support for quitting. Those who scored orange or red were daily cigarette smokers with those scoring red smoking a higher number of cigarettes. They were informed about the cardiovascular risks and given advice in a patient-centered manner. They were also offered professional support for quitting and a brochure about risks with tobacco and how to quit using it.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe scores for alcohol use were also defined as green, yellow, orange and red and were based on the frequency of alcohol use, the amount of consumed alcohol (standard glasses) and the frequency of heavy drinking. The cutpoints (e.g. number of glasses) were higher for men than for women. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThose who scored yellow in the health profile alcohol category were encouraged to decrease their alcohol consumption. Those who scored orange were asked again about their consumption and were given advice in a patient-centered manner. They were offered a brochure about alcohol and, if needed, further professional support for reduced consumption. Those who scored red were offered qualified advice with healthcare professionals specially educated in treatment of alcohol problems. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eAll collected data in the THDs were stored in a national quality register within the Scania County Council. From there, pseudonymized data for participants in the research project were transferred to our research group. Participant characteristics are presented with numbers and percentages. Differences in characteristics between participants who proceeded with the follow-up versus did not proceed with the follow-up were tested using Chi-squared tests. The health profiles for tobacco use, and alcohol consumption were dichotomized into green versus not green, and the differences between baseline and one year follow up were tested using McNemar\u0026rsquo;s tests. Questions about tobacco and alcohol consumption were tested using Wilcoxon signed rank test for the continuous variable, and sign tests for the categorical variables. The chosen level of statistical significance was 0.05. All statistical analyses were done in R version 4.4.0 (R Core Team, 2024).\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eBaseline characteristics\u003c/h3\u003e\n\u003cp\u003eOut of 952 70-year-olds that were invited to a THD, 511 completed a THD at baseline. A total of 294 (58%) THD participants consented to take part in the research project. Of those, 155 (30%) also responded to the follow-up questionnaire and were thus included in this evaluation. Table 1 shows the study population where 59.4% were women, 52.9% had post-secondary education and 9% were born outside Sweden. Aggregated data on all 70-year-old THD participants that responded to the follow-up-questionnaire (regardless of research participation) showed a similar distribution of the sociodemographic characteristics (data not shown). We also compared baseline characteristics between those research participants who filled out both the baseline and follow-up questionnaires with those who only filled out the baseline questionnaire. There were no significant differences in level of education, place of birth, tobacco use, or alcohol consumption. However, more women than men completed the follow-up questionnaire (p = 0.008) (data not shown). On average, the follow-up questionnaire was filled out 319.3 days (approximately 10.5 months) after baseline. \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTobacco use\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows that the difference between those who scored green (no tobacco use) at baseline (n = 140) and at follow-up (n = 138) was non-significant. Among all study participants at baseline, 5.2% (n = 8) participants classified themselves as daily smokers, whereas 42.6% (n = 66) reported that they had never been smokers. At the follow up, 3.9% (n = 6) of the participants reported daily smoking. Among those who classified themselves as daily smokers at baseline, the mean number of cigarettes decreased from 9.4 to 7.1 at follow-up (p = 0.23) (data not shown). A total of 5 out of the 8 daily smokers reported that they had decreased the number of cigarettes per day, 1 consumed a similar number of cigarettes and 2 had increased the number of cigarettes per day between baseline and follow up (Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAlcohol habits\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows that the difference between those who scored green at baseline (n = 110) and at the follow-up (n = 112) was non-significant. Figure 3 shows the distribution of participants by number of standard glasses per week at baseline and follow-up. The mean number of standard glasses consumed per week decreased from 3.4 (SD = 3.5) to 2.7 (SD = 2.8) (p \u0026lt; 0.001) at follow-up (Table 2). In addition, the proportion of study participants who drank alcohol four times per week or more decreased from 14 (9.0) to 8 (5.2), though this difference did not reach statistical significance (p = 0.12) (Table 2). No significant differences were found regarding how often the study participants consumed more than four (women) or five (men) standard glasses in one day (p = 0.99) (Table 2).\u003cem\u003e\u003cbr\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSelf-estimated impact of the THD\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMost study participants, i.e., 130 (83.9%), did not believe that the THD had any impact on their tobacco use. Among those who did not score green at baseline, 33.3% believed that the THD had improved their tobacco habits, which was significant (p \u0026lt; 0.001) compared to those who scored green at baseline (3.6%) (Table 3). Regarding alcohol consumption, most study participants, i.e., 135 (87.1%), did not believe that the THD had any impact on their alcohol habits but 21.6% of participants classified as not green for the alcohol variable in the health profile believed that the THD had positively affected their alcohol habits (p = 0.003) (Table 3).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 584px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDescriptive characteristics of the 155 included 70-year-old study participants who participated in the targeted health dialogue\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=155)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e63 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e92 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026le; 9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e31 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Upper secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e42 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Post-secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e82 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of birth, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Sweden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e141 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Other European country\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e9 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Non-European country\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e5 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cem\u003eData is presented as n (%).\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 584px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Tobacco and alcohol use at baseline and follow up according to the health profile and number of standard glasses during a normal week among 155 study participants aged 70-years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTobacco use \u0026ndash; health profile, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.56\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eGreen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e140 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e138 (89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eNot green\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e15 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol \u0026ndash; health profile, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eGreen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e110 (71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e112 (72.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eNot green\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e37 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e36 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of standard glasses during a normal week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2.0 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.0 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3.4 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.7 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eMissing, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e18 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow often do you drink alcohol?\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e14 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.12\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e1 time per month or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e24 (15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e31 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e2-4 times per month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e60 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e51 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e2-3 times per week\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e43 (27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e48 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e4 times per week or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e14 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eDo not know/do not want to answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 584px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow often do you consume more than four (women) or five (men) standard glasses in one day?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e84 (54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e75 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.99\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eLess than one time per month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e44 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e49 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEvery month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e11 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEvery week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eDo not know/do not want to answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e McNemar\u0026rsquo;s test. \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eWilcoxon signed rank test, see figure 3 for distribution.\u0026nbsp;\u003csup\u003ec\u003c/sup\u003e Sign test. Data is presented as n, (%).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 622px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Self-estimated impact of the targeted health dialogues on tobacco use habits among all 70-year-old study participants and categorized by alcohol consumption status at baseline in the health profile\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll study-participants\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=155\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGreen health profile at baseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot green health profile at baseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eHow do you feel that the targeted health dialogue affected your lifestyle habits regarding tobacco use?\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Improved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e5 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Unchanged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e130 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e121 (86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e9 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Worsened\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Do not know/do not want to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e15 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e14 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cem\u003eHow do you feel that the targeted health dialogue affected your lifestyle habits regarding alcohol?\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Improved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e8 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Unchanged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e135 (87.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e28 (75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Worsened\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Do not know/do not want to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 622px;\"\u003e\n \u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eFisher exact test. Does not know/do not want to answer is excluded from test. Data is presented as n (%). Statistically significant differences are \u003cstrong\u003ebolded.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this pilot study of 70-year-olds, we found that participation in a THD was not associated with a higher proportion of participants who scored green on tobacco and alcohol use at the follow-up. However, we found that those participants who did not score green reported that they had improved their tobacco and alcohol habits with, for example, a significantly reduced self-reported number of standard glasses of alcohol per week. We also found that five of the eight daily smokers reported that they had reduced their number of daily cigarettes. Among those who scored not green at baseline for tobacco use and alcohol use, approximately one third and one fifth, respectively, believed that the THDs had improved these behaviors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study indicates that older adults may be susceptible to lifestyle interventions and that lifestyle habits could be changed at older ages.\u0026nbsp;Previous research that has examined the THDs in 40- and 50-year-olds has shown a decline in cardiovascular risk markers including cholesterol levels and systolic blood pressure, albeit with smaller effects on smoking and alcohol habits (18-20). This study contributes to new knowledge by suggesting that THDs also may impact tobacco and alcohol habits among the elderly, although the results for tobacco were more difficult to interpret, possibly due to small sample sizes. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother interesting finding is that the number of study participants who drank alcohol four times per week or more decreased from 9.0% to 5.2%. Even though this difference was not statistically significant, the finding is noteworthy as frequent drinking, in addition to the\u0026nbsp;total amount of alcohol consumed, is an important risk factor. The small sample size may lie behind our inability to detect a potential difference in excessive drinking. The effect of THDs on the frequency of alcohol consumption per week should be further evaluated in future studies based on larger sample sizes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough debated, small amounts of alcohol (i.e. one standard glass per day or less), have been associated with improved cardiovascular health and lower dementia risk (22, 23). In contrast, frequent excessive drinking in older adults is associated with several adverse health effects, including an increased risk of falls, cardiovascular complications, and cognitive decline (5, 9, 14, 22, 23). It can also exacerbate chronic conditions such as hypertension and diabetes, while negatively interacting with commonly used medications in this age group. Given these risks, it would be particularly beneficial if THDs could reduce excessive drinking among elderly. However, we found no significant association between THDs and the frequency of “binge” drinking, i.e., consuming more than four standard glasses for women and five for men on one occasion which may be due to the small study population. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn a larger perspective, the aim of improving tobacco and alcohol habits among the elderly is primarily to reduce morbidity and mortality in the population but also to reduce the economic burden and load on the healthcare system. Even though most study participants in this study did not feel that the THD had impacted their tobacco and alcohol use, it seems like those with the worst habits, and who subsequently got extensive advice, were most susceptible to the intervention. From a public health perspective, this is an important finding as improving habits among those who have the poorest lifestyle may be associated with the most health benefits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study strengths include the representative selection of study participants with different socioeconomic backgrounds and from different areas. Another strength is that the follow-up survey was performed one year after baseline, which decreases the risk of seasonal bias. Yet another strength is that our research group was not responsible for the actual implementation of the pilot project in 70-year-olds; we thus had an independent role in the evaluation. However, due to the small sample size, the results should be interpreted with caution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWith these limitations in mind, this study also has important strengths as we studied a previously rarely examined age group as well as suggesting that older adults may also be able to change their lifestyle habits even if the results need to be confirmed in larger study populations and other settings.\u003c/p\u003e\n\u003cp\u003eIn conclusion, THDs among 70-year-olds may have improved tobacco and alcohol habits among those participants who did not score green at baseline and thus received more extensive health advice.\u0026nbsp;The results suggest that an elderly population may be susceptible to lifestyle interventions. Future studies should examine the impact of THD on tobacco use and alcohol consumption on a larger scale as our findings were based on a quite small pilot study of 70-year-olds.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNCD \u0026nbsp; \u0026nbsp;Non-communicable diseases\u003c/p\u003e\n\u003cp\u003ePHCC\u0026nbsp;\u0026nbsp;Primary healthcare centers\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standard deviations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTHDs\u0026nbsp;\u0026nbsp;Targeted health dialogues\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; World Health Organization\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003e\u0026nbsp;Human Ethics and Consent to Participate\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Swedish Ethical Review Authority (registration number 2020-02689 with later amendments). Written informed consent was a prerequisite for taking part in the research study. The study is registered at ClinicalTrials.gov, identifier: NCT04912739. Registration date: 04/23/2021.\u003cbr\u003e\u003cem\u003eEthics, Consent to Participate, and Consent to Publish\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u003cem\u003e\u003cbr\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Availability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to national regulations but are available from the corresponding author on reasonable request. \u0026nbsp;\u003cbr\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding Declaration \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by funding to Kristina Sundquist from the Swedish Heart-Lung Foundation (20210553) and the Swedish Research Council (2021-06456).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA.L, as the corresponding author, was responsible for writing the manuscript, contributing to the intellectual content, developing the methodology, and overseeing the submission process. E.S contributed to writing, revising the manuscript, and the intellectual content. A.G performed the statistical analyses. D.B contributed to the writing of the article. K.S, as professor, provided intellectual input, contributed to the study design, and had overall responsibility for the study.\u003cem\u003e\u003cbr\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePeto R, Boreham J, Lopez AD. Mortality from smoking in developed countries. Oxford University Press; 1996.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurns DM. Cigarette smoking among the elderly: disease consequences and the benefits of cessation. Am J Health Promot. 2000;14(6):357\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFederation WH. World Heart Report 2023; Confronting the World\u0026rsquo;s Number One Killer. Geneva, Switzerland; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMons U, M\u0026uuml;ezzinler A, Gellert C, Sch\u0026ouml;ttker B, Abnet CC, Bobak M, et al. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ. 2015;350:h1551.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHalme JT, Sepp\u0026auml; K, Alho H, Poikolainen K, Pirkola S, Aalto M. Alcohol consumption and all-cause mortality among elderly in Finland. Drug Alcohol Depend. 2010;106(2):212\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Availiable at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/tobacco\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/tobacco\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Cited: 25\u0026ndash;02.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurling TA, Ziff DC. Tobacco smoking: a comparison between alcohol and drug abuse inpatients. Addict Behav. 1988;13(2):185\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiller NS, Gold MS. Comorbid cigarette and alcohol addiction: epidemiology and treatment. J Addict Dis. 1998;17(1):55\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlazer DG, Wu L-T. The Epidemiology of At-Risk and Binge Drinking Among Middle-Aged and Elderly Community Adults: National Survey on Drug Use and Health. Am J Psychiatry. 2009;166(10):1162\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZnaor A, Brennan P, Gajalakshmi V, Mathew A, Shanta V, Varghese C, et al. Independent and combined effects of tobacco smoking, chewing and alcohol drinking on the risk of oral, pharyngeal and esophageal cancers in Indian men. Int J Cancer. 2003;105(5):681\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi D, Jiao L. Molecular epidemiology of pancreatic cancer. Int J Gastrointest Cancer. 2003;33(1):3\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang LY, You SL, Lu SN, Ho HC, Wu MH, Sun CA, et al. Risk of hepatocellular carcinoma and habits of alcohol drinking, betel quid chewing and cigarette smoking: a cohort of 2416 HBsAg-seropositive and 9421 HBsAg-seronegative male residents in Taiwan. Cancer Causes Control. 2003;14(3):241\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlot WJ, McLaughlin JK. The changing epidemiology of esophageal cancer. Semin Oncol. 1999;26(5 Suppl 15):2\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarry KL, Blow FC. Drinking Over the Lifespan: Focus on Older Adults. Alcohol Res. 2016;38(1):115\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarengo NC, Antikainen R, Harald K, Jousilahti P. Smoking and cancer, cardiovascular and total mortality among older adults: The Finrisk Study. Prev Med Rep. 2019;14:100875.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDoolan DM, Stotts NA, Benowitz NL, Covinsky KE, Froelicher ES. The Women's Initiative for Nonsmoking (WINS) XI: Age-Related Differences in Smoking Cessation Responses Among Women With Cardiovascular Disease. Am J Geriatr Cardiol. 2008;17(1):37\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGodoy P, Castilla J, Soldevila N, Mayoral JM, Toledo D, Mart\u0026iacute;n V, et al. Smoking may increase the risk of influenza hospitalization and reduce influenza vaccine effectiveness in the elderly. Eur J Pub Health. 2017;28(1):150\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHellstrand M, Simonsson B, Engstr\u0026ouml;m S, Nilsson KW, Molarius A. A health dialogue intervention reduces cardiovascular risk factor levels: a population based randomised controlled trial in Swedish primary care setting with 1-year follow-up. BMC Public Health. 2017;17(1):669.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEliasson M, Eriksson M, Lundqvist R, Wennberg P, S\u0026ouml;derberg S. Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme. Eur J Prev Cardiol. 2018;25(16):1765\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLingfors H, Persson LG, Lindstr\u0026ouml;m K, Bengtsson C, Lissner L. Effects of a global health and risk assessment tool for prevention of ischemic heart disease in an individual health dialogue compared with a community health strategy only results from the Live for Life health promotion programme. Prev Med. 2009;48(1):20\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStenman E, Borgstrom Bolmsjo B, Grundberg A, Sundquist K. Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people. Scand J Prim Health Care. 2024:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKunzmann AT, Coleman HG, Huang W-Y, Berndt SI. The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study. PLoS Med. 2018;15(6):e1002585.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoch M, Fitzpatrick AL, Rapp SR, Nahin RL, Williamson JD, Lopez OL, et al. Alcohol Consumption and Risk of Dementia and Cognitive Decline Among Older Adults With or Without Mild Cognitive Impairment. JAMA Netw Open. 2019;2(9):e1910319\u0026ndash;e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Targeted health dialogues, Smoking, Tobacco use, Alcohol, Elderly ","lastPublishedDoi":"10.21203/rs.3.rs-6519810/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6519810/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTargeted Health Dialogues (THDs), an intervention program aimed at improving health behaviors in 40- and 50-year-olds to prevent cardiovascular disease and type 2 diabetes, was piloted to 70-year-olds in Scania County, Sweden. This study evaluates tobacco use and alcohol habits, along with self-estimated impact of the THD after one year.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFourteen primary healthcare centers invited all their registered 70-year-olds to a THD. A total of 155 (30.3%) out of 511 THD-participants also consented to take part in our research project and filled out both the baseline and one-year follow-up questionnaires on health behaviors. In addition to the baseline questionnaire, the participants underwent physical measurements and received a visual health profile with 13 risk factors across four levels: green (lowest risk), yellow, orange and red (highest risk). The one-year follow-up questionnaire assessed changes in tobacco and alcohol use, analyzed using Chi-squared and Wilcoxon signed-rank tests.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study participants reported that they had reduced their weekly alcohol consumption from a mean of 3.4 to 2.7 glasses (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among the participants with the highest consumption of alcohol at baseline, 21.6% reported that they had improved their alcohol habits at follow-up, which was significant compared to those who scored green in the health profile at baseline (p\u0026thinsp;\u0026lt;\u0026thinsp;0.007). For tobacco use, the results were similar but less consistent.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTHDs may reduce alcohol consumption in older adults. In addition, many study participants with high consumption reported that they had improved their tobacco and alcohol habits, which needs further evaluation. Further research on larger sample sizes is needed to assess the impact of THDs on tobacco and alcohol use in elderly participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial registration:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eClinicalTrials.gov, identifier: NCT04912739, registration date: 04/23/2021\u003c/p\u003e","manuscriptTitle":"Alcohol habits and tobacco use in 70-year-olds—Evaluation of a pilot project of targeted health dialogues","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-09 05:55:36","doi":"10.21203/rs.3.rs-6519810/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a78b2154-d1a8-465b-bdaa-d7ecc7450fea","owner":[],"postedDate":"July 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-07T15:23:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-09 05:55:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6519810","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6519810","identity":"rs-6519810","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}