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Heidi D. Nelson, MD, MPH; Michael C. Nevitt, PhD; Jean C. Scott, DrPH; Katie L. Stone, MA; Steven R. Cummings, MD; Study of Osteoporotic Fractures Research Group; S. R. Cummings; M. C. Nevitt; D. Black; H. K. Genant; C. Arnaud; W. Browner; L. Christianson; M. Dockrell; C. Fox; C. Gluer; S. Harvey; S. B. Hulley; M. Jergas; L. Palermo; A. Pressman; P. San Valentin; D. Seeley; K. Stone; R. Sherwin; J. Scott; K. Fox; J. Lewis; G. Greenberg; M. Bahr; S. Trusty; L. Finazzo; S. Snyder; E. Oliner; B. Hohman; T. Page; K. Ensrud; R. Grimm, Jr; C. Bell; E. Mitson; I. Chavier; K. Jacobson; S. Fillhouer; C. Shoberg; D. Michel; S. Estill; J. Hansen; M. Baumhover; J. A. Cauley; L. H. Kuller; L. Harper; M. Nasim; C. Bashada; L. Buck; A. Githens; A. McCune; D. Medve; S. Rudovsky; N. Watson; T. M. Vogt; W. M. Vollmer; E. Orwoll; J. Blank; F. Heinith; R. Bright; J. Downing; B. Packer; C. Souvanlasy; L. Puderbaugh; D. Franco

JAMA. 1994;272(23):1825-1831.

Abstract
Objective.
—To determine the associations of current and lifetime smoking and alcohol use with physical function in an older population.

Design.
—Survey.

Setting.
—Four clinic centers in the United States.

Participants.
—A total of 9704 community-dwelling, ambulatory white women 65 years or older recruited from four areas of the United States.

Main Outcome Measures.
—Twelve performance tests of muscle strength, agility and coordination, gait and balance, and self-reported functional status.

Results.
—Compared with women who never smoked, current smokers had significantly poorer function on all of the performance measures except grip strength after adjusting for age, history of stroke, body mass index, clinic site, physical activity, and alcohol use (P<.05). This decrease in function was 50% to 100% as great as that associated with a 5-year increase in age, and most measures worsened with increasing numbers of pack-years. Compared with current moderate drinkers, nondrinkers had significantly poorer function on all of the performance measures except tandem walk (P<.05). Evaluation of a dose effect with alcohol was limited by the small number of heavy drinkers in the study.

Conclusions.
—In this population, women who currently smoke are weaker and have poorer balance and poorer performance on measures of integrated physical function than nonsmokers. Smoking is associated with a decline in physical function. Current moderate drinkers have better physical function compared with nondrinkers, but associations of function with heavy drinkers could not be assessed.

(JAMA. 1994;272:1825-1831)

Author Affiliations
University of California— San Francisco (Coordinating Center); University of Maryland, Baltimore; University of Minnesota, Minneapolis; University of Pittsburgh (Pa); The Kaiser Permanente Center for Health Research, Portland, Ore

From the Division of General Internal Medicine, Oregon Health Sciences University, Portland (Dr Nelson); Department of Epidemiology and Biostatistics, University of California—San Francisco (Drs Nevitt and Cummings and Ms Stone); and Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore (Dr Scott).

Footnotes
A complete list of the investigators in the Study of Osteoporotic Fractures Research Group appears at the end of this article.

Reprint requests to Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, L475, Portland, OR 97201-3098 (Dr Nelson).

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