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Tobacco is one of the leading preventable causes of death in the United States. The role of some of the specific components of tobacco and tobacco pyrolysis in causing human disease has been well described. However, the health risks attributable to nicotine alone have not been fully determined, especially for long-term use. Nicotine is a potent chemical that has powerful effects on the human body, especially when administered rapidly or at high doses. Although many of these effects are deleterious, others may be beneficial. In certain special populations, such as the developing fetus, or persons with significant cardiovascular disease, nicotine has greater adverse effects. Because of the recent emphasis on using nicotine to treat tobacco dependence, as well as the interest in using nicotine as a possible agent for reducing overall tobacco use, clarifying the effects of long-term nicotine use on human health is important.

Premature chronic disease mortality continues to be a problem among American Indian populations. To document the chronic disease burden in the Wisconsin American Indian population, age- and sex-specific incidence-density mortality rates for ten chronic diseases (ischemic heart disease, stroke, diabetes, chronic obstructive pulmonary disease, cirrhosis, and cancer of the breast, cervix, lung, colorectum and prostate) were estimated for a 10-year period (1984-1993) and compared with the Wisconsin non-Hispanic white population. Compared with whites, American Indians had markedly higher mortality rates from diabetes and cirrhosis in all age- and sex-specific groups. Ischemic heart disease mortality was significantly greater in both American Indian men and women 45-64 years of age (Rate Ratio [RR] = 1.7 and 2.1, respectively) compared to whites of the same age, but was lower in American Indians 65 years of age or older (RR = 0.9 for both sexes). Overall, these ten chronic diseases were responsible for a significant excess number of deaths in middle-aged American Indian men and women (i.e., 45-64 years of age), whereas the chronic disease mortality experience of older American Indian men and women (i.e., > or = 65 years of age) was similar to that of the older white population. Diabetes and cirrhosis were the most important causes of increased mortality overall; however, ischemic heart disease was responsible for a large number of excess deaths in middle-aged American Indian men and women.

The mortality trends analyzed suggest lack of progress toward both national and state objectives and the need for primary and secondary prevention programs targeting black and older adults with diabetes.

The Wisconsin Diabetes Control Program will address the health needs of people with diabetes by working closely with the Wisconsin Affiliate of the American Diabetes Association and other diabetes health professionals in the state. The 5-year program will use both health systems and community-based approaches to coordinate prevention, detection, and control activities required to reduce the burden of this chronic condition. This program represents a major shift in focus from previous diabetes control programs supported by the CDC, and is designed to establish the program as a key component of an evolving health care environment.

It is a common perception that alcohol use increases body weight. In fact, people are often advised to reduce their drinking if they wish to lose weight. To assess the relationship between alcohol use and body weight, we analyzed data from 5,496 Wisconsin men and women. We compared weights of drinkers and non-drinkers and adjusted for potential confounders. For women, there was a strong inverse relationship between drinking and weight. Women who drank any alcohol weighed an average of 2.6 kg (5.6 lbs) less than women who did not drink (p less than .0001). This association was found for all types of alcoholic beverages. No difference in weight was found overall between drinking and non-drinking men, although men who drank wine weighed significantly less (1.8 kg, p less than .05) than non-drinkers. These results, combined with other recent studies, suggest that alcohol use does not lead to increased weight among Wisconsin adults, and may be associated with lower weight among women.