Holden et al. BMC Public Health 2010, 10:96 http://www.biomedcentral.com/1471-2458/10/96 Smoking Adjusting for age, smoking (either current or former) showed no significant association with ED or LUTS (Table 1). However, both current and former smokers had a modestly increased likelihood of reporting pAD, although in the fully adjusted model the confidence intervals included the value. Current smokers were less likely than ‘never smokers’ to report PD in both the age-adjusted and fully adjusted models (Table 1 & Fig- ure 1). Physical Activity Compared to men with sufficient levels of physical activ- ity, sedentary men had a higher risk of ED and pAD. An upper confidence limit of 1.0 for the reduced likelihood of sedentary men reporting PD suggests the evidence for this association is weak (Table 1 & Figure 1). The ‘insuf- ficient physical activity’ category did not show associa- tions with male reproductive health problems (Figure 1). Association of co-morbid conditions and medication use with male reproductive health disorders After controlling for age, men with self-reported cere- brovascular disease, cardiovascular disease, hypertensive disease, diabetes and depressive symptomatology (in the last 12 months) were more likely to report ED, LUTS and pAD than men without these conditions, although the CI around the OR of 1.3 for pAD in men with cere- brovascular disease included the value (Table 2). In general, the associations with these co-morbid condi- tions were stronger for ED, with several ORs greater than 2, than for the other male reproductive disorders. After controlling for all other factors diabetes remained associated with ED and pAD and associations between cardiovascular disease and ED persisted (Figure 1). The age-adjusted associations between self-reported depressive symptomatology and all reproductive health Page 5 of 9 disorders (Table 2) persisted in the fully adjusted models (Figure 1). The associations between depression medica- tion and reproductive health conditions were similar to those for self-reported depressive symptomatology. While self-reported hypertensive disease was asso- ciated with LUTS, and pAD in fully adjusted models, medication use for high blood pressure was not asso- ciated with any reproductive health disorder (Figure 1). With the exception of depressive symptomatology, the reporting of co-morbid conditions and use of the medi- cations we studied were not significantly associated with PD (Figure 1). Prostate surgery was associated with ED and pAD, in both age-adjusted (Table 2) and fully adjusted models (Figure 1). Discussion With a wide-ranging approach that considers male reproductive health as a whole, this large, cross-sectional and population-based study provides a more complete picture than previous studies of the associations between lifestyle and clinical factors and male reproductive health disorders, notably ED, LUTS, prostate disease (PD) and symptoms of perceived androgen deficiency (pAD). As the first ever national stratified random sam- ple survey of older men, it has provided information on male reproductive health and associated factors that is more robust and generalisable than that from previous smaller clinical cohorts or even large population based studies confined to single cities or regions. The study highlights relationships between a range of reproductive health disorders and general health issues in men that would not be evident when viewing reproductive health problems in isolation. Associations between ED and lifestyle risk factors similar to those for cardiovascular disease (such as waist Table 2 Age-adjusted associations of biomedical factors with male reproductive health problems: OR (95% CI) Characteristic Co-morbid condition (self-report) Cerebrovascular disease Cardiovascular disease Hypertensive disease Diabetes requiring treatment Depressive symptomatology Prostate surgery Medication Depression High Blood pressure High cholesterol Number of men with the condition/ taking medicationa 177 559 1294 345 640 303 706 1218 857 ED LUTS PD pAD 2.1 (1.5-3.0)* 2.0 (1.6-2.5)** 1.6 (1.3-1.8)** 2.8 (2.1-3.7)** 1.8 (1.4-2.3)** 3.0 (2.3-4.0)** 1.9 (1.5-2.3)** 1.7 (1.5-2.0)** 1.8 (1.5-2.1)** 1.5 (1.1-2.1)* 1.4 (1.2-1.7)** 1.5 (1.3-1.7)** 1.4 (1.1-1.8)* 1.7 (1.4-2.1)** 1.3 (1.0-1.7) 1.7 (1.4-2.1)** 1.3 (1.1-1.5)* 1.3 (1.1-1.5)* 1.0 (0.7-1.4) 1.2 (1.0-1.4) 1.1 (1.0-1.4) 0.8 (0.7-1.1) 1.6 (1.2-2.1)** – 1.5 (1.2-1.8)** 1.2 (1.0-1.5) 1.2 (1.0-1.5) 1.3 (0.9-1.9) 1.5 (1.2-1.8)** 1.5 (1.3-1.8)** 2.2 (1.7-2.8)** 2.1 (1.7-2.7)** 1.8 (1.4-2.3)** 2.1 (1.7-2.5)** 1.4 (1.2-1.6)** 1.6 (1.4-1.9)** a Note: numbers included in each analysis differ slightly from those presented here due to missing data. * p < 0.01 ** p < 0.001