Elsevier

Preventive Medicine

Volume 48, Issue 2, February 2009, Pages 173-179
Preventive Medicine

Associations between health-related quality of life and smoking status among a large sample of U.S. adults

https://doi.org/10.1016/j.ypmed.2008.11.012Get rights and content

Abstract

Objective

To examine the association between self-perceived health-related quality of life (HRQoL) and smoking status.

Methods

We used data from 2006 Behavioral Risk Factor Surveillance System, USA participants in four states (n = 17,800) to compare the HRQoL of current smokers who unsuccessfully attempted to quit (unsuccessful quitters), former smokers, and never smokers with the HRQoL of current smokers who made no attempts to quit (non-quitters).

Results

Overall, unsuccessful quitters were more likely than non-quitters to report frequent mental distress, physical distress, and pain but not frequent depressive symptoms; former and never smokers were less likely than non-quitters to report frequent depressive symptoms. When study subjects were stratified by sex, these associations held true for men, but not for women. Among women, the prevalence of frequent mental and physical distress among former smokers and never smokers was not significantly different from the prevalence among non-quitters, whereas unsuccessful quitters were 2.4 times more likely to report frequent mental distress and 2.1 times more likely to report frequent physical distress than were non-quitters.

Conclusions

Certain HRQoL characteristics were worse among smokers who unsuccessfully attempted to quit and better among former smokers than among smokers who made no attempts to quit.

Introduction

Numerous deleterious effects of active smoking on health have been documented over the past half-century, including bladder, cervical, and lung cancer; leukemia; coronary heart disease; reduced fertility; and peptic ulcer disease (USDHHS, 2004). However, recent research suggests that smoking may also be associated with other adverse health characteristics, including lower health-related quality of life (HRQoL) (Strine et al., 2005, Martinez et al., 2004, Mitra et al., 2004). HRQoL encompasses a holistic examination of well-being in which health is considered to be “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (WHO, 1948). HRQoL measures how people perceive their health, including their perceptions of physical limitations, pain, vitality, mental health, and related role and social functioning (Mulder et al., 2001). Previous research has demonstrated that HRQoL is inversely related to the number of cigarettes that people smoke (Mulder et al., 2001, Wilson et al., 1999) and that this relationship is even stronger among more nicotine-dependent smokers (Schmitz et al., 2003).

Successful smoking cessation has been shown to have major and immediate health benefits, such as reduced risk for cardiovascular disease and cancer of the lungs, mouth, throat, esophagus, bladder, cervix, and pancreas (USDHHS, 1990). Some research results have suggested that smoking cessation is also associated with improved HRQoL (Mitra et al., 2004, Bolliger et al., 2002). However, findings from other studies have indicated that cessation does not lead to improvement in HRQoL (Tillman and Silcock, 1997, Wiggers et al., 2006). Specifically, a clinical follow-up study to a smoking cessation intervention conducted by Wiggers et al. (2006) suggested that while smoking cessation was associated with improved cardiovascular health, it was not associated with improved overall well-being; however, because this study was conducted among clinical outpatients with atherosclerotic disease, these findings may not be applicable to the general population.

Most studies of the relationship between people's smoking status and their HRQoL have been conducted outside the United States (Martinez et al., 2004, Mitra et al., 2004, Mulder et al., 2001, Wilson et al., 1999, Schmitz et al., 2003, Bolliger et al., 2002, Tillman and Silcock, 1997, Wiggers et al., 2006) and in clinical settings (Bolliger et al., 2002, Wiggers et al., 2006). To our knowledge, no studies have used a large population-based sample to examine the HRQoL of smokers who unsuccessfully attempted to quit in the previous year. In our study, we attempted to fill these research gaps by investigating the relationship between smoking status (including quit attempts) and HRQoL using a large noninstitutionalized sample of U.S. adults from four states.

Section snippets

Methods

We analyzed data from the Healthy Days Core Module (CDC HRQoL-4) and the Healthy Days Symptoms Module (Moriarty et al., 2003) included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys of Delaware, Hawaii, Rhode Island, and New York. The BRFSS collects data from ongoing random-digit-dial telephone surveys administered to noninstitutionalized U.S. adults (residents aged 18 or older) on health risk behaviors, preventive health practices, and access to and use of health care

Results

Overall, 17.8% (95% CI = 16.6%–19.1%) of the respondents were current smokers, 25.2% (95% CI = 24.0%–26.5%) were former smokers, and 57.0% (95% CI = 55.4%–58.5%) were never smokers. Among current smokers, 59.0% (95% CI = 55.2%–62.7%) reported having attempted to quit in the previous year.

Discussion

The current study provides novel findings on the associations between attempts to quit smoking in the past year and HRQoL among a large non-institutionalized adult sample from four states. In general, we found that unsuccessful quitters were more likely to report negative HRQoL experiences than were non-quitters, and that successful quitters (former smokers) were more likely to report positive HRQoL experiences than either.

Our results were consistent with those from previous studies showing a

Conflict of interest statement

None declared.

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