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Health-related quality of life and health risk behaviors among smokers

https://doi.org/10.1016/j.amepre.2004.10.002Get rights and content

Background

It is well established that smoking has detrimental effects on physical health, but its associations with health-related quality of life (HRQOL) and a variety of health behaviors have not been widely investigated in the U.S. population.

Methods

Data obtained from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized persons aged ≥18 years in the United States, Guam, Puerto Rico, and the Virgin Islands, were used in this investigation. The BRFSS monitors the prevalence of key health- and safety-related behaviors and characteristics. In 2001 and 2002 combined, trained interviewers administered HRQOL questions in 23 states and the District of Columbia (n=82,918). This analysis was conducted in 2004.

Results

Overall, an estimated 22.4% of adults were current smokers, 24.1% were former smokers, and 53.6% never smoked. Current smokers had significantly poorer HRQOL than those who had never smoked, and were more likely to drink heavily, to binge drink, and to report depressive and anxiety symptoms. Additionally, current smokers were significantly more likely than those who never smoked to be physically inactive, to report frequent sleep impairment, to report frequent pain, and to eat less than five servings of fruits and vegetables per day.

Conclusions

While there are strong positive relationships between smoking and both alcohol consumption and mood disturbance, smoking is also associated with an array of other modifiable risk factors meriting assessment and intervention. In addition to smoking cessation, the increased morbidity and mortality characterizing smokers may potentially be further reduced by improvements in diet, physical activity, and sleep.

Introduction

With an estimated 46.2 million adult smokers in the United States, tobacco use has been identified as the leading preventable cause of mortality, resulting in >18% of all deaths. 1, 2, 3, 4 Notably, smoking poses serious economic implications as well, accounting for >$75 billion per year in medical costs and $82 billion per year in lost productivity. 1, 3 Given the detrimental effect of smoking on health, Healthy People 2010 5 seeks to reduce the prevalence of smoking from 24% in 1998 to ≤12% by 2010.

Although much previous research has described the associations between smoking and poor physical health, 1, 2, 3, 4 few studies have examined the associations of smoking status with health-related quality of life (HRQOL) and health behaviors among non-institutionalized adults. Research in this area has been largely restricted to studies conducted outside of the United States. 6, 7, 8, 9, 10, 11, 12 Yet, examining the associations among smoking, HRQOL, and health behaviors appears to be particularly important for identifying behaviors and conditions linked with smoking that may further jeopardize the health of smokers in the U.S. population. To better address these issues, data were analyzed from the 2001 and 2002 Behavioral Risk Factor Surveillance System (BRFSS). These analyses were conducted in 2004.

Section snippets

Methods

The BRFSS, an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized persons aged ≥18 years in the United States, Guam, Puerto Rico, and the Virgin Islands, monitors the prevalence of key health- and safety-related behaviors and characteristics. 13 In 2001 and 2002 combined, trained interviewers administered HRQOL questions in 23 states (2001: Alaska, Arizona, Delaware, Georgia, Maryland, Minnesota, Nebraska, New Jersey, Ohio, Tennessee, Utah, and Virginia; 2002:

Demographic characteristics

Overall, an estimated 22.4% (95% CI=21.8%–22.9%) of adults aged ≥18 years were current smokers; 24.1% (95% CI=23.5%–24.6%) former smokers; and 53.6% (95% CI=52.9%–54.3%) never smoked. With the exception of those aged 35 to 44 years, as age increased, the prevalence of current smoking decreased, from 27.3% among those aged 18 to 24 years to 10.6% among those aged ≥65 years (Table 1). Men were significantly more likely to be current smokers than women (p<0.01), while Hispanics were significantly

Discussion

This is the first national population-based study of U.S. adults examining associations among smoking status, HRQOL, and health risk behaviors. The relationship between smoking and impaired physical health 1, 2, 3, 4 is corroborated by the results of this study. Specifically, compared to persons who never smoked, current smokers are more likely to report fair/poor general health, frequent physical distress, frequent activity limitations, and frequent pain.

While previous research suggests that

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