Research articlesHealth-related quality of life and health risk behaviors among smokers
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.
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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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