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Smoking status and health-related quality of life: a longitudinal study in young adults

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Abstract

Purpose

The possibility that tobacco use affects health-related quality of life (HRQoL) has attracted interest. However, a lack of prospective evidence weakens the case for a causal relationship. The aim was to examine the longitudinal relationship between change in smoking status and change in HRQoL in young adults.

Methods

We conducted a population-based cohort study with data collected in 2004–2006 (aged 26–36) and 2009–2011 (aged 31–41). Exposure was change in self-reported smoking status during follow-up. Outcomes were changes in physical and mental HRQoL measured by SF-12.

Results

For physical HRQoL (n = 2080), quitters had a 2.12 (95 % confidence interval (CI) 0.73, 3.51) point improvement than continuing smokers, whereas former smokers who resumed smoking had a 2.08 (95 % CI 0.21, 3.94) point reduction than those who maintained cessation. Resumed smokers were 39 % (95 % CI 10, 75 %) more likely to have a clinically significant (>5 point) reduction of physical HRQoL than former smokers who maintained cessation. In contrast, quitters were 43 % (95 % CI 3, 98 %) more likely to have a clinically significant (>5 point) improvement in physical HRQoL than continuing smokers. Change in smoking status was not significantly associated with change in mental HRQoL (n = 1788).

Conclusions

Smoking by young adults was cross-sectionally associated with lower physical HRQoL and longitudinally associated with reductions in physical HRQoL. The expectation of short- to medium-term gains in physical HRQoL as well as long-term health benefits may help motivate young adult smokers to quit.

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Acknowledgments

This study was supported by grants from the National Heart Foundation (Grant GOOH0578 and Fellowship PH11H6047 to S.L.G.); the National Health and Medical Research Council (Grants 211316 and 544923 and fellowship APP1008299 to A.J.V.); the Tasmania Graduate Research Scholarship (to J.T.); the Tasmanian Community Fund (Grant D0013808); and Veolia Environmental Services (Sydney, New South Wales, Australia). The study was sponsored by Sanitarium Health and Wellbeing Australia (Melbourne, Victoria, Australia), ASICS Ltd. (Kobe, Japan) and Target Australia Pty. Ltd. (North Geelong, Victoria, Australia). We gratefully acknowledge the contributions of the study project manager, Marita Dalton, and all other project staff.

Author information

Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia

    Jing Tian, Alison J. Venn, Leigh Blizzard, Terry Dwyer & Seana L. Gall

  2. Murdoch Childrens Research Institute, Melbourne, VIC, Australia

    George C. Patton

  3. The George Institute for Global Health, University of Oxford, Wellington Square, Oxford, UK

    Terry Dwyer

Authors
  1. Jing Tian
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  2. Alison J. Venn
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  3. Leigh Blizzard
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  5. Terry Dwyer
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  6. Seana L. Gall
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Correspondence to Seana L. Gall.

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Appendices

Appendix 1

See Table 5.

Table 5 Comparison of baseline characteristics of participants and non-participants*
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Appendix 2: sensitivity analysis using propensity score weighting technique

Sensitivity analyses were conducted by re-analysing the data with weighting by propensity. Compared with the original models as shown in Appendix 2, the associations remained significant at the same patters and the changes in the magnitude of significant associations were small, ranging from 0.0 to 14.7 %. See Tables 6, 7 and 8.

Table 6 Cross-sectional associations of smoking status and HRQoL at baseline
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Table 7 Associations of baseline smoking status and change in smoking status with change in HRQoL
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Table 8 Association between changes in smoking status and clinically meaningful changes (or 5 or more score points) in HRQoL
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Appendix 3: sensitivity analyses by re-reanalysing data using 0.5 SD of baseline HRQoL values

Findings using half a SD of baseline HRQoL as the MCSD were broadly similar with the result with complete case analyses, with changes within 10.9 % of the original significant associations. The clinically significant reduction of physical HRQoL for continuing smokers was at the borderline statistical significance level (RR 1.14, 95 % CI 0.99, 1.32), and the clinically significant improvement of physical HRQoL for quitters disappeared relative to continuing smokers. See Table 9.

Table 9 Association between changes in smoking status and clinically meaningful changes in HRQoL
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Appendix 4: sensitivity analyses by removing quitters who quit smoking owing to emerged health problems during follow-up

See Tables 10 and 11.

Table 10 Associations of baseline smoking status and change in smoking status with change in HRQoL
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Table 11 Association between changes in smoking status and clinically meaningful changes (or 5 or more score points) in HRQoL
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Appendix 5: sensitivity analyses by redefining former smokers’ smoking status according to length of abstinence

See Tables 12, 13 and 14.

Table 12 Cross-sectional associations of smoking status and HRQoL at baseline
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Table 13 Associations of baseline smoking status and change in smoking status with change in HRQoL
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Table 14 Association between changes in smoking status and clinically meaningful changes (or 5 or more score points) in HRQoL
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Tian, J., Venn, A.J., Blizzard, L. et al. Smoking status and health-related quality of life: a longitudinal study in young adults. Qual Life Res 25, 669–685 (2016). https://doi.org/10.1007/s11136-015-1112-6

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