Quality of Life Research

, Volume 25, Issue 3, pp 669–685 | Cite as

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

  • Jing Tian
  • Alison J. Venn
  • Leigh Blizzard
  • George C. Patton
  • Terry Dwyer
  • Seana L. Gall



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.


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.


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).


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.


Smoking Smoking cessation Quality of life Mental health Longitudinal studies 



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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Toghianifar, N., Najafian, J., Pooya, A., Rabiei, K., Eshrati, B., Anaraki, J., & Sarrafzadegan, N. (2012). Association of smoking status with quality of life in a cross-sectional population-based sample of Iranian adults: Isfahan Healthy Heart Program. Asia-Pacific Journal of Public Health, 24(5), 786–794.CrossRefPubMedGoogle Scholar
  2. 2.
    Schmitz, N., Kruse, J., & Kugler, J. (2003). Disabilities, quality of life, and mental disorders associated with smoking and nicotine dependence. American Journal of Psychiatry, 160(9), 1670–1676.CrossRefPubMedGoogle Scholar
  3. 3.
    Vogl, M., Wenig, C. M., Leidl, R., & Pokhrel, S. (2012). Smoking and health-related quality of life in English general population: implications for economic evaluations. BMC Public Health, 12, 203.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Wilson, D., Parsons, J., & Wakefield, M. (1999). The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers. Preventive Medicine, 29(3), 139–144.CrossRefPubMedGoogle Scholar
  5. 5.
    Dube, S. R., Thompson, W., Homa, D. M., & Zack, M. M. (2013). Smoking and health-related quality of life among U.S. Adolescents. Nicotine & Tobacco Research, 15(2), 492–500.CrossRefGoogle Scholar
  6. 6.
    Heikkinen, H., Jallinoja, P., Saarni, S. I., & Patja, K. (2008). The impact of smoking on health-related and overall quality of life: a general population survey in Finland. Nicotine & Tobacco Research, 10(7), 1199–1207.CrossRefGoogle Scholar
  7. 7.
    Holahan, C. K., Holahan, C. J., North, R. J., Hayes, R. B., Powers, D. A., & Ockene, J. K. (2013). Smoking status, physical health-related quality of life, and mortality in middle-aged and older women. Nicotine & Tobacco Research, 15(3), 662–669.CrossRefGoogle Scholar
  8. 8.
    Strandberg, A. Y., Strandberg, T. E., Pitkala, K., Salomaa, V. V., Tilvis, R. S., & Miettinen, T. A. (2008). The effect of smoking in midlife on health-related quality of life in old age: A 26-year prospective study. Archives of Internal Medicine, 168(18), 1968–1974.CrossRefPubMedGoogle Scholar
  9. 9.
    Guiterrez-Bedmar, M., Segui-Gomez, M., Gomez-Gracia, E., Bes-Rastrollo, M., & Martinez-Gonzalez, M. A. (2009). Smoking status, changes in smoking status and health-related quality of life: Findings from the SUN (“Seguimiento Universidad de Navarra”) cohort. International Journal of Environmental Research and Public Health, 6(1), 310–320.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Sarna, L., Bialous, S. A., Cooley, M. E., Jun, H. J., & Feskanich, D. (2008). Impact of smoking and smoking cessation on health-related quality of life in women in the Nurses’ Health Study. Quality of Life Research, 17(10), 1217–1227.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000). Smoking and mental illness: A population-based prevalence study. JAMA, 284(20), 2606–2610.CrossRefPubMedGoogle Scholar
  12. 12.
    Munafo, M. R., Zetteler, J. I., & Clark, T. G. (2007). Personality and smoking status: A meta-analysis. Nicotine & Tobacco Research, 9(3), 405–413.CrossRefGoogle Scholar
  13. 13.
    Goldney, R. D., Fisher, L. J., Wilson, D. H., & Cheok, F. (2000). Major depression and its associated morbidity and quality of life in a random, representative Australian community sample. Australian and New Zealand Journal of Psychiatry, 34(6), 1022–1029.CrossRefPubMedGoogle Scholar
  14. 14.
    van Straten, A., Cuijpers, P., van Zuuren, F. J., Smits, N., & Donker, M. (2007). Personality traits and health-related quality of life in patients with mood and anxiety disorders. Quality of Life Research, 16(1), 1–8.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P. (2014). Change in mental health after smoking cessation: Systematic review and meta-analysis. BMJ, 348, g1151.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Gall, S., Jose, K., Smith, K., Dwyer, T., & Venn, A. (2009). The childhood determinants of adult health study: a profile of a cohort study to examine the childhood influences on adult cardiovascular health. Australasian Epidemiologist, 16(1), 35–38.Google Scholar
  17. 17.
    Ware, J, Jr, Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.CrossRefPubMedGoogle Scholar
  18. 18.
    Sanderson, K., & Andrews, G. (2002). The SF-12 in the Australian population: Cross-validation of item selection. Australian and New Zealand Journal of Public Health, 26(4), 343–345.CrossRefPubMedGoogle Scholar
  19. 19.
    Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., et al. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1171–1178.CrossRefPubMedGoogle Scholar
  20. 20.
    Lim, L. L., & Fisher, J. D. (1999). Use of the 12-item short-form (SF-12) Health Survey in an Australian heart and stroke population. Quality of Life Research, 8(1–2), 1–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Craig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35(8), 1381–1395.CrossRefPubMedGoogle Scholar
  22. 22.
    Smith, K. J., McNaughton, S. A., Gall, S. L., Blizzard, L., Dwyer, T., & Venn, A. J. (2009). Takeaway food consumption and its associations with diet quality and abdominal obesity: A cross-sectional study of young adults. International Journal of Behavioral Nutrition and Physical Activity, 6, 29.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Costa, P. T. J., & McCrae, R. R. (1992). Revised NEO personality inventory (NEO-PI-R) and NEO five-factor inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  24. 24.
    Henderson, S., Duncan-Jones, R., McAuley, H., & Ritchie, K. (1978). The patient’s primary group. British Journal of Psychiatry, 132, 74–86.CrossRefGoogle Scholar
  25. 25.
    World Health Organization. (1997). Composite international diagnostic interview (CIDI). Geneva: World Health Organization.Google Scholar
  26. 26.
    Blizzard, L., & Hosmer, D. W. (2007). The log multinomial regression model for nominal outcomes with more than two attributes. Biom J, 49(6), 889–902.CrossRefPubMedGoogle Scholar
  27. 27.
    Hosmer, D. W, Jr, Lemeshow, S., & Sturdivant, R. X. (2013). Applied logistic regression (3rd ed., Vol. 398). Mississauga: Wiley.CrossRefGoogle Scholar
  28. 28.
    Blizzard, C. L., Quinn, S. J., Canary, J. D., & Hosmer, D. W. (2013). Log-link regression models for ordinal responses. Open Journal of Statistics, 3(04), 16–25.CrossRefGoogle Scholar
  29. 29.
    Gill, S. C., Butterworth, P., Rodgers, B., & Mackinnon, A. (2007). Validity of the mental health component scale of the 12-item Short-Form Health Survey (MCS-12) as measure of common mental disorders in the general population. Psychiatry Research, 152(1), 63–71.CrossRefPubMedGoogle Scholar
  30. 30.
    Borzecki, A. M., Lee, A., Kalman, D., & Kazis, L. E. (2005). Do poor health behaviors affect health-related quality of life and healthcare utilization among veterans? The Veterans Health Study. The Journal of Ambulatory Care Management, 28(2), 141–156.CrossRefPubMedGoogle Scholar
  31. 31.
    Vianna, E. O., Gutierrez, M. R., Barbieri, M. A., Caldeira, R. D., Bettiol, H., & Da Silva, A. A. (2008). Respiratory effects of tobacco smoking among young adults. American Journal of the Medical Sciences, 336(1), 44–49.CrossRefPubMedGoogle Scholar
  32. 32.
    Urrutia, I., Capelastegui, A., Quintana, J. M., Muniozguren, N., Basagana, X., & Sunyer, J. (2005). Smoking habit, respiratory symptoms and lung function in young adults. The European Journal of Public Health, 15(2), 160–165.CrossRefPubMedGoogle Scholar
  33. 33.
    Krause, N. M., & Jay, G. M. (1994). What do global self-rated health items measure? Medical Care, 32(9), 930–942.CrossRefPubMedGoogle Scholar
  34. 34.
    Aubin, H. J., Rollema, H., Svensson, T. H., & Winterer, G. (2012). Smoking, quitting, and psychiatric disease: A review. Neuroscience and Biobehavioral Reviews, 36(1), 271–284.CrossRefPubMedGoogle Scholar
  35. 35.
    Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.CrossRefPubMedGoogle Scholar
  36. 36.
    Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., et al. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine, 368(4), 341–350.CrossRefPubMedGoogle Scholar
  37. 37.
    Pirie, K., Peto, R., Reeves, G. K., Green, J., & Beral, V. (2013). The 21st century hazards of smoking and benefits of stopping: A prospective study of one million women in the UK. Lancet, 381(9861), 133–141.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Burns, D. M. (2008). Live fast, die young, leave a good-looking corpse. Archives of Internal Medicine, 168(18), 1946–1947.CrossRefPubMedGoogle Scholar
  39. 39.
    Patrick, D. L., Cheadle, A., Thompson, D. C., Diehr, P., Koepsell, T., & Kinne, S. (1994). The validity of self-reported smoking: A review and meta-analysis. American Journal of Public Health, 84(7), 1086–1093.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Jing Tian
    • 1
  • Alison J. Venn
    • 1
  • Leigh Blizzard
    • 1
  • George C. Patton
    • 2
  • Terry Dwyer
    • 1
    • 3
  • Seana L. Gall
    • 1
  1. 1.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
  2. 2.Murdoch Childrens Research InstituteMelbourneAustralia
  3. 3.The George Institute for Global HealthUniversity of OxfordOxfordUK

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