• Users Online: 1743
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 144-148

Disparities in the quality of life among smokers, nonsmokers, and ex-smokers


Departments of Public Health Dentistry, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission23-Dec-2019
Date of Decision18-Oct-2020
Date of Acceptance30-Dec-2020
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. V Anu
Department of Public Health Dentistry, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-4534.322614

Rights and Permissions
  Abstract 


Introduction: Ill effects of smoking and the advantage of smoking cessation on health are well reported. This study was undertaken with the aim to assess the Quality of Life (QOL) among smokers, non -smokers and ex-smokers which will help clinicians to point out the influence of smoking on quality of life to assist in their everyday work with the patients and to the researchers in more comprehensive evaluation of the respondents' life quality. Materials and Methods: The study was carried out among 234 current smokers, 233 non-smokers and 253 ex-smokers aged above 20 years using WHO- Quality of life- BREF(WHOQOL-BREF). Sociodemographic variables that were recorded includes age, Gender, educational status, marital status. Smoking history was obtained using a closed ended questionnaire. The collected data was entered in Windows Excel and statistical analysis was carried out using SPSS version 11 software. Descriptive statistics, One-way ANOVA test and Tukey's HSD Post hoc test was done. Level of significance was set as 0.05. Results: 103(45.4%)smokers are 'satisfied' with their health, while majority of the ex-smokers,99(39.2%) are 'neither satisfied nor dissatisfied' with their health. Non-smokers reports higher mean values in all domains when compared to smokers and ex-smokers. The smokers showed higher rating in physical(53.39%) and environmental(52.7%) domains when compared to ex-smokers(50.56% and 59.21% respectively) while lower ratings were found in psychological and social domains among smokers than ex-smokers. Statistical test showed a significant difference among all groups based on domains except smokers and ex-smokers in psychological and social relationship. Conclusion: Quality of life among smokers are relatively lower than the non-smokers in the Physical health, Psychological, Social relationships and Environment attributes. Also, the ex-smokers are found to have similar quality of life as smokers when it comes to psychological and social relationship.

Keywords: Ex-smokers, never smokers, quality of life, smokers, World Health Organization quality of life-BREF


How to cite this article:
Anu V, Laksmi B S, Sharmila S, Shivani S, Mahalakshmi S M. Disparities in the quality of life among smokers, nonsmokers, and ex-smokers. J Datta Meghe Inst Med Sci Univ 2021;16:144-8

How to cite this URL:
Anu V, Laksmi B S, Sharmila S, Shivani S, Mahalakshmi S M. Disparities in the quality of life among smokers, nonsmokers, and ex-smokers. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 23];16:144-8. Available from: http://www.journaldmims.com/text.asp?2021/16/1/144/322614




  Introduction Top


Smoking is a well-known cause of mortality around the world. The ill effects of smoking and the advantage of smoking cessation on health are well reported. Smokers report several reasons for smoking and their concern about the effect of quitting smoking. Reasons for their need to smoke include ability to cope with stress and cravings, social facilitation, and mood improvement.[1],[2] Their concern about the effect of quitting smoking includes increasing weight, reduced ability to cope with stressors, loss of pleasure, social ostracism, and intense cravings.[3],[4] Such findings increase the interest of the researchers to study about how smoking affects general mood, life satisfaction, perceived health status, and quality of life in smokers who quit smoking and who continue smoking.

The quality of life (QOL) is multidimensional and can be measured subjectively and objectively.[5],[6] The World Health Organization (WHO) defines QOL, as “a person's approach, their position in life, in the background of their culture and value system, they inhabit in relation to expectancies, patterns, and concerns.”[1]

Literature shows that smokers have worse mental health than never smokers and former smokers.[7],[8] In addition, ex-smokers report that they are happier after quitting smoking than they were while smoking.[9] From a public health perspective, it is essential to educate the population on the burden of disease related to smoking and its impact not only on morbidity and mortality but also on their QOL. Hence, this study was undertaken with the aim to assess the QOL among smokers, nonsmokers, and ex-smokers. This study will help to point out the influence of smoking on QOL to assist both clinicians in their day-to-day work with the patients and the researchers in more comprehensive evaluation of the respondents' life quality.


  Methodology Top


The study was conducted after obtaining ethical clearance from the Institutional Human Ethical Committee, Sathyabama Dental College and Hospital, Chennai (Sathyabama University/IHEC/Study No. 013). The study was carried out in Chennai, Tamil Nadu, among 234 current smokers (those who smoke at least one cigarette per day for the last 6 months), 233 nonsmokers (those who have never smoked), and 253 ex-smokers (individuals who had smoked in the past and have quitted at least before 6 months), aged above 20 years.

The WHO-QOL-BREF was used to measure the QOL among the study population. This questionnaire developed by the WHO has 26 items with four domain structures (physical health, psychological, social relationships, and environment).[10] The “physical health” domain has seven items such as activities of daily living, dependence on medicinal substances and medical aids, energy and fatigue, mobility, pain and discomfort, sleep and rest, and work capacity. The “psychological health” has six items that assess bodily image and appearance; negative and positive feelings; self-esteem; spirituality and personal beliefs; and capacity of learning, memory, and concentration. The “social relationship” domain has three items that assess personal relationship, social support, and sexual activities, and the “environment” domain has eight items such as the financial resources, physical safety, accessibility and quality of health and social care, home environment, opportunities of acquiring new information and skills, participation in and opportunities for leisure activities, transport, and quality of environment.[10] Two further items estimate the global indicator of QOL and satisfaction with health. The WHOQOL-BREF employs a 5-point scale, with a higher score indicating a higher level of self-perceived QOL. The mean score of items within each domain is used to calculate the domain score.

Sociodemographic variables that were recorded include age, gender, educational status, and marital status. Smoking history was obtained using a close-ended questionnaire. The collected data were entered in Windows Excel, and statistical analysis was carried out using SPSS version 11 software (IBM, Armonk, New York, USA). Descriptive statistics were carried out. One-way ANOVA test was used to compare domain scores (physical health, psychological, social relationships, and environment) between the smokers, nonsmokers, and ex-smokers. Tukey's honestly significant difference post hoc test was used to compare each combination (smokers vs. nonsmokers, nonsmokers vs. ex-smokers, and smokers vs. ex-smokers). The level of significance was set as 0.05.

Ethical clearance

The study was conducted after obtaining ethical clearance from the Institutional Human Ethical Committee, Sathyabama Dental College and Hospital, Chennai(Sathyabama University/ IHEC/Study No. 013.


  Results Top


The present study was carried out among 720 individuals, of which 234 were current smokers, 233 were nonsmokers, and 253 were ex-smokers. The mean age of the study population was 34.22 years. Among the 234 smokers, 60 were occasional smokers, 51 individuals smoked ½–1 pack/day, 58 individuals smoked 1–2 packs/day, 39 smokers smoked 2 packs/day, and 26 individuals smoked more than 3 packs/day.

[Table 1] shows the study groups' self-rating regarding their health. A total of 138 (50.4%) smokers rate their health as “good,” whereas 124 (59.4%) of the nonsmokers and 113 (48%) of the ex-smokers rate their health as good. From [Table 2], it is observed that majority of the smokers (103, 45.4%) are “satisfied” with their health, whereas majority of the ex-smokers (99, 39.2%) are “neither satisfied nor dissatisfied” with their health.
Table 1: Smokers', nonsmokers', and ex-smokers' self-rating of their quality of life

Click here to view
Table 2: Smokers', nonsmokers', and ex-smokers' satisfaction with health

Click here to view


[Table 3] shows the overall QOL among smokers, ex-smokers, and nonsmokers. Smokers and ex-smokers have almost the same low QOL when compared to nonsmokers. The smokers show higher rating in physical (53.39%) and environmental (52.7%) domains when compared to ex-smokers (50.56% and 59.21%, respectively), whereas lower ratings were found in psychological and social domains among smokers than ex-smokers.
Table 3: Overall quality of life among smokers, nonsmokers, and ex-smokers

Click here to view


From [Table 4], we observe that the significance value is <5% for all the domain scores (physical health, psychological, social relationships, and environment), which indicates that the scores significantly vary between smokers, nonsmokers, and ex-smokers. In order to understand the QOL of smokers, the domain scores of smokers were further analyzed using the post hoc test [Table 2] to compare with nonsmokers' and ex-smokers' domain scores. From [Table 5], we observe that the significance value is <5% in all the comparisons except smokers versus ex-smokers in psychological and social relationships' scores. This indicates that the smokers and ex-smokers have a similar QOL when it comes to psychological and social relationships' domains.
Table 4: Comparison of domain scores between groups

Click here to view
Table 5: Pairwise comparison (Tukey's post hoc test)

Click here to view



  Discussion Top


The WHOQOL-BREF or WHOQOL-26 is a short version of WHOQOL-100, which is used widely to subjectively assess the QOL in epidemiological studies that are conducted on a large scale, routine clinical work, and clinical trials. The WHOQOL-BREF comprises of one question for each 24 facets in the WHOQOL-100 with four domains (physical health, psychological health, social relationships, and environment) and two further questions on the global indicators of QOL and satisfaction with health. The reference time to consider was previous 2 weeks.[11]

The present study was carried out to assess the QOL among smokers, ex-smokers, and never smokers in Chennai, India, using WHOQOL-BREF. This study provides significant evidence that quitting smoking will provide better QOL than continuing smoking. This is in accordance with studies done by Sarna et al.[12] and Piper et al.(2011).[13] Considering the ill effects of smoking, quitting smoking will definitely improve the QOL among ex-smokers. However, it should be noted from this study that majority of smokers rate their health as “good” and are satisfied with their health than ex-smokers. This shows that the smokers adapt themselves to adjust with their lifestyle and consider their health as “satisfactory.”

The physical and environment domains though showed a difference between smokers and ex-smokers, the values were found to be higher when compared to those of nonsmokers. Lyon et al.[14] reported similar findings among smokers and never smokers. From this study, it is also observed that smokers and ex-smokers tend to have a similar QOL when it comes to psychological and social relationship domains. The findings are in accordance with studies done by Wilson et al.[15] and Lyon et al.,[14] who reported that smokers have poor emotional and social functioning when compared to never smokers. This reinforces that smoking is injurious to health and points out the strong link between smoking and mental health not only among the smokers but also among the ex-smokers. This study recommends that tobacco cessation measures should not only consider the cessation of habit, but also help individuals quitting the habit to adapt and modify healthy lifestyles and practices to improve their QOL.


  Conclusion Top


It can be concluded from this study that the QOL among smokers is relatively lower than the nonsmokers in the physical health, psychological, social relationships, and environment attributes. Furthermore, the ex-smokers are found to have similar QOL as smokers when it comes to psychological and social relationships.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kassel JD, Stroud LR, Paronis CA. Smoking, stress, and negative affect: Correlation, causation, and context across stages of smoking. Psychol Bull 2003;129:270-304.  Back to cited text no. 1
    
2.
White MM, Gilpin EA, Emery SL, Pierce JP. Facilitating adolescent smoking: Who provides the cigarettes? Am J Health Promot 2005;19:355-60.  Back to cited text no. 2
    
3.
Sorensen G, Pechacek TF. Attitudes toward smoking cessation among men and women. J Behav Med 1987;10:129-37.  Back to cited text no. 3
    
4.
McKee SA, O'Malley SS, Salovey P, Krishnan-Sarin S, Mazure CM. Perceived risks and benefits of smoking cessation: Gender-specific predictors of motivation and treatment outcome. Addict Behav 2005;30:423-35.  Back to cited text no. 4
    
5.
Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004;13:299-310. Available from: https://doi.org/10.1023/B:QURE.0000018486.91360.00. [Last accessed on 2020 Jul 18].  Back to cited text no. 5
    
6.
Bonomi AE, Patrick DL, Bushnell DM, Martin M. Validation of the United States' version of the World Health Organization quality of life (WHOQOL) instrument. J Clin Epidemiol 2000;53:1-12. Available from: https://doi.org/10.1016/S0895-4356 (99) 00123-7. [Last accessed on 2020 Jul 18].  Back to cited text no. 6
    
7.
Strine TW, Okoro CA, Chapman DP, Balluz LS, Ford ES, Ajani UA, et al. Health-related quality of life and health risk behaviors among smokers. Am J Prev Med 2005;28:182-18711.  Back to cited text no. 7
    
8.
Tillmann M, Silcock J. A comparison of smokers' and ex-smokers' health-related quality of life. J Public Health Med 1997;19:268-73.  Back to cited text no. 8
    
9.
Bloom EL, Minami H, Brown RA, Strong DR, Riebe D, Abrantes AM. Quality of life after quitting smoking and initiating aerobic exercise. Psychol Health Med 2017;22:1127-35.  Back to cited text no. 9
    
10.
WHO. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998;28:551-8.  Back to cited text no. 10
    
11.
Jalenques I, Galland F, Malet L, Morand D, Legrand G, Auclair C, et al. Quality of life in adults with Gilles de la Tourette Syndrome. BMC Psychiatry 2012;12:109.  Back to cited text no. 11
    
12.
Sarna L, Bialous SA, Cooley ME, Jun HJ, Feskanich D. Impact of smoking and smoking cessation on health-related quality of life in women in the Nurses' Health Study. Qual Life Res 2008;17:1217-27.  Back to cited text no. 12
    
13.
Piper ME, Kenford S, Fiore MC, Baker TB. Smoking cessation and quality of life: Changes in life satisfaction over 3 years following a quit attempt. Ann Behav Med 2012;43:262-70.  Back to cited text no. 13
    
14.
Lyons RA, Lo SV, Littlepage B. Perception of health amongst ever-smokers and never-smokers: A comparison using the SF-36 Health Survey Questionnaire. Tob Control 1994;3:213-5.  Back to cited text no. 14
    
15.
Wilson D, Parsons J, Wakefield M. The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers. Prev Med 1999;29:139-44.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methodology
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed158    
    Printed24    
    Emailed0    
    PDF Downloaded20    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]