Association between smoking behaviors and health-related quality of life among adolescents aged 12-17 years

Background: Preventing tobacco use and reducing its prevalence among adolescents is a national goal for Healthy People 2020. Previous research among adults has documented poor health related quality of life (HRQoL) among smokers compared to non-smokers; however little is known about the association among adolescents.

Methods: Data on smoking and HRQoL from a sample of 5,301 adolescents aged 12 to 17 years from the 2001-2008 National Health and Nutrition Examination Survey (NHANES) were analyzed. Smoking status was classified as current smokers (N=514), non-current smokers (N=1,258), or never smoked (N=3,519). HRQoL of participants was defined as number of days in the past month that their physical or mental health was not good. To account for the complex survey design, weighted analyses were conducted using SUDAAN.

Results: Overall the percent of adolescents that reported ever smoking decreased from 39% in 2001 to 28% in 2008. After adjustment for age, sex, race/ethnicity, income-poverty ratio, and cohort, adolescents who were current smokers reported more physically unhealthy days (2.9 [95% CI ,2.3-3.6]) than non-smokers (1.8 [95% CI,1.6-2.0]). Similarly, current smokers reported more mentally unhealthy days (4.3 [95%CI 3.5-5.2]) than non-smokers (2.2 [95%CI 1.9-2.4]). Non-current smokers also reported more mentally unhealthy days (3.3 [95%CI 2.7-4.0]) than non-smokers.

Conclusions: The current study provides evidence that smoking is associated with poor HRQoL in this age group. The association between smoking and poor mental and physical health among adolescents further highlights the need to address tobacco prevention efforts, as well as, efforts to address cessation in this age group,