Smoking and SF-36 health functioning
Introduction
The discussion on health effects of smoking has been dominated by the well-known association of smoking with several chronic diseases and subsequent mortality (World Health Organization, 2002, Ezzati and Lopez, 2004). The chronic diseases that smoking is largely responsible for include cardiovascular diseases, lung and other cancers and diseases of the respiratory system. It has been estimated that smokers may lose even up to 10 years of life because of their smoking (Anon, 2002, Doll et al., 2004, Brønnum-Hansen and Juel, 2001). However, smokers are also expected to have shorter lifetime in good health and spend more years with disability than non-smokers (Brønnum-Hansen and Juel, 2001, Nusselder et al., 2000). Yet, relatively little is known about how smoking affects general health, including functioning and personal well-being. The possible effect of smoking on self-evaluated general health is important for estimating the total health burden of smoking. Functional status and well-being are increasingly important outcome measures in medical care (Guyatt et al., 1993).
The Short-Form Health Survey (SF-36) is one of the most widely used measures of general health. The SF-36 is a broad-spectrum profile measure that consists of eight subscales and component summaries on physical and mental health. The measure basically indicates the self-assessed impact of ill-health and diseases on functioning and well-being. The primary focus is on functioning and the ability to perform daily tasks and activities. Furthermore, the SF-36 measures how people feel physically and emotionally and what they think about their health. As a non-specific measure, the SF-36 has been used in connection with various risk factors, such as hypertension (Bardage and Isacson, 2001) or obesity (Doll et al., 2000, Laaksonen et al., in press).
Only few population studies have examined the association between smoking and the SF-36. Furthermore, the results vary greatly. Some studies have found current smokers to report consistently poorer health than non-smokers or ex-smokers (Tillmann and Silcock, 1997, Wilson et al., 1999), while others have found such differences only on some SF-36 subscales (Bellido-Casado et al., 2004, Lyons et al., 1994, Mulder et al., 2001, Olufade et al., 1999). Some studies have found a dose–response relationship between the amount of smoking and one or more subscales (Mulder et al., 2001, Wilson et al., 1999). Most studies are based on very small samples (Bellido-Casado et al., 2004, Lyons et al., 1994, Olufade et al., 1999, Tillmann and Silcock, 1997), and none has examined men and women separately.
The aim of this study was to compare general health as measured by the SF-36 questionnaire between current heavy and moderate smokers, ex-smokers and never smokers among middle-aged employed men and women.
Section snippets
Data
Data are derived from women and men employed by the City of Helsinki (Lahelma et al., 2005). In 2000, 2001 and 2002, a self-administered questionnaire was mailed to each employee aged 40, 45, 50, 55 or 60 at the year of the survey. The response rate to the three surveys was 69% among women and 60% among men. The data include 1.799 men and 7.171 women, reflecting the fact that 80% of the employees of the City of Helsinki are women. Younger respondents and manual workers were slightly
Results
Among men, 27% and among women 23% were current smokers. Roughly half of them were classified as heavy smokers. One third of men and one fifth of women were ex-smokers, and the rest were never smokers. Women reported slightly poorer health than men on most SF-36 subscales.
Among men, current smokers reported poorer physical functioning and general health than non-smokers (Table 1). All mental subscales except role limitations due to emotional problems showed poorer health among current smokers
Discussion
We examined the health effects of smoking over and above mortality and specific chronic diseases using the SF-36, a well-regarded research instrument of general health and functioning.
Physical health differences between current smokers and non-smokers were found only on the subscales of general health and physical functioning in men, and the physical component summary showed minimal differences. On the mental subscales, current smokers showed consistently poorer health than non-smokers.
Acknowledgments
The Helsinki Health Study is supported by Academy of Finland (#53245 and #205588) and the Finnish Work Environment Fund (#99090). ML (#204894), OR (#45664) and PM (#70631 and #48600) are supported by the Academy of Finland.
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