title: Is cigarette smoking associated with impaired physical and mental functional status? An office-based survey of primary care patients.
abstract: OBJECTIVE
  To examine the relationship between cigarette smoking and self-reported physical and mental functional status.
  
  
  METHODS
  Cross-sectional survey of 837 patients visiting 2 family-practice centers. Patients completed a self-administered survey about functional status, tobacco use, and demographic characteristics while waiting to be called back for their appointments.
  
  
  METHODS
  An inner-city family practice clinic in Richmond, Virginia, and a more affluent suburban practice outside Washington, DC.
  
  
  METHODS
  Physical and mental functional status, as measured by the SF-36 (Medical Outcomes Trust, Boston, MA); current and former cigarette use; and demographic variables (age, gender, education, income).
  
  
  RESULTS
  Among current smokers, self-reported functional status scores were significantly lower than those of nonsmokers in all SF-36 domains (p < or = 0.02), a pattern that was more dramatic for mental functional status domains (social function, vitality, emotional role limitations, mental health). In several SF-36 domains, a dose-response relationship between smoking and functional status was noted. After multivariate adjustment for demographic confounders and practice site, the statistical significance of these differences diminished considerably, but it remained significant for certain domains and for the overall difference across all domains (MANCOVA p = 0.017).
  
  
  CONCLUSIONS
  Current smokers report lower functional status than nonsmokers, in physical and especially in mental domains. The meaning of this cross-sectional relationship is unclear without further longitudinal study. Smoking may be associated with other variables that have a causal role.
authors.affiliation: Department of Family Practice, Medical College of Virginia at Virginia Commonwealth University, Richmond, USA. shwoolf@aol.com
authors.forename: S H
authors.initials: SH
authors.lastname: Woolf
authors.forename: S F
authors.initials: SF
authors.lastname: Rothemich
authors.forename: R E
authors.initials: RE
authors.lastname: Johnson
authors.forename: D W
authors.initials: DW
authors.lastname: Marsland
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D012016:Reference Values; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D014768:Virginia / Q000453:epidemiology