title: Was John Reid right? Smoking, class, and pleasure: a population-based cohort study in England.
abstract: OBJECTIVE
  To assess whether there is a relationship between smoking and levels of overall quality of life, or with the pleasure domain of quality of life, in lower socio-economic groups (SES).
  
  
  METHODS
  Cohort study involving 9176 individuals aged 50 years and over who participated in the Health Survey for England and were followed up in Wave 1 of the English Longitudinal Study of Ageing in 2002.
  
  
  METHODS
  We classified smokers as never-smokers, ex-smokers and current smokers, and used household wealth as a marker for socio-economic position. Pleasure was assessed using the pleasure subscale of the CASP-19 instrument, a 19-point measure of quality of life that covers four theoretical domains: control, autonomy, self-realization and pleasure.
  
  
  RESULTS
  We found that the odds ratio for experiencing lower than median levels of pleasure for smokers with low SES was 1.42 (95% CI 1.16-1.74), and for all smokers was 1.33 (95% CI 1.17-1.51). The same pattern of associations was found when the outcome was total CASP-19 score or positive GHQ-12 score.
  
  
  CONCLUSIONS
  We found no evidence to support a claim that smoking is associated with heightened levels of pleasure, either in people with low SES or in the general population. In fact, our results suggest the opposite: that smoking is associated with lower levels of pleasure and poorer overall quality of life. Policy decisions on smoking should consider its potentially harmful effect on quality of life and pleasure as well as on other aspects of health.
authors.affiliation: Epidemiology and Public Health Group, Peninsula Medical School, RD&E Hospital Site, Barrack Road, Exeter EX2 5DW, UK. iain.lang@pms.ac.uk
authors.forename: I
authors.initials: I
authors.lastname: Lang
authors.forename: E
authors.initials: E
authors.lastname: Gardener
authors.forename: F A
authors.initials: FA
authors.lastname: Huppert
authors.forename: D
authors.initials: D
authors.lastname: Melzer
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004739:England; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012680:Sensitivity and Specificity; D012907:Smoking / Q000191:economics / Q000453:epidemiology*