title: Smoking status, physical health-related quality of life, and mortality in middle-aged and older women.
abstract: BACKGROUND
  Women who smoke, particularly older women, have been relatively neglected in smoking research. There is a lack of knowledge concerning the relation of level of smoking to quality of life and mortality among middle-aged and older women smokers.
  
  
  METHODS
  This study examined the relation of smoking status to physical health-related quality of life (PHRQL) and total mortality in women in the Women's Health Initiative (WHI) Observational Study. Participants were 90,849 postmenopausal women, who were an average age of 63.6 years at baseline. Analyses used multiple linear and Cox proportional hazards regression and controlled for age, educational level, and ethnicity. Never-smokers were the reference group.
  
  
  RESULTS
  We found that smoking status was significantly related to PHRQL cross-sectionally at baseline and prospectively at a 3-year follow-up, with those who smoked having lower PHRQL. Heavier smokers showed large, clinically meaningful associations with PHRQL and light smokers showed small associations. In addition, we found that the smoking status at baseline was significantly related to 10-year total mortality. Both light and heavier smoking at baseline significantly correlated with higher mortality risk; however, the relationship of smoking to mortality was dose dependent. Among former smokers, those who had smoked longer showed significantly lower PHRQL and significantly increased mortality risk.
  
  
  CONCLUSIONS
  Findings suggest that the risks of smoking may not be evident to light smokers and that educational interventions targeted to middle-aged and older women stressing the consequences of light smoking may be particularly beneficial.
authors.affiliation: Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX 78712, USA. c.holahan@austin.utexas.edu
authors.forename: Carole K
authors.initials: CK
authors.lastname: Holahan
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Holahan
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: North
authors.forename: Rashelle B
authors.initials: RB
authors.lastname: Hayes
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Powers
authors.forename: Judith K
authors.initials: JK
authors.lastname: Ockene
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003710:Demography; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008875:Middle Aged; D019370:Observation; D017698:Postmenopause; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012306:Risk; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality; D012959:Socioeconomic Factors; D013997:Time Factors; D016387:Women's Health / Q000706:statistics & numerical data*