How does tobacco usage impact quality of life?

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In a recent study published in the BMC Public Health Journal, researchers evaluated age- and gender-based differences in the impact of tobacco smoking and snuff usage on the health-associated quality of life (QoL).

Study: Tobacco impact on quality of life, a cross-sectional study of smokers, snuff-users and non-users of tobacco. Image Credit: Finn-b/Shutterstock.comStudy: Tobacco impact on quality of life, a cross-sectional study of smokers, snuff-users and non-users of tobacco. Image Credit: Finn-b/


Tobacco smoking is a key population health concern that can lower health-associated QoL by increasing the risk of chronic medical conditions, such as chronic obstructive pulmonary disease (COPD), cardiovascular disorders, and malignancy.

However, tobacco smoking is a modifiable risk factor, and limiting its intake can prevent diseases.

Snuff, placed beneath the lip and above the gums, is frequently presented as an innocuous or less hazardous tobacco form than tobacco smoke, despite having a 20-fold greater nicotine content than cigarettes.

Previous studies have reported greater mortality among snuff users than non-users and an increased risk of type 2 diabetes mellitus (T2D), cardiac failure, stillbirths, and oral cavity tumors.

In addition, snuff users reportedly have poorer health than individuals with no tobacco consumption; however, the health impairments were less severe than those of tobacco smokers.

However, data on the effects of regular snuff use on health-associated QoL are limited and warrant further research.

About the study

In the present study, researchers evaluated the effects of tobacco consumption (smoking or snuff) on health-associated QoL by age and gender.

The study included adults aged up to 65 enrolled through the Swedish Population Archive (SPAR) database. The participants filled out the 36.0-component Short Form Health Survey (SF-36) for QoL assessment and a questionnaire on tobacco intake concerning form, duration, and frequency of tobacco use.

SF-36 provided data on the perceived status of health in 8.0 domains: role-physical, physical functioning, body pain, vitality, role-emotional, social functioning, mental health, and general health.

The scores for these domains were combined to yield the more comprehensive mental component summary and physical component summary scores.

Multivariate logistic regression modeling was performed to calculate the odds ratio (OR). The median value for the perceived health-associated QoL for age-matched Swedish individuals was used as a threshold.

Tobacco intake was described as pack years for cigarette smokers and box years for snuff users. The corresponding values were multiplied by 10.0 years to assess decade-wise tobacco consumption among Swedish adults.

Results and discussion

Initially, 3,000 men and women were randomly selected and sent invites to participate in the study, 43.0% (n=1,279) of whom, including 605 and 674 men and women, respectively, with a mean age of 44.0 years, participated in the analysis. Among the study participants, 45% had prior tobacco use histories.

Tobacco smoking was linked to lower physical functioning, social functioning, vitality, general health, mental health, and the component summary scores concerning mental and physical well-being.

Snuff usage was linked to lower physical component summary and vitality scores and higher body pain scores. Advancing age was related to lower physical functioning, vitality, general health, mental health, and component summary scores.

Scores for vitality and physical functioning were lower among women than men. The OR values for women compared to men for physical functioning, body pain, general health, and vitality were 0.58, 0.77, 0.85, and 0.64, respectively. The corresponding values for a 10.0-year increase in age were 0.70, 0.92, 0.91, and 1.1, respectively.

Snuff usage was related to worse QoL in a few aspects, albeit to a lower extent than tobacco use. Variables such as occupation, level of education, and employment status were not accounted for in the analysis.

Such variables could be related to lower QoL and, therefore, could have confounded the results. However, all individuals assessed their health-associated QoL to be similar to the Swedish population, indicating no selection bias.

Tobacco consumers may experience body pain since nicotine decreases blood flow to the vertebral column. QoL scores may be lower among women than men due to multiple reasons.

Ovulation, menstruation, and endometriosis could cause variable degrees of pain in the female reproductive organs, such as the uterus and ovaries.

Further, menopause could explain gender-based differences in body pain and sleeping difficulties that influence vitality.

Moreover, most carers for older people are female, and senior care is often associated with poorer physical well-being. Women are reportedly more prone to physical and sexual violence, which may adversely affect their mental health, vitality, and physical functioning.


Overall, the study findings showed that tobacco smoking was related to worsened perceived health and lower health-associated QoL scores, consistent with previous studies.

A novel observation was that snuff use was related to lower QoL scores in the vitality and body pain domains. The findings indicated that snuff use raises health concerns and affects consumers.

Journal reference:
Pooja Toshniwal Paharia

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.


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