Association of smoking with poor health-related quality of life among health-profession students in China: A 31-university multilevel, multivariable analysis

Abstract

INTRODUCTION While many studies have confirmed that smoking is causally associated with various diseases, some have found an association between smoking and human functional impairment. Relationships between smoking and poor healthrelated quality of life (HRQoL) have been investigated in general populations. However, these studies have examined only individual-level correlates. This study examined the association between smoking and poor HRQoL, at both the individual and contextual levels, in university settings across China. METHODS Large-scale survey sampling was conducted among 11659 healthprofession students from 31 Chinese universities. HRQoL was measured by the EQ-5D instrument. This multilevel, multivariable analysis utilized unadjusted and adjusted methods. RESULTS Prevalence of poor HRQoL in this study was 2.7% (95% CI: 1.9-3.5). Multilevel logistic regression analysis revealed that frequent (OR=3.18; 95% CI: 2.35-4.33) and occasional smokers (OR=2.73; 95% CI: 1.61-4.65) and universities with high (OR=2.68; 95% CI: 1.34-5.35) and medium smoking prevalence (OR=1.49; 95% CI: 0.95-5.35) had excess odds of poor HRQoL compared to their respective referents, non-smokers and universities with a low smoking prevalence. CONCLUSIONS This multilevel study provides new evidence that smoking is associated with poor HRQL. Findings underscore the importance of alerting the populace that functional impairment is linked to smoking.