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Song, Fujian, Bachmann, Max O. 
ORCID: https://orcid.org/0000-0003-1770-3506, Aveyard, Paul, Barton, Garry, Brown, Tracey, Maskrey, Vivienne, Blyth, Florence, Notley, Caitlin ORCID: https://orcid.org/0000-0003-0876-3304, Holland, Richard, Sutton, Stephen and Brandon, Thomas
(2018)
Relapse to smoking and health-related quality of life: Secondary analysis of data from a study of smoking relapse prevention.
PLoS One, 13 (11).
ISSN 1932-6203
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Abstract
Background: Previous studies have shown that smoking and smoking cessation may be associated with health-related quality of life (HRQoL). In this study, we compared changes in HRQoL in people who maintained abstinence with people who had relapsed to smoking. Methods: This was a secondary analysis of data from a trial of a relapse prevention intervention in 1,407 short-term quitters. The European Quality of Life -5 Dimensions (EQ-5D) measured HRQoL at baseline, 3 and 12 months. Smoking outcome was continuous abstinence from 2 to 12 months, and 7-day smoking at 3 and 12 months. We used nonparametric test for differences in EQ-5D utility scores, and chi-square test for dichotomised response to each of the five EQ-5D dimensions. Multivariable regression analyses were conducted to evaluate associations between smoking relapse and HRQoL or anxiety/depression problems. Results: The mean EQ-5D tariff score was 0.8252 at baseline. People who maintained abstinence experienced a statistically non-significant increase in the EQ-5D score (mean change 0.0015, P=0.88), while returning to smoking was associated with a statistically significant decrease in the EQ-5D score (mean change -0.0270, P=0.004). After adjusting for multiple baseline characteristics, the utility change during baseline and 12 months was statistically significantly associated with continuous abstinence, with a difference of 0.0288 (95% CI: 0.0006 to 0.0571, P=0.045) between relapsers and continuous quitters. The only difference in quality of life dimensions between those who relapsed and those who maintained abstinence was in the proportion of participants with anxiety/depression problems at 12 months (30% vs. 22%, P=0.001). Smoking relapse was associated with a simultaneous increase in anxiety/depression problems. Conclusions: People who achieve short-term smoking abstinence but subsequently relapse to smoking have a reduced quality of life, which appears mostly due to worsening of symptoms of anxiety and depression. Further research is required to more fully understand the relationship between smoking and health-related quality of life, and to develop cessation interventions by taking into account the impact of anxiety or depression on smoking.
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