kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.4.185 kjhp-15-185 Original Article Association between Secondhand Smoke and Health-related Quality of Life in Middle-aged Korean Adults KangSang-Yun 1 ChoYoung Hye 1 JeongDong-Wook 1 LeeSang-Yeoup 1 3 KimYun Jin 2 LeeJeong Gyu 2 LimHyun-Ju 1 Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea Department of Family Medicine, Pusan National University Hospital, Busan, Korea Medical Education Unit and Medical Research Institute Pusan National University School of Medicine, Yangsan, Korea ￭ Corresponding author：Young Hye Cho, MD Department of Family Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-2018, Fax: +82-55-360-2019 E-mail: younghye82@naver.com 122015 19122015 154 185193 06082015 12102015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The relationship between secondhand smoke and health-related quality of life is still unclear. The aim of this study was to investigate the association between secondhand smoke and health-related quality of life (HRQoL) in middle-aged Korean adults.

 Methods

Data from 583 men and 3,869 women aged 40 to 64 years who participated in the fifth Korea National Health and Nutrition Examination Survey in 2010 to 2012 were evaluated. All of them are non-smokers or have smoked less than 5 packs of cigarettes for their whole life. Secondhand smoke exposed at home and workplace was assessed by using a questionnaire and HRQoL was assessed by EuroQoL five dimensions (EQ-5D). The association of secondhand smoke and HRQoL was analyzed by logistic regression analysis.

 Results

Low HRQoL was associated with sex, age, body mass index, education level, family income level, occupation status, underlying diseases and secondhand smoke exposure. After adjustment for variables, secondhand smoke exposure at home was positively associated with the anxiety/depression dimension of EQ-5D (Odds ratio: 1.49, 95% Confidence interval: 1.02-2.18).

 Conclusions

Secondhand smoke exposure at home is associated with anxiety and depression dimensions of EQ-5D in middle-aged Korean adults.

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General characteristics of the study participants according to secondhand smoke exposurea

Secondhand smoke exposure Pb
No exposure Home alone Work alone Both
Sex <0.001
Male 309 (13.0) 5 (2.3) 259 (34.5) 10 (5.4)
Female 2,691 (87.0) 374 (97.7) 590 (65.5) 214 (94.6)
Age, y 50.72±0.164 50.02±0.441 49.67±0.281 48.85±0.423 <0.001
Body mass index, kg/m2 23.89±0.079 23.82±0.205 24.03±0.126 24.64±0.256 0.034
Educational level <0.001
Elementary school 704 (21.6) 104 (23.7) 175 (17.7) 47 (17.6)
Middle school 470 (15.8) 57 (13.1) 152 (19.1) 46 (21.1)
High school 1,070 (36.4) 156 (48.0) 316 (39.8) 100 (47.8)
University above 754 (26.1) 62 (15.3) 206 (23.4) 31 (13.4)
Monthly income 0.191
Low 330 (11.3) 39 (9.9) 75 (8.8) 21 (7.5)
Middle-low 738 (27.5) 105 (31.3) 225 (26.5) 49 (23.8)
Middle-high 833 (28.2) 116 (31.6) 248 (30.2) 64 (28.4)
High 1,065 (33.1) 115 (27.2) 297 (34.5) 85 (40.3)
Occupation <0.001
No 1,449 (44.4) 192 (47.8) 16 (1.8) 5 (2.0)
Yes 1,548 (55.6) 187 (52.2) 832 (98.2) 219 (98.0)
Underlying disease 0.005
No 1,634 (57.3) 185 (51.5) 513 (61.4) 138 (66.8)
Yes 1,365 (42.7) 194 (48.5) 336 (38.6) 86 (33.2)

Values are presented as N (%) or mean±SE unless otherwise indicated.

Calculated by chi-square test/t-test.

Comparison of EQ-5D according to secondhand smoke exposurea

Secondhand smoke exposure Pb
No exposure Only at Home Only at Work At Both
Mobility 0.298
No 2,686 (90.6) 335 (89.1) 785 (93.0) 204 (91.7)
Some 312 (9.4) 43 (10.6) 63 (6.9) 20 (8.3)
Extreme problems 2 (0.0) 1 (0.3) 1 (0.1) 0 (0.0)
Self-care 0.459
No 2,953 (98.5) 374 (99.4) 841 (98.9) 219 (98.5)
Some 47 (1.5) 4 (0.5) 7 (1.0) 5 (1.5)
Extreme problems 0 (0.0) 1 (0.1) 1 (0.1) 0 (0.0)
Usual activities 0.172
No 2,868 (95.8) 367 (97.4) 824 (97.4) 216 (97.0)
Some 129 (4.1) 11 (2.3) 23 (2.4) 8 (3.0)
Extreme problems 3 (0.1) 1 (0.2) 2 (0.2) 0 (0.0)
Pain/discomfort 0.399
No 2,382 (80.3) 291 (79.3) 694 (81.8) 174 (80.5)
Some 598 (19.2) 83 (19.5) 145 (17.2) 49 (19.3)
Extreme problems 20 (0.5) 5 (1.2) 10 (1.0) 1 (0.2)
Depression/anxiety 0.023
No 2,692 (90.3) 318 (85.2) 774 (91.1) 198 (87.8)
Some 296 (9.3) 57 (13.3) 73 (8.8) 25 (11.8)
Extreme problems 12 (0.4) 4 (1.5) 2 (0.2) 1 (0.3)

Abbreviations: EQ-5D, EuroQoL five dimensions.

Values are presented as N (%) unless otherwise indicated.

Calculated by chi-square test.

Simple logistic regression of the association between SHS and EQ-5Da

EQ-5D
Mobility Self-care Usual activities Pain/discomfort Anxiety/depression
SHS exposure
No 1 1 1 1 1
Home alone 1.18 (0.80-1.74) 0.41 (0.13-1.23) 0.60 (0.33-1.58) 1.07 (0.78-1.44) 1.61 (1.12-2.32)b
Work alone 0.72 (0.50-1.04) 0.72 (0.29-1.76) 0.61 (0.36-1.03) 0.91 (0.71-1.16) 0.91 (0.67-1.23)
Both 0.87 (0.50-1.50) 1.01 (0.34-3.03) 0.72 (0.33-1.58) 0.99 (0.68-1.45) 1.28 (0.77-2.15)
Sex
Male 1 1 1 1 1
Female 2.40 (1.50-3.83)c 1.72 (0.55-5.40) 2.23 (1.07-4.65)* 2.00 (1.45-2.75)c 1.82 (1.19-2.80)b
Age, y 1.12 (1.10-1.14)c 1.11 (1.08-1.15)c 1.09 (1.06-1.12)c 1.04 (1.03-1.06)c 1.03 (1.02-1.05)c
BMI, kg/m2 1.10 (1.07-1.14)c 1.08 (0.97-1.20) 1.08 (1.02-1.14)b 1.03 (0.10-1.05) 1.00 (0.96- 1.04)
Educational level
Elementary school 7.43 (4.94-11.19)c 7.99 (2.91-21.89)c 5.18 (2.67-10.04)c 1.97 (1.54-2.52)c 2.13 (1.50-3.02)c
Middle school 3.69 (2.38-5.72)c 6.12 (2.05-18.29)c 3.20 (1.59-6.46)b 1.46 (1.11-1.92)c 1.54 (1.04-2.28)b
High school 1.35 (0.85-2.15) 2.30 (0.75-7.10) 1.48 (0.70-3.09) 0.87 (0.67-1.14) 1.45 (1.01-2.07)
University above 1 1 1 1 1
Monthly income
Low 3.30 (2.33-4.69)c 3.80 (1.49-9.73)c 3.86 (2.32-6.41)c 1.79 (1.31-2.44)c 2.00 (1.35-2.96)b
Middle-low 1.72 (1.27-2.32)c 1.01 (0.41-2.48) 1.29 (0.79-2.12) 1.25 (0.10-1.57) 1.25 (0.92-1.71)
Middle-high 1.33 (0.96-1.84) 1.85 (0.87-3.94) 1.32 (0.81-2.16) 1.15 (0.90-1.45) 0.85 (0.62-1.16)
High 1 1 1 1 1
Occupation
No 1.51 (1.18-1.92)b 1.71 (0.98-2.98) 1.28 (0.91-1.81) 1.22 (1.02-1.46)b 1.18 (0.92-1.51)
Yes 1 1 1 1 1
Underlying disease
No 1 1 1 1 1
Yes 3.62 (2.72-4.81)c 5.70 (2.72-11.96)c 4.18 (2.72-6.43)c 2.35 (1.94-2.83)c 3.27 (2.52-4.24)c

Abbreviations: SHS, secondhand smoke; EQ-5D, EuroQoL five dimensions; BMI, body mass index.

Values are presented as Odds ratio (95% confidence interval) and calculated by simple logistic regression analysis.

P＜0.05

P＜0.001.

Multiple logistic regression of the association SHS and EQ-5Da

EQ-5D
Mobility Self-care Usual activities Pain/discomfort Anxiety/depression
SHS exposure
No 1 1 1 1 1
Home alone 1.10 (0.71-1.71) 0.38 (0.12-1.18) 0.55 (0.27-1.10) 1.02 (0.75-1.39) 1.49 (1.02-2.18)b
Work alone 0.96 (0.64-1.43) 1.02 (0.38-2.75) 0.70 (0.39-1.26) 1.12 (0.86-1.46) 1.04 (0.74-1.45)
Both 1.22 (0.68-2.19) 1.62 (0.51-5.09) 0.72 (0.30-1.74) 1.20 (0.80-1.80) 1.52 (0.90-2.58)
Sex
Male 1 1 1 1 1
Female 1.44 (0.86-2.42) 0.91 (0.29-2.83) 1.46 (0.68-3.13) 1.72 (1.24-2.39)b 1.31 (0.80-2.15)
Age, y 1.05 (1.03-1.08)c 1.04 (0.99-1.09) 1.03 (0.99-1.06) 1.02 (1.00-1.03)b 1.00 (0.98-1.02)
BMI, kg/m2 1.06 (1.02-1.11)b 1.03 (0.91-1.16) 1.04 (0.98-1.10) 1.00 (0.97-1.04) 0.97 (0.93-1.01)
Educational level
Elementary school 2.84 (1.74-4.65)c 3.61 (1.04-12.60)b 2.15 (0.99-4.63) 1.10 (0.80-1.51) 1.22 (0.79-1.88)
Middle school 1.98 (1.23-3.20)b 3.68 (1.02-13.33)b 1.86 (0.88-3.94) 1.00 (0.75-1.35) 1.11 (0.74-1.67)
High school 1.04 (0.63-1.72) 2.07 (0.57-7.49) 1.12 (0.52-2.43) 0.70 (0.53-0.93)b 1.21 (0.83-1.75)
University above 1 1 1 1 1
Monthly income
Low 1.51 (1.02-2.24)b 1.79 (0.64-4.99) 2.07 (1.14-3.74)b 1.31 (0.93-1.86) 1.56 (1.01-2.40)b
Middle-low 1.22 (0.88-1.69) 0.70 (0.27-1.75) 0.95 (0.54-1.70) 1.13 (0.89-1.44) 1.08 (0.78-1.50)
Middle-high 1.14 (0.81-1.60) 1.59 (0.75-3.36) 1.15 (0.68-1.96) 1.10 (0.86-1.41) 0.80 (0.58-1.10)
High 1 1 1 1 1
Occupation
No 1.28 (0.96-1.70) 1.62 (0.84-3.13) 0.96 (0.64-1.44) 1.08 (0.88-1.33) 1.04 (0.79-1.36)
Yes 1 1 1 1 1
Underlying disease
No 1 1 1 1 1
Yes 2.07 (1.53-2.81)c 3.61 (1.65-7.89)b 2.85 (1.85-4.41)c 1.92 (1.56-2.35)c 3.09 (2.33-4.09)c

Abbreviations: SHS, secondhand smoke; EQ-5D, EuroQoL five dimensions; BMI, body mass index.

Values are presented as Odds ratio (95% confidence interval) and calculated by multiple logistic regression analysis.

P＜0.05

P＜0.001