A study comparing smokers’ and nonsmokers’ scores on a personality inventory is most likely to be

Most of the World Health Organization (WHO) reports on addictive and non-addictive substances state that cigarette consumption and cigarette addiction are a major threat to public health and that more focus should be given on this subject1. The physiological, hemodynamic, and pathological effects of cigarette consumption affect all organs and systems, leading to various systemic and inter-system problems. In particular, smoking has adverse effects on pulmonary and cardiac health due to the toxic and harmful substances in cigarettes. Cigarette consumption is considered one of the main risk factors of many chronic diseases, especially cancer, cardiovascular diseases (CVD) and some like diseases like chronic obstructive pulmonary disease (COPD), lung cancer, asthma, pneumonia, tuberculosis, and pulmonary hypertension2.

Cigarette exposure adversely affects quality of life in many disease groups. It has been shown that active smokers have negative symptomatic health perceptions and decreased quality of life even without active airway limitation or changes in the lungs compared to non-smokers3. Cigarette consumption is also reported to decrease exercise capacity by damaging the vascular endothelial tissue4.

Field observations and cohort studies have revealed a close relationship between smoking cessation skills and health literacy5,6. Low levels of health literacy are one of the reasons for the smoking cessation rate in people of lower socioeconomic status5. Yang et al.7 found that active smokers have less awareness and acknowledgment of the health risks of smoking than non-smokers and former smokers.

International health associations and national health authorities agree that smoking is the most universal and common health problem. In recent years, the Global Alliance Against Chronic Respiratory Diseases has emphasized the importance of chronic respiratory diseases among the world’s most critical health problems, and this approach is supported by Turkish governmental policies8. Since 2006, various initiatives aimed at reducing smoking have been implemented in Turkey, such as prohibiting the sale of cigarettes to minors, smoking in public places, and advertisements and broadcasting programs that promote cigarette smoking9.

Although the health, economic, and social aspects and adverse effects of cigarette consumption and addiction have been revealed in numerous studies, there is ongoing interest among scientists and especially social science researchers regarding why smokers persist in this behavior. In an effort to understand this phenomenon, many questionnaires have been developed and dozens of non-interventional field studies, focus group interviews, and face-to-face in-depth interviews have been conducted. There are few published studies evaluating differences between smokers and non-smokers in terms of exercise capacity, physical activity level, access to health-related information, and their interpretation and application of this information. Therefore, in the present study, we aimed to compare health-promoting behaviors, exercise capacity, physical activity level, health literacy, level of knowledge about smoking-related diseases, and quality of life in smokers and non-smokers. Determining the cardiovascular and pulmonary disease awareness, health-promoting behaviors, and health literacy of smokers may guide health policy-making and public health perspectives on coping with cigarette consumption. We hypothesized that there would be significant differences in these variables between smokers and non-smokers.

This study shows that although smokers and non-smokers had similar health literacy, health-promoting behaviors, knowledge about CVDs, and physical activity levels, smokers had reduced exercise capacity. Smokers have increased number of CAD risk factors compared to non-smokers. Otherwise, both smokers and non-smokers have a lower overall awareness in some informations regarding chronic respiratory diseases (COPD and asthma) compared to non-smokers.

Despite the development of numerous strategies, the cigarette epidemic has not been conquered yet23. Although some progress has been made in recent years, 26% of the total population and 29% of youth between the ages of 15 and 24 in European Union countries continue to smoke24. A study on people aged 25 and over in Norway demonstrated that people of low socioeconomic status were more likely to smoke and drink alcohol and less able to allocate sufficient time to physical activity25. The prevalence of tobacco consumption was shown to be higher among men and closely associated with alcohol consumption and stress level26. Consistent with the literature, the majority of smokers in our study were men, and higher alcohol consumption was associated with more cigarette consumption. This is related to the fact that cigarette consumption also increases the sensitivity and orientation towards other addictive substances, especially alcohol27.

In a study including 1,200 office workers, Balci et al.28 showed that non-smokers had higher levels of knowledge about CVD risk factors when compared to smokers. The comparable CVD risk factors knowledge in smokers and nonsmokers in our study may be attributable to the low number of participants having CVD risk factors such as hypertension, obesity, and stress, the similar percentage of participants with increased CAD risk, as well as the high education level of study participants (most had undergraduate/postgraduate degrees). Levels of knowledge about asthma and COPD among our study participants were also higher compared to a previous study by Yildiz et al.18. In another study including 230 smokers, nearly half of the participants were not aware of COPD and the young population had the largest proportion of high awareness level29. The high level of knowledge about asthma and COPD in the smokers and non-smokers in our study may be related with the higher education level and younger mean age of our participants. However, there are still some areas for both groups to be informed about lung diseases.

In a 2013 study conducted among teachers, levels of health literacy were lower in those who did not have any chronic diseases and did not use cigarettes and alcohol30. The lower health literacy in smokers was shown to be associated with greater nicotine dependence and lower expectations of adverse outcomes of smoking, independent of demographic characteristics and socioeconomic level5,6. As with COPD/asthma awareness, the comparable health literacy levels in our study groups could be related to the participants’ high education level and younger mean age.

Garrison et al.31 reported that appetizing foods, stress sources, and irritating/disturbing images affect smoking habit and physical activity levels. Boutelle et al.32 showed that smokers engage in less low- and moderate-intensity physical activity. We thought that the main reason for the similar activity levels in smokers and non-smokers was the high numbers of participants who were not employed or held white-collar positions and the younger age distribution in both groups. A study of cardiac patients showed that higher health-promoting behavior scores were associated with male sex, the 49–60 age group, being married, having completed undergraduate or graduate education, higher socioeconomic status, earning an income, and having no additional disease33. To the best of our knowledge, there are no previous studies investigating the relationship between smoking and health-promoting behaviors. The similar HPLP-II scores between smokers and nonsmokers in our study may be because most of the participants were younger, university graduates, married, and were gainfully employed34. Another possible factor is that smokers may have engaged in more health-promoting behaviors in order to protect their health due to their higher CVD risk compared to non-smokers.

Smoking has been shown to reduce exercise capacity in various age groups and sports groups35. Ben Saad et al.36 revealed that individuals using hookahs had a statistically significantly lower 6MWT distance than healthy individuals. Studies in the literature have also revealed that severe lung damage and airway limitation caused by emphysema and chronic bronchitis in smokers increases pulmonary workload37. The lower exercise capacity and increased perceived dyspnea in smokers compared to the non-smokers in our study is compatible with the literature35,36. The decrease in functional capacities affects smokers in many ways, leading to limitations in activities of daily living and loss of work efficiency.

Cheng et al.38 conducted a study of 154 older adults (≥60 years of age) and found that quality of life and exercise capacity were lower among the smokers than non-smokers. It was stated that this age group was more affected by tobacco and tobacco products due to decreased total lung capacities. Demirturk and Kaya39 determined that smokers with regular exercise habits had higher quality of life scores. The lack of difference between the smoker and non-smoker groups may be related to their similar rates of health-promoting behaviors in our study. Even if there was similar quality of life between two groups, the higher overall well-being, physical health, psychological well-being, and total quality of life scores of the nonsmokers were consistent with the literature40.

This study has some limitations. The first limitation of our study was that due to limited resources, we were not able to evaluate the factors limiting the participants’ exercise capacity using a cardiopulmonary exercise test system, which is the gold standard evaluation method. The second limitation of our study was that the proportion of older participants was not large enough to allow generalization of our findings.

In conclusion, exercise performance decreases and dyspnea perception during exercise increases is smoker compared to non-smokers. Physical activity level is preserved in smokers who are mostly young group. Smokers have increased CAD risk and both smokers and non-smokers have a lower knowledge about some informations related with chronic respiratory diseases (COPD and asthma). The data from this study recall the need that any actions and policies to increase levels of health literacy and knowledge of COPD/asthma among both smokers and non-smokers for decreasing their CVD risk and increasing their health-promoting behaviors.

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Which type of study begins with a group of people who already have a disease and then looks into factors that are associated with that disease?

Which scientific method most strongly yields evidence for cause and effect relationships?

What is the placebo effect?

When comparing how two American ethnic groups rank in life expectancy with each other and with other world nations which of these is true?