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Evaluation of smoking-specific and generic quality of life measures in current and former smokers in Germany and the United States
Open Access Articles
  • John E. Ware, Jr., University of Massachusetts Medical School
  • Barbara L. Gandek, University of Massachusetts Medical School
  • Anuradha Kulasekaran, British American Tobacco (Investments) Ltd.
  • Rick Guyer, John Ware Research Group
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
BACKGROUND: Health-related quality of life (QOL) surveys include generic measures that enable comparisons across conditions and measures that focus more specifically on one disease or condition. We evaluated the psychometric properties of German- and English-language versions of survey scales representing both types of measures in samples of current and former smokers. METHODS: TQOLITv1 integrates new measures of smoking-specific symptoms and QOL impact attributed to smoking with generic SF-36 Health Survey measures. For purposes of evaluation, cross-sectional data were analyzed for two independent samples. Disease-free (otherwise healthy) adults ages 23-55 used a tablet to complete surveys in a clinical trial in Germany (125 current and 54 former smokers). Online general population surveys were completed in the US by otherwise healthy current and former smokers (N = 149 and 110, respectively). Evaluations included psychometric tests of assumptions underlying scale construction and scoring, score distributions, and reliability. Tests of validity included cross-sectional correlations and analyses of variance based on a conceptual framework and hypotheses for groups differing in self-reported smoking behavior (current versus former smoker, cigarettes per day (CPD)) and severity of smoking symptoms in both samples and, in the German trial only, clinical parameters of biomarkers of exposure. RESULTS: Tests of scaling assumptions and internal consistency reliability (alpha = 0.71-0.79) of the smoking-specific measures were satisfactory, although ceiling effects attenuated correlations for former smokers in both samples. Correlational evidence supporting validity of smoking-specific symptom and impact measures included their substantial inter-correlation and higher correlations (than generic measures) with smoking behavior (favoring former over current groups) and CPD in both samples. In the German trial, both smoking-specific measures correlated significantly (p < 0.05) with all four biomarkers. QOL impact attributed to smoking correlated with the SF-36 mental but not physical summary measures in both samples. CONCLUSIONS: German- and English-language TQOLITv1 surveys have comparable and satisfactory psychometric properties. Cross-sectional tests, including correlations with four biomarkers, support the validity of the new smoking-specific measures for use in studies of otherwise healthy smokers. Smoking-specific measures consistently performed better than generic QOL measures in all tests of validity.
  • Smoking,
  • Biomarkers of exposure,
  • Health-related quality of life,
  • Smoking-specific measures,
  • Reliability,
  • Validity
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© 2015 Ware et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

DOI of Published Version
Health Qual Life Outcomes. 2015 Aug 16;13(1):128. doi: 10.1186/s12955-015-0316-3. Link to article on publisher's site
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Creative Commons Attribution 4.0
Citation Information
John E. Ware, Barbara L. Gandek, Anuradha Kulasekaran and Rick Guyer. "Evaluation of smoking-specific and generic quality of life measures in current and former smokers in Germany and the United States" Vol. 13 Iss. 1 (2015) ISSN: 1477-7525 (Linking)
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