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Smoking status, nicotine dependence and happiness in nine countries of the former Soviet Union
  1. Andrew Stickley1,2,3,
  2. Ai Koyanagi4,5,
  3. Bayard Roberts1,
  4. Mall Leinsalu2,6,
  5. Yevgeniy Goryakin7,
  6. Martin McKee1
  1. 1European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Stockholm Centre on Health of Societies in Transition (SCOHOST), Södertörn University, Huddinge, Sweden
  3. 3Department of Human Ecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
  4. 4Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
  5. 5Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Cibersam, Spain
  6. 6Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
  7. 7Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
  1. Correspondence to Dr Andrew Stickley, Stockholm Centre on Health of Societies in Transition, (SCOHOST), Södertörn University, Huddinge 141 89, Sweden; andrew.stickley{at}


Background The US Food and Drug Administration has established a policy of substantially discounting the health benefits of reduced smoking in its evaluation of proposed regulations because of the cost to smokers of the supposed lost pleasure they suffer by no longer smoking. This study used data from nine countries of the former Soviet Union (fSU) to explore this association in a setting characterised by high rates of (male) smoking and smoking-related mortality.

Methods Data came from a cross-sectional population-based study undertaken in 2010/2011 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine. Information was collected from 18 000 respondents aged ≥18 on smoking status (never, ex-smoking and current smoking), cessation attempts and nicotine dependence. The association between these variables and self-reported happiness was examined using ordered probit regression analysis.

Results In a pooled country analysis, never smokers and ex-smokers were both significantly happier than current smokers. Smokers with higher levels of nicotine dependence were significantly less happy than those with a low level of dependence.

Conclusions This study contradicts the idea that smoking is associated with greater happiness. Moreover, of relevance for policy in the fSU countries, given the lack of public knowledge about the detrimental effects of smoking on health but widespread desire to quit reported in recent research, the finding that smoking is associated with lower levels of happiness should be incorporated in future public health efforts to help encourage smokers to quit by highlighting that smoking cessation may result in better physical and emotional health.

  • happiness
  • health
  • nicotine dependence
  • smoking
  • consumer surplus

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