An outcome-wide study of the associations of daily smoking with subsequent well-being and other outcomes in the Global Flourishing Study

Abstract Prior research on the relationship between tobacco use and well-being is plagued by reliance on cross-sectional data, limited measures of well-being, and a lack of cross-national comparisons and synthesis of country-specific relationships. To address these oversights, we analyze the first two waves of data from the Global Flourishing Study of over 200,000 adults being representative of 22 countries and one territory. In this outcome-wide study, we meta-analyzed country-specific effects of daily cigarette smoker status at the baseline on 78 variables of well-being and other outcomes, measured a year later, controlling for demographic and childhood factors and contemporaneous potential confounders of the daily smoker status. We repeated this analysis using a quantity measure of daily smoking for smokers only. Meta-analytic estimates were typically of similar magnitude in the total and smoker samples, although confidence intervals were wider and more likely to include zero in the latter. Specifically, daily smoking tended to be inversely associated with human flourishing and various indicators of well-being and related to worse psychological and social distress. Although those average effects were very small for all but two outcomes (subsequent daily smoking and weekly alcohol consumption), cross-national variations in country-specific effects indicated that daily smoking had more influence on well-being in some countries than others.