(2008), and significantly increased mortality risk. The health decrements for both PHRQL and mortality were essentially linear for inhibitor 17-AAG each approximately 10 years of additional smoking. Across the full range of years of regular smoking, these associations were clinically meaningful (Samsa et al., 1999) for PHRQL and large for mortality risk. Overall, these findings reinforce those of previous research (Hermanson, Omenn, Kronmal, & Gersh, 1988; Ockene, 1993; U.S. DHHS, 2001, 2004) documenting significant health benefits of smoking cessation for middle-aged and older women. Past research has shown reduced mortality risk for women with smoking cessation (Kenfield et al., 2008), with substantial reduction in mortality risk for cardiovascular disease over 5 years, and a slower reduction in mortality risk for respiratory diseases.

Further, these results extend research on smoking and quality of life by clarifying previously conflicting findings with women. Consistent with Heikkinen et al. (2008), Sarna et al. (2008), and Wilson et al. (2004), we found a link between smoking status and PHRQL among these middle-aged and older women, with the strongest association for heavier smoking. The relationships for light versus heavier smokers are instructive. Both light and heavier smoking showed large associations with objectively indexed mortality. In fact, consistent with Bjartveit and Tverdal (2005), even very light, daily smoking of 1�C4 cigarettes/day was associated with a more than 2 times greater mortality risk compared with never smoking.

In contrast, on self-perceived PHRQ, whereas heavier smokers showed large, clinically meaningful associations, light smokers showed only small associations. Researchers have suggested that the link between heavier smoking and perceived quality of life may motivate heavy smokers to reduce or quit smoking (Wilson et al., 1999). Without comparable perceptions, light smokers may underestimate GSK-3 the risks of light smoking (Ayanian & Cleary, 1999; Donze et al., 2007; Moran, Glazier, & Armstrong, 2003), especially in regard to cardiovascular disease (Moran et al., 2003). For example, in a study of women in midlife, Moran et al. (2003) found that only heavier smokers perceived an above-average risk for heart disease. It remains possible that adverse quality-of-life effects may become apparent to continuing light smokers in later aging (U.S. DHHS, 2010). There is relatively little research on the relationship of light smoking to health (Fagan & Rigotti, 2009). However, emerging evidence suggests that light smoking carries considerable health risk (Bjartveit & Tverdal, 2005; Pope et al., 2009; Prescott, Scharling, Osler, & Schnohr, 2002; Shavelle et al., 2008).