Aging, Chronic Disease, Cognitive Decline, Disability, Evaluation, Health, Subjective, Loneliness, Mental Disorder, Well-being
Conditions
Keywords
Health Status, Well-being, Mental Health, Risk Factors, Aging
Brief summary
Age with Health is a longitudinal cohort study aimed to examine trajectories of health, disability and wellbeing and their determinants for Spanish ageing population. The data that makes up the baseline was collected from a nationally representative sample of non-institutionalized adults as part of the Collaborative Research on Aging in Europe (COURAGE in Europe) project between July 2011 and May 2012. The second wave was carried out as part of the Age with Health project between December 2014 and June 2015, and three years later, in 2018, the third wave was carried out. In 2019-2021, a new cohort of participants were brought in (2019 cohort), some of whom were interviewed again by telephone during the first Coronavirus (COVID-19) lockdown, in early 2020. During 2022 a new evaluation of the participants of both cohorts (2011 and 2019) is expected.
Detailed description
Study Design: A prospective cohort general population study. Sample: Wave 1: A nationally representative sample of non-institutionalized adults aged 18 years or older from the Spanish population was collected (with an over-sampling of people aged 50+ years). A multi-stage clustered design was employed; four strata based on the number of inhabitants of the municipalities were built for each of the 17 Spanish autonomous communities. Clusters were selected within the strata with a probability of inclusion relative to their size. Within each cluster, households were randomly selected from a list of all households. In case there was more than one individual from the corresponding age group in the household, a random method was employed to select the individual participant. Wave 2: Wave 1 sample was re-interviewed (Wave 2) in 2014-2015. Wave 3: in 2018, participants were again evaluated. Complementarily, between 2019 and 2021 a new sample from the regions of Madrid and Barcelona were brought in, and it was interviewed again by telephone during the first COVID-19 lockdown, in May-June 2020. Wave 4: a new evaluation of the participants of both cohorts 2011 and 2019 was carried out, in the fist case it terminated in 2022, while the data collection for 2019 cohort is still going on, expected to terminate for December 2023. Wave 5: a new and last evaluation is expected for both cohort in 2025. Data collection: Face-to-face interviews by Computer-Assisted Personal Interviewing at the respondents' homes by trained interviewers. All interviewers received a standardized training. Data quality control was also performed. A proxy interview was administered in those cases in which the participant presents physical or cognitive limitations that may impede the correct administration of the individual interview. Main project objectives: To assess trajectories of general health, disability and well-being in Spanish ageing population. Secondary objectives: To identify trajectories of healthy ageing (in terms of physical health, mental health, functioning and well-being) in Spanish adult population as well as their determinants To analyse prevalence and impact of chronic health conditions, mental health problems, well-being and loneliness on mortality in Spanish adult population. To determine risk factors for incidence and persistence of mental and physical health problems in Spanish ageing population. Main project hypotheses: The trajectories of health, functioning and well-being will be encompassed by relevant environmental factors such as social support, loneliness and health care utilization, personal factors (socio-demographic characteristics, healthy lifestyles, and high cognitive reserve among others) and other biological and health-related factors (weight, height, waist circumference, executive functions, blood pressure, grip strength, vision acuity, presence of mental and physical health problems and quality of life).
Interventions
None listed
Sponsors
Fundació Sant Joan de Déu
Universidad Autonoma de Madrid
Fundación de Investigación Biomédica - Hospital Universitario de La Princesa
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Non-institutionalized Spanish residents * 18 years and over
Exclusion criteria
* Institutionalized population
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Heath Status | Baseline | Measure: Health composite total score. Construct: Health status. Final result: A global total score. Range: 0-100. 0 means lower health status. |
| Quality of Life (WHOQOL-AGE) | Baseline | Measure: World Health Organization Quality of Life-Age (WHOQOL-AGE) (Caballero, et al., 2013). Construct: Quality of life. Final Result: A global total score. Range 0-100. 0 means lower quality of life |
| Experienced Well-being | Baseline | Abbreviated Version of the Day Reconstruction Method. Construct: Experienced wellbeing. Final Result: The used scale reports two global scores: * Positive Affect total score. Range: 0-100 where 0 means lower positive affect. * Negative Affect total score. Range 0-100 where 0 means lower negative affect. |
| Disability | Baseline | Measure: World Health Organization's Disability Assessment Schedule-II (WHODAS-II). Construct: Disability. Final result: A global total score. Range: 0-100. 0 means lower disability |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Presence of Anxiety Disorders | Baseline | Measure: The World Health Organization Composite International Diagnostic Interview (CIDI). Anxiety disorders module (WHO-CIDI, 1990). Construct: Presence of anxiety Disorders Final Result: The instrument included in the study reports six measures of anxiety disorders according to Research diagnostic criteria. * Presence of 12 month panic disorder. Values (yes/no) * Presence of 12 month generalized anxiety disorder. Values (yes/no) * Presence of 12 month phobic disorder. Values (yes/no) * Presence of lifetime panic disorder. Values (yes/no) * Presence of lifetime generalized anxiety disorder. Values (yes/no) * Presence of lifetime phobic disorder. Values (yes/no) |
| Number of Participants With Depression | Baseline | Measure: The World Health Organization Composite International Diagnostic Interview (CIDI). Depression module (WHO-CIDI, 1990). Construct: Presence of Depression. Final result: Two measures of depression according to Research Diagnostic Criteria. * Presence of 12 month depression. Values (yes/no). * Presence of lifetime depression. Values (yes/no). |
| Presence of Suicide Behavior | Baseline | Measure: The World Health Organization Composite International Diagnostic Interview (CIDI). Suicide module (WHO-CIDI, 1990). Construct: Presence of Suicide behavior The instrument reports six measures of suicide behavior. * Presence of 12 month suicide ideation. Values (yes/no) * Presence of 12 month suicide planning. Values (yes/no) * Presence of 12 month suicide attempts. Values (yes/no) * Presence of lifetime suicide ideation. Values (yes/no) * Presence of lifetime suicide planning. Values (yes/no) * Presence of lifetime suicide attempts. Values (yes/no) |
| Presence of Diabetes | Baseline | Construct: Presence of diabetes Measure: Self-reported information of 12-month presence of diagnosis and/or of treatment for diabetes Values: (Yes/No) |
| Presence of Lung Disease | Baseline | Construct: Presence of any lung disease Measure: Self-reported information of 12-month presence of diagnosis and/or of treatment for any lung disease Values: (Yes/No) |
| Presence of Stroke | Baseline | Construct: Presence of stroke Measure: Self-reported information of 12-month presence of diagnosis and/or of treatment for stroke Values: (Yes/No) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Tobacco Use Information | Baseline | Construct: Tobacco use Measure: Self-reported information of how many cigarettes/pipes/tobacco products/ have been used in the last week. Values: Four categories of tobacco use: 0= Never smokers: Participants who have never used tobacco 1. Daily smokers: Participants who have used tobacco last week 2. Non daily smokers: Participants who have ever used tobacco but not in the previous week 3. Former smokers: Participants who smoked in the past (ex smokers) |
| Intensity of Subjective Perception of Loneliness | Baseline | Construct: Loneliness Measure: Three-item University of California, Los Angeles (UCLA) Loneliness Scale (Hughes et al, 2004) Result: A total loneliness score, then transformed into a percentile scale. Range: 0-100. Higher scores means higher loneliness |
| Alcohol Use Information | Baseline | Construct: Alcohol use Measure: Self-reported information of how many standard drinks per day in last 7 days have been used. Values: four categories of alcohol use: 0= Lifetime abstainers: Participants that have never used alcohol 1. Occasional drinkers: Participants that have ever used alcohol but not in the previous 7 days 2. Non-heavy drinker: Participants did consume alcohol in the last 30 days and in the last 7 days 3. Infrequent heavy drinker: Participants did consume alcohol 1-2 days per week, with 5 or more standard drinks per day in last 7 days for men and 4 or more standard drinks per day in last 7 days for women. 4. Frequent heavy drinkers: Participants did consume alcohol 3 or more days per week with 5 or more standard drinks per day in last 7 days for men and 4 or more standard drinks per day in last 7 days for women. |
| Level of Social Support | Baseline | Construct: Social Support Measure: 3-Item Oslo Social Support Scale (OSLO) (Abiola et al., 2013) Result: A global total score, then transformed into a percentile scale. Range: 0-100. Higher scores indicate a higher social support. |
| Level of Physical Activity | Baseline | Construct: Level of physical activity Scale: Global Physical Activity Questionnaire version 2 (GPAQ v2); It collects information on physical activity participation in three settings (or domains) and sedentary behavior. The responses given by the participants have been converted to Metabolic Equivalent to Task (MET) values. Applying MET values to activity levels allows for calculating total physical activities. Values: Three values of physical activity can be obtained 3=High physical activity 2=Moderate physical activity 1=Low physical activity |
Countries
Spain
Participant flow
Recruitment details
Spanish general adult population non-institutionalized; aged 18+ years with oversampling of those aged 50+ years and those 80+ years); multi-stage stratified sampling; representative sample.
Pre-assignment details
Respondents unable to undertake the interview because of severe cognitive or physical impairment were administered a shorter version of the questionnaire to a proxy respondent.
Participants by arm
| Arm | Count |
|---|---|
| Cohort 2011 Sample Demographic Characteristics The 2011 Cohort is part of a nationally representative sample of the Spanish noninstitutionalized adult population. Potential respondents were selected by a stratified, multistage, clustered area probability design, without replacement, according to the Spanish regions and population size. | 4 |
| Cohort 2019 Sample Demographic Characteristics In 2019-2021 3,002 participants were brought in (2019 cohort), using the same sample characteristics . | 3,002 |
| Total | 3,006 |
Baseline characteristics
| Characteristic | Cohort 2011 Sample Demographic Characteristics | Cohort 2019 Sample Demographic Characteristics | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 2011 Participants | 1,135 Participants | 3146 Participants |
| Age, Categorical Between 18 and 65 years | 2742 Participants | 1,867 Participants | 4609 Participants |
| Age, Continuous | 60.44 years STANDARD_DEVIATION 16.24 | 58.19 years STANDARD_DEVIATION 17.89 | 59.32 years STANDARD_DEVIATION 17.07 |
| Education High School | 874 Participants | 724 Participants | 1598 Participants |
| Education Less than primary | 1,001 Participants | 353 Participants | 1354 Participants |
| Education missing data | 1 Participants | 1 Participants | 2 Participants |
| Education No education | 373 Participants | 100 Participants | 473 Participants |
| Education Post graduate degree | 64 Participants | 175 Participants | 239 Participants |
| Education Primary | 1,306 Participants | 761 Participants | 2067 Participants |
| Education Secondary | 562 Participants | 428 Participants | 990 Participants |
| Education University+ | 572 Participants | 460 Participants | 1032 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4753 Participants | 3002 Participants | 7755 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Health Status | 66.55 units on a scale STANDARD_DEVIATION 13.11 | 68.95 units on a scale STANDARD_DEVIATION 19.87 | 67.75 units on a scale STANDARD_DEVIATION 16.49 |
| Marital status Cohabiting | 175 Participants | 127 Participants | 302 Participants |
| Marital status Married | 2,670 Participants | 1,666 Participants | 4336 Participants |
| Marital status Separated/divorced | 346 Participants | 306 Participants | 652 Participants |
| Marital status Single | 680 Participants | 495 Participants | 1175 Participants |
| Marital status widowed | 882 Participants | 408 Participants | 1290 Participants |
| Region of Enrollment Spain | 4753 Participants | 3002 Participants | 7755 Participants |
| Sex: Female, Male Female | 2,602 Participants | 1,302 Participants | 3904 Participants |
| Sex: Female, Male Male | 2,151 Participants | 1,700 Participants | 3851 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 591 / 4,753 | 157 / 3,002 |
| other Total, other adverse events | 1,447 / 4,753 | 1,474 / 3,002 |
| serious Total, serious adverse events | 706 / 4,753 | 234 / 3,002 |
Outcome results
Primary
Disability
Measure: World Health Organization's Disability Assessment Schedule-II (WHODAS-II). Construct: Disability. Final result: A global total score. Range: 0-100. 0 means lower disability
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort 2011 | Disability | 11.17 score on a scale | Standard Deviation 17.59 |
| Cohort 2019 | Disability | 9.01 score on a scale | Standard Deviation 18.2 |
Primary
Experienced Well-being
Abbreviated Version of the Day Reconstruction Method. Construct: Experienced wellbeing. Final Result: The used scale reports two global scores: * Positive Affect total score. Range: 0-100 where 0 means lower positive affect. * Negative Affect total score. Range 0-100 where 0 means lower negative affect.
Time frame: Baseline
Population: Proxy respondent were not analysed
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Cohort 2011 | Experienced Well-being | Positive Affect | 4.88 score on a scale | Standard Deviation 1.11 |
| Cohort 2011 | Experienced Well-being | Negative Affect | 0.64 score on a scale | Standard Deviation 0.89 |
| Cohort 2019 | Experienced Well-being | Positive Affect | 4.75 score on a scale | Standard Deviation 1.59 |
| Cohort 2019 | Experienced Well-being | Negative Affect | 0.33 score on a scale | Standard Deviation 0.61 |
Primary
Heath Status
Measure: Health composite total score. Construct: Health status. Final result: A global total score. Range: 0-100. 0 means lower health status.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort 2011 | Heath Status | 66.55 score on a scale | Standard Deviation 13.11 |
| Cohort 2019 | Heath Status | 68.95 score on a scale | Standard Deviation 19.87 |
Primary
Quality of Life (WHOQOL-AGE)
Measure: World Health Organization Quality of Life-Age (WHOQOL-AGE) (Caballero, et al., 2013). Construct: Quality of life. Final Result: A global total score. Range 0-100. 0 means lower quality of life
Time frame: Baseline
Population: Proxy respondent were not analysed
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort 2011 | Quality of Life (WHOQOL-AGE) | 72.30 score on a scale | Standard Deviation 14.9 |
| Cohort 2019 | Quality of Life (WHOQOL-AGE) | 76.17 score on a scale | Standard Deviation 15.25 |
Secondary
Number of Participants With Depression
Measure: The World Health Organization Composite International Diagnostic Interview (CIDI). Depression module (WHO-CIDI, 1990). Construct: Presence of Depression. Final result: Two measures of depression according to Research Diagnostic Criteria. * Presence of 12 month depression. Values (yes/no). * Presence of lifetime depression. Values (yes/no).
Time frame: Baseline
Population: Proxy respondent were not analysed
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 2011 | Number of Participants With Depression | 510 Participants |
| Cohort 2019 | Number of Participants With Depression | 203 Participants |
Secondary
Presence of Anxiety Disorders
Measure: The World Health Organization Composite International Diagnostic Interview (CIDI). Anxiety disorders module (WHO-CIDI, 1990). Construct: Presence of anxiety Disorders Final Result: The instrument included in the study reports six measures of anxiety disorders according to Research diagnostic criteria. * Presence of 12 month panic disorder. Values (yes/no) * Presence of 12 month generalized anxiety disorder. Values (yes/no) * Presence of 12 month phobic disorder. Values (yes/no) * Presence of lifetime panic disorder. Values (yes/no) * Presence of lifetime generalized anxiety disorder. Values (yes/no) * Presence of lifetime phobic disorder. Values (yes/no)
Time frame: Baseline
Population: Proxy respondent were not analysed
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 2011 | Presence of Anxiety Disorders | 69 Participants |
| Cohort 2019 | Presence of Anxiety Disorders | 77 Participants |
Secondary
Presence of Diabetes
Construct: Presence of diabetes Measure: Self-reported information of 12-month presence of diagnosis and/or of treatment for diabetes Values: (Yes/No)
Time frame: Baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 2011 | Presence of Diabetes | 661 Participants |
| Cohort 2019 | Presence of Diabetes | 353 Participants |
Secondary
Presence of Lung Disease
Construct: Presence of any lung disease Measure: Self-reported information of 12-month presence of diagnosis and/or of treatment for any lung disease Values: (Yes/No)
Time frame: Baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 2011 | Presence of Lung Disease | 399 Participants |
| Cohort 2019 | Presence of Lung Disease | 152 Participants |
Secondary
Presence of Stroke
Construct: Presence of stroke Measure: Self-reported information of 12-month presence of diagnosis and/or of treatment for stroke Values: (Yes/No)
Time frame: Baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 2011 | Presence of Stroke | 183 Participants |
| Cohort 2019 | Presence of Stroke | 82 Participants |
Secondary
Presence of Suicide Behavior
Measure: The World Health Organization Composite International Diagnostic Interview (CIDI). Suicide module (WHO-CIDI, 1990). Construct: Presence of Suicide behavior The instrument reports six measures of suicide behavior. * Presence of 12 month suicide ideation. Values (yes/no) * Presence of 12 month suicide planning. Values (yes/no) * Presence of 12 month suicide attempts. Values (yes/no) * Presence of lifetime suicide ideation. Values (yes/no) * Presence of lifetime suicide planning. Values (yes/no) * Presence of lifetime suicide attempts. Values (yes/no)
Time frame: Baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Cohort 2011 | Presence of Suicide Behavior | 161 Participants |
| Cohort 2019 | Presence of Suicide Behavior | 75 Participants |
Other Pre-specified
Alcohol Use Information
Construct: Alcohol use Measure: Self-reported information of how many standard drinks per day in last 7 days have been used. Values: four categories of alcohol use: 0= Lifetime abstainers: Participants that have never used alcohol 1. Occasional drinkers: Participants that have ever used alcohol but not in the previous 7 days 2. Non-heavy drinker: Participants did consume alcohol in the last 30 days and in the last 7 days 3. Infrequent heavy drinker: Participants did consume alcohol 1-2 days per week, with 5 or more standard drinks per day in last 7 days for men and 4 or more standard drinks per day in last 7 days for women. 4. Frequent heavy drinkers: Participants did consume alcohol 3 or more days per week with 5 or more standard drinks per day in last 7 days for men and 4 or more standard drinks per day in last 7 days for women.
Time frame: Baseline
Population: Proxy respondent were not analysed
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cohort 2011 | Alcohol Use Information | Lifetime abstainers | 1,345 Participants |
| Cohort 2011 | Alcohol Use Information | Occasional drinkers | 1,424 Participants |
| Cohort 2011 | Alcohol Use Information | Non-heavy drinker | 1,671 Participants |
| Cohort 2011 | Alcohol Use Information | Infrequent heavy drinker | 111 Participants |
| Cohort 2011 | Alcohol Use Information | Frequent heavy drinker | 32 Participants |
| Cohort 2011 | Alcohol Use Information | Missing | 0 Participants |
| Cohort 2019 | Alcohol Use Information | Frequent heavy drinker | 38 Participants |
| Cohort 2019 | Alcohol Use Information | Lifetime abstainers | 871 Participants |
| Cohort 2019 | Alcohol Use Information | Infrequent heavy drinker | 95 Participants |
| Cohort 2019 | Alcohol Use Information | Occasional drinkers | 1,055 Participants |
| Cohort 2019 | Alcohol Use Information | Missing | 6 Participants |
| Cohort 2019 | Alcohol Use Information | Non-heavy drinker | 846 Participants |
Other Pre-specified
Intensity of Subjective Perception of Loneliness
Construct: Loneliness Measure: Three-item University of California, Los Angeles (UCLA) Loneliness Scale (Hughes et al, 2004) Result: A total loneliness score, then transformed into a percentile scale. Range: 0-100. Higher scores means higher loneliness
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort 2011 | Intensity of Subjective Perception of Loneliness | 12.34 score on a scale | Standard Deviation 24.25 |
| Cohort 2019 | Intensity of Subjective Perception of Loneliness | 10.74 score on a scale | Standard Deviation 22.82 |
Other Pre-specified
Level of Physical Activity
Construct: Level of physical activity Scale: Global Physical Activity Questionnaire version 2 (GPAQ v2); It collects information on physical activity participation in three settings (or domains) and sedentary behavior. The responses given by the participants have been converted to Metabolic Equivalent to Task (MET) values. Applying MET values to activity levels allows for calculating total physical activities. Values: Three values of physical activity can be obtained 3=High physical activity 2=Moderate physical activity 1=Low physical activity
Time frame: Baseline
Population: Proxy respondent were not analysed
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cohort 2011 | Level of Physical Activity | high | 1,464 Participants |
| Cohort 2011 | Level of Physical Activity | Moderate | 1,724 Participants |
| Cohort 2011 | Level of Physical Activity | Low | 1,395 Participants |
| Cohort 2019 | Level of Physical Activity | high | 898 Participants |
| Cohort 2019 | Level of Physical Activity | Moderate | 1,013 Participants |
| Cohort 2019 | Level of Physical Activity | Low | 991 Participants |
Other Pre-specified
Level of Social Support
Construct: Social Support Measure: 3-Item Oslo Social Support Scale (OSLO) (Abiola et al., 2013) Result: A global total score, then transformed into a percentile scale. Range: 0-100. Higher scores indicate a higher social support.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort 2011 | Level of Social Support | 77.50 score on a scale | Standard Deviation 16.73 |
| Cohort 2019 | Level of Social Support | 77.44 score on a scale | Standard Deviation 17.7 |
Other Pre-specified
Tobacco Use Information
Construct: Tobacco use Measure: Self-reported information of how many cigarettes/pipes/tobacco products/ have been used in the last week. Values: Four categories of tobacco use: 0= Never smokers: Participants who have never used tobacco 1. Daily smokers: Participants who have used tobacco last week 2. Non daily smokers: Participants who have ever used tobacco but not in the previous week 3. Former smokers: Participants who smoked in the past (ex smokers)
Time frame: Baseline
Population: Proxy respondent were not analysed
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cohort 2011 | Tobacco Use Information | Never smokers | 2,339 Participants |
| Cohort 2011 | Tobacco Use Information | Daily smokers | 1,049 Participants |
| Cohort 2011 | Tobacco Use Information | Non daily smokers | 100 Participants |
| Cohort 2011 | Tobacco Use Information | Former smokers | 1095 Participants |
| Cohort 2019 | Tobacco Use Information | Former smokers | 690 Participants |
| Cohort 2019 | Tobacco Use Information | Never smokers | 1,543 Participants |
| Cohort 2019 | Tobacco Use Information | Non daily smokers | 52 Participants |
| Cohort 2019 | Tobacco Use Information | Daily smokers | 626 Participants |