Clean Living Linked to Lower Mortality in Former Smokers

Eliza Partika 

September 23, 2022

Dr Maki Inoue-Choi

An important message for former smokers: You can overcome a history of vice through virtue.

People with a history of smoking who exercise regularly, eat nutritious foods, and maintain a healthy weight can reduce their risk for premature death by almost 30% compared with those who don't adopt such good habits, researchers have found. 

"Engaging in more aspects of a healthy lifestyle was associated with a lower risk of mortality than engaging in one aspect," said Maki Inoue-Choi, PhD, an epidemiologist at the National Cancer Institute, Bethesda, Maryland, who led the new study. "Former smokers may benefit from engaging in one of the healthy lifestyle recommendations but receive an even larger benefit if they follow more of them." 

For the study, published in JAMA Network Open, Inoue-Choi and her colleagues analyzed survey data from 159,937 former smokers in the United States. The data were part of a larger look at some 570,000 people participating in the National Institutes of Health-AARP Diet and Health Study. The primary outcome of the study was mortality on or before December 31, 2019, and participants had a mean follow-up period of roughly 19 years.  

Former smokers who adhered to health recommendations were as much as 27% less likely to die over the study period than those who didn't follow the suggestions.

The effect appeared to be cumulative. The risk for all-cause mortality was 12% lower for those who had average adherence to health recommendations and 4% lower for those who had slightly above average adherence, according to the researchers. People who adhered more closely to the recommendations also were less likely to die of cancer, cardiovascular disease, and respiratory conditions during the study period, they found.

Overall mortality rates were lower among those who quit smoking earlier. However, better adherence to the healthy lifestyle recommendations was associated with a lower risk for death regardless of when a person had quit smoking.

More than 50 million Americans have quit smoking, according to Inoue-Choi. Previous studies have shown substantial health benefits to a healthier lifestyle and to quitting smoking.  

Dr Hilary Tindle

"Former smokers are a large group of people who by nature of their quitting smoking may be especially motivated to adhere to other evidence-based healthy lifestyle recommendations," she said.

Evidence shows that alcohol consumption and smoking increased during the pandemic, but according to Inoue-Choi, there's very little research about the effects of these increases on former smokers.

According to Hilary Tindle, MD, MPH, founding director of the Vanderbilt Center for Tobacco Addiction and Lifestyle, Nashville, Tennessee, the new findings are significant because of the message they send to patients.  

"You don't have to be the poster child for health — midrange adherence still decreases mortality. Even if you do some of the recommendations, you promote your overall health," Tindle said.

JAMA Netw Open. Published online September 22, 2022. Full text

The study was funded by the Intramural Research Program of the National Cancer Institute for government employees' official duties. Inoue-Choi reports no relevant financial relationships. Tindle reports no relevant financial relationships.

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