Smoking and Multidimensional Well-Being: Gender and Cohort Differences in China

Smoking behavior (SB) remains a critical public health challenge in China, yet evidence on its longitudinal associations with multidimensional well-being remains limited. This study examines the relationship between smoking and three dimensions of well-being-depression, self-rated health, and happiness-using three recent waves of the China Family Panel Studies (CFPS; 2018, 2020, 2022) with 61,127 observations from 32,329 individuals. Growth curve modeling was employed to assess whether smoking is associated with well-being and whether these associations vary by gender and birth cohort. Three main findings emerge. First, smoking is positively associated with depressive symptoms (β = 0.210, p < 0.001) and self-rated health (β = 0.085, p < 0.001), but shows no significant association with happiness. Second, gender significantly moderates the relationship between smoking and well-being. The association between smoking and depressive symptoms is stronger among women, while gender differences are less pronounced for happiness. Third, cohort differences reveal substantial variation in the smoking-well-being relationship. For depression, smoking is associated with lower levels of depressive symptoms among older cohorts, but this association reverses among younger cohorts, as indicated by a significant smoking × cohort interaction (β = 0.230, p < 0.001). For self-rated health, the positive association between smoking and perceived health weakens across successive cohorts (β = -0.029, p < 0.001). No significant cohort variation is observed for happiness. These findings highlight that the relationship between smoking and well-being is shaped by gender norms and generational change. The results underscore the importance of gender-sensitive and cohort-specific tobacco control strategies, particularly in addressing the vulnerabilities of women and younger populations.