The Associations Between Life Satisfaction and Health-related Quality of Life, Chronic Illness, and Health Behaviors among U.S. Community-dwelling Adults

Abstract

The primary purpose of this article was to examine the associations between life satisfaction level and health-related quality of life (HRQOL), chronic illness, and adverse health behaviors among adults in the U.S. and its territories. Data were obtained from the 2005 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit telephone survey of the noninstitutionalized U.S. population aged >or=18 years. An estimated 5.6% of U.S. adults (about 12 million) reported that they were dissatisfied/very dissatisfied with their lives. As the level of life satisfaction decreased, the prevalence of fair/poor general health, disability, and infrequent social support increased as did the mean number of days in the past 30 days of physical distress, mental distress, activity limitation, depressive symptoms, anxiety symptoms, sleep insufficiency, and pain. The prevalence of smoking, obesity, physical inactivity, and heavy drinking also increased with decreasing level of life satisfaction. Moreover, adults with chronic illnesses were significantly more likely than those without to report life dissatisfaction. Notably, all of these associations remained significant after adjusting for sociodemographic characteristics. Our findings showed that HRQOL and health risk behaviors varied with level of life satisfaction. As life satisfaction appears to encompass many individual life domains, it may be an important concept for public health research.

Full text

ORIGINAL PAPER
The Associations Between Life Satisfaction and Health-
related Quality of Life, Chronic Illness, and Health
Behaviors among U.S. Community-dwelling Adults
Tara W. Strine Æ Daniel P. Chapman Æ Lina S. Balluz Æ
David G. Moriarty Æ Ali H. Mokdad
Published online: 23 August 2007
 Springer Science+Business Media, LLC 2007
Abstract The primary purpose of this article was to examine the associations between
life satisfaction level and health-related quality of life (HRQOL), chronic illness, and
adverse health behaviors among adults in the U.S. and its territories. Data were
obtained from the 2005 Behavioral Risk Factor Surveillance System, an ongoing, state-
based, random-digit telephone survey of the noninstitutionalized U.S. population aged
‡18 years. An estimated 5.6% of U.S. adults (about 12 million) reported that they were
dissatisfied/very dissatisfied with their lives. As the level of life satisfaction decreased,
the prevalence of fair/poor general health, disability, and infrequent social support
increased as did the mean number of days in the past 30 days of physical distress, mental
distress, activity limitation, depressive symptoms, anxiety symptoms, sleep insufficiency,
and pain. The prevalence of smoking, obesity, physical inactivity, and heavy drinking
also increased with decreasing level of life satisfaction. Moreover, adults with chronic
illnesses were significantly more likely than those without to report life dissatisfaction.
Notably, all of these associations remained significant after adjusting for sociodemo-
graphic characteristics. Our findings showed that HRQOL and health risk behaviors
varied with level of life satisfaction. As life satisfaction appears to encompass many
individual life domains, it may be an important concept for public health research.
Keywords Life satisfaction  Health behaviors 
Quality of life  Chronic illness  Surveillance
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily
represent the views of the Centers for Disease Control and Prevention.
T. W. Strine (&)  D. P. Chapman  L. S. Balluz  D. G. Moriarty  A. H. Mokdad
Division of Adult and Community Health, Centers for Disease Control and Prevention,
4770 Buford Highway NE, Mailstop K-66, Atlanta, GA 30341, USA
e-mail: tws2@cdc.gov
J Community Health (2008) 33:40–50
DOI 10.1007/s10900-007-9066-4
123

Introduction
Life satisfaction is the cognitive evaluation of one’s life as a whole [1]. Research
indicates that characteristics such as race, socioeconomic status, marital status,
education, and social involvement [2–8], as well as level of self-esteem, presence or
absence of depression, and locus of control may influence life satisfaction [9, 10].
Research further suggests that levels of life satisfaction may be mediated by cultural and
social values [11–14] and may depend on whom one is comparing one’s life to, as well as
experiences in the past decade and expectations of the future [15].
Life satisfaction is a predictor of longevity and psychiatric morbidity, with a dose-
response relationship evident between life dissatisfaction and all-cause disease, injury, and
mortality [16]. In addition, life satisfaction is related to other health predictors such as
favorable self-reported health, social support, and positive health behaviors [16]. Despite
the importance of these findings, there are few recent U.S. prevalence estimates available
for life satisfaction, and very little is known about the relationship between life
satisfaction, health behaviors, chronic illness, and health-related quality of life (HRQOL)
among community dwelling adults throughout the United States and its territories.
Most life satisfaction research conducted in the United States has focused on
subpopulations—persons with chronic illnesses, such as spinal cord injury [17–24] and
cancer [25, 26], older adults [27–35], and persons of specific racial/ethnic identities [36–
38]. We found only a few studies that examined life satisfaction in the general U.S.
population [3, 6, 39, 40], and these were conducted in the early to mid-1970s. Because
significant social changes have occurred since then, we used data from the 2005
Behavioral Risk Factor Surveillance System (BRFSS) to examine the associations
between life satisfaction level and HRQOL, chronic illness, and adverse health
behaviors among adults in the U.S. and its territories.
Methods
The BRFSS is an ongoing, state-based telephone survey conducted by random-digit
dialing of noninstitutionalized U.S. adults. BRFSS monitors the prevalence of key
health- and safety-related behaviors and characteristics [41, 42]. In 2005, trained
interviewers in the 50 states, the District of Columbia, Puerto Rico, and the US Virgin
Islands administered identical questionnaires about life satisfaction, social and
emotional support, HRQOL, disability, chronic illness, and health behaviors over the
telephone to an independent probability sample of adults aged 18 years or older. Data
from all states and areas were pooled to produce national estimates. BRFSS methods,
including the weighting procedure, have been described elsewhere [43].
Life satisfaction was evaluated by asking the respondent, ‘‘In general, how satisfied
are you with your life?’’ Possible responses were: very satisfied, satisfied, dissatisfied,
and very dissatisfied. For analysis, we divided responses into three groups: very satisfied,
satisfied, or dissatisfied/very dissatisfied.
Four HRQOL questions with demonstrated validity and reliability for population
health surveillance were examined [44–46]. General health was assessed by asking
respondents to rate their health on a scale from excellent to poor. We divided responses
into two groups: excellent/very good/good or fair/poor. The remaining three questions
were about the respondent’s own assessment of his or her health in the previous 30 days:
‘‘How many days was your physical health, which includes physical illness or injury, not
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J Community Health (2008) 33:40–50 41

good?’’ (recent physical distress), ‘‘How many days was your mental health, which
includes stress, depression, and problems with emotions, not good?’’ (recent mental
distress), and ‘‘How many days did poor physical or mental health keep you from doing
your usual activities, such as self-care, work, or recreation?’’ (recent activity limitations).
Additionally, a Healthy Days Symptoms module was used in two states: Hawaii,
and New York. Questions in this module also referred to the previous 30 days: ‘‘How
many days did you feel sad, blue, or depressed?’’ (recent depressive symptoms);
‘‘How many days did you feel worried, tense, or anxious?’’ (recent anxiety symptoms);
‘‘How many days have you felt you did not get enough rest or sleep?’’ (recent sleep
insufficiency); ‘‘How many days did pain make it difficult to do your usual activities?’’
(recent pain); and ‘‘How many days have you felt very healthy and full of energy?’’
(recent vitality).
In order to examine important predictors of life satisfaction after adjusting for
potential confounders, HRQOL responses were dichotomized into 0–13 (infrequent)
and 14–30 (frequent) unhealthy days in each domain, or, in the case of vitality, healthy
days. This dichotomy has been used in previous research [47–49], with the term
‘‘frequent’’ representing the respondent’s status for a substantial portion of the month.
The survey assessed social and emotional support by asking the respondent, ‘‘How
often do you get the social and emotional support that you need?’’ Possible responses
include always, usually, sometimes, rarely, and never. We divided responses into two
groups: always/usually/sometimes, or rarely/never.
Two yes/no questions assessed disability: ‘‘Are you limited in any way in any
activities because of a physical, mental, or emotional problem?’’ and ‘‘Do you have a
health problem that requires you to use special equipment such as a cane, a wheelchair,
a special bed, or a special telephone?’’
The BRFSS respondents were also asked about their smoking habits, physical
activity, height and weight, and alcohol consumption. Respondents were considered to
be current smokers if they had smoked at least 100 cigarettes in their lifetime and
reported being smokers at the time of the interview. Persons were considered to be
physically inactive if they had not participated in any leisure-time physical activity or
exercise during the past 30 days. Body mass index (BMI = weight [kg] divided by height
[m
2
]) was determined from self-reported height and weight. Persons were considered
obese if their BMI was ‡30 kg/m
2
. Consistent with the guidelines of the U.S.
Department of Agriculture and the U.S. Department of Health and Human Services
[50], heavy drinkers were defined as men who reported drinking more than two drinks
per day and women who reported drinking more than one drink per day.
Cardiovascular disease (CVD) was assessed using three questions: ‘‘Has a doctor,
nurse, or other health professional EVER told you that you had a heart attack, also
called a myocardial infarction?,’’ ‘‘Has a doctor, nurse, or other health professional
EVER told you that you had angina or coronary heart disease?,’’ and ‘‘Has a doctor,
nurse, or other health professional EVER told you that you had a stroke?’’ Persons
were considered to have CVD if they responded to all three questions and at least one
response was a ‘‘yes.’’ Persons were considered not to have CVD if they answered ‘‘no’’
to all three questions. Diabetes status was accessed using one question: ‘‘Have you ever
been told by a doctor that you have diabetes?’’ Women who reported diabetes only
during pregnancy were not considered to have diabetes. Persons were considered to
have asthma if they responded ‘‘yes’’ to the question ‘‘Have you ever been told by a
doctor, nurse, or other health professional that you had asthma?’’ Finally, persons were
considered to have arthritis if they responded ‘‘yes’’ to the question ‘‘Have you ever
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42 J Community Health (2008) 33:40–50

been told by a doctor or other health professional that you have some form of arthritis,
rheumatoid arthritis, gout, lupus, or fibromyalgia?’’
Data were available for 340,575 participants in the 50 states and the District of
Columbia, Puerto Rico, and the US Virgin Islands who responded to the life satisfaction
question. Data were available for 13,483 participants who responded to the life
satisfaction question in New York and Hawaii. Prevalence estimates, adjusted odds
ratios (AORs), and 95% confidence intervals (95% CI) were computed using
SUDAAN (Research Triangle, release 9.0.1, Research Triangle Park, NC, 2007) to
account for the complex survey design.
Results
Approximately 5.6% (95% CI: 5.5–5.8%) of the U.S. adult population reported that
they were dissatisfied or very dissatisfied with their lives. Persons aged 45–54 years were
Table 1 Level of life satisfaction among adults aged 18 years or older by selected sociodemographic
characteristics
Characteristics Very satisfied Satisfied Dissatisfied/very dissatisfied
% (95% CI) % (95% CI) % (95% CI)
Overall 44.6 (44.3–44.9) 49.8 (49.5–50.1) 5.6 (5.5–5.8)
Age
18–24 years 39.3 (38.0–40.6) 54.5 (53.1–55.8) 6.3 (5.6–7.0)
25–34 years 43.8 (43.0–44.7) 51.3 (50.4–52.2) 4.9 (4.5–5.3)
35–44 years 43.7 (43.0–44.5) 50.4 (49.7–51.2) 5.9 (5.5–6.2)
45–54 years 44.1 (43.3–44.8) 49.2 (48.4–49.9) 6.8 (6.5–7.1)
55–64 years 48.0 (47.2–48.7) 46.2 (45.4–46.9) 5.9 (5.5–6.3)
65–74 years 50.7 (49.8–51.6) 45.2 (44.3–46.0) 4.2 (3.9–4.5)
75+ years 45.8 (44.8–46.8) 50.2 (49.2–51.2) 4.0 (3.6–4.5)
Sex
Male 44.5 (43.9–45.0) 50.2 (49.7–50.8) 5.3 (5.1–5.6)
Female 44.7 (44.3–45.1) 49.4 (49.0–49.8) 5.9 (5.7–6.1)
Race/ethnicity
White non-Hispanic 47.4 (47.1–47.8) 47.5 (47.1–47.8) 5.1 (5.0–5.3)
Black non-Hispanic 37.0 (35.9–38.1) 54.6 (53.4–55.8) 8.4 (7.7–9.1)
Hispanic 37.5 (36.2–38.7) 56.7 (55.4–58.0) 5.9 (5.3–6.5)
Other non-Hispanic
a
40.7 (39.1–42.3) 52.7 (51.1–54.4) 6.6 (5.8–7.5)
Education
<High school 32.4 (31.3–33.6) 58.3 (57.1–59.5) 9.3 (8.6–10.0)
High school graduate 39.7 (39.1–40.3) 54.1 (53.5–54.7) 6.2 (5.9–6.5)
>High school 49.6 (49.2–50.1) 45.8 (45.4–46.3) 4.5 (4.4–4.7)
Marital status
Married 51.8 (51.3–52.2) 44.9 (44.5–45.3) 3.4 (3.2–3.5)
Previously married
b
33.3 (32.7–33.9) 56.6 (55.9–57.2) 10.1 (9.7–10.5)
Never married 34.4 (33.5–35.3) 57.5 (56.6–58.4) 8.1 (7.6–8.6)
Employment status
Employed 46.0 (45.6–46.5) 49.9 (49.5–50.4) 4.1 (3.9–4.2)
Unemployed 27.2 (25.6–28.8) 57.2 (55.4–58.9) 15.7 (14.5–16.9)
Retired 50.2 (49.5–50.8) 46.1 (45.5–46.8) 3.7 (3.5–4.0)
Unable to work 21.3 (20.1–22.6) 54.5 (53.0–55.9) 24.2 (23.0–25.5)
Homemaker/student 46.5 (45.4–47.5) 49.2 (48.1–50.2) 4.4 (4.0–4.9)
a
Asian, non-Hispanic; Native Hawaiian/Pacific Islander, non-Hispanic; American Indian/Alaska
Native, non-Hispanic; other race, non-Hispanic; multirace, non-Hispanic
b
Previously married includes those divorced, widowed or separated
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J Community Health (2008) 33:40–50 43

most likely to report dissatisfaction with life (6.8%) followed by those aged 18–24 years
(6.3%) (Table 1). Females (5.9%) were slightly more likely to report dissatisfaction with
life than males (5.3%) as were black non-Hispanics (8.4%) compared to other race/
ethnicities. There was an inverse relationship between educational attainment and life
dissatisfaction (9.3% among those with less than a high school education, 6.2% among
those with a high school education, and 4.5% among those with greater than a high
school education). Those previously married (10.1%) and never married (8.1%) were
significantly more likely to report dissatisfaction with life than those currently married
(3.4%). Finally, 24.2% of those unable to work, and 15.7% of those unemployed
reported life dissatisfaction as compared to 4.1%, 3.7% and 4.4% respectively of those
employed, retired, and homemakers or students.
Decreased level of life satisfaction was inversely related to mean number of days in
the past 30 days of poor mental health (1.5 days in the past 30 days among those who
are very satisfied with their lives, 3.8 days in the past 30 days among those who are
sometimes satisfied with their lives, and 13.7 days among those who are dissatisfied/very
dissatisfied with their lives), depressive symptoms (1.2, 3.4, and 14.4 days, respectively),
and anxiety symptoms (3.0, 5.7, and 17.0 days, respectively), as well as with somatic
complaints including poor physical health (2.4, 4.0, and 9.9 days, respectively), sleep
insufficiency (6.8, 9.5, and 16.2 days, respectively), pain (1.9, 2.9, and 8.6 days,
respectively), and activity limitations (1.1, 2.3, and 8.8 days, respectively) (Table 2).
As life satisfaction decreased, so did the mean number of days of vitality in the past
30 days (21.4, 15.4, and 7.6 days, respectively).
Notably, after adjusting for sociodemographic characteristics, persons who reported
that they were dissatisfied/very dissatisfied with their lives were 4.4 times more likely to
have physical distress, 17.5 times more likely to have mental distress, 7.7 times more
likely to have activity limitations, and 41.4 times more likely to have depressive
symptoms for 14 or more of the past 30 days as compared to those who were very
satisfied with their lives. Moreover, they were 24.7 times more likely to report anxiety
symptoms, 7.6 times more likely to report insufficient sleep, and 5.7 times more likely to
have pain for 14 or more of the past 30 days than those who were very satisfied with
their lives. Conversely, persons who were very satisfied with their lives were 14.4 times
more likely to report 14 or more days in the past 30 days of vitality as compared to those
dissatisfied/very dissatisfied with their lives.
Decreased life satisfaction was also associated with an increased prevalence of fair/
poor general health (Table 3). After adjusting for sociodemographic characteristics,
persons who were dissatisfied/very dissatisfied with their lives were 6.2 times more likely
than those very satisfied with their lives to report fair/poor general health, 11.1 times
more likely to report rarely or never receiving the social and emotion support they need,
5.4 times more likely to report limitations due to physical, mental, or emotional
problems, and 2.7 times more likely to have a health problems that requires special
equipment than those who were very satisfied with their lives.
As the level of life satisfaction decreased, the prevalence of obesity, smoking,
drinking heavily, and physical inactivity increased (Table 4). Persons who were
dissatisfied/very dissatisfied with their lives were 2.3 times more likely than those very
satisfied to smoke, 1.5 times more likely to be obese, 1.6 times more likely to drink
heavily, and 2.2 times more likely to be physically inactive. Additionally, persons who
were dissatisfied/very dissatisfied with their lives were more likely than those very
satisfied with their lives to have asthma (AOR = 1.7), arthritis (AOR = 2.0), diabetes
(AOR = 1.8), and heart disease (AOR = 2.2).
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44 J Community Health (2008) 33:40–50

Discussion
Our results, from a large representative sample of the U.S. population, suggest that life
satisfaction may be an important public health construct. We found that over one of
every 20 U.S. adults (about 12 million) reported that they were dissatisfied or very
dissatisfied with their lives. According to our findings, increased life satisfaction is
inversely related to mean number of days in the past 30 days of poor mental health,
depressive symptoms, and anxiety symptoms, as well as with somatic complaints
including poor physical health, sleep insufficiency, pain, and activity limitations. Even
after adjusting for sociodemographic characteristics, HRQOL impairments in 14 or
more of the previous 30 days were noted for all domains, with a particularly strong
association between life dissatisfaction and depressive and anxiety symptoms; adults
who are dissatisfied/very dissatisfied with life were over 41 times more likely to have
Table 2 Mean number of impaired health-related quality of life days in the past 30 days, prevalence of
‡14 or more impaired days, and adjusted odds of ‡14 impaired health-related quality of life days, by level
of life satisfaction, 2005
Characteristics Very satisfied Satisfied Dissatisfied/very dissatisfied
Mean (95% CI) Mean (95% CI) Mean (95% CI)
Questions asked in 50 states, DC, the Virgin Islands and Puerto Rico
Physical distress
Mean (95% CI) 2.4 (2.3–2.5) 4.0 (3.9–4.0) 9.9 (9.6–10.2)
% (95% CI) ‡14 days 6.8 (6.6–7.1) 11.9 (11.6–12.2) 33.4 (32.1–34.7)
AOR (95% CI)
a
Referent 1.7 (1.6–1.8) 4.4 (4.0–4.7)
Mental distress
Mean (95% CI) 1.5 (1.4–1.5) 3.8 (3.8–3.9) 13.7 (13.4–14.1)
% (95% CI) ‡14 days 3.7 (3.5–3.9) 11.3 (11.0–11.6) 48.2 (46.8–49.7)
AOR (95% CI)
a
Referent 3.0 (2.8–3.2) 17.5 (16.0–19.1)
Activity limitations
Mean (95% CI) 1.1 (1.1–1.2) 2.3 (2.2–2.3) 8.8 (8.5–9.1)
% (95% CI) ‡14 days 3.2 (3.0–3.4) 6.8 (6.6–7.0) 30.2 (29.0–31.5)
AOR (95% CI)
a
Referent 1.9 (1.8–2.0) 7.7 (7.0–8.5)
Questions asked in New York and Hawaii
Depressive symptoms
Mean (95% CI) 1.2 (1.0–1.4) 3.4 (3.0–3.7) 14.4 (12.7–16.1)
% (95% CI) ‡14 days 2.2 (1.5–3.4) 7.9 (6.5–9.5) 50.1 (42.1–58.1)
AOR (95% CI)
a
Referent 3.5 (2.2–5.7) 41.4 (23.7–72.2)
Anxiety symptoms
Mean (95% CI) 3.0 (2.7–3.4) 5.7 (5.3–6.2) 17.0 (15.1–18.8)
% (95% CI) ‡14 days 6.1 (4.8–7.6) 15.5 (13.6–17.6) 59.3 (51.1–67.0)
AOR (95% CI)
a
Referent 2.8 (2.1–3.8) 24.7 (15.8–38.7)
Insufficient sleep
Mean (95% CI) 6.8 (6.3–7.4) 9.5 (8.9–10.0) 16.2 (14.4–17.9)
% (95% CI) ‡14 days 19.5 (17.3–21.9) 30.4 (27.9–33.0) 67.0 (53.2–68.3)
AOR (95% CI)
a
Referent 1.8 (1.5–2.2) 7.6 (5.1–11.2)
Pain
Mean (95% CI) 1.9 (1.6–2.2) 2.9 (2.6–3.3) 8.6 (7.0–10.2)
% (95% CI) ‡14 days 5.7 (4.6–6.9) 8.7 (7.4–10.1) 29.7 (23.3–37.1)
AOR (95% CI)
a
Referent 1.5 (1.1–2.0) 5.7 (3.4–9.5)
Vitality
Mean (95% CI) 21.4 (20.8–21.9) 15.4 (14.9–16.0) 7.6 (6.0–9.3)
% (95% CI) ‡14 days 81.9 (79.5–84.1) 58.6 (56.0–61.3) 25.3 (19.0–32.9)
AOR (95% CI)
a
14.4 (9.6–21.7) 4.5 (3.1–6.7) Referent
a
Adjusted by age, sex, race/ethnicity, education, marital status, and employment status
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J Community Health (2008) 33:40–50 45

depressive symptoms than those who are very satisfied with life and adults who are
dissatisfied/very dissatisfied with life were over 24 times more likely to have anxiety
symptoms than those who are very satisfied with life.
Table 3 Prevalence and odds of fair/poor general health, inadequate social and emotional support, and
disability by level of life satisfaction, 2005
Characteristics Very satisfied Satisfied Dissatisfied/very dissatisfied
% (95% CI) % (95% CI) % (95% CI)
Questions asked in 50 states, DC, the Virgin Islands and Puerto Rico
General health (fair/poor)
% (95% CI) 9.3 (9.0–9.6) 19.4 (19.1–19.9) 45.7 (44.2–47.1)
AOR (95% CI)
a
Referent 2.2 (2.1–2.3) 6.2 (5.7–6.8)
Social support (rarely/never)
% (95% CI) 4.2 (3.9–4.4) 9.1 (8.8–9.4) 37.4 (35.9–38.8)
AOR (95% CI)
a
Referent 2.0 (1.8–2.1) 11.1 (10.1–12.3)
Disability
Limited due to physical, mental, or emotional problem?
% (95% CI) 12.3 (12.0–12.6) 20.2 (19.9–20.6) 49.2 (47.7–50.6)
AOR (95% CI)
a
Referent 1.8 (1.7–1.9) 5.4 (5.0–5.9)
Health problem that requires special equipment?
% (95% CI) 4.3 (4.1–4.5) 6.9 (6.7–7.1) 17.3 (16.4–18.3)
AOR (95% CI)
a
Referent 1.5 (1.4–1.6) 2.7 (2.4–3.0)
a
Adjusted by age, sex, race/ethnicity, education, marital status, and employment status
Table 4 Prevalence and odds of health risk behaviors and chronic illness by level of life satisfaction
among adults aged 18 years or older, 2005
Characteristics Very satisfied Satisfied Dissatisfied/very dissatisfied
% (95% CI) % (95% CI) % (95% CI)
Smoking
% (95% CI) 15.1 (14.7–15.5) 23.2 (22.7–23.6) 37.8 (36.4–39.3)
AOR (95% CI)
a
Referent 1.2 (1.4–1.5) 2.3 (2.1–2.5)
Obesity
% (95% CI) 20.8 (20.4–21.2) 25.8 (25.3–26.2) 32.0 (30.7–33.3)
AOR (95% CI)
a
Referent 1.3 (1.2–1.3) 1.5 (1.4–1.6)
Heavy drinking
% (95% CI) 4.6 (4.4–4.9) 5.3 (5.0–5.5) 7.5 (6.7–8.4)
AOR (95% CI)
a
Referent 1.1 (1.0–1.2) 1.6 (1.4–1.9)
Physical inactivity
% (95% CI) 19.3 (18.9–19.7) 28.2 (27.8–28.7) 42.4 (41.0–43.8)
AOR (95% CI)
a
Referent 1.5 (1.4–1.5) 2.2 (2.1–2.4)
Asthma
% (95% CI) 10.9 (10.6–11.2) 13.3 (12.9–13.6) 21.0 (19.8–22.1)
AOR (95% CI)
a
Referent 1.2 (1.1–1.3) 1.7 (1.6–1.9)
Arthritis
% (95% CI) 24.3 (23.9–24.7) 27.6 (27.2–28.0) 39.3 (38.0–40.7)
AOR (95% CI)
a
Referent 1.3 (1.3–1.4) 2.0 (1.9–2.2)
Diabetes
% (95% CI) 6.5 (6.3–6.7) 8.3 (8.0–8.5) 13.4 (12.5–14.4)
AOR (95% CI)
a
Referent 1.3 (1.2–1.4) 1.8 (1.6–1.9)
Heart disease
% (95% CI) 6.6 (6.4–6.8) 8.3 (8.1–8.6) 14.8 (13.8–15.8)
AOR (95% CI)
a
Referent 1.3 (1.3–1.4) 2.2 (2.0–2.4)
a
Adjusted by age, sex, race/ethnicity, education, marital status, and employment status
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46 J Community Health (2008) 33:40–50

Our study confirmed findings from previous research suggesting that life satisfaction
is associated with several sociodemographic characteristics. Factors such as employment
[2, 6, 8, 11, 51, 52], marital status [2, 8, 11, 53], race [3] and education [40] have
consistently shown associations with life satisfaction in previous research. As summa-
rized by Clemente and Sauer [3] and Hong and Giannakopoulos [9], there have been
inconsistent findings with regard to the associations between life satisfaction, sex, and
age. We found that young and middle-aged adults have a higher prevalence of life
dissatisfaction than older adults and that women are slightly more likely than men to
report life dissatisfaction.
Additionally, we found that life dissatisfaction is related to obesity and adverse
health behaviors such as smoking, heavy drinking, and physical inactivity. Although we
were unable to find research that addressed the association between health behaviors
and life satisfaction in the general U.S. adult population, prior research has investigated
this association among subpopulations of U.S. adults. Specifically, smoking and drinking
among college students were related to decreased life satisfaction [54, 55]; low levels of
life satisfaction were predictors of weight gain in older women [56]; and waist/hip
circumference ratio was negatively associated with life satisfaction among middle-aged
men [57]. Additionally, physical activity was positively related to life satisfaction among
older adults [58–60], and there was a dose-response effect between physical activity and
psychosocial well-being in adults aged 20–79 [61].
Moreover, after adjusting for sociodemographic characteristics, the associations
between life dissatisfaction and asthma, arthritis, diabetes, and heart disease remained
significant. In fact, adults who were dissatisfied/very dissatisfied with life were twice as
likely as those who were very satisfied with life to have arthritis and heart disease, the
two most potentially debilitating conditions we examined in this study. This corrob-
orates existing research suggesting that conditions that cause disability are more likely
than conditions that do not to decrease life satisfaction [62].
Our study has several limitations. First, because BRFSS is a telephone survey, it
potentially excludes people of low socioeconomic status and people with severly
impaired physical or mental health. BRFSS also excludes adults who are institution-
alized or hospitalized. Therefore, we might have underestimated dissatisfaction with life
in this study. Second, in this investigation, level of life satisfaction was necessarily
determined from one question and therefore may not effectively convey the diverse
components comprising this construct. Third, five of the HRQOL measures were
limited to data from two states, therefore our results for these measures may not be
representative of the entire country. Finally, we cannot infer a causal relationship
between dissatisfaction with life, impairment in HRQOL domains, adverse health
behaviors, or chronic illness, although our cross-sectional data support our conclusion
that these characteristics are associated.
These limitations notwithstanding, our results corroborate previous research
suggests that life satisfaction is strongly affected by poor mental health, particularly
depression and anxiety [63–65], and chronic illness or injury, particularly those that
cause disability [62]. Additionally, our research suggests that the prevalence of risk
behaviors and level of HRQOL vary with level of life satisfaction. As life satisfaction
appears to encompass many individual life domains, it may be an important concept
for public health research. Future research should examine in more depth the
associations between physical and psychiatric diagnoses and level of life satisfaction as
well as the potential utility of life satisfaction as a predictor of mental health and
illness.
123
J Community Health (2008) 33:40–50 47

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