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Strengths and limitations This study had many strengths, a nationally representative US sample, choice of a well-validated measure of global health that includes a physical and mental component 17,35 , testing of the associations between a novel smoking-descriptor (childhood smoking) and poor HRQOL, adjustment for many other aspects of cigarette smoking that also independently relate to HRQOL, and a sensitivity analysis that appropriately considers smoking-related disease measures as mediators rather than independent risk factors