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The dependent variables, depression and stress symptoms were evaluated using the validated Malay version of the DASS 21 questionnaire

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The use of pack-years to assess the risk of developing COPD or some other lung diseases has been criticized for being a measure based on the assumption that both smoking intensity and duration are of equal importance.11,16,26 However, some authors argue that it should continue to be used because of its simplicity and because it is a measure that provides information on the cumulative amount of tobacco consumption.9,16,27,28 In this study, COPD risk increases linearly with the increase in pack/years, an aspect that also occurs in the nonparametric model

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BJOG An Int J Obstet Gynaecol