Alcohol, stress-related factors, and short-term absenteeism among urban transit operators

The impact of COVID-19 on nurse alcohol consumption: A qualitative exploration

AIMS AND OBJECTIVES

To explore the long-term impact of the COVID-19 pandemic on nurse alcohol consumption.

BACKGROUND

The COVID-19 pandemic has caused immense disruption to healthcare services worldwide, and nurses have not been immune, experiencing burnout, declining mental health and ultimately, attrition from the profession. Increases in alcohol consumption have been reported across subsections of society, including those with pre-existing mental ill health and experiencing high stress, and exploring this phenomenon in nurses is essential for workforce well-being and sustainability.

DESIGN

Qualitative descriptive study design.

METHODS

Secondary analysis of individual, semi-structured interviews with nurses (N = 42) from diverse settings across Australia, including community, primary and hospital settings, conducted in July and August 2021. Data were analysed using structural coding and reported in accordance with the CORE-Q guidelines.

FINDINGS

Two key themes were found after analysis of the data: (1) factors influencing alcohol consumption (subthemes: workplace factors and external factors), and (2) the pandemic's influence on alcohol consumption (subthemes: increased consumption, moderation of consumption and alcohol as a reward).

CONCLUSIONS

Several participants described increased alcohol consumption because of the COVID-19 pandemic, particularly due to the stress of working in an environment where resources were scarce. Workplace factors such as overtime, missed breaks and heightened workload were all described as driving stress, and in turn increased alcohol consumption.

RELEVANCE TO CLINICAL PRACTICE

Increased alcohol consumption has been associated with burnout, absenteeism and intention to leave. The nursing profession is currently undergoing significant continuing stress providing care and management to patients with the SARS-CoV-2 virus, and increased alcohol consumption is a significant threat to personal and workforce well-being, workforce sustainability and quality nursing care.

Association Between Workplace Absenteeism and Alcohol Use Disorder From the National Survey on Drug Use and Health, 2015-2019

IMPORTANCE

Alcohol use disorder (AUD) is common and associated with increased morbidity. The degree to which AUD currently factors into workplace absenteeism needs further characterization in the US.

OBJECTIVE

To examine the association between AUD and workplace absenteeism in a nationally representative sample.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used data from a nationally representative sample of noninstitutionalized US residents from the 2015-2019 National Survey on Drug Use and Health to examine the association of AUD with workplace absenteeism. Eligible respondents were aged 18 years and older who reported full-time employment. Data were analyzed from March to September 2021.

MAIN OUTCOMES AND MEASURES

Primary outcomes were markers of workplace absenteeism as defined by the number of days missed from work because of illness or injury and days skipped from work in the last 30 days. Descriptive statistics, prevalence ratios, and logistic regression analyses were performed to assess the association between AUD and absenteeism.

RESULTS

A total of 110 701 adults aged 18 years and older reported current full-time employment (58 948 [53.2%] men, 51 753 [46.8%] women; 12 776 [11.5%] Black, 18 096 [16.3%] Hispanic, and 69 506 [62.8%] White respondents). Weighted prevalence of AUD in this sample of working adults was 9.3% (95% CI, 9.0%-9.5%); 6.2% (95% CI, 6.0%-6.4%) of respondents met criteria for mild AUD, 1.9% (95% CI, 1.7%-2.0%) for moderate AUD, and 1.2% (95% CI, 1.1%-1.3%) for severe AUD. Mean days missed from work annually increased in a stepwise fashion with increasing AUD severity (no AUD, 13.0 days; 95% CI, 12.7-13.2 days; mild AUD, 17.7 days; 95% CI, 16.4-19.1 days; moderate AUD, 23.6 days; 95% CI, 21.5-25.7 days; severe AUD, 32.3 days; 95% CI, 27.5-37.0 days). People with AUD represented 9.3% of the full-time workforce and contributed to 14.1% of total reported workplace absences.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, AUD was disproportionately associated with an increased prevalence of workplace absenteeism, with individuals with AUD contributing over 232 million missed workdays annually. These results provide economic incentive for increased investment in AUD prevention and treatment, both for employers and policy makers.

A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference

AIM

Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term).

METHOD

Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078.

RESULTS

Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33-10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16-8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73-8.60).

CONCLUSION

This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

More Than Just "Stressful"? Testing the Mediating Role of Fatigue on the Relationship Between Job Stress and Occupational Crashes of Long-Haul Truck Drivers

Introduction

Recent evidence consistently highlights the adverse work environment of long-haul professional drivers, whose task structure typically involves the performance of extensive shifts, driving under stressful working conditions. In this regard, job stress and fatigue - that are highly prevalent in this workforce - seem to play a crucial role in explaining this group's negative traffic safety outcomes. The aim of this study was to assess whether work-related fatigue is a mechanism that mediates the relationship between job stress, health indicators and occupational traffic crashes of long-haul truck drivers (LHTD).

Methods

The data used in this study were collected from 521 Spanish long-haul truck drivers (97% males) from all 17 regions of Spain, with a mean age of 47 years.

Results

Utilizing structural equation models (SEM), it was found that work-traffic crashes of long-haul truck drivers could be explained through work-related fatigue that exerts a full mediation between job stress (job strain), health-related factors and traffic crashes suffered during the previous two years.

Discussion

Overall, the findings of this research support that a) stressful working conditions and health issues of drivers have significant effects on traffic crashes, and b) fatigue is a mechanism relating stress-related factors and work-traffic crashes of long-haul drivers. This study highlights the need of stress- and fatigue-management policies and interventions, in order to reduce the crash risk of long-haul truck drivers.

Age differences in the association between stressful work and sickness absence among full-time employed workers: evidence from the German socio-economic panel

Purpose

We aim to extend current knowledge on associations between stressful work and sickness absence, first, by studying associations between ERI and sickness absence among full-time employees from various occupations, and second, by investigating if associations vary by age.

Methods

We use data from four waves of the German socio-economic panel (GSOEP), collected among men and women between 2006 and 2012, with 9418 observations. Stressful work is measured with a short form of the ERI questionnaire. We investigate an imbalance between effort and reward (ER ratio) as well as the two main components (“high effort” and “low reward”). Sickness absence is measured by self-reported number of sickness days (assessed the following year). After descriptive analyses, we estimate a series of multivariable regressions, including tests for interactions between age and work stress.

Results

Each of the three indicators of stressful work is related to higher number of sickness days, with except of “high effort” in case of men. Findings remain significant after adjusting for social position (income, education and occupational class) and health. In addition, for both men and women, associations were slightly higher among older workers, though interactions did not reach statistical significance.

Conclusion

Our findings support that stressful work is linked to sickness absence across a wide spectrum of jobs with varying incomes and educational levels, and also that associations are slightly more pronounced among older workers.

Electronic supplementary material

The online version of this article (10.1007/s00420-018-1298-3) contains supplementary material, which is available to authorized users.

Changes in drinking as predictors of changes in sickness absence: a case-crossover study

Background

We investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design.

Methods

Finnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey.

Results

Periods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence.

Conclusion

Increase in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk.

Burnout Syndrome and alcohol consumption in prison employees

OBJECTIVE

The aims of this study were to estimate the association between an at-risk drinking pattern and sociodemographic variables, and to compare the mean scores of the factors associated with the Burnout Syndrome, according to the alcohol consumption pattern in staff members from two Brazilian prisons.

METHODS

A cross-sectional study was developed with 339 participants (response rate = 63.8%). The instruments used were a sociodemographic questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the Maslach Burnout Inventory - General Survey (MBI-GS).

RESULTS

The participants' average age was 40.2 (SD = 8.8) years, and 81.0% were male. Among 78.5% of participants (95%CI 74.1 - 82.8) reported consuming alcoholic beverages. The prevalence of at-risk drinking behavior in the sample was 22.4% (95%CI 18.0 - 26.9), and of the Burnout Syndrome was 14.6% (95%CI 10.8 - 18.4). We observed a significant association between at-risk drinking behavior with gender, higher risk for men (OR = 7.32, p < 0.001), smoking, increased risk for smokers (OR = 2.77, p < 0.001), and religious practice, showing lower risks for religion practitioners (OR = 0.364, p < 0.001). We noticed significantly higher mean scores (p < 0.001) of emotional exhaustion and cynicism, and lower scores of professional achievement among individuals who reported consuming alcoholic beverages.

CONCLUSION

Men who smoke were more likely to develop an at-risk drinking pattern, while religion is presented as a protective factor. Individuals who consume alcohol were more affected by the different factors of the Burnout Syndrome.

The association between insomnia and cardiovascular risk factors in bus drivers in Iran

BACKGROUND

Road accidents are one of the most important issues in Iran which more than eighteen thousand persons are died annually because of this problem. Among the major reasons for this issue, sleepiness and cardiovascular disorder can be mentioned.

OBJECTIVE

To investigate the association between insomnia and cardiovascular risk factors among professional drivers who are at high risk during driving.

METHODS

A total of 1232 male bus drivers were included in the study and two different kinds of data sets were collected: (1) Sleep disorder information using Athens Insomnia Scale (AIS) and (2) Cardiovascular parameters such as systematic measurement of blood pressure, electrocardiography (ECG), total cholesterol, and triglyceride.

RESULTS

Our study demonstrated that the prevalence of insomnia in professional bus drivers was 8 percent. The study showed significant association between age, diastolic hypertension and work experience with final awakening earlier than desired (P < 0.05), the rate of the triglyceride level and total sleep duration (p = 0.02), and BMI and sleepiness during the day (P < 0.05).

CONCLUSIONS

Our study suggested that elevated serum triglyceride levels and increased diastolic blood pressure may be associated with some sleep complaints in drivers.

Alcohol use-sickness absence association and the moderating role of gender and socioeconomic status: A literature review

ISSUES

How strong is the available empirical evidence for an association between alcohol use and sickness absence? Does type of measures influence the association, and is the association moderated by gender and socioeconomic status?

APPROACH

We designed a search strategy to find all studies on the alcohol use-sickness absence association using individual-level data, published in peer-reviewed journals from 1980 onwards. The quality of the associations was evaluated, giving a score of 0-4 points.

KEY FINDINGS

Our inclusion criteria were met by 27 papers containing 28 separate studies, testing 48 associations. There is empirical evidence for an association between alcohol use and both long- and short-term absence. High-quality associations were statistically significant in 100% of the cases. Among low-medium-quality associations, alcohol was less consistently related to long-term than to short-term absence (significant in 25% and 100% of the cases, respectively). Second, the association did not vary systematically across measures of alcohol use. Third, the association applies to both genders and in all socioeconomic strata, but in some instances more strongly in lower socioeconomic strata.

IMPLICATIONS

Preventive strategies have to be targeted at all drinking employees, but more research into group differences for example across gender, socioeconomics, occupations and age, could prove valuable. More longitudinal studies are needed to explore causal mechanisms.

CONCLUSION

The alcohol use-sickness absence association is well founded in research. The association may be moderated by gender and socioeconomics, but more research is needed to draw firm conclusions on this issue.

Care delivery for Filipino Americans using the Neuman systems model

Filipino Americans are at risk of coronary heart disease due to the presence of multiple cardiometabolic factors. Selecting a framework that addresses the factors leading to coronary heart disease is vital when providing care for this population. The Neuman systems model is a comprehensive and wholistic framework that offers an innovative method of viewing clients, their families, and the healthcare system across multiple dimensions. Using the Neuman systems model, advanced practice nurses can develop and implement interventions that will help reduce the potential cardiovascular problems of clients with multiple risk factors. The authors in this article provides insight into the cardiovascular health of Filipino Americans and has implications for nurses and other healthcare providers working with various Southeast Asian groups in the United States.

Alcohol consumption, problem drinking, abstention and disability pension award. The Nord-Trøndelag Health Study (HUNT)

AIMS

To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption ('sick-quitting') could explain some of the increased risk for DP among abstainers.

DESIGN

Prospective population-based study.

SETTING AND PARTICIPANTS

Data were from two waves of the Nord-Trøndelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37,729 (alcohol consumption) and 34,666 (problem drinking) participants.

MEASUREMENTS

Alcohol consumption was measured by self-reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health-related behaviour, socio-economic status and social activity.

FINDINGS

Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92-1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08-3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48-2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01-2.74) were at higher risk for DP than constant abstainers.

CONCLUSIONS

Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by 'sick-quitting'.

Absenteísmo-doença, modelo demanda-controle e suporte social: um estudo caso-controle aninhado em uma coorte de trabalhadores de hospitais, Santa Catarina, Brasil

O objetivo do estudo foi identificar a contribuição do Modelo Demanda-Controle (MDC) e do suporte social para duração do absenteísmo-doença segundo Licenças para Tratamento de Saúde (LTS) nos trabalhadores de hospitais (servidores públicos) da Secretaria de Estado da Saúde de Santa Catarina (SES/SC), Brasil. Entre as secretarias deste estado, a SES/SC tem a segunda maior frequência de LTS, com destaque nos hospitais. Este é um estudo caso-controle aninhado em uma coorte de trabalhadores de hospitais da SES/SC, com acompanhamento entre 01/07/2008 e 30/06/2009. Os casos foram aqueles que apresentaram LTS nesse período, os critérios de pareamento foram sexo, faixa etária e setor de trabalho. O desfecho foi o total de dias de LTS, as variáveis de exposição foram MDC e o suporte social do supervisor e do colega. Utilizou-se dados primários e secundários, nas análises a regressão Zero-inflado Binomial Negativa, e as variáveis socioeconômicas e ocupacionais nos ajustes. O banco de dados para as análises teve 425 (144 casos; 281 controles) participantes. O baixo suporte do colega aumentou a expectativa de dias de LTS em 2,04 (IC95%: 1,05-3,93), unido ao trabalho de baixa exigência aumentou 2,68 (IC95%: 1,37-5,27) e ao de alta exigência (iso-strain) 78% (IC95%: 1,02-3,12) mais do que o MDC com alto suporte do colega. Este estudo mostrou a importância do suporte do colega sobre a duração absenteísmo-doença, e auxiliou conjeturar que a variável tempo nos trabalhadores de hospital leva a adaptação às exigências das tarefas e a monotonia. Intervenções no relacionamento entre os trabalhadores provavelmente diminuirão a duração de LTS.

Drinking habits and sickness absence: The contribution of working conditions

Aims: The main aim was to examine whether drinking habits including average, binge and problem drinking are associated with self-certified and medically confirmed sickness absence among middle-aged municipal employees. Another aim was to examine whether psychosocial and physical working conditions and work arrangements explain these associations. Methods: The data on drinking habits and working conditions of 5,119 female and 1,390 male middle-aged employees of the City of Helsinki was obtained from postal questionnaires collected in 2000—2002. The data on sickness absence (2000—2005) were derived from the employer’s registers. Poisson regression analysis with self-certified (1—3 days) and medically confirmed (over 3 days) sickness absence spells as outcomes was used in performing the analyses. Results: Heavy average, binge and problem drinking were all associated with an increase in self-certified sickness absence. Both non-drinkers and heavy drinkers had excess medically confirmed sickness absence compared to moderate drinkers. Problem drinking and among women also binge drinking were associated with medically confirmed sickness absence. Psychosocial working conditions slightly attenuated the association of drinking habits and sickness absence mainly among men. Physical working conditions and work arrangements slightly explained medically confirmed sickness absence among male problem drinkers. Conclusions: All studied drinking habits were associated with both self-certified and medically confirmed sickness absence. Thus, a decrease in unhealthy drinking habits among employees is likely to prevent sickness absence. The effects of working conditions were small but psychosocial working conditions slightly explained the associations between drinking habits and sickness absence mainly among men.

Association of occupational and substance use factors with burnout among urban transit operators

Burnout is a special type of prolonged occupational stress that is linked with numerous psychosomatic and psychological sequelae and negative job consequences. The purpose of this study is to estimate the contribution of occupational and substance use factors to burnout among a multiethnic sample of urban transit operators (n = 1231). Survey and medical exam data were obtained from participants in the 1993-1995 San Francisco MUNI Health & Safety Study. Burnout was measured with the Maslach Burnout Inventory emotional exhaustion subscale. Occupational factors included frequency of job problems (e.g., equipment, passengers, and traffic), years driving, full or part-time work status, and ergonomic problems (e.g., adjusting the seat, back support, vibration, and rocking or bouncing of seat). Substance use measures were alcohol consumption and smoking status (i.e., current, former, and never smokers). The results of multivariable linear regression analysis showed that job problems (beta = 0.426, p < 0.001), ergonomic problems (beta = 0.138, p < 0.001), and full-time work status (beta = 0.070, p < 0.01) were associated with burnout. Smoking was not significant, but alcohol consumption was positively associated with burnout (beta = 0.067, p < 0.01). Age was negatively correlated with burnout (beta = -0.106, p < 0.001), which may reflect a healthy worker effect. Because aspects of the psychosocial and physical work environments can be modified, the findings have important implications for the prevention of burnout among municipal transit operators.

Alcohol use and abuse in adolescence: proposal of an alternative analysis

BACKGROUND

A national, representative, school-based sample of Portuguese youths was used to examine the prevalence of alcohol use in this population and to analyse differences between demographic variables such as gender and age, as well as to propose a statistical procedure that optimally quantifies categorical variables.

METHODS

Data on 6109 state school students from Portugal, in the 6th, 8th and 10th grades, aged 11-18, who participated in the 2002 (Health Behaviour in School-aged Children/WHO) survey of adolescent health, were analysed. Adolescents aged between 11 and 14 were placed in the younger group, and those 15-18 years old were placed in the older group. Optimal scaling was used to optimize the computation of factor scores, which were subsequently submitted to multiple regression analysis in order to analyse the impact of gender and age on alcohol use.

RESULTS

The results of this study show that the majority of Portuguese school-aged adolescents attending regular school at 6th, 8th and 10th grades do not drink alcoholic beverages (beer, wine or spirits) on a regular basis (at least once a month). However, about 8% of these adolescents do drink beer, 3% do drink wine and 12% do drink spirits on a regular basis. With regard to age and gender, about a quarter of the older boys stated that they drink beer or spirits regularly. The multiple regression analysis showed that age and gender had a significant impact on alcohol use.

CONCLUSION

Alcohol - in particular spirits - is a substance used by some Portuguese adolescents. Alcohol use and abuse is more frequent in boys and increases with age. The importance of these findings for health promotion strategies is discussed.

Workers' drinking patterns: the impact on absenteeism in the Australian work-place

AIMS

To examine the relationship between Australian workers' patterns of alcohol consumption and absenteeism.

DESIGN

A secondary analysis of the 2001 National Drug Strategy Household Survey data.

SETTING

Australia 2001.

PARTICIPANTS

A total of 13 582 workers aged >or=14 years.

MEASUREMENTS

Alcohol consumption levels associated with National Health and Medical Research Council (NHMRC) guidelines for short- and long-term harm were identified and compared with self-reported measures of absenteeism due to alcohol use and due to any illness/injury.

FINDINGS

More than 40% of the Australian work-force consumed alcohol at risky or high-risk levels at least occasionally. High-risk drinkers were up to 22 times more likely to be absent from work due to their alcohol use compared to low-risk drinkers. Short-term high-risk drinkers were also significantly more likely to be absent from work due to any illness or injury than employed low-risk drinkers. Young employees and males were more likely to report alcohol-related absenteeism compared to older workers and females.

CONCLUSIONS

The relationship between workers' alcohol consumption patterns and absenteeism is more substantial than previously recognized or documented. Alcohol-related absenteeism is not restricted to small numbers of chronic heavy drinkers, but also involves the much larger number of risky non-dependent drinkers who drink less frequently at risky levels. To improve workers' health and wellbeing and enhance productivity and economic prosperity, appropriate education, prevention and policy strategies are warranted and necessitate revision of previously narrow approaches undertaken with work-place programmes.

Highly active antiretroviral therapy use and HIV transmission risk behaviors among individuals who are HIV infected and were recently released from jail

We evaluated highly active anti-retroviral therapy (HAART) use and risk behaviors among 177 inmates who were HIV infected and were released and reincarcerated in San Francisco, Calif, jails over a 12-month period. During the month preceding reincarceration, HIV transmission risk behaviors were common among respondents, and 59% of those with a history of antiretroviral use were not taking HAART. HAART discontinuation was independently associated with homelessness, marijuana use, injection drug use, and not receiving community medical care. Postrelease interventions for inmates who are HIV infected are needed.

Occupational correlates of smoking among urban transit operators: a prospective study

BACKGROUND

Workers in blue-collar and service occupations smoke at higher rates than workers in white-collar and professional occupations. Occupational stress may explain some of the occupational class differences in smoking and quitting behavior. The purpose of this study is to investigate the contribution of occupational factors to smoking behavior over a ten year period among a multiethnic cohort of urban transit operators, while accounting for demographic factors and alcohol.

METHODS

The sample consists of 654 San Francisco Municipal Railway (MUNI) transit operators who participated in two occupational health studies and biennial medical examinations during 1983-85 and 1993-95. Workers who had initiated, increased, or maintained their smoking over the ten year period were compared to workers who remained non-smokers. Occupational factors included self-rated frequency of job problems (e.g., difficulties with equipment, passengers, traffic), job burnout (i.e., the emotional exhaustion subscale of the Maslach Burnout Inventory), time needed to unwind after work, and years employed as a transit operator. A series of logistic regression models were developed to estimate the contribution of occupational factors to smoking behavior over time.

RESULTS

Approximately 35% of the workers increased, initiated, or maintained their smoking over the ten-year period. Frequency of job problems was significantly associated with likelihood of smoking increase, initiation, or maintenance (OR = 1.30; 95% CI 1.09, 1.55). Black operators were significantly more likely to have smoked over the ten-year period compared to operators in other racial/ethnic groups.

CONCLUSION

Understanding the role of work-related stress vis-à-vis smoking behavior is of critical importance for crafting workplace smoking prevention and cessation interventions that are applicable to blue-collar work settings, and for developing policies that mitigate occupational stress.