Associations of sleep problems and recent life events with smoking behaviors among female staff nurses in Japanese hospitals

Differences in occupational stress by smoking intensity and gender in cross-sectional study of 59 355 Japanese employees using the Brief Job Stress Questionnaire (BJSQ): the Niigata Wellness Study

OBJECTIVES

It has been hypothesised that smoking intensity may be related to occupational stress. This study aimed to investigate whether stress, including problems with superiors or co-workers, is a driver of smoking.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

59 355 employees (34 865 men and 24 490 women) across multiple occupations who completed a self-reported questionnaire-based occupational stress survey between April 2016 and March 2017 in Niigata Prefecture.

MAIN OUTCOME MEASURES

Stress scores for the Brief Job Stress Questionnaire subscales summed up after assigning high points for high stress and converted to Z-scores based on the mean of all participants. Heavy smokers (HS) smoked ≥15 cigarettes/day and light smokers (LS) smoked <15 cigarettes/day and were compared with non-smokers (NS) by gender.

RESULTS

The main subscale items that were significantly associated with smoking status in both genders included 'physical burden', 'irritation' and 'physical symptoms'. In the analysis that included smoking intensity, the stress score for 'co-workers' support' was significantly lower for LS men than NS men (NS 0.091±0.98, LS -0.027±1.00, HS 0.033±0.99), and was significantly higher for HS women than NS women (NS -0.091±1.00, LS -0.080±1.05, HS 0.079±1.03). However, the stress score for 'co-workers' support' was low among LS women aged ≤39 years in the manufacturing industry.

CONCLUSIONS

It was speculated that LS men and some LS women gained 'co-workers' support' using smoking as a communication tool while reducing the degree of smoking. The existence of such 'social smokers' suggested that to promote smoking cessation, measures are essential to improve the communication between workers in addition to implementing smoking restrictions in the workplace.

Relationships between insomnia, long working hours, and long commuting time among public school teachers in Japan: a nationwide cross-sectional diary study

OBJECTIVES

The present study aimed to clarify the prevalence and risk factors of insomnia among public school teachers in Japan by examining the relationships between working hours, commuting time, and insomnia. Time spent on work activities among teachers with insomnia was also investigated.

METHODS

This study was a secondary analysis of data obtained in a 2016 survey of working conditions among public elementary/junior high school teachers in Japan. A total of 11,390 teachers (women: 47.4%, average age: 42.2 ± 11.3 years) were selected for analysis. The relationships between working hours, commuting time, and insomnia were evaluated using a binomial logistic regression model. The primary outcome was insomnia, defined by a score of ≥6 on the Athens Insomnia Scale. Explanatory factors were working hours/week, commuting time/day, six subscales of occupational stress, age group, presence of children, type of job, type of the school, and the urbanicity of the school.

RESULTS

In total, 41.7% of men and 44.0% of women were classified into the insomnia group. The insomnia group spent more time preparing for lectures, and a significant association was observed between insomnia and long working hours and commuting time. Results of multivariate logistic regression analysis showed that long working hours, long commuting time, and urbanicity of the school were statistically significantly associated with insomnia.

CONCLUSIONS

Insomnia is common among public school teachers in Japan. Our findings suggest the importance of reducing the time spent on working to prevent insomnia.

Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review

Shift workers often experience reduced sleep quality, duration and/or excessive sleepiness due to the imposed conflict between work and their circadian system. About 20-30% of shift workers experience prominent insomnia symptoms and excessive daytime sleepiness consistent with the circadian rhythm sleep disorder known as shift work disorder. Individual factors may influence this vulnerability to shift work disorder or sleep-related impairment associated with shift work. This paper was registered with Prospero and was conducted using recommended standards for systematic reviews and meta-analyses. Published literature that measured sleep-related impairment associated with shift work including reduced sleep quality and duration and increased daytime sleepiness amongst healthcare shift workers and explored characteristics associated with individual variability were reviewed. Fifty-eight studies were included. Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, higher scores on neuroticism and lower on hardiness were related to a higher risk of sleep-related impairment in response to shift work, whereas physical activity was a protective factor. The review highlights the diverse range of measurement tools used to evaluate the impact of shift work on sleep. Use of standardised and validated tools would enable cross-study comparisons. Longitudinal studies are required to establish causal relationships between individual factors and the development of shift work disorder.

Tobacco exposure and sleep disturbance in 498 208 UK Biobank participants

Background

The prevalence of sleep disturbance is high and increasing. The study investigated whether active, former and passive smoking were associated with sleep disturbance.

Methods

This cross-sectional study used data from the UK Biobank: a cohort study of 502 655 participants, of whom 498 208 provided self-reported data on smoking and sleep characteristics. Multivariable multinomial and logistic regression models were used to examine the associations between smoking and sleep disturbance.

Results

Long-sleep duration (>9 h) was more common among current smokers [odds ratio (OR): 1.47; 95% confidence interval (CI): 1.17-1.85; probability value (P) = 0.001] than never smokers, especially heavy (>20/day) smokers (OR: 2.85; 95% CI: 1.66-4.89; P < 0.001). Former heavy (>20/day) smokers were also more likely to report short (<6 h) sleep duration (OR: 1.41; 95% CI: 1.25-1.60; P < 0.001), long-sleep duration (OR: 1.99; 95% CI: 1.47-2.71; P < 0.001) and sleeplessness (OR: 1.47; 95% CI: 1.38-1.57; P < 0.001) than never smokers. Among never smokers, those who lived with more than one smoker had higher odds of long-sleep duration than those not cohabitating with a smoker (OR: 2.71; 95% CI: 1.26-5.82; P = 0.011).

Conclusions

Active and passive exposure to high levels of tobacco smoke are associated with sleep disturbance. Existing global tobacco control interventions need to be enforced.

The Prevalence of Insomnia, Its Demographic Correlates, and Treatment in Nurses Working in Chinese Psychiatric and General Hospitals

PURPOSE

To determine the prevalence of insomnia and its socio-demographic correlates in Chinese nurses.

DESIGN AND METHODS

Up to 799 nurses were examined. Demographic data, total sleep time (TST), and insomnia were collected.

FINDINGS

The mean expected and actual TST were 8.3 ± 1.5 and 6.1 ± 1.1 hr, respectively. The prevalence of at least one type of reported sleep disturbance was 69.7%; the rates of difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were 54.6%, 54.7%, and 55.9%, respectively.

PRACTICE IMPLICATIONS

There is a large discrepancy of actual and expected sleep duration, and insomnia is common among nurses in China.

Associations of Short Sleep and Shift Work Status with Hypertension among Black and White Americans

Objective. The purpose of this study was to investigate whether short sleepers (<6 hrs) who worked the non-day-shift were at greater likelihood of reporting hypertension and if these associations varied by individuals' ethnicity. Methods. Analysis was based on the 2010 National Health Interview Survey (NHIS). A total of 59,199 American adults provided valid data for the present analyses (mean age = 46.2 ± 17.7 years; 51.5% were female). Respondents provided work schedule and estimated habitual sleep durations as well as self-report of chronic conditions. Results. Of the sample, 30.8% reported a diagnosis of hypertension, 79.1% reported daytime shift work, 11.0% reported rotating shift work, and 4.0% reported night shift work. Logistic regression analysis showed that shift work was significantly associated with hypertension among Blacks [OR = 1.35, CI: 1.06–1.72. P < 0.05], but not among Whites [OR = 1.01, CI: 0.85–1.20, NS]. Black shift workers sleeping less than 6 hours had significantly increased odds of reporting hypertension [OR = 1.81, CI: 1.29–2.54, P < 0.01], while their White counterparts did not [OR = 1.17, CI: 0.90–1.52, NS]. Conclusions. Findings suggest that Black Americans working the non-day-shift especially with short sleep duration have increased odds of reporting hypertension.

[Tobacco and alcohol consumption according to workday in Spain]

OBJECTIVE

To examine the association between smoking and alcohol consumption and the type of working day in the Spanish population

METHODS

Cross-sectional study among employees residing in Spain aged >18 years (N=8,736). We took data from the National Health Survey (2011-2012). Information was collected on the type of working day (morning, afternoon, evening, part-time, reduced hours, and shift-work) and smoking and drinking habits. Demographic characteristics and health- and work-related factors were also taken into account. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated through log-binomial regressions.

RESULTS

Among respondents, 32.1% smoked regularly, especially those working the night shift (43.5%). Moderate alcohol consumption was found in 54.8% of workers and excessive consumption in 1.5%. Most of the moderate and heavy drinkers worked part-time, with 57.6% and 1.8% respectively. The aOR of being a smoker was higher among night workers (OR=1.58; 95% CI: 1.01-2.46). None of the work shifts were significantly associated with alcohol consumption.

CONCLUSIONS

Night shift work was associated with regular smoking. This collective of workers should be monitored closely by occupational health services and regularly undergo programs to control tobacco consumption and smoking-related diseases. Additional research to elucidate the reasons for this association could help to achieve preventive and therapeutic success.

Maquinistas ferroviários: trabalho em turnos e repercussões na saúde

Objetivo descrever o impacto do trabalho em turnos na saúde, no sono e na qualidade de vida de maquinistas ferroviários. Métodos foram avaliados 611 maquinistas (escalas de trabalho 4 x 1 e 6 x 2), por meio de polissonografia, Índice da Qualidade do Sono de Pittsburgh, Índice de Gravidade de Insônia, Questionário de Qualidade de Vida SF-36, Questionário de Horne e Östberg, Capacidade de Trabalho e Escala de Sonolência de Epworth. Resultados os maquinistas apresentaram idade média de 36,6 ± 15,1 anos, 22% apresentaram obesidade e 38,1% risco para doenças cardiovasculares. Em relação ao sono, 64,2% dos maquinistas relataram qualidade ruim de sono, 11,6% apresentaram distúrbios do sono e 29,3% sonolência excessiva. Os resultados da polissonografia mostraram que 36,1% deles apresentaram apneia do sono e 47,2% demonstraram eficiência do sono reduzida. Além disso, os maquinistas apresentaram baixos índices de qualidade de vida, especialmente os da escala 4 x 1. Conclusão é possível afirmar, na população estudada, que a exposição ao trabalho em turnos, a rotatividade inversa, pouco tempo dispensado às folgas e horas extras de trabalho estão associados a danos ao bem-estar, saúde, sociabilização e ao sono de qualidade desses trabalhadores e que provavelmente os fatores relacionados aos turnos de trabalho contribuem para esses danos.

Stress modulates illness-course of substance use disorders: a translational review

Childhood trauma and post-childhood chronic/repeated stress could increase the risk of a substance use disorder by affecting five stages of addiction illness-course: (a) initial experimentation with substances; (b) shifting from experimental to regular use; (c) escalation from regular use to abuse or dependence; (d) motivation to quit; and (e) risk of (re-)lapse. We reviewed the human literature on relationships between stress and addiction illness-course. We explored per illness-course stage: (i) whether childhood trauma and post-childhood chronic/repeated stress have comparable effects and (ii) whether effects cut across classes of substances of abuse. We further discuss potential underlying mechanisms by which stressors may affect illness-course stages for which we relied on evidence from studies in animals and humans. Stress and substances of abuse both activate stress and dopaminergic motivation systems, and childhood trauma and post-childhood stressful events are more chronic and occur more frequently in people who use substances. Stressors increase risk to initiate early use potentially by affecting trait-like factors of risk-taking, decision making, and behavioral control. Stressors also accelerate transition to regular use potentially due to prior effects of stress on sensitization of dopaminergic motivation systems, cross-sensitizing with substances of abuse, especially in people with high trait impulsivity who are more prone to sensitization. Finally, stressors increase risk for abuse and dependence, attenuate motivation to quit, and increase relapse risk potentially by intensified sensitization of motivational systems, by a shift from positive to negative reinforcement due to sensitization of the amygdala by corticotropin releasing factor, and by increased sensitization of noradrenergic systems. Stress generally affects addiction illness-course across stressor types and across classes of substances of abuse.

Smoking habits in relation to reproductive events among Japanese women: findings of the Japanese Nurses' Health Study

OBJECTIVE

The purposes of this study were to examine smoking habits in relation to the reproductive events of pregnancy and menopause and clarify the reasons for smoking cessation among ex-smokers.

METHOD

This is a cross-sectional study based on a baseline survey of a prospective cohort study. From 2001 to 2007, a self-administered questionnaire survey was conducted on 49,927 female nurses from all 47 prefectures in Japan. Logistic regression models were used to estimate age-adjusted odds ratios.

RESULTS

Of the respondents, 17.2% were current smokers, 11.6% were ex-smokers and 69.8% had never smoked. The prevalence of smoking during pregnancy was 7.8%. Among ex-smokers, 30.3% gave "reproductive events" as their reason for smoking cessation. Current smoking and the number of cigarettes smoked per day before menopause were significantly related to onset of menopause.

CONCLUSION

Women's smoking habits have mutual relationships with reproductive events such as pregnancy and menopause. Although "reproductive events" were an important reason for smoking cessation among women, 7.8% of women still smoked during pregnancy. Smoking was correlated with onset of menopause. Support for smoking cessation is an important healthcare issue throughout women's lifetimes.

Bidirectional associations between insomnia symptoms and unhealthy behaviours

It has been suggested that there are associations among insomnia symptoms and unhealthy behaviours. However, previous studies are sparse and mainly cross-sectional, and have not been focused on several key unhealthy behaviours. The aim of this study was to examine whether the associations are bidirectional, i.e. whether insomnia symptoms are associated with subsequent unhealthy behaviours, and whether unhealthy behaviours are associated with subsequent insomnia symptoms. The data were derived from the Helsinki Health Study prospective cohort study. The baseline data were collected in 2000-02 (n = 8960, response rate 67%) among 40-60-year-old employees of the City Helsinki, Finland. The follow-up data were collected in 2007 (n = 7332, response rate 83%). Logistic regression analysis was used to examine the associations among insomnia symptoms and unhealthy behaviours, including smoking, heavy and binge drinking, physical inactivity and unhealthy food habits. Frequent insomnia symptoms at baseline were associated with subsequent heavy drinking [odds ratio (OR): 1.34; 95% confidence interval (CI): 1.07-1.68] and physical inactivity (OR: 1.27; 95% CI: 1.08-1.48) after full adjustment for gender, age, corresponding unhealthy behaviour at baseline, marital status, occupational class, sleep duration and common mental disorders. Additionally, heavy drinking (OR: 1.48; 95% CI: 1.22-1.80) and binge drinking (OR: 1.26; 95% CI: 1.08-1.46) at baseline were associated with subsequent insomnia symptoms at follow-up after full adjustment. In conclusion, insomnia symptoms were associated with subsequent heavy drinking and physical inactivity, and heavy and binge drinking were also associated with subsequent insomnia symptoms.

[Knowledge, attitudes and behaviors of hospital staff members towards smoking and anti-smoking regulations: results of a survey in F.-Hached University Teaching Hospital of Sousse (Tunisia)]

BACKGROUND

Promoting a smoke-free hospital is a priority component for tobacco control strategies. The aim of our investigation was to study the attitudes and behaviors of the hospital staff of the F.-Hached UH of Sousse towards smoking, and to assess their knowledge about the harms of passive smoking and about tobacco regulations in the hospital.

METHODS

We conducted a descriptive cross-sectional study using an anonymous self-administered questionnaire. In January-February 2008, the questionnaire was submitted to hospital staff members selected at random from the care units at F.-Hached UH of Sousse, Tunisia.

RESULTS

The response rate was 92.8% (452 participants). The average age of the population was 39.7±19 years; all professional categories were represented. The prevalence of active smoking among the staff interviewed was 19% (89.5% males). About 75% of the smokers stated they smoked on the work site and 8% in the presence of patients. The majority of the smokers wished to stop smoking. Discomfort from exposure to tobacco smoke was reported by 83.4% of respondents. The large majority of staff respondents (95%) knew that tobacco smoke is dangerous and 80% were aware of the existence of a law that prohibits smoking in the hospital.

CONCLUSION

The prevalence of smoking remains high among male hospital workers. In our hospital, the majority of the care staff favored promotion of a tobacco-free hospital. The success of this project will depend on education, implicating the entire hospital staff in the anti-smoking battle. Smoking staff members should be supported in their attempts to stop smoking.

Sleep disorders and secondhand smoke exposure in the U.S. population

INTRODUCTION

Sleep disorders in the United States are pervasive and have been linked to increased risk of injury, morbidity, and mortality. Smoking is a known risk factor for sleep disorders; the association between secondhand smoke (SHS) exposure and sleep disorders is less clear. We sought to examine the relationship between SHS exposure and sleep disorders among a representative sample of U.S. adults (n = 4,123).

METHODS

Data were from the 2005-2006 National Health and Nutrition Examination Survey. Multivariable logistic regression models examined the association between both smoking and SHS exposure with two measures of sleep disorder (i.e., self-reported health care provider diagnosis and self-report of two or more sleep symptoms). SHS exposure status was based on a combination of self-report and serum cotinine levels.

RESULTS

Relative to nonsmokers without SHS exposure, smokers were significantly more likely to have been diagnosed with a sleep disorder (odds ratio [OR] = 1.73 [95% CI = 1.16-2.60]) and more likely to report at least two sleep disorder symptoms (OR = 1.42 [95% CI = 1.09-1.84]). SHS-exposed nonsmokers were not significantly more likely to report a sleep disorder or sleep symptoms (OR = 1.43 [95% CI = 0.79-2.57] and OR = 1.03 [95% CI = 0.83-1.27]), respectively.

DISCUSSION

Although smoking appears to play an important role in the prevalence of sleep disorders in the U.S. adult population, the role of SHS exposure is inconclusive and warrants further investigation.

Smoking among Shift Workers: More Than a Confounding Factor

In studies on the cardiovascular disease risk among shift workers, smoking is considered to be a confounding factor. In a study of 239 shift and 157 daytime workers, it was found that shift work was prospectively related to increased cigarette consumption, indicating that smoking might be in the causative pathway; however, the number of study subjects was too low to warrant sound conclusions. Therefore, data from the Maastricht Cohort study were used to investigate the longitudinal relation between smoking and shift work in a much larger population. In this study, a total of 12,140 employees were followed for two years by means of self-administered questionnaires. The authors compared workers who normally worked during daytime hours only (74%) with those who worked other than day shifts (26%). Logistic regression analyses were performed, adjusting for demographic factors of age, gender, and educational level to evaluate the risk of starting to smoke (n = 25) in the group of non-smoking workers and the risk of quitting (n = 318) in the group of smoking workers. Logistic regression analysis showed a significant association between shift work and taking up smoking during the two-year follow-up (odds ratio: 1.46, p = 0.03). The risk to stop smoking was somewhat lower in shift workers (odds ratio: 0.91) but not statistically significant (p = 0.5). To conclude, this study showed that, independent of educational level, shift workers are more prone to start smoking. This finding might have important implications for studies on the health effects of shift workers and for possible interventions aimed at the reduction of the excess health risk among shift workers.

Menstrual disorders and their influence on low back pain among Japanese nurses

An increasing body of evidence now suggests that menstrual disorders may influence the development of Low Back Pain (LBP) among women of reproductive age. To investigate this issue in Japan, we conducted a large cross-sectional survey of female nurses from a university teaching hospital during 2008. Nurses reported a wide range of symptoms both prior to and during menstruation, including breast tenderness, stomach pain, light headedness and fatigue. Around three-quarters had experienced at least one episode of LBP in the previous 12-months, with most symptoms lasting one week or less. Increasing body weight was correlated with an increased risk of LBP affecting their daily activities (OR: 12.94, 95%CI: 1.54-116.56). Having three or more children was correlated with a reduced risk of experiencing LBP (OR: 0.13, 95%CI: 0.01-0.97). Nurses who reported breast tenderness prior to menstruation were twice as likely to suffer LBP (OR: 2.09, 95%CI: 1.20-3.73), while those who reported breast tenderness during menstruation were almost twice as likely to suffer LBP that interfered with their daily activities (OR: 1.85, 95%CI: 1.06-3.32). Overall, our study suggests that reproductive symptoms and menstrual disorders may influence the development of LBP among Japanese nurses, although the magnitude of this effect appears to be less than that reported in some previous research.

Workplace Stressors and Lifestyle‐Related Cancer Risk Factors among Female Physicians: Assessment Using the Occupational Stress Index

This study examined the relationship between work stressors and lifestyle-related cancer risk factors (LRCRF): smoking, obesity, sedentariness and alcohol consumption, among 112 female physicians in Novi Sad, a region of high LRCRF prevalence. The participation rate was 92.6%. Participants completed the physician-specific version of the Occupational Stress Index (OSI). Self-reported data concerning LRCRF and working conditions were cross-validated with medical records, as well as with worksite measurements and expert observations. A total of 35 (31.3%) of the physicians were current smokers and 10 (8.9%) were heavy smokers (>20 cigarettes/day); 23 (20.5%) had a body mass index (BMI) of 28 or more, and 11 (9.8%) were obese (BMI> or =30). Only 27 (24.1%) regularly engaged in recreational physical activity (PA). Slightly over 5% consumed alcohol daily. Altogether 15 (13.4%) had a low lifestyle-related cancer risk profile (not a current smoker, BMI<28, regular recreational PA and no daily alcohol consumption). Total OSI and several OSI aspects, particularly threat avoidance alone or in combination, showed significant multivariate associations with LRCRF, as did individual OSI elements. The latter included long work hours, restricted problem-solving strategy, insufficient help with clinical difficulties and supervisory responsibility (obesity and/or sedentariness) and problems hampering patient care (smoking). There is an urgent need to lower the LRCRF among female physicians in this high risk region. Our findings suggest that diminishing the work stressor burden should be considered when developing intervention strategies aimed at these risk factors.