Relationship of job stress with nicotine dependence of smokers--a cross-sectional study of female nurses in a general hospital.

The degree of nicotine dependence is an important predictor of successful cessation of smoking among smokers. Some investigators reported a possible relationship between reducing job stress and successful smoking cessation . This may be attributable to the effect of job stress on nicotine dependence. That is, high levels of job stress could produce and/or maintain high levels of nicotine dependence among smokers, and could result in difficulty in smoking cessation. If this hypothesis were true, workplace smoking cessation programs should take account of the influence of job stress on nicotine dependence, and measures to curb nicotine dependence resulting from coping with job stress should be introduced into the programs. There are, however, few reports that deal with the influence of job stress on the nicotine dependence of smokers in the workplace. Tobacco dependence is a multi-dimensional addiction that includes psychological and behavioral aspects of dependence on smoking or nicotine as well as physiological dependence 7, . It is important to measure various aspects of nicotine dependence separately. Two short and easyto-apply self-reporting questionnaires are frequently used to screen for nicotine dependence. They are the Fagerstrom Test of Nicotine Dependence (FTND) 2) and the Tobacco Dependence Screener (TDS). They evaluate different aspects of nicotine dependence. The FTND assesses the physiological aspects of nicotine dependence and is positively associated with the number of cigarettes smoked per day and the plasma level of nicotine and cotinine 2, . On the other hand, the TDS is closely correlated with the psychological aspects of nicotine dependence; a TDS score of 6 or greater indicates nicotine dependence diagnosed according to the International Classification of Diseases, 10 revision (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, third edition revised (DSM-III-R), with sensitivity values of 95% and 79%, and specificity values of 81% and 66%, respectively. In addition, previous studies reported a poor concordance between the FTND score and the DSM-III-R diagnosis; Moolchan et al. showed that the highest kappa (at a cutoff of the FTND=7 or greater) was .205. The objective of this cross-sectional study was to examine the relationship between perceived job stress and nicotine dependence assessed with two self-reporting questionnaires (i.e., the FTND and TDS) completed by workers who smoked tobacco. Nurses were chosen as subjects in this study. They are health professionals with a reportedly high prevalence of smoking ; in addition, they are expected to act as role models for patients with a desire to quit smoking. Elkind has reported that certain peculiar characteristics associated with the hospital environment and the nursing process may contribute to the smoking habits of nurses. Nurses deserve special attention in developing a smoking cessation program which considers the influence of job stress on the smoking habit.