Job strain and tobacco smoking: an individual-participant data meta-analysis of 166,130 adults in 15 European studies.
BACKGROUND
Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults.


RESULTS
We analysed cross-sectional data from 15 European studies comprising 166,130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166,130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking.


CONCLUSIONS
Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.
Finnish Institute of Occupational Health, Helsinki, Finland. katriina.heikkila@ttl.fi
Katriina
K
Heikkilä
Solja T
ST
Nyberg
Eleonor I
EI
Fransson
Lars
L
Alfredsson
Dirk
D
De Bacquer
Jakob B
JB
Bjorner
Sébastien
S
Bonenfant
Marianne
M
Borritz
Hermann
H
Burr
Els
E
Clays
Annalisa
A
Casini
Nico
N
Dragano
Raimund
R
Erbel
Goedele A
GA
Geuskens
Marcel
M
Goldberg
Wendela E
WE
Hooftman
Irene L
IL
Houtman
Matti
M
Joensuu
Karl-Heinz
KH
Jöckel
France
F
Kittel
Anders
A
Knutsson
Markku
M
Koskenvuo
Aki
A
Koskinen
Anne
A
Kouvonen
Constanze
C
Leineweber
Thorsten
T
Lunau
Ida E H
IE
Madsen
Linda L
LL
Magnusson Hanson
Michael G
MG
Marmot
Martin L
ML
Nielsen
Maria
M
Nordin
Jaana
J
Pentti
Paula
P
Salo
Reiner
R
Rugulies
Andrew
A
Steptoe
Johannes
J
Siegrist
Sakari
S
Suominen
Jussi
J
Vahtera
Marianna
M
Virtanen
Ari
A
Väänänen
Peter
P
Westerholm
Hugo
H
Westerlund
Marie
M
Zins
Töres
T
Theorell
Mark
M
Hamer
Jane E
JE
Ferrie
Archana
A
Singh-Manoux
G David
GD
Batty
Mika
M
Kivimäki
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012907:Smoking; D016540:Smoking Cessation; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D044465:White People; D017132:Workplace; D055815:Young Adult