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Work stress, smoking status, and smoking intensity: an observational study of 46 190 employees
  1. Anne Kouvonen1,
  2. Mika Kivimäki1,
  3. Marianna Virtanen2,
  4. Jaana Pentti3,
  5. Jussi Vahtera3
  1. 1Department of Psychology, University of Helsinki, Finland
  2. 2Finnish Institute of Occupational Health, Helsinki, Finland
  3. 3Finnish Institute of Occupational Health, Turku, Finland
  1. Correspondence to:
 Dr A Kouvonen
 Department of Psychology, POB 9, FI-00014 University of Helsinki, Finland.;


Study objective: To examine the relation between work stress, as indicated by the job strain model, and the effort-reward imbalance model, and smoking.

Setting: Ten municipalities and 21 hospitals in Finland.

Design and participants: Binary logistic regression models for the prevalence of smoking were related to survey responses of 37 309 female and 8881 male Finnish public sector employees aged 17–65. Separate multinomial logistic regression models were calculated for smoking intensity for 8130 smokers. In addition, binary logistic regression models for ex-smoking were fitted among 16 277 former and current smokers. In all analyses, adjustments were made for age, basic education, occupational status, type of employment, and marital status.

Main results: Respondents with high effort-reward imbalance or lower rewards were more likely to be smokers. Among smokers, an increased likelihood of higher intensity of smoking was associated with higher job strain and higher effort-reward imbalance and their components such as low job control and low rewards. Smoking intensity was also higher in active jobs in women, in passive jobs, and among employees with low effort expenditure. Among former and current smokers, high job strain, high effort-reward imbalance, and high job demands were associated with a higher likelihood of being a current smoker. Lower effort was associated with a higher likelihood of ex-smoking.

Conclusions: This evidence suggests an association between work stress and smoking and implies that smoking cessation programmes may benefit from taking into account the modification of stressful features of work environment.

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  • Funding: this study was supported by the Finnish Work Environment Fund, the Academy of Finland (projects 77560, 104891, and 105195) and the participating towns and hospitals.

  • Conflicts of interest: none declared.

  • Dr Kouvonen was working as a Visiting Fellow Research at the Institute of Work, Health and Organisations, the University of Nottingham when preparing this paper.

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