Gender Differences in Smoking Among an Urban Emergency Department Sample.

BACKGROUND: Urban emergency department (ED) patients have elevated smoking and substance use compared with the general population. We analyzed gender differences in smoking among an urban ED sample and assessed the contribution of substance use, demographic, and couple factors. METHODS: We conducted a secondary analysis of data obtained from a cross-sectional, observational survey (N = 1037 participants) on drinking, drug use, and intimate partner violence (IPV). Gender-specific logistic regression models for current (past 30-day) smoking and multinomial regression models for smoking intensity (light: ⩽5 cigarettes per day [CPD]; moderate: 6 to 10 CPD; heavier: >10 CPD) were estimated. RESULTS: Smoking prevalence was higher among men than women (35.5% vs 18.9%; P < .001). Substance use (frequency of intoxication, marijuana, amphetamine, and cocaine use), demographic (food insufficiency, unemployment), and couple-related factors (having a spouse/partner who smoked, IPV involvement, being in a same-gender couple) were differentially associated with current smoking and level of intensity among men and women. CONCLUSIONS: Emergency department staff should consider the impact of polysubstance use, food insufficiency, unemployment, and whether both partners in the couple smoke when screening patients for smoking and formulating cessation treatment plans. Women in same-gender relationships and those who have experienced IPV involvement may require additional referral.

Prevalence and Correlates of Current and Former Smoking among Urban Transit Workers.

Transit workers constitute a blue-collar occupational group that have elevated smoking rates relative to other sectors of employed adults in the United States. This study analyzed cross-sectional tobacco survey data from 935 workers (60% African American; 37% female) employed at an urban public transit agency in California. Prevalence of current and former smoking was 20.3% and 20.6%, respectively. Younger workers were less likely than older workers to be current or former smokers. Having a complete home smoking ban was associated with decreased likelihood of being a smoker [odds ratio (OR) = 0.04, 95% confidence interval (CI) = 0.01-0.17], as were neutral views about whether it is easy for a smoker to take a smoking break during their shift (OR = 0.50, 95% CI 0.28-0.88). Current smoking among the sample is > 50% higher than the adult statewide prevalence. Potential points of intervention identified in this study include perceived ease of worksite smoking breaks and establishing home smoking bans. Tailored cessation efforts focusing on older transit workers more likely to smoke are needed to reduce tobacco-related disparities in this workforce.

Discrepant Patterns of Heavy Drinking, Marijuana Use, and Smoking and Intimate Partner Violence: Results From the California Community Health Study of Couples.

This study analyzed whether discrepant (husband or wife use only) or concordant (both partners use) patterns of heavy drinking, marijuana use, and smoking are associated with increased risk for male-to-female partner violence and female-to-male partner violence among adult couples. Based on a geographic sample of married or cohabiting couples residing in 50 California cities, logistic regression analyses were conducted using dyadic data on past-year partner violence, binge drinking and frequency of intoxication, marijuana use, and smoking. When all substance use patterns were included simultaneously, wife-only heavy drinking couples were at elevated risk for male-to-female partner violence, as were concordant marijuana-using couples. Husband-only marijuana discrepant couples were at increased risk for female-to-male partner violence. Further research is needed to explore the processes by which discrepant and concordant substance use patterns may contribute to partner aggression.

Smoking cessation among transit workers: beliefs and perceptions among an at-risk occupational group.

BACKGROUND: Transit workers, in comparison to the general population, have higher rates of smoking. Although smoking cessation programs are often available through workers' HMOs, these programs are frequently underutilized. Quitting practices, including participation in cessation programs, are often associated with beliefs about smoking behaviors and the ability to quit. We analyzed how transit workers' beliefs about cessation might function as barriers to or facilitators of participating in cessation activities. FINDINGS: We conducted 11 focus group discussions with 71 workers (45% female; 83% African American) at an urban public transit agency. Most participants (83%) were bus operators. Only current smokers and former smokers were recruited. Both current and former smokers recognized the need to quit and some were familiar with or at least aware of cessation programs and pharmaceutical aids offered through their HMO. Many, however, believed there were factors, such as smoker's readiness to quit, recognition of the elements of addiction, and personal or observed experience with cessation, that facilitated or impeded successful quit attempts. CONCLUSION: Beliefs play an important role and influence the extent to which transit workers participate in smoking cessation. Being cognizant of and addressing these beliefs so that workers gain an informed understanding is important when designing cessation programs. Doing so may help in creating tobacco cessation efforts that are seen as both attractive and beneficial to transit workers.

BINGE DRINKING, SMOKING AND MARIJUANA USE: THE ROLE OF WOMEN's LABOR FORCE PARTICIPATION.

This study analyzed the role of women's labor force participation in relation to binge drinking, smoking and marijuana use among employment age married/cohabiting women. The sample consisted of 956 women who were employed as construction workers (n=104), or were unemployed (n=101), homemakers (n=227) or employed in non-physically demanding occupations (n=524). Results of multivariate logistic regression analyses showed that women construction workers were at elevated risk for smoking and monthly binge drinking; unemployed women were more likely to use marijuana. Women in both categories were at risk for polysubstance use. Additional research is needed to explicate how labor force participation influences women's substance use.

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.

Dimensions of problem drinking among young adult restaurant workers.

BACKGROUND: Nationwide surveys identify food service workers as heavy alcohol users. OBJECTIVES: This article analyzes dimensions and correlates of problem drinking among young adult food service workers. METHODS: A telephone survey of national restaurant chain employees yielded 1,294 completed surveys. RESULTS: Hazardous alcohol consumption patterns were seen in 80% of men and 64% of women. Multivariate analysis showed that different dimensions of problem drinking measured by the AUDIT were associated with workers' demographic characteristics, smoking behaviour, and job category. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: These findings offer evidence of extremely high rates of alcohol misuse among young adult restaurant workers.

Contribution of occupational factors to current smoking among active-duty U.S. Navy careerists.

Rates of cigarette smoking among active-duty U.S. military personnel remain elevated, ranging from 23% among Air Force personnel to 38% among Army personnel. The purpose of this study was to estimate the contribution of occupational factors to current smoking and heavy smoking among a sample of Navy careerists (those with at least 7 years of military service), and to determine if gender moderates these associations. Participants in the study (n = 2,922) were randomly recruited within over-sampled strata of women and racial/ethnic minorities, and voluntarily completed confidential self-administered questionnaires on drinking, smoking, demographic, and occupational factors during 2001-2002. Approximately 23% of study participants reported current smoking; 9% reported heavy smoking. Multivariate logistic regression models were developed to estimate the contribution of occupational factors to current smoking and heavy smoking. The results indicated that careerists in the enlisted ranks were significantly more likely to be current smokers and heavy smokers compared with careerist officers. In addition, those who were deployed at sea were significantly more likely to report current smoking compared with those not currently deployed at sea. Mean daily ounces of alcohol were also significantly associated with likelihood of current and heavy smoking. Gender did not modify the association between occupational factors and smoking. Because aspects of the work environment are potentially modifiable, understanding the role of occupational factors vis-à-vis smoking can aid in smoking prevention and cessation efforts within the military.

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.

Survey nonresponse bias among young adults: the role of alcohol, tobacco, and drugs.

The purpose of this study is to determine the role of alcohol, tobacco, and drug use as predictors of survey panel attrition among an occupational cohort of young adults in the U.S. military. Baseline data on substance use and sociodemographic factors were obtained from 2838 men and women through confidential, self-administered questionnaires while they attended Navy basic training or Officer Candidate School in 1998. Longitudinal follow-up using mailed self-administered questionnaires was begun in 2000. Multivariate logistic regression models were developed to estimate the odds of attrition in relation to baseline substance use. Results revealed that tobacco use was a significant predictor of attrition [Odds ratio (OR) = 1.63; 95% Confidence Interval (CI): 1.37, 1.95]. A significant interaction between level of education and drug use indicated that respondents with less than a college education who were also drug users were at elevated risk for attrition (OR = 2.39; 95% CI 1.09, 5.28). Other significant predictors of panel attrition were male gender and younger age. Alcohol use was not significantly associated with attrition. The findings suggest that tobacco users and drug users with less than a college education may be an important source of nonresponse bias in longitudinal surveys of employed young adults.

Did substance use change after September llth? An analysis of a military cohort.

The purpose of this study was to assess changes in alcohol, tobacco, and other drug use after the terrorist attacks of September 11 among a cohort of young military personnel consisting of 661 active duty Navy personnel, including 164 women. Paired sample t tests were computed to assess mean differences in substance use in the 30 days before and after September 11. Average daily alcohol consumption significantly declined in the 30 days after September 11 among enlisted personnel (n = 315) and officers (n = 360). Significant increases in the usual number of cigarettes smoked and in the number of days using prescription drugs after September 11 were observed among enlisted personnel, but not among officers. Increased use of cigarettes and prescription drugs among enlisted personnel after September 11 suggests that some sectors of the military may turn to tobacco and other substances to cope with traumatic circumstances such as the events of September 11.

Alcohol, tobacco, and drug use among young adults prior to entering the military.

This study examined the prevalence and correlates of alcohol, tobacco, and drug use among military recruits prior to enlistment. As part of a 5-year longitudinal study, a baseline survey was conducted with 2,002 Naval recruits. Despite being overwhelmingly underage, 75% of recruits consumed alcohol in the year before enlistment, and 26% had engaged in heavy drinking. About half had used tobacco, and 31% had used drugs. Multivariate logistic regression analysis revealed that although men were not at significantly greater risk than were women for preenlistment alcohol, heavy drinking or drug use, they were at elevated risk for preenlistment tobacco use (Odds Ratio = 1.71; 95% Confidence Interval = 1.21, 2.41). Normative beliefs concerning best friend's drinking were highly predictive of each outcome. Prior use of each substance was significantly associated with prior use of other substances. Preenlistment drinking, smoking, and drug use are prevalent behaviors in this population. These data can help to heighten awareness among employers as to the prevalence of substance use in the 17-24-year-old age group, and thereby inform policy and prevention programs.