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1 =A B S T R A CT S = E ff e c t s of Cig are tt e S m okin g on P s y ch o s o ci al D i s t re s s an d O c cu pat i on al Ri s k s B on g - S uk Ch a, S ei - Jin Ch an g, Jon g - K u P ark, S an g - B aek K o, M y u n g - Gu en K an g, S an g - Y ul K o Departm ent of Pr ev entiv e M edicine and In stitute of Occupational M edicine W onju College of M edicin e, Yon sei Univ er sity, W onju, Korea T h e effect s of cigarette sm okin g on the psy ch osocial distress, th e ab senteeism, the occupational injuries, an d on the prev alence for the accidents w ere a sses sed in 795 m ale w orker s w h o had been employ ed sin ce M arch T h e result s show that the prev alence of current sm okers w ere higher in y oun g m en, low er edu cational lev el, low er incom e, sin gle m en (unm arried or div orced), alcoh ol drink er s, an d blu e collar w orker s. In th e biv ariate an aly ses, the w orkers w ith the high job dem an d an d low w ork control w ere m ore lik ely to sm oke, although th e relation ship w as n ot strong. T hose w ho reported low er satisfaction on his job ten ded to sm oke m ore. M ean scores of p sy chosocial w ell- bein g In dex (PW I) w ere higher in current sm okers th an n on sm okers. F or the hierarchical multiple regression an aly ses, interaction term s betw een cig arette sm okin g an d job stressor s (job dem an d an d w ork control) w ere not significant. F or sm oker s, th e odds ratios for the occupational injuries, and th e accident s w er e 1.40(95% confiden ce int erv al ) and 1.96 (95% confiden ce interv al ), respectiv ely. T h e mean ab sent day w ere 4.13 for sm oker s, 3.65 for n on sm okers, although the differences w ere n ot statistically significant. It seem s that cigarette sm okin g h ad n ot cau sed any crucial effect s on the psy ch osocial w ell- b ein g statu s an d the occupational risk s. Som e con sideration s for the further research on th e relation ship of cig arette sm okin g on the m ental health statu s an d the occupation al risk s w ere also discu ssed. K ey W or d s : Cig a r e t t e s m ok ing, J ob s t r e s s or, P s y chos oc ia l W e ll - b e ing S ta t us, O c c up a t iona l r is k s * 1995.

2 I.,,, (US. Departm ent of H ealth and Hum an Serv ices, 1989) (Surgeon Gen eral) (Surg eon Gen eral, 1985)..,. Fiore (1990) 39, 1/ 6. (1988) 16.60%, 3.51%. (Doll P eto, 1976 ; Rog ot Murray, 1980 ; T sai,1990), (V ogt Schw eitzer, 1983 ; Rice, 1986),,, (P enn er Penner, 1990 ; Bertera, 1991),.,. (Sch w artz, 1981)...,,, (Park es, 1983 ; V an T uinen Lan d, 1986 ; Bertera, 1991 ; Ry an, 1992)., 77% (H aw ker H oltby, 1988). (V an Peenen, 1986) (Nation al In stitute for Occupational Safety an d Health, 1979 ; T sai, 1990 ; Sack s Nelson, 1994)., (M etts, 1981).,., (occupational risk s ).

3 .?,.,..,.., (Kan del Davis, 1986 ; Glassm an, 1988 ; Anada, 1990). (Sch w artz, 1970),. (P arkes, 1983). (Caplan Cobb, 1975 ; Conw ay, 1981 ; W estm an Shiron, 1985 ; H ou se, 1986). Green John son (1990).,. (w ork disability ) T u omi(1991),.,. (,,,,, ), (job dem an d) (w ork control),.,, (job strain ). ( )

4 , Pieper (1989)5 (,, ). Albrigt (1992) 1,396.,,,.,.,.., (,,, ) (, ),.,,,,.

5 . 1. WH ,200, ,172 ( : 801, : 371 ) ,.,,,, (, ), ). - (,,, ) - (,,,,,, ) - (, ) - 2). - - (,, ) John son H all(1988) (job content in dicator ). (2 ) (10 ),, , 0-30,

6 ( ) ( ) (1993) Goldb erg (1979) GH Q- 60 (Gen eral H ealth Qu estionn aire )(P sy chosocial W ell- bein g Index : PW I). PW I 45,,,,,, PW I. PW I PW I. PW I.94. ( ) ( ). 4. SP SS/ PC + (v er sion 4.0) t,, 2, (odds ratio) 95%. (, ) (hierarchical multiple regression )..

7 1. III % % 24%. 58.5%,,,.,, (43.8% ) (30.2% ), (26.0% ) , 78%. 83.5%. 3 41% 10 14% 5.37 ( 5.01 ) % ( 1). 2..,.... 3, 60 ( 2). 3 95% , 1220,. 3, ,

8 ( 3).,.,, ( 4).. 2 (interaction effect ).. 3.,,,,,,.,,,,,,,,.,,,,,,,.,,, ( 5). ( 6) (R 2 ). 1 8, 2 21% , ,

9 5. PWI * ** ** ** * ** ** * ** * ** ** ** * * ** ** * ** ** ** ** ** ** ** ** * ** ** ** PWI * * ** ** ** a : (1:, 0: ) b : (1:,,, 0: ) c : (1:, 0:, ) d : (1:, 0:) e : (1:, 0:) PWI: P sy chosocial W ell- being Index * : P <.01, ** : P <.001

10 ,. 8 ( ) 95% ,, %.

11 . 78%..,,,,. (Orlean s, 1987), Rom ano (1991) 1,137. (Hunter, 1987 ; Nelson, 1994). (, ),., N elson (1994) % 24.2%8% 43.7% 39.2% 37.2% 34.5% 2. (Serx ner, 1991 : Serx n er 1992)., (selection m odel) ( ). (stress model)., (Green John son, 1990) (Caplan, 1975 ; Kaplan Cow les, 1978 ; Con w ay, 1981 ; W estm an, 1985 ; Strech er, 1986 ; Hou se, 1986). (culture m odel). (). (Green John son, 1990 ; Serx ner, 1992). (H ou se, 1988 ; John son, 1988 ; Serxn er, 1991 ; Rom ano, 1991)., 1.47, Pieper (1989)..

12 . (Ep stein Perkin s, 1988), (Shiffm an, 1982 ; Benfari, 1982)., (Ep stein Perkin s, 1988).,.,... (, ),.., (1 25 ).,..? (Epstein Perkin s, 1988). (Pomerlean, 1984) (Nesbitt, 1973 ; Pom erlean, 1984), (Epstein Jenning s, 1986). (A shton Stepney, 1982), (Henningfield Goldberg, 1983).. Gilbert (1979) (nicotine paradox ).,..,.

13 .,, ( )., (T sai, 1990 ; Ry an, 1992 ; Sack s N elson, 1994) (Van T uinen Lan d, 1986 ; Bertera, 1991 ; Ry an, 1992)., T sai (1990) 2.5, Ry an (1991),,,,, 1.4. (Kristein, 1983)....,. (M elam ed, 1989).. V an T uin en Land (1986) ( )...,,.,, (longitudin al)..

14 V., WH ,,.,,,,,.., ( 25 )..,,...,., () (, ),....

15 ;10(2): A lbright CL, W inkleby MA, Ragland DR, Fisher J, Sym e SL. Job strain and prev alen ce of hyperten sion in a biracial population of urban bu s driv er s. A m erican Journ al of Public H ealth. 1992;82: A shton H, Stepn ey R. Sm okin g : p sy chology an d pharm acology. London, T avistock Bertera RL. T he effects of beh avioral risk s on ab senteeism and h ealth - care cost s in th e w orkplace. Journal of Occupational M edicine. 1991;33: Caplan RD, Cobb S, Fren ch JRP. Relation ships of cessation of sm okin g w ith job stres s, per son ality, an d social support. Journ al of A pplied P sy chology. 1975;60: Conw ay T L, W ard HW, Vicker s RR, Rahe RH. Occupational stress an d v ariation in cigarette, coffee, and alcohol con sumption. Journ al of Health and Social Beh avior.1981;22: Doll R, Peto R. M ortality in relation to sm okin g : 20 y ear s ob serv ation s on male British doctor s. British M edical Journal. 1976;2: Epstein LH, Jennin g s JR. Sm okin g, stres s, cardiov ascular reactivity and coron ary heart disease. In K.A. M atth ew s, S.M. W eiss, T. Detre, T.M. Dembroski, B. F alkn er, S.B. M anuck, R.B. W illiam s (Eds.), Han dbook of stress, reactivity, an d cardiov ascular disease.1986: New York : W iley. Gilb ert DG. Paradoxical tranquilizin g and emotion - reducing effect s of nicotine. P sy ch ological Bulletin. 1979;86: Green KL, John son JV. T he effects of p sy chosocial w ork org anization on pattern s of cigarette sm oking am on g m ale chemical plant employ ees. Am erican Journ al of Public H ealth. 1990;80: H aw ker R, Holtby I. Sm okin g and ab sen ce fr om w ork in a population of student nur ses.

16 Public Health (Lon don ). 1988;102: H enningfield JE, Goldberg SR. Nicotine as a reinforcer in hum an subject s an d laboratory anim als. Pharm acology, Biochemistry, an d Behavior. 1983;19: H ou se JS, Landis KR, Umber son D. Social relation ship s an d health. Science. 1986;241: H ou se JS, Strech er V, M etzn er HL, Robbin s CA. Occupation al stress and health among m en w om en in the T ecum seh Community Health Stu dy. Journ al of H ealth an d Social Beh avior. 1986;27: Hunter SM, Croft JB, Vizelberg IA, Beren son GS. P sy chosocial influ ences on cigarette sm okin g am ong y outh in a southern community : th e Bog alu sa H eart Stu dy. MMW R.1987;36 (4S ):17S - 23S. John son JV, H all EM. Job strain, w ork place social support, and cardiov ascular disease : a cr os s - section al stu dy of a random sam ple of th e sw edish w orkin g population. A m erican Journal of Public H ealth. 1990;78: John son JV, H all EM, T heorell T. T he combin ed effect s of job strain an d social isolation on cardiov ascular disease m orbidity an d mortality in a ran dom sample of the Sw edish m ale w orkin g population. Scan dinav ian Journ al of W ork and Env ironm ental Health. 1989;15: Kara sek RA. Job dem ands, job decision latitu de, an d m ental strain : implication s for job redesign. A dministrativ e Science Qu arterly. 1979;24: M elam ed S, Luz J, Najen son T, Ju cha E, Green M. Erg on omic stress lev els, person al characteristics, accident occurrence an d sickn ess ab sence am ong factory w orker s. Ergonomics. 1989;32: M ett s A. T he relation ship betw een w ork injuries and sm oking habit s am on g a group of cotton textile w orkers. Oklahoma City : Univ er sity of Oklah om a Dissertation. N elson DE, Em ont SL, Brackbill RM, Cam er son LL, P eddicord J, F iore M C. Cig arette sm okin g prev alen ce by occupational in the United States - a comparison betw een 1978 to 1980 an d 1987 to Journ al of Occupational M edicine. 1994;36:

17 Orlean s CT, Schoenbach VJ, Salm on MA, et al. A surv ey of sm okin g and quitting pattern s am on g Black A merican s. Am erican Journal of Public Health. 1989;79: P arkes KR. Sm oking as a m oderator of the relation ship betw een affectiv e state and ab sence from w ork. Journ al of Applied P sy ch ology. 1983;68: P enn er M, Penn er S. Ex ces s in sured h ealth care cost s from tobacco- u sin g employ ees in a larg e group plan. Journal of Occupational M edicine. 1990; 32: Pieper C, Lacroix AZ, Karasek RA. T he relation of p sy chosocial dim en sion s of w ork w ith coronary heart disease risk factors : a m eta - analy sis of fiv e united states data bases. Am erican Journal of Epidemiology. 1989;129: P om erleau OF, T urk DC, F ertig JB. T he effect s of cig arette sm okin g on pain and anx iety. A ddictiv e Behav iors. 1984;9: Rice DP, H odg son T A, Sin sheim er P, Brow ner W, Kopstein AN. T he economic cost s of the health effects of sm oking Milbank Quterly. 1986;64: Rog ot E, Murray JL. Sm okin g and cau ses of death am ong U.S. v eteran s :16 y ear s of ob serv ation. Public H ealth Report. 1980;3: Rom an o PS, Bloom J, Sym e SL. Smoking, social support, an d has sles in an urban African - Am erican community. A merican Journ al of Public H ealth. 1991;81: Ru s sell MAH. Nicotine intake and it s regulation. Journal of P sy chosom atic Research. 1980;24: Ry an J, Zw erlin g C, Orav EJ. Occupation al risk s associated w ith cigarette sm okin g : a prospectiv e study. Am erican Journal of Public Health. 1992; 82: Sack s JJ, Nelson DE. Sm okin g and injuries : an ov erview. Prev entiv e M edicin e. 1994;23: S chiffm an SM. Relap se follow in g sm okin g ces sation : a situ ational analy sis. Journal of Con sulting and Clinical P sychology. 1982;50: Serx n er S, Catalan o R, Dooley D, Mishra S. T ob acco u se : selection, stress, or culture? Journal of Occupational M edicine. 1991;33:

18 Serx n er S, Catalano R, Dooley D, Mishra S. Influen ces on cigarette sm okin g quantity? Journal of Occupational M edicine. 1992;34: Shiffm an SM. Relap se follow ing sm oking cessation : A situ ational an aly sis. Journ al of Con sulting and Clinical P sychology. 1982;30: T heorell T, Ham sten A, de F aire U, Orth - Gom er K, Per ski A. P sy ch osocial w ork condition s before my ocardial infaction in y oung m en. International Journal of Cardiology. 1987;15: T sai SP, Cow les SR, Ros s CE. Sm oking and m orbidity frequency in a w orking population. Journal of Occupational M edicine. 1990;32: T uomi K, LSocSc, Lu ostarinen T, llm arin en J, Klock ar s M. W ork load and in dividu al factor s affecting w ork disability am on g aging municipal employ ees. Scandinavian Journal of W ork and Environm ental H ealth. 1991;17: U S Public H ealth S ervice, Office on sm oking an d H ealth : T h e H ealth Con sequen ces of Sm oking : Cancer and Chronic Lung Diseases in the W orkplace, a Report of th e Sur geon Gen er al DHHS Pub. N O. PHS W a shington, DC : Govt Printin g Office, 1985; V an Peen en PF D, Blanch ard A G, W olkon sky PM, Gill T M. H ealth in surance claim s of petrochemical company employ ees. Journ al of Occupation al M edicin e. 1986;28: V an T uinen M, Land G. Sm okin g an d ex cess sick leav e in a departm ent of health. Journ al of Occupation al M edicin e. 1986;28: V ogt T, Sch w eitzer S. M edical costs of cigarette sm okin g. Cited in Kristein MM. H ow much can bu sin ess expect to profit from sm okin g cessation? Prev entiv e M edicin e. 1983;12: W estm an M, Eden D, Shirom A. Job stress, cig arette sm okin g, an d ces sation : T he conditioning effects of per support. Social Science an d M edicin e. 1985;20:

19 1. :, ( ):% (% ) (% ) ( ) (44.7) 523 (79.0) (43.2), 43 ( 6.5) ( 8.9) 92(13.9) ( 3.2) 486 (64.8) 593 (77.6) 85 (11.3), 171(22.4) 180(29.9) 444 (58.5) 135 (17.8) 57 ( 7.5) 644 (83.5) 127 (16.5) 117 (15.4) 6 ( 0.8),, 301(39.0) 470(61.0) (40.9) 135 (17.9) 204 (27.0) ( 8.9) 15 40( 5.3), 348 (43.8) 240(30.2) 207 (26.0) ( ) (16.2) 222(31.2) 222(31.2) (10.8) (10.6)

20 2. :, ( ):%

21 P ( ) (81.9) 241(75.3) 46 (69.7) 17 (70.8) 60(18.1) 79 (24.7) 20(30.3) 7 (29.2) (78.8) 69 (83.1) 123 (71.9) 100(21.2) 14 (16.9) 48 (28.1) (80.3) 88 (68.8) 47 (83.9) 86 (76.1) 84 (19.7) 40(31.2) 9 (16.1) 27 (23.9) ,, 237 (81.7) 340(75.1) 53 (18.3) 113 (24.9) , 281(83.9) 147 (72.8) 145 (72.5) 54 (16.1) 55 (27.2) 55 (27.5) , ( ) (80.4) 25 (64.1) 66 (75.0) 502(80.4) 76 (63.3) 253 (84.6) 93 (73.2) 146 (74.1) 74 (71.2) 81(85.3) 148 (78.7) 145 (78.4) 44 (73.3) 51(78.5) 99 (19.6) 14 (35.9) 22(25.0) 122(19.6) 44 (36.7) 46 (15.4) 34 (26.8) 51(25.9) 30(28.2) 14 (14.7) 40(21.3) 40(21.6) 16 (26.7) 14 (21.5)

22 3. 95 % 95%,

23 4., N P , ()

24 T T a b c d e * * * * * * R F R 2 F * * a : (1:,,, 0: ) b : (1:, 0: ) c : (1:, 0:, ) d : (1:, 0:) e : (1:, 0:) * : P < 0.05, ** : P < 0.01

25 7.,, P 4.13 (6.49) 3.65 (4.99) (4.23) 0.95 (2.45) (2.06) 1.59 (2.00) ( / ) a > 25 < = 25 P 4.05 (6.52) 4.30(5.64) (4.46) 1.06 (2.63) (2.13) 1.56 (1.63) a : % 95% ( ) a, a (25 24 ) a, a a :

26

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