616397
research-article2015
WHSXXX10.1177/2165079915616397Workplace Health & SafetyWorkplace Health & Safety
vol. 64  ■  no. 3
Impact of Work Environments and Occupational
Hazards on Smoking Intensity in Korean Workers
Young-Ju Kim, RN, ACNP, PhD1
Abstract: The purpose of this study was to investigate
the influence of work environments and occupational
hazards on smoking intensity by occupation type in Korean
workers. This study used the data from the Fourth Korea
National Health and Nutrition Examination Survey in
2009. The sample of this study included 3,769 adults who
were aged 18 years or older and had an occupation of
office work, sales, or manufacturing. After controlling for
sociodemographic characteristics, the generalized linear
models revealed that office workers and the sales force
who had smoking co-workers at the workplace were more
likely to smoke than those who did not. A dirty workplace
and exposure to occupational noise were significant
factors increasing the smoking intensity for manufacturers.
A smoking cessation program considering physical work
environments and co-workers’ support should be developed
for Korean workers.
Keywords: global occupational health, health promotion,
occupational hazards, occupational health and safety
programs, organizational culture/climate
I
t is well established that smoking is associated with a high
prevalence of occupational injury. Active smokers without a
history of occupational noise exposure are more likely to
have a hearing impairment than non-smokers (Nakanishi,
Okamoto, Nakamura, Suzuki, & Tatara, 2000). Smoking is also
associated with reduced vision in the dark (Havelius & Hansen,
2005) and sleep disorders (Nakata et al., 2005), which can cause
job-related injuries. Furthermore, for employees who smoke,
additional financial costs may be incurred due to absenteeism,
less productivity (Tsai, Wen, Cheng, & Huang, 2005), and health
care expenditures (Yang, Fann, Wen, & Cheng, 2005).
Many workplaces in Korea have now prohibited smoking,
provided smoking cessation programs, or at least introduced
smoking policies. These measures and a range of community-
based initiatives have significantly decreased smoking
prevalence rates. Although smoking prevalence among men in
DOI: 10.1177/2165079915616397. From 1Sungshin Women’s University. Address correspondence to: Young-Ju Kim, RN, ACNP, PhD, Associate Professor, College of Nursing, Sungshin Women’s
University, 76ga-gil 55, Dobong-ro, Kangbuk-gu, Seoul, 142-732, Korea; email: yjkim727@sungshin.ac.kr.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2015 The Author(s)
Workplace Health & Safety
ARTICLE
Korea was 42.1% in 2012, it has been declining over the past
two decades (Korean Statistical Information Service [KOSIS],
2012). In contrast, the smoking prevalence among Korean
women was only 6.2% in 2012, but it has been increasing over
the past two decades (KOSIS, 2012). Thus, smoking is a
significant issue for many Korean workers as it is for workers in
other countries, and it is important to identify ways in which the
workplace, work environment, and organization of work might
contribute to smoking behavior.
This study used the social ecological theory (McLeroy,
Bibeau, Steckler, & Glanz, 1988) as a theoretical framework to
identify the association between work environments,
occupational hazards, and smoking intensity. A contention
within the social ecological theory is that an individual’s health
is influenced by physical aspects (e.g., ergonomic design of
jobs, exposure to toxic substances), social aspects (e.g., shift
work, hours worked per week), and psychological aspects (e.g.,
decision latitude, work demands) of workers’ jobs as well as
their dispositions, resources, and characteristics (Chin, Hong,
Gillen, Bates, & Okechukwu, 2013; Ettner & Grzywacz, 2001).
Based on a literature review and theoretical framework, we
selected variables from individual, health, behavioral,
psychological, interpersonal, and occupational aspects that
influence smoking intensity among Korean workers.
Work environmental factors and occupational hazards other
than psychosocial factors have received only limited attention in
previous research. Many studies have focused on assessing the
relationships between current smoking status and psychological
stress as indicated by models of job strain (Fujishiro & Heaney,
2009; Heikkila et al., 2012; Kouvonen, Kivimaki, Virtanen, Pentti, &
Vahtera, 2005; Kouvonen et al., 2007; Li et al., 2010; Ota et al.,
2010; Radi, Ostry, & LaMontagne, 2007). Some studies have
examined the association of smoking and work environment in
terms of work shift, perception of one’s work (Sanderson, Ekholm,
Hundrup, & Rasmussen, 2005), physical workload (Albertsen,
Hannerz, Borg, & Burr, 2004), peer smoking at the worksite
(Honjo, Tsutsumi, Kawachi, & Kawakami, 2006), or social support
(May & West, 2000; Steptoe, Wardle, Pollard, Canaan, & Davies,
1996). However, these studies have not produced consistent
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Workplace Health & Safety March 2016

Korean National Health Survey in 2009

N = 10,078

Participants aged 18 years or older

N = 8,012

N = 4,243 (excluded)
- Unemployed (including housewives, students): 3,142
- Jobs other than office work, sales, or manufacturing: 644
- No response to question of occupation: 457

Participants who were employed at the time of survey & answered

that their occupation was office work, sales, or manufacturing
N = 3,769

Figure 1.  Screening process used to select the study sample.

(KNHANES VI-3) conducted by the Korea Centers for Disease

Applying Research to Practice Control and Prevention (KCDC). The KNHANES VI-3 data were
publicly available and provided only de-identified data, and the
The study found that office workers and the sales force
researchers did not contact the participants.
who had smoking co-workers at the workplace were more
likely to smoke than those who did not. More importantly, Setting and Sample
exposure to occupational noise and dirty workplaces were
The KNHANES VI-3 is a large, population-based, cross-
significant factors increasing smoking intensity for
sectional survey of Korean non-institutionalized civilians. The
manufacturers. These findings emphasize that supporting
survey used a systematic stratified cluster sampling design based
co-workers’ smoking cessation is an important factor to be
on geographic area, gender, and age. The sampling frame was
considered when implementing a workplace smoking
based on the 2009 Korean National Census Registry. Weights
cessation program for office workers and sales force. A
indicating the probability of being sampled were assigned to
tailored smoking cessation program that focuses on
each respondent, enabling the results to represent the entire
physical work environments as well as co-workers’ support
Korean population (KCDC, 2010).
should be developed for Korean workers.
The KNHANES VI-3 consisted of three questionnaires: Health
Interview Survey (HIS), Nutrition Survey, and Health
Examination Survey. The authors extracted data from
findings. The main reason for inconsistent results may be that
approximately 10,078 HIS, which included sociodemographic
sample sizes were too small to detect effects (Albertsen et al.,
and health-related behavior (i.e., physical activity, cigarette
2004). There might be an association between smoking and
smoking, and alcohol use as well as information about work
occupational hazards such as dust, chemicals, or noise, but
environments) data (KCDC, 2010).
relatively few studies (Albertsen et al., 2004; Chin, Hong, Gillen,
The sample for this study included adults aged 18 years or
Bates, & Okechukwu, 2012) have investigated such associations.
older working in offices, sales, or manufacturing. Unemployed
It is important to identify significant workplace factors
individuals, including housewives and students, were excluded.
related to smoking so that occupational health nurses can
Participants who did not respond to the question about
develop and implement more effective workplace strategies to
occupation were also excluded. Consequently, 3,769
impact smoking behavior. Therefore, the purpose of this study
respondents were selected for the final analysis. Figure 1
was to assess the influence of work environments and
illustrates the screening process for selecting the study sample.
occupational hazards on smoking intensity by occupation type
after adjusting for sociodemographic characteristics of a large Measures
sample of Korean workers.
Sociodemographic variables included age (i.e., 18-24, 25-34,
35-44, 45-54, 55-64, ≥65 years), gender (male, female), marital
Method status (married, divorced/separated/widowed, never married),
This secondary data analysis used data from the Fourth education (elementary school graduate or less, middle school
Korea National Health and Nutrition Examination Survey graduate, high school graduate, college graduate or higher),

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vol. 64  ■  no. 3
household income (lower, lower-middle, upper-middle, upper),
and living arrangement (living alone, living with others).
Health-related behavioral characteristics included frequency
of alcohol consumption (none or <1 time per month, 1-4 times
per month, 2-3 times per week, ≥4 times per week) and
perceived stress level (high, moderate, low).
Working conditions were assessed by determining
employment status (employed full-time, employed part-time),
weekly working hours (≤40, >40 hours per week), working time
of the day (day shift, night shift), and co-workers’ smoking at
workplace (yes, no).
Work environments were assessed using eight questions: “Is
your worksite clean and pleasant?” (Clean worksite); “Is your
work so dangerous that you are at a high risk of an accident?”
(Risk of accident); “Is your workload so demanding that you are
always short of time?” (Psychological demand); “Do you have
power in deciding working time or process?” (Decision
authority); “Are you respected or trusted by your co-workers?”
(Respect/trust); “Does your work require that you are in an
uncomfortable posture for a long time?” (Uncomfortable
posture); “Does your work require that you lift or move a heavy
object?” (Physical strain); and “Do you have to hide your
emotions at work?” (Hiding one’s emotion). All these questions
were originally measured by using four scales: to a high degree,
to some degree, to lesser degree, or no degree. In this study,
responses were dichotomized into high (high and some degree)
or low degree (low and no degree).
Occupational hazards were measured using six single
questions: “Are you exposed to risky chemical substances such as
organic solvents, heavy metals, or agricultural chemicals?”
(Chemical substance); “Are you exposed to air pollution such as
dust, fumes, or humectants?” (Air pollution); “Do you handle
dangerous equipment or machinery?” (Dangerous equipment); “Are
you exposed to fire or electrical shock?” (Fire/electrical shock); “Are
you exposed to noise so high that you have to raise your voice to
talk with others?” (Noise); and “Do you handle infectious specimens
or microorganisms?” (Infection). Responses for these questions
were categorized as either not exposed or exposed to each hazard.
Smoking intensity, as a dependent variable, was measured
by a question asking the average number of cigarettes smoked
per day. If respondents reported that they were ex-smokers or
lifetime non-smokers, smoking intensity was recorded as zero.
Data Analysis
For the study results to represent the entire Korean
population, the complex sample analysis which included strata,
cluster, and sample weight was used. A bivariate analysis using t
test (a test to compare the means of two groups) or analysis of
variance (a test to compare the means among more than two
groups) compared the average number of cigarettes per day by
sociodemographic and work environment characteristics. A
generalized linear model (GLM) was used to identify the impact
of work environment and occupational hazards on smoking
intensity. The GLM is a flexible generalization of ordinary linear
regression that allows response variables to have error
Workplace Health & Safety
distribution models other than a normal distribution. A two-
tailed, p < .05 level of significance was used. All analyses were
conducted using SPSS version 21.0 (IBM Corp., Armonk, NY).
Results
Table 1 illustrates the bivariate comparisons of smoking
intensity by sociodemographic variables, health-related
behavioral characteristics, and working conditions among the
three occupational groups (i.e., office workers, sales force, and
manufacturing workers). The number of cigarettes per day
differed significantly by age, gender, education, and frequency
of alcohol consumption. Long work hours, full-time
employment, and co-workers’ smoking were related to higher
smoking intensity for all occupations. Day shift work was
associated with higher smoking intensity in office workers,
whereas evening shift work was associated with higher smoking
intensity in manufacturing workers.
Table 2 shows the smoking intensity according to type of work
environment. For office workers, a clean worksite and lower level
of decision authority correlated significantly with a lower average
number of cigarettes smoked per day. For the sales force, a
significant relationship was found between a higher risk of
accidents and more intense smoking. For manufacturing workers, a
clean worksite, lower risk of accidents, and lower decision
authority correlated significantly with less smoking intensity.
Office workers who handled dangerous equipment smoked
heavily in comparison with officer workers who were not
exposed to this risk (Table 3). Handling dangerous equipment
and exposure to fire or electrical shock and noise significantly
increased manufacturers’ smoking intensity.
Multivariate Analysis
The impact of work environments and occupational hazards
on smoking intensity among the three occupational groups is
presented in Table 4. All GLM statistics were controlled for age,
gender, education, household income, and frequency of alcohol
consumption. Office workers who had smoking co-workers
were more likely to smoke than those who did not have
smoking co-workers (β = 0.751, 95% confidence interval [CI] =
0.005-1.498). Sales force who had smoking co-workers (β =
0.978, 95% CI = [0.56, 1.90]) and had not been exposed to fire
or electrical shock risk (β = 1.75, 95% CI = [0.39, 3.11]) were
significantly more likely to smoke compared with sales workers
who had been exposed to fire or electrical shock hazards and
did not have smoking co-workers. A dirty workplace (β = 1.69,
95% CI = [0.64, 2.74]) and exposure to occupational noise (β =
0.83, 95% CI = [0.09, 1.15]) correlated significantly with
increased smoking intensity for manufacturing workers.
Discussion
The researchers found that the impact of work environments
and occupational hazards on smoking intensity differed by
occupational type. Office workers and sales workers who had
smoking co-workers were significantly more likely to smoke; this
105
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Table 1.  Comparisons of Smoking Intensity by Sociodemographic Characteristics Among Occupations

Office workers Sales force Manufacturers

Variables n M ± SD p n M ± SD p n M ± SD p
Age, years
 18-24 121 1.91 ± 4.45 .004  96 4.55 ± 6.74 .000 40 3.97 ± 5.59 .000
 25-34 440 3.39 ± 6.77 150 6.80 ± 8.23 150 9.53 ± 9.36  
Workplace Health & Safety

 35-44 482 4.35 ± 8.08 272 4.47 ± 8.22 306 7.18 ± 10.5  
 45-54 284 5.01 ± 9.62 313 3.53 ± 8.51 398 5.29 ± 9.78  
 55-64 867 3.60 ± 7.22 122 3.23 ± 8.09 272 5.59 ± 9.85  
  ≥65 18 4.06 ± 11.4  45 1.58 ± 4.28 174 2.91 ± 6.98  
Gender
 Female 652 0.38 ± 2.08 .000 606 1.18 ± 3.76 .000 481 0.66 ± 3.22 .000
 Male 772 6.89 ± 9.48 392 8.98 ± 10.4 859 8.85 ± 10.7  
Marital status
  Married or living with a partner 977 4.35 ± 8.40 .002 707 3.96 ± 8.31 .164 1,053 6.00 ± 9.92 .008
  Divorced, separated, or widowed 60 4.75 ± 8.07 114 4.55 ± 8.13 167 4.41 ± 8.35  
  Never married 394 2.74 ± 6.04 176 5.23 ± 7.26 118 7.68 ± 8.53  
Education
  Up to elementary school graduate 13 2.30 ± 8.32 .046 148 2.61 ± 7.31 .000 383 3.99 ± 8.54 .000
  Middle school graduate 24 7.71 ± 8.53 151 2.51 ± 6.89 236 5.69 ± 9.95  
  High school graduate 407 4.32 ± 8.10 485 4.48 ± 8.03 594 6.97 ± 9.94  
  College graduate or higher 987 3.70 ± 7.68 214 6.08 ± 9.16 127 7.14 ± 10.1  
Household income
 Lower 60 4.92 ± 9.15 .712 115 3.72 ± 7.88 .296 243 4.05 ± 8.15 .005
(continued)
March 2016
 Table 1.  (continued)

Office workers Sales force Manufacturers

Variables n M ± SD p n M ± SD p n M ± SD p
vol. 64  ■  no. 3

 Lower-middle 209 3.71 ± 6.97 246 3.54 ± 7.30 372 5.92 ± 9.91  
 Upper-middle 424 4.04 ± 8.07 330 4.62 ± 8.46 412 6.83 ± 9.94  
 Upper 722 3.80 ± 7.84 296 4.65 ± 8.44 307 6.02 ± 9.77  
Living arrangement
  Living alone 56 3.37 ± 6.64 .588  39 2.44 ± 5.03 .154 79 4.41 ± 8.40 .153
  Living with others 1,375 3.95 ± 7.88 959 4.32 ± 8.21 1,261 6.01 ± 9.71  
Frequency of alcohol consumption
  Fewer than 1 time per month 516 1.15 ± 4.39 .000 347 2.25 ± 6.36 .000 472 3.51 ± 8.14 .000
  1-4 times per month 585 3.80 ± 7.39 393 3.78 ± 7.31 437 5.07 ± 8.85  
  2-3 times per week 259 7.49 ± 9.18 154 6.72 ± 9.13 278 8.63 ± 10.4  
  4 or more times per week 71 12.3 ± 13.1 104 9.02 ± 11.3 153 10.7 ± 11.6  
Level of perceived stress
  High level of stress 518 4.45 ± 8.33 .133 329 5.11 ± 9.01 .031 353 6.09 ± 10.2 .573
  Moderate level of stress 790 3.56 ± 7.19 564 3.99 ± 7.78 799 5.71 ± 9.16  
  Low level of stress 123 4.11 ± 9.42 104 2.94 ± 6.59 187 6.47 ± 10.6  
Employment status
  Full-time employed 1,227 4.14 ± 7.94 .010 817 4.51 ± 8.29 .037 1,141 6.26 ± 9.93 .001
  Part-time employed 203 2.60 ± 6.99 180 3.11 ± 7.19 199 3.89 ± 7.54  
Working hours per week
  ≤40 hours 689 3.19 ± 7.41 .001 348 3.53 ± 7.56 .039 585 4.76 ± 8.71 .000
  >40 hours 741 4.61 ± 8.16 650 4.63 ± 8.37 755 6.80 ± 10.2  
Working time of the day
  Day shift 1,219 4.10 ± 8.03 .026 744 4.01 ± 8.24 .140 1,088 5.56 ± 9.52 .005
  Night shift 209 2.79 ± 6.32 251 4.91 ± 7.72 252 7.44 ± 10.1  
Co-workers smoking at worksite
 Yes 650 5.01 ± 8.55 .000 560 5.21 ± 9.07 .000 722 6.91 ± 9.99 .000
 No 781 3.03 ± 7.07 437 3.03 ± 6.51 617 4.75 ± 9.10  
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Table 2.  Comparisons of Smoking Intensity by Work Environments Among Occupation

Office workers Sales people Manufacturers

Variables n M ± SD p n M ± SD p n M ± SD p
Clean worksite
 Low 147 5.22 ± 8.81 .034 151 5.32 ± 9.09 .081 458 7.90 ± 10.7 .000
 High 1,283 3.77 ± 7.70 846 4.06 ± 7.92 882 4.88 ± 8.89  
Workplace Health & Safety

Risk of accident
 Low 1,240 3.81 ± 7.74 .157 781 3.91 ± 7.73 .011 702 4.34 ± 8.49 .000
 High 190 4.67 ± 8.37 216 5.50 ± 9.28 638 7.64 ± 10.5  
Psychological demands
 Low 858 3.61 ± 7.69 .072 634 4.31 ± 8.16 .780 864 5.92 ± 9.46 .952
 High 569 4.37 ± 8.03 363 4.15 ± 8.05 476 5.89 ± 9.99  
Decision authority
 Low 257 2.26 ± 5.54 .000 221 3.83 ± 7.64 .386 528 4.81 ± 8.74 .001
 High 1,173 4.28 ± 8.20 776 4.37 ± 8.25 812 6.63 ± 10.1  
Respected by peers
 Low 100 4.98 ± 8.18 .160  81 5.41 ± 9.35 .178 163 6.82 ± 9.94 .189
 High 1,329 3.83 ± 7.80 914 4.14 ± 7.98 1,176 5.76 ± 9.96  
Uncomfortable posture
 Low 1,229 3.97 ± 7.82 .511 728 4.26 ± 8.21 .948 851 5.79 ± 9.52 .530
 High 200 3.58 ± 7.86 268 4.23 ± 7.87 488 6.13 ± 9.88  
Physical strain
 Low 1,323 3.83 ± 7.72 .138 687 4.30 ± 8.02 .781 830 5.56 ± 9.39 .086
 High 106 5.01 ± 9.05 310 4.15 ± 8.34 509 6.49 ± 10.0  
Hide one’s emotions
 Low 917 4.03 ± 8.01 .451 571 3.89 ± 7.81 .104 841 5.68 ± 9.41 .259
 High 513 3.71 ± 7.51 426 4.74 ± 8.50 498 6.30 ± 10.1  
March 2016
 vol. 64  ■  no. 3

Table 3.  Comparisons of Smoking Intensity by Exposure to Occupational Hazards Among Occupation

Office workers Sales people Manufacturers

Variables n M ± SD p n M ± SD p n M ± SD p
Chemical substance
  Not exposed 1,302 3.81 ± 7.76 .105 930 4.16 ± 7.97 .236 1,066 5.92 ± 9.70 .969
 Exposed 128 4.99 ± 8.46 66 5.39 ± 10.0 272 5.90 ± 9.47  
Air pollution
  Not exposed 1,055 3.74 ± 7.66 .158 563 4.94 ± 8.86 .282 492 5.34 ± 9.17 .093
 Exposed 375 4.41 ± 8.26 433 3.93 ± 7.90 846 6.25 ± 9.91  
Dangerous equipment
  Not exposed 1,229 3.58 ± 7.61 .000 830 4.14 ± 8.01 .354 857 4.57 ± 8.76 .000
 Exposed 201 5.98 ± 8.82 166 4.78 ± 8.66 480 8.34 ± 10.6  
Fire/electrical shock
  Not exposed 1,318 3.86 ± 7.83 .286 825 4.52 ± 8.41 .018 1,054 5.50 ± 9.34 .002
 Exposed 112 4.67 ± 7.81 171 2.91 ± 6.38 283 7.49 ± 10.6  
Noise
  Not exposed 1,063 3.75 ± 7.69 .178 708 4.04 ± 7.71 .202 672 4.99 ± 9.05 .000
 Exposed 367 4.39 ± 8.19 289 4.76 ± 9.03 667 6.84 ± 10.1  
Infection
  Not exposed 1,275 4.05 ± 7.88 .076 867 4.33 ± 8.19 .389 1,174 5.93 ± 9.62 .924
 Exposed 154 2.86 ± 7.35 129 3.67 ± 7.64 164 5.85 ± 9.88  
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Workplace Health & Safety March 2016

Table 4.  Impact of Work Environments and Occupational Hazards on Smoking Intensity Among Occupations

Office workers Sales people Manufacturers

Variables Coefficient (95% confidence interval)
Working conditions
  Employment status
   Full-time (vs. part-time employed) −.424 [−1.586, 0.739] .580 [−0.767, 1.928] .525 [−0.886, 1.935]
  Working hours per week
  ≤40 hours (vs. >40 hours) −.104 [−0.901, 0.693] .038 [−1.048, 1.124] −.058 [−1.099, 0.983]
  Working time of the day
   Day shift (vs. night shift) .540 [−0.554, 1.634] −.108 [−1.189, 0.972] −.946 [−2.167, 0.276]
  Co-workers’ smoking at worksite
   Yes (vs. No) .751 [0.005, 1.498]* .978 [0.056, 1.900]* −.404 [−1.402, 0.595]
Work environments
  Clean worksite
   Low (vs. High) .948 [−0.298, 2.194] .900 [−0.391, 2.191] 1.691 [0.641, 2.741]*
  Risk of accident
   Low (vs. High) .600 [−0.582, 1.781] −.744 [−1.891, 0.403] −.503 [−1.574, 0.567]
  Decision authority
   Low (vs. High) −.497 [−1.459, 0.466] .386 [−0.733, 1.505] −.462 [−1.446, 0.522]
Occupational hazards
  Air pollution
   Not exposed (vs. Exposed) −.064 [−1.012, 0.883] .488 [−0.509, 1.484] .329 [−0.738, 1.396]
  Dangerous equipment
   Not exposed (vs. Exposed) −.543 [−1.868, 0.781] −.245 [−1.628, 1.137] −.868 [−2.087, 0.351]
  Fire/electrical shock
   Not exposed (vs. Exposed) 1.448 [−0.102, 2.998] 1.754 [0.392, 3.116]* .297 [−0.978, 1.571]
 Noise
   Not exposed (vs. Exposed) −.402 [−1.321, 0.518] −.397 [−1.448, 0.655] .083 [0.009, 1.154]*

Note. Adjusted for age, gender, education level, household income, and frequency of alcohol consumption.
*p < .005.

finding is consistent with previous studies (Chin et al., 2013;
Perrine & Aloise-Young, 2004). Peer pressure is widely assumed to
be a significant causal factor in the initiation of smoking. Perrine
and Aloise-Young (2004) found that the likelihood of smoking
was 4 times higher if one friend was a smoker and increased by
up to 160 times if four friends were smokers. Yasin, Retneswari,
Moy, and Koh (2012) found a strong association between
co-workers’ support and smoking cessation. When attempting to
quit, the effect of co-worker support may be enhanced when
offered by non-smoking colleagues or ex-smokers.

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vol. 64  ■  no. 3
According to social cognitive theory, individuals’ perceptions
of the environment create behavioral norms, which in turn
impact health behaviors. A social environment with many
smokers creates a barrier for smokers to quit smoking because
social norms that approve smoking are promoted (Honjo et al.,
2006). Social support from co-workers is a critical factor for
many workplace health promotion programs. As social support
at work is associated with employees’ health risks and
predictive of subsequent behavior change, workplace health
promotion interventions could achieve desired outcomes by
ensuring that the support of smoking partners and co-workers is
integrated into the design and delivery of programs (Chin et al.,
2013).
In this study, sales workers who reported no exposure to fire
or electrical shock in their workplaces were more likely to smoke
than those who were exposed to potential fire or electrical shock
hazards in their workplaces. Lit cigarettes are the leading cause of
unintentional residential fires in Korea. In 2010, 37.6% of a total
of 1,432 residential building fires were unintentional, and 11.7%
of these unintentional fires were caused by smoking (Life Safety,
2011). Using modeling, a 1% decrease in smoking corresponded
to a 7% decrease in the residential fire mortality rate (Diekman,
Ballesteros, Berger, Caraballo, & Kegler, 2008). Iacobelli et al.
(2008) found that current smokers perceived that the risk of an
accident while smoking was drastically lower than that perceived
by the non-smoking public. This finding is consistent with current
smokers’ tendencies to minimize the health impact of their own
smoking behavior (Weinstein, Marcus, & Moser, 2005). Thus,
knowledge of an elevated risk of accidents for smokers is not as
common as knowledge of an elevated risk of health problems
associated with smoking, such as cancer or respiratory disease
(Iacobelli et al., 2008).
Cigarette smoking is a modifiable behavior at the individual
level. However, efforts to change individual behaviors often
have little effect at the population level (Diekman et al., 2008).
Environmental influences at community and societal levels
interact with individual-level human behavior (Ettner &
Grzywacz, 2001). The adoption of nationwide fire-safe cigarette
laws may be one example of the interplay between
environmental and individual factors (Diekman et al., 2008).
Successful efforts to reduce smoking and adhere to workplace
fire protection recommendations may translate into a reduction
in residential fire mortality rates.
Worksite cleanliness was found to be related to increased
smoking intensity in manufacturing workers but not related for
office or sales workers. Arguably, cleanliness of the workplace
environment may be associated with worksite smoking policies;
workplaces with full smoking bans are more likely to be clean
compared with worksites with absent or less directive policies.
In Korea, smoking has been prohibited inside major public
buildings such as hospitals, schools, or theaters since 1995 and
in all business offices since 2015 (Korean Ministry of Health and
Welfare, 2015). Blue-collar workers such as manufacturers are
less likely than office or service workers to be employed at
worksites with restrictive smoking policies (Honjo et al., 2006).
Workplace Health & Safety
According to the study by Heloma and Jaakkola (2003), a
long-term effect of the national smoke-free workplace law is
less exposure to environmental tobacco smoke (ETS). Also,
implementation of the law seemed to be linked to changes in
employee attitudes favoring more restrictive workplace smoking
policies. Reduction of ETS exposure and attitude change was
strongest in industrial workplaces. The systematic review by
Fichtenberg and Glantz (2002) revealed that totally smoke-free
workplaces had about twice the impact on rates of smoking
cessation as workplaces with less restrictive policies, such as
smoking only in designated areas. As a clean workplace was
shown to influence the amount workers smoked, maintaining
workplace cleanliness with a strict non-smoking policy is
strongly recommended to reduce workers’ exposure to ETS.
Noise is a common occupational hazard. Long-term
exposure to noise damages the hair cells of the organ of Corti
in the inner ear and eventually leads to noise-induced hearing
loss (Mohammadi, Mazhari, Mehrparvar, & Atttarchi, 2009).
Studies by Topplia, Pyykko, Starck, Kaksonen, and Ishizaki
(2000) and Nakanishi et al. (2000) found that cigarette smoking
was significantly associated with a higher likelihood of noise-
induced hearing loss. After adjusting for cardiovascular events
and risk factors, Blue Mountains Hearing Study participants
demonstrated that current smoking was related to hearing loss
(Gopinath et al., 2010). A more marked association between
current smoking and hearing loss was observed for participants
who did not report significant occupational noise exposure,
thus indicating that noise exposure may mask the harmful effect
of smoking (Gopinath et al., 2010). Data from a large
community-based survey supported the growing body of
evidence that ex- and current smokers have more hearing
impairment than lifetime non-smokers, even after controlling for
occupational noise exposures (Palmer, Griffin, Syddall, &
Coggon, 2004). Moreover, the joint effects of smoking and
exposure to noise significantly increased hearing impairment in
young people aged 20 years to 40 years (Ferrite & Santana,
2005).
The authors found that workers who were exposed to
occupational noise were more likely to smoke. Palmer et al.
(2004) asserted that smoking workers should be encouraged to
refrain from both smoking and exposure to noise. Smokers
should periodically participate in smoking cessation programs.
Although Li et al. (2010) and Radi et al. (2007) found that
smoking intensity was related to job strain and decision latitude,
this study did not find any significant associations between
smoking intensity and job strain or decision latitude in the
occupational groups investigated. Possible reasons for these
discrepancies could include differences in the intensity of job
strain, the nature of work across different jobs, and varying
social capital. Furthermore, smoking intensity may also be
masked by the role of addiction and nicotine (Parascandola,
2011), which varies among individuals and was not assessed in
this study.
This study has several limitations. One weakness was that
workers may have under-reported data about work
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Workplace Health & Safety
environments and occupational hazards. Therefore, the results
may not be generalizable, and it may be difficult to reach
definite conclusions. Clearly, longitudinal studies using both
self-reported and objective measurements of work environment
variables are needed. It is also necessary to investigate how
smoking culture in various countries influences workers’
smoking. Although the researchers accounted for several
confounding variables, other potential factors were not
accounted for in the analyses. For example, self-belief in
smoking cessation, motivation, or spousal support may
influence smoking behavior. Furthermore, smoking intensity
was not validated by any biochemical indicators.
Conversely, this study had several strengths. The study is one
of the few to examine the impact of work conditions,
psychological and physical work environments, and
occupational hazards on smoking intensity. Several studies
about smoking have focused on only one aspect of the work
environment. Also, for most other studies, the sample included
only a small number of workers from one workplace, whereas
this study drew participants from three occupational groups
within a large population-based sample.
Implications for Practice
The underlying impact of smokers’ individual characteristics
and their work environments on rates of smoking must be
better understood. These findings emphasize that supporting
co-workers’ smoking cessation should be considered when
implementing a workplace smoking cessation program for office
and sales workers. Furthermore, a tailored smoking cessation
program focused on the physical work environment (e.g.,
establishing clean worksites and reducing exposure to
occupational noise) should be developed. Workers and health
care providers should establish workplace support and tobacco
control measures to improve success of workplace smoking
cessation efforts. More research is needed to determine the
precise associations between various aspects of work
environments and smoking.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial
support for the research, authorship, and/or publication of this
article: This work was supported by the Sungshin Women’s
University Research Grant 2013-1-21-007.
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Author Biography
Young-Ju Kim, RN, ACNP, PhD, is associate professor at the
Sungshin Women’s University College of Nursing in Seoul, Korea.
She is conducting research on community-based health promotion.
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