Smoking among shift workers: more than a confounding factor

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1 Smoking among shift workers: more an a confounding factor Ludovic van Amelsvoort Nicole Jansen IJmert Kant Occupational Heal Epidemiology Maastricht University The Neerlands.

2 Background Shift work: Associated wi an elevated cardiovascular disease risk. Smoking is seen as a nuisance or confounding factor. Elevated CVD risk of shift work normally reported adjusted for smoking habits.

3 Shift work and CVD: possible paways Several paways Unknown factor e.g. SES Shift work Cardiovascular diseases Smoking habits

4 Smoking a confounder? Definition of a confounding factor: Confounding can be defined most simply as e distortion in e observed association between an exposure and an outcome due to factor(s) associated wi bo e exposure and e outcome*. However: Factors at are believed to be intermediate steps in e causal paway between exposure and outcome on e basis of previous research should not be treated as confounders*. *) Roman: modern epidemiology

5 Smoking among shift workers Review of Bøggild and Knutsson (1999) supplemented wi four recent studies : Cross sectional studies 9 of 17 studies: significantly more smokers, 7 studies: no significant difference, one study: significantly less smokers among shift workers Longitudinal studies Only very few respondents so difficult to draw conclusions

6 Objectives current analysis Assess in a large study sample wheer smoking is more frequent among shift workers as compared to daytime workers. To assess in a longitudinal design wheer shift workers are more likely to start or stop smoking.

7 Data used: Maastricht Cohort Study Prospective cohort study 4 ½ years of follow-up Exposure variables work-related, domestic & social factors, individual characteristics Outcome variables fatigue complaints and consequences in terms of sickness absence and work disability Frequent measurements (3/year)

8 Data used: Maastricht Cohort Study Heterogeneous population different educational level, jobs and tasks different sectors & trades Inclusion criteria men and women full- and part-timers (minimum of 16 hours/week) aged 18 to 65 Exclusion criterion temporary workers

9 Data used: Maastricht Cohort Study Data from respondents wi at least two years of complete follow up employees (2039 working in shifts) 27.3 % females 24.5 % smoking at baseline 225 started smoking in 2 years follow up 318 quitted in 2 years follow up

10 Risk factor Results: cross-sectional Odds ratio 95 % CI working in shifts (vs. day work) Secondary education (vs. primary) Higher education (vs. primary) Females ( vs. male) High job demands (vs. low) Low decision latitude (vs. high) The risk of being a current smoker Logistic regression model (additional adjustment for age)

11 Longitudinal results: starters Risk factor Odds ratio 95 % CI working in shifts (vs. day work) Secondary education (vs. primary) Higher education (vs. primary) Females ( vs. male) High job demands (vs. low) Low decision latitude (vs. high) The risk to start smoking for never smokers. Logistic regression model (additional adjustment for age)

12 Longitudinal results: quitters Risk factor Odds ratio 95 % CI working in shifts (vs. day work) Secondary education (vs. primary) Higher education (vs. primary) Females ( vs. male) High job demands (vs. low) Low decision latitude (vs. high) The risk to quit smoking for subjects who smoked at baseline. Logistic regression model (additional adjustment for age)

13 Results: summary Shift workers are more often smokers, even when adjusted for educational level and job strain Shift workers have a significantly higher risk to take up smoking as compared to day workers

14 Comparison wi previous research So far not much longitudinal research One longitudinal study (239 shift, 157 day workers): Shift workers RR 1.9 to take up smoking (ns).shift working smokers sign. increased cigarettes smoked per day*. *) Amelsvoort et al. JOEM 2004;46(7):

15 Possible mechanisms Shift workers emselves reported e use of nicotine as a way to cope wi feelings of sleepiness. Possibly mediated by depressive or anxious feelings.

16 Conclusion Smoking is not merely a confounding factor in relation between shift work and cardiovascular disease risk. The results of studies on e CVD risk among shift workers might have underestimated e risk by adjustment for smoking

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