Why nurses smoke: a review of the literature

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Abstract

The smoking behaviour of nurses has been widely debated in the context of their professional role and responsibilities. There has been much speculation about why nurses smoke and possible explanations include a stressful nursing environment, peer pressure and socio economic status and education. This paper provides an overview of the literature which offers insights into the reasons why nurses smoke and compares the findings from this literature with those studies examining the smoking behaviour of women in general and young women in particular. This review reveals that many students take up smoking before commencing their training and the factors which influence nurses smoking are similar to those that influence similar groups of females in the general population.

Introduction

Over the years there has been an ongoing debate about the implications of the smoking behaviour of nurses in relation to their own health and their health promotion role. (Faulkner and Ward, 1983, Macleod Clark et al., 1987, Rowe, 1998). Empirical data about the smoking behaviour of nurses is limited with many studies being out of date or based on small samples (Adriaanse et al., 1991, Rowe, 1998). There seems to be a general consensus from the literature that the incidence of smoking amongst nurses equates with that of women in the population in general, and is around 28% (Office for National Statistics, 1996). This rate in nursing is influenced by status and professional role, with those in more senior managerial positions smoking less than student nurses, enrolled nurses, new staff nurses and nursing auxiliaries (Becker et al., 1986, Feldman and Richard, 1986). This again equates with variations in smoking rates in the general female population which relate to occupational status (Office for National Statistics, 1996).

A number of explanations have been offered in an attempt to establish why nurses smoke. The three main themes that emerge from a review of the literature are those of stress, peer and social influence and socio economic status and education. The review which is presented under these three headings was undertaken using a number of computer data bases but with particular scrutiny of CINAHL 1982–1997 and Medline 1992–1997.

Section snippets

The influence of stress on smoking amongst nurses

Many studies of nurses’ smoking behaviour have attempted to demonstrate that smoking is a coping mechanism against stress, caused by the nursing environment (Leathar, 1980, Tagliacozzo and Vaughn, 1982, Spencer, 1984, Booth and Faulkner, 1986, Elkind, 1988, Cinelli and Glover, 1988, Carmichael and Cockcroft, 1990, Charlton et al., 1997). While a number of these studies support this theory, conflicting findings are also reported. The studies are presented in chronological order and reflect the

The influence of peer and social influences on smoking amongst nurses

Wagner (1985) surveyed the smoking behaviour of 504 registered nurses in New York. Using a questionnaire approach, a 62% response rate was achieved. Twenty-eight per cent of the sample self reported that they were smokers. Corresponding with most of the above studies, the majority of nurses who smoked did so prior to commencing nursing with 43% taking up the habit during their training. Seventy-one per cent reported that the main reason they commenced smoking was because their friends smoked

The influence of educationl attainment and type of course on smoking behaviour

A few general adolescent smoking studies have looked at educational attainment at school as a predictor of smoking. The general idea is that smokers tend to be “fed up” with school, are underachievers and often leave school by the age of sixteen (Charlton, 1984). For example, Krohn et al. (1986) surveyed the smoking behaviour of 1800 grade 9–12 students in Iowa. Using a questionnaire approach a response rate of 91% was achieved. The aim was to to examine if adolescent social disaffection with

Smoking and gender issues

Many of the studies reviewed above, point to explanations for smoking which lie outside the occupational context but may relate to other factors including gender. Graham (1989) stresses the need for qualitative studies which explore the place of smoking in the lives of women, especially women with dual roles. This is supported by Adriaanse et al. (1991) who suggest that research into nurses’ smoking should be based on comprehensive designs, taking into account life-style variables, as well as

Summary

In summary, this review of the literature demonstrates that there is limited up-to-date information which offers explanations of nurses’ smoking behaviour. Given the importance attached to the nurse’s health professional role and the pressure for nurses and other health professionals to act as good role models, there is a need to gain a clearer understanding of the factors influencing their smoking behaviour. The literature reviewed in this article points to the dangers of linking smoking

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