Need to manage job stress for smoking workers using nicotine replacement therapy during smoking cessation?

Introduction
Smoking remains a major public health problem worldwide. Currently, the smoking prevalence in Japan is about 38% for males, showing the highest rate among developed countries. Furthermore, over 60% of employees in Japan are reported to have job stress. The present study describes changes in job stress during successful smoking cessation (SSC) and unsuccessful smoking cessation (USC) using nicotine replacement therapy (NRT). 

Methods
A total of 81 (75 males and 6 females) smoking workers at worksites covered by DEPARTMENTSTORE HEALTH INSURANCE in Tokyo, Japan requested NRT. Of 81 participants, 36 (35 males and 1 female) took NRT, and completed the first survey at pre-NRT in 2009 and the second survey at post-NRT in 2010. The survey consisted of the smoking status and the Brief Job Stress Questionnaire (BJSQ) including four sub-scales of work-related stressors (17 items), psychological stress response (11 items), physical stress response (11 items) and social support factors (9 items). To compare pre- and post-NRT findings, the paired t test was performed in the SSC and USC groups. One female in USC was excluded.

Results
After NRT, 17 participants successfully quit smoking while 18 participants did not. The average age was 42.2 (SD: 7.3) years in SSC and 43.1 (7.7) in USC. After one year follow-up, the scores for work-related stressors in SSC had decreased significantly from 28.1(3.6) to 26.0(3.6) (p=0.036); and those scores in USC had decreased from 24.0 (3.4) to 23.6 (3.2) (p=0.689). The other three sub-scales did not show any significant changes. 

Discussion
NRT is useful during smoking cessation. However, the level of the job stress in workers might influence their ability to quit smoking successfully. These findings indicate that changing job stress may impact on individual quit smoking. Therefore, management of job stress would likely promote smoking cessation efforts in workers.