摘要：Objectives. We examined the relationship between smoking and work–family conflict among a sample of New England long-term-care facility workers. Methods. To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities. Results. There was a strong association between smoking likelihood and work–family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict. Conclusions. The results of this study indicate that there is a robust relationship between work–family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict. Tobacco use is the foremost cause of preventable death and illness in the United States. Tobacco use, primarily in the form of cigarette smoking, is responsible for 1 in 5 deaths, or about 440 000 Americans every year, 1 and about 5 million people worldwide each year. 2 In addition to shortening human lives, tobacco also places a significant economic burden on society. Cigarette smoking is not distributed randomly among the population but is associated with social and economic disadvantage and stress. 3 Smoking is highest in groups with lower socioeconomic status and increasingly occurs in areas marked by low income, limited services, and chronic unemployment. 4–7 In addition, research on the relationship between working conditions and smoking has been the focus of public health research, which has demonstrated that smoking and occupation are linked and that job stress may be associated with increased levels of smoking. 8–11 Both the social environment and work-based factors have been demonstrated to be influential in determining tobacco use, but there has been little attention to date paid to smoking in relation to work–family conflict. Work–family conflict refers to the expectations, demands, skills, or knowledge associated with one domain (e.g., work) affecting the other domain (e.g., family), with the term “conflict” implying that the 2 domains compete for the individual’s time and energy in a negative interaction. 12 There are well-established links between work–family conflict and health outcomes, including depression and general well-being, 13–15 and the research has shown that the direction of the conflict (i.e., work interfering with family vs family interfering with work) is an important distinction to make when one is studying work–family conflict. 12 In addition to health outcomes, researchers are investigating links between work–family conflict and health behaviors, such as substance use and diet. 16,17 Work–family conflict has been found to be associated with alcohol consumption among diverse groups. 18–20 This association suggests the need to examine the relationship between work–family conflict and tobacco use, another substance believed to relieve stress. 21,22 Finally, much of the work performed by workers in long-term-care facilities is both physically and emotionally demanding, provides relatively low wages, and is likely to be associated with adverse health consequences. 23–25 These characteristics make these workers important to consider when one is investigating the links between working conditions, work–family conflict, and health. We examined the relationship between smoking and work–family conflict among workers in 4 New England long-term-care facilities. We assessed both the direction of work–family conflict (i.e., work-to-home vs home-to-work) and the effects of overall conflict (i.e., experiencing both forms of conflict) because we hypothesized that experiencing conflict in both directions may influence smoking likelihood more than experiencing conflict in 1 direction alone. We also examined the contributions of work and home factors as potential confounders because each may be separately associated with both smoking and work–family conflict.
