Smoking cessation in the Greek Air Force: Associations with shift work and flight status

Abstract: Tobacco use is highly prevalent among military personnel.1 Continued tobacco use and cessation failure depends on work-related aspects of the service, and thus requires a tailored approach.2 We aimed to investigate smoking habits and smoking cessation trials in a cohort of Greek Air Force service members, who were active or ex-smokers and working in rotating shifts. Officers serving in the Greek Air Force in Attica region (total population 3946) were recruited during their yearly physical evaluation in the 251 Air Force General Hospital in Athens between June and December 2018 and filled out an anonymous questionnaire regarding their work schedule, their smoking habits and their smoking cessation attempts. The term ‘shift working days’ was used to describe evening and night shifts. Participants who had smoked ≥5 packs of cigarettes during their lifetime and were currently smoking were classified as ‘smokers’ and those who had successfully quit smoking were classified as ‘ex-smokers’. A quit attempt was defined as one that lasted for at least 1 week. One hundred and twenty-two members of the Air Force personnel (46.7% flying crew, 53.3% ground crew, all male) were included; 42 claimed to be ex-smokers, while 80 declared to be smokers. Logistic regression revealed that age and specialty were significantly associated with smoking habit. The odds of being a smoker decreases for older participants (OR=0.931, 95% CI 0.868 to 0.998) and for ground personnel compared with flying crews (OR=0.310, 95% CI 0.134 to 0.718). Goodman and Kruskal τ test demonstrated a significant association (p=0.003), revealing that the percentage of smokers increases as the number of shifts increase. The non-parametrical sign test revealed significant difference in numbers of cigarettes during shift compared with regular working days (p=0.001); 48.8% of smokers and 47.62% of ex-smokers smoke or used to smoke more heavily during shift working days, respectively. Our analysis showed that fewer shift working days correspond to fewer attempts until successfully quitting smoking. A possible explanation might be that these shift workers have a better chance of entering and completing smoking cessation programmes. Another reason is a less disturbed circadian rhythm.3 People who smoke may be able to easier adjust their biological clocks to the continuously changing circadian pattern of work and sleep cycles. Sleep disturbance is also commonly reported by quitting smokers,4 so it might be that shift workers face an aggravation of their sleep problems when attempting to quit smoking. Our results should raise awareness on ineffective cessation attempts and prompt the design of effective interventions tailored to the needs of military crews. A more appropriate scheduling of the shifts of a career officer could result in longer periods of reduced work pressure and stress, thus creating opportunities for successful smoking cessation.