Study Reveals Smoking's Effect On Nurses' Health, Death Rates

"Nurses witness firsthand how smoking devastates the health of their patients with cancer and respiratory and cardiovascular diseases," said principal investigator Linda Sarna, D.N.Sc, a professor at the UCLA School of Nursing. "Yet nurses struggle with nicotine addiction like the rest of the 45 million smokers in America. We are concerned that nurses who smoke may be less apt to support tobacco-control programs or encourage their patients to quit."

Sarna led a team of researchers who analyzed data from the Nurses' Health Study, a historic study on women's health. Launched at Brigham and Women's Hospital in the mid-1970s, the study relied upon surveys completed every two years by 237,648 female registered nurses about their health, including smoking habits.

"The Nurses' Health Study is the largest study of women's health in the world," Sarna said. "From a workforce perspective, however, the findings also hold a mirror up to the well-being of nurses, the largest group of health care professionals in the country."

The current UCLA research explored changes in smoking trends and death rates among female nurses enrolled in the Nurses' Health Study between 1976 and 2003, a span of 27 years.

Sarna and her colleagues compared the differences in death rates among nurses who never smoked, former smokers and current smokers. In all age groups, roughly twice as many current smokers had died in comparison to nurses who never smoked.

"Quitting smoking made a big difference in enhancing longevity, especially among nurses in their late 70s," Sarna said. "Death rates among former smokers that age were 1.5 times higher than those of non-smokers, while current smokers were 2.3 times more likely to have died by that age than nurses who never smoked."

According to the most recent data, the smoking rate among registered nurses nationwide is nearly 12 percent.

The rate of smoking among women in the Nurses' Health Study declined from 33.2 percent in 1976 to 8.4 percent in 2003. The number of cigarettes smoked per day also dropped. However, the daily number among current smokers still averaged more than 15 cigarettes, or over half a pack.

"When the Nurses' Health Study began in 1976, nursing education gave limited attention to smoking's effect on health. Today, the amount of time devoted to tobacco cessation in the curriculum remains inadequate," Sarna said.

"Nurses in the study demonstrated behavior patterns similar to women in the general population," she added. "For example, the younger nurses in the study began smoking before entering the profession, a pattern reflected by American women starting smoking at younger ages in general. Being a nurse did not make these women immune to nicotine addiction."

Although data from the Nurses' Health Study has been used by the U.S. Surgeon General, researchers and health care providers to craft health policy, the findings have rarely been directed to the nursing community itself.

"It is encouraging to see that fewer and fewer nurses are smoking, but we can't declare the problem solved," said Michelle Larkin, senior program officer for the Robert Wood Johnson Foundation, which funded the UCLA team's research. "The devastating effects of smoking are all too real for those nurses who still smoke. We need research to learn about the factors that lead them to smoke and more resources to help them quit."

Sarna's co-authors included Stella Bialous, Dr.P.H., president of Tobacco Policy International; Hee-Jin Jun, Sc.D., M.P.H., and Diane Feskanich, Sc.D., both of Brigham and Women's Hospital and Harvard University Medical School; Mary Ellen Wewers, Ph.D., M.P.H., professor and associate dean for research at the College of Public Health at Ohio State University; and Mary Cooley, Ph.D., a nurse scientist at the Dana-Farber Cancer Institute.

The Nurses' Health Study was established by Dr. Frank Speizer at Brigham and Women's Hospital with funding from the National Institutes of Health.