Scand J Soc Med 4: 21-23, 1976
Smoking and the Subjective Health Condition among Finnish Military Conscripts Paavo Moilanen, Leo Hirvonen, Jouni Timisjarvi and Onni Kari-Koskinen From the Department ofPublic Health and the Department of Physiology, University of Oulu, Oulu, Finland
Smoking and the subjective health condition among Finnish military conscripts. Moilanen, P., Hirvonen, L., Timisjarvi, J. and Karl-Koskinen, O. (Department of Public Health and Department of Physiology, University ofOulu, Oulu, Finland). Scand J Soc Med 1976, 1 (21-23).
of certain non-specific subjective symptoms (of stress). This report concerns the correlation of these symptoms with smoking habits.
Information on smoking habits and a subjective selfestimate of general state of health was collected by means of a questionnaire from 400 conscripts in Northern Finland. The data were treated by factor analysis. Long-term fatigue, frequent headache, insomnia and occasional depression were less frequent among non-smokers than among smokers.
An inquiry was carried out on April 1,1974, among the 400 conscripts who had joined the Pohjan Prikaati (Northern Brigade), stationed in Oulu, Northern Finland, in February 1974. The subjects came in equal numbers from the provinces of Oulu and Lapland (the two northernmost in Finland). Medical students participated in designing the questionnaire and compiling the data. The common variance of certain health variables (as listed in Table I) and the incidence of smoking was then studied, although more general factors were also looked for. The distribution of the health variables between non-smokers, casual smokers and regular smokers was investigated. Factor analysis and its varimax rotation were employed in examining the common variance of the variables. The statistical significances of the difference in distribution were tested with the X2 test.
Various opinions have been expressed concerning the association between smoking and subjective sensations. Schneider & Houston (9), employing an anxiety measuring test, found that non-smokers experienced less anxiety. Faust et al. (1) reported that smokers complained more often of disturbed sleep, anxiety and moods of depression, while Hall & Morrison (3) were able to demonstrate a relation between smoking, nicotine dependence and alleviation of stress. The most common adverse effects of smoking reported by Finnish conscripts (5) concerned symptoms of the respiratory system (29 % of the replies). Others included poor general condition, fatigue or weakness (7 %), and certain symptoms of the nervous and digestive systems (3 %). This survey formed part of a wider investigation dealing with social background, living habits and the individual's subjective estimate of his health. It provided an opportunity for observing the incidence
METHODS
RESULTS The three-factor varimax solution (Table I) yielded a clearly differentiated pattern capable of interpretation. The solution accounted for 35 % of the total variance. In the first factor (I) the greatest loadings are on frequent headache, recurrent fatigue of long duration, insomnia, occasional depression, and smoking. In the second (II) the loadings are on continuous or recurrent phobias, occasional depression and allergic symptoms, while the third (III) contains loadings on pains in the limbs, back, and stomach. The first of these analyses gives cause for a more Scand J Soc Med 4
22
P. Moilanen et ale
Table I. Factorization of smoking and general health variables A three-factor (I-III) varimax solution Factor Health variable Smoking Frequent headache Recurrent long-term fatigue Insomnia Occasional depression Pains in limbs Back pains Cardiac dysfunctions Stomach aches Continuous or recurrent phobias Allergic symptoms or hypersensitivity Eigenvalues Eigenvalues as % of total variance Eigenvalues as % of common variance
II
III
h2
0.30 0.57
0.04 0.08
0.02 0.27
0.095 0.402
0.50 0.48 0.40 0.26 0.21 0.25 0.14
0.35 0.15 0.57 0.21 0.14 0.07 0.18
0.33 0.36 0.29 0.59 0.59 0.16 0.57
0.475 0.380 0.563 0.451 0.405 0.091 0.381
0.14
0.65
0.12
0.457
-0.09
0.38
0.11
0.165
1.27
1.14
1.46
3.865
11.5
10.4
13.3
32.7
29.5
37.7
35.1
detailed examination of smoking and related symptoms. Table II shows the relation between smoking and the principal variables in the first factor. The results show that as a rule non-smokers have fewer of these symptoms. The most pronounced difference between the groups under comparison occurs in the case of recurrent long-term fatigue, from which one out of ten non-smokers and one out of three smokers suffered. Fewer non-smokers than smokers suffered from headaches. Non-smokers also experienced less insomnia and occasional depression. DISCUSSION The non-smokers experienced less recurrent longterm fatigue, frequent headache, insomnia and occasional depression than the smokers. These nonspecific symptoms are common even among the normal population, especially in strenous circumstances. One out of four normal schoolchildren reported headaches according to Peltonen (7). It was more common among dystonic children (61 %) and rarer among children interested in sports (4 %). 13 % of the control children, 11-13 years of age, had disturbed sleep and tired easily. These symptoms, too, were four to five times as common amongst the Scand J Soc Med 4
dystonic children. The question arises whether smoking is of significance for the frequent occurrence of these symptoms among smokers. Tobacco is not well tolerated by dystonic people. The toxic effects of nicotine and/or carbon monoxide may explain some of the differences between the smokers) and the non-smokers. In a previous study by Hirvonen et al. (5) 42 % of officer trainees and 26 % of men in the ranks considered smoking detrimental to health." The most common site of symptoms was the respiratory organs; 29% of the total series reported coughs, shortness of breath, etc. Impaired general condition, tiredness or weakness were reported only by 7 % of the conscripts. Headaches or insomnia were experienced by only a few individuals. Moilanen & Karl-Koskinen (6). have observed that non-smoking servicemen drink alcohol less frequently, are more active in taking physical exercise and have a better subjective opinion of their general condition. Acquisition and continuation of the smoking habit and the quantity of tobacco consumed may be increased by situations which even without smoking may provoke stress symptoms. Tobacco is commonly used to calm and release tension. Frankenhaeuser et al. (2) postulated that the nicotine in tobacco may help the smoker to deal with stress and avoid open anxiety, whether the stress be physical or psychological. It is also of interest that tiredness and headache are two of the five most common .:withdrawal symptoms experienced after cessation of smoking (4). The present study indicates that some nonspecific stress symptoms seem to be more common among smokers. These may be caused by smoking, which is certainly used as a means of avoiding them. The symptoms may occur during a certain Table II. Incidence of symptoms (%) reported significantly more often by smokers than nonsmokers
Symptom Frequent headache Recurrent long-term fatigue Insomnia Occasional depression
Smokers (N=128)
Nonsmokers (N=270)
P
43
27
Smoking and the Subjective Health Condition among Finnish Military Conscripts Paavo Moilanen, Leo Hirvonen, Jouni Timisjarvi and Onni Kari-Koskinen From the Department ofPublic Health and the Department of Physiology, University of Oulu, Oulu, Finland
Smoking and the subjective health condition among Finnish military conscripts. Moilanen, P., Hirvonen, L., Timisjarvi, J. and Karl-Koskinen, O. (Department of Public Health and Department of Physiology, University ofOulu, Oulu, Finland). Scand J Soc Med 1976, 1 (21-23).
of certain non-specific subjective symptoms (of stress). This report concerns the correlation of these symptoms with smoking habits.
Information on smoking habits and a subjective selfestimate of general state of health was collected by means of a questionnaire from 400 conscripts in Northern Finland. The data were treated by factor analysis. Long-term fatigue, frequent headache, insomnia and occasional depression were less frequent among non-smokers than among smokers.
An inquiry was carried out on April 1,1974, among the 400 conscripts who had joined the Pohjan Prikaati (Northern Brigade), stationed in Oulu, Northern Finland, in February 1974. The subjects came in equal numbers from the provinces of Oulu and Lapland (the two northernmost in Finland). Medical students participated in designing the questionnaire and compiling the data. The common variance of certain health variables (as listed in Table I) and the incidence of smoking was then studied, although more general factors were also looked for. The distribution of the health variables between non-smokers, casual smokers and regular smokers was investigated. Factor analysis and its varimax rotation were employed in examining the common variance of the variables. The statistical significances of the difference in distribution were tested with the X2 test.
Various opinions have been expressed concerning the association between smoking and subjective sensations. Schneider & Houston (9), employing an anxiety measuring test, found that non-smokers experienced less anxiety. Faust et al. (1) reported that smokers complained more often of disturbed sleep, anxiety and moods of depression, while Hall & Morrison (3) were able to demonstrate a relation between smoking, nicotine dependence and alleviation of stress. The most common adverse effects of smoking reported by Finnish conscripts (5) concerned symptoms of the respiratory system (29 % of the replies). Others included poor general condition, fatigue or weakness (7 %), and certain symptoms of the nervous and digestive systems (3 %). This survey formed part of a wider investigation dealing with social background, living habits and the individual's subjective estimate of his health. It provided an opportunity for observing the incidence
METHODS
RESULTS The three-factor varimax solution (Table I) yielded a clearly differentiated pattern capable of interpretation. The solution accounted for 35 % of the total variance. In the first factor (I) the greatest loadings are on frequent headache, recurrent fatigue of long duration, insomnia, occasional depression, and smoking. In the second (II) the loadings are on continuous or recurrent phobias, occasional depression and allergic symptoms, while the third (III) contains loadings on pains in the limbs, back, and stomach. The first of these analyses gives cause for a more Scand J Soc Med 4
22
P. Moilanen et ale
Table I. Factorization of smoking and general health variables A three-factor (I-III) varimax solution Factor Health variable Smoking Frequent headache Recurrent long-term fatigue Insomnia Occasional depression Pains in limbs Back pains Cardiac dysfunctions Stomach aches Continuous or recurrent phobias Allergic symptoms or hypersensitivity Eigenvalues Eigenvalues as % of total variance Eigenvalues as % of common variance
II
III
h2
0.30 0.57
0.04 0.08
0.02 0.27
0.095 0.402
0.50 0.48 0.40 0.26 0.21 0.25 0.14
0.35 0.15 0.57 0.21 0.14 0.07 0.18
0.33 0.36 0.29 0.59 0.59 0.16 0.57
0.475 0.380 0.563 0.451 0.405 0.091 0.381
0.14
0.65
0.12
0.457
-0.09
0.38
0.11
0.165
1.27
1.14
1.46
3.865
11.5
10.4
13.3
32.7
29.5
37.7
35.1
detailed examination of smoking and related symptoms. Table II shows the relation between smoking and the principal variables in the first factor. The results show that as a rule non-smokers have fewer of these symptoms. The most pronounced difference between the groups under comparison occurs in the case of recurrent long-term fatigue, from which one out of ten non-smokers and one out of three smokers suffered. Fewer non-smokers than smokers suffered from headaches. Non-smokers also experienced less insomnia and occasional depression. DISCUSSION The non-smokers experienced less recurrent longterm fatigue, frequent headache, insomnia and occasional depression than the smokers. These nonspecific symptoms are common even among the normal population, especially in strenous circumstances. One out of four normal schoolchildren reported headaches according to Peltonen (7). It was more common among dystonic children (61 %) and rarer among children interested in sports (4 %). 13 % of the control children, 11-13 years of age, had disturbed sleep and tired easily. These symptoms, too, were four to five times as common amongst the Scand J Soc Med 4
dystonic children. The question arises whether smoking is of significance for the frequent occurrence of these symptoms among smokers. Tobacco is not well tolerated by dystonic people. The toxic effects of nicotine and/or carbon monoxide may explain some of the differences between the smokers) and the non-smokers. In a previous study by Hirvonen et al. (5) 42 % of officer trainees and 26 % of men in the ranks considered smoking detrimental to health." The most common site of symptoms was the respiratory organs; 29% of the total series reported coughs, shortness of breath, etc. Impaired general condition, tiredness or weakness were reported only by 7 % of the conscripts. Headaches or insomnia were experienced by only a few individuals. Moilanen & Karl-Koskinen (6). have observed that non-smoking servicemen drink alcohol less frequently, are more active in taking physical exercise and have a better subjective opinion of their general condition. Acquisition and continuation of the smoking habit and the quantity of tobacco consumed may be increased by situations which even without smoking may provoke stress symptoms. Tobacco is commonly used to calm and release tension. Frankenhaeuser et al. (2) postulated that the nicotine in tobacco may help the smoker to deal with stress and avoid open anxiety, whether the stress be physical or psychological. It is also of interest that tiredness and headache are two of the five most common .:withdrawal symptoms experienced after cessation of smoking (4). The present study indicates that some nonspecific stress symptoms seem to be more common among smokers. These may be caused by smoking, which is certainly used as a means of avoiding them. The symptoms may occur during a certain Table II. Incidence of symptoms (%) reported significantly more often by smokers than nonsmokers
Symptom Frequent headache Recurrent long-term fatigue Insomnia Occasional depression
Smokers (N=128)
Nonsmokers (N=270)
P
43
27
