Yonago Acta medica 2012;55:63–68

Evaluation of Relationships among Occupational Stress,
Alcohol Dependence and Other Factors in Male Personnel
in a Japanese Local Fire Fighting Organization
Takenobu Hosoda,* Yoneatsu Osaki,† Hiroteru Okamoto,‡ Takako Wada,§ Shinji Otani,||
Haosheng Mu,* Yae Yokoyama,* Mikizo Okamoto* and Youichi Kurozawa**Division of Health Administration and Promotion, Department of Social Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan, †Division of Environmental andPreventive Medicine, Department of Social Medicine, School of Medicine, Tottori University Faculty of
Medicine, Yonago 683-8503, Japan, ‡Department of Hygiene and Public Health, School of Medicine,
Kyorin University, Mitaka 181-8611, Japan, §Department of Paramedics, Faculty of Health Sciences,
Kyorin University, Hachioji 192-8508, Japan, ||Division of Surgical Oncology, Department of Surgery,
School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
Recent large-scale disasters have made middle-ranked fire defense officers responsible forroutine fire fighting activities, and a tendency of alcohol dependence associated with otherstressful problems is noted in Japan. We assessed the alcohol dependence tendency with thealcohol use disorders identification test (AUDIT) in firefighters. Occupational stress, depression and other factors were evaluated with the brief job stress questionnaire, Center for Epidemiologic Studies depression scale, K10 and a face sheet. Subjects were 294 male personnel
in a local fire defense headquarters, and 246 of them (83.4%) answered effectively. Data wereanalyzed first with univariate analysis between the AUDIT score and other items, and thenwith multivariate analysis of the AUDIT score as a dependent variable and other items as
independent variables. The AUDIT score (mean ± SD) in the 246 respondents classified byage ranges was 7.9 ± 5.4 points (the lowest, 0 points; the highest, 27 points). The multivariate
analysis showed significant correlations of the AUDIT score with the workplace environment(P = 0.003) and the rank of work (P = 0.019). The present survey was cross-sectional, and we
could not clarify the subjects’ past drinking states and applicability of the results to the whole
Japan personnel. It is necessary to further investigate the relationship between alcoholism
and depression in the present subjects. As a pilot study, we first clarified the state of alcohol
dependence in personnel in a Japanese local fire fighting organization, and examined related
factors.
Key words: alcohol dependence; depression; firefighter; occupational stress

As a characteristics of the alcohol-drinking behavior
in Japan, many persons have a habit of drinking tofall asleep more easily. The Japanese shift workers
have a stronger tendency of drinking to fall asleep
more easily as compared with non-shift workers(Ohira et al., 1969). Japanese regular fire departments are operating 24 h a day, when someone is on
administrative leave, the working schedules of othermembers need to be adjusted, and, accordingly, theburden is heavier in smaller-scale fire headquarters.

Abbreviations: AUDIT, alcohol use disorders identification test; CES-D, center for epidemilogic studies depression scale

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T. Hosoda et al.

Staff of the Japanese regular fire departments aremostly male (Fire Disaster Management Agency,
http://www.fdma.go.jp/en/). In Japan, however, thestate of alcohol dependence has not been reported
in fire department personnel. Also, relevant studies reported a relationship between such dependence and posttraumatic stress disorder (van der
Velden et al., 2008; Chiu et al., 2011). But very
few described the relationship of alcohol dependence with general occupational stress (Murphy etal.,1999), and such reports have not been publishedin Japan. In fire stations established and operated
by a local, municipal, broader-based government,
some personnel are on sick leave due to alcohol
dependence. Thus, it is a major issue to take somemeasures for problems regarding alcohol dependence. To clarify the tendency of alcohol dependence in firefighters, we analyzed the relationshipamong alcohol dependence, occupational stress,
depression and other factors for Japanese local
male firefighters.

AUDIT
The AUDIT was developed by Babor and associates
in 1992 as a screening test for alcohol dependence.
This test includes 10 items called the core AUDIT,
which is employed worldwide (Babor et al., 1992).
We used its Japanese version translated under specialist’s supervision (Hiro, 2000). As for the cutoffsof the AUDIT, persons with a score of 8 points or
higher, used as a measure against drink-driving by
the Japanese police, were suspected as having a
hazardous drinking problem, and those with a scoreof 15 points or higher were suspected as having
alcohol dependence (Cho, 2011), as fire department
personnel often use a car in their daily business.
Brief job stress questionnaire
The brief job stress questionnaire developed by
Japanese Professor Teruichi Shimomitsu and others (Department of Preventive Medicine and Public
Health, Tokyo Medical University, http://www.tmuph.ac/topics/stress_table.php) to clarify the generation of stress, is widely used in Japan to measure thefollowing factors: 9 factors possibly responsible forstress (the quantity of psychological stress, qualityof psychological stress, physical stress, human relationship, workplace environment, job control, skill
utilization, job suitability and rewarding work); 6
factors of physical and mental responses caused bystress (vitality, frustration, fatigue, anxiety, depression and complaints regarding the body) and 4 otherfactors influencing stress (the support of a supervisor, colleagues, family and friends). To clarify occupational stress, the occupational stress questionnairecreated by the National Institute for Occupational
Safety and Health (Kawakami and Haratani, 1998)
is often used, but, in the present study, we used thebrief job stress questionnaire, because this questionnaire can be filled in straightforwardly in a shorttime.

Subjects and Methods
We conducted a self-rating questionnaire survey
involving 294 male personnel in the Fire Department, Administrative Management Society of theGreater Western Region of Tottori Prefecture, alocal fire defense headquarter in Japan, consisting of Firefighters, Assistant Fire Sergeants, Fire
Sergeants, Fire Lieutenants, Fire Captains andBattalion Chiefs. Female personnel were excluded
because most of the personnel were males. To
evaluate the tendency of alcohol dependence inthe subjects, we performed the alcohol use disorders identification test (AUDIT). To assess theiroccupational stress, we used the brief job stressquestionnaire, Center for Epidemiologic Studies
depression scale (CES-D), K10 and a face sheet(age, length of service, assignment of work, rankof work, presence of living children, presence ofliving partners, presence of persons who needcare, presence of low-back pain, tobacco dependence screener and body mass index).

CES-D
The CES-D developed by Radolf to screen for depression is employed worldwide (Radoloff, 1977).
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Alcoholism and health status in firefighters

In the present study, we used its Japanese version(Shima et al., 1985). Persons with a score of 16
points or higher were regarded in early studies as
having depression.
K10
Kessler and associates developed K10, a moresensitive screening test for depressive disorder andanxiety disorder (Kessler et al., 2002), than the general health questionnaire, a conventionally standard
screening test. In the present study, we used theJapanese translation of K10 (Furukawa et al., 2002).
We used both CES-D and K10, because CES-D
scores in the Japanese tend to be higher than inWesterners (Iwata, 2009).

Fig. 1. Age structure of the subjects. Age ranges in the increasing order are shown from the top of the circle clockwise, with proportions in %.
Table 1. Age-distribution of AUDIT scores
Age range (yr)Data analysis
All analyses were conducted with SPSS for 19.0
(SPSS Japan, Tokyo, Japan). We first determined thecoefficient of Spearman’s rank correlation between
the AUDIT score and other items, and then multiple
regression analysis with the AUDIT score as a dependent variable and the other items as independent
variables.

AUDIT score (mean ± SD)

20–29
30–39
40–49
50–54
55–60

6.0
7.9
8.9
8.7
7.3

±
±
±
±
±

5.1
5.6
5.8
5.7
4.7

20–60

7.9

± 5.4

AUDIT, alcohol use disorders identification test.

Results
Of the 294 subjects, 246 provided effective answers(83.4%). The proportions of the respondents by age
ranges are shown in Fig. 1: 12.0% (n = 29) from 20
to 29 years, 22% (n = 54) from 30 to 39 years, 17% (n= 42) from 40 to 49 years, 26% (n = 65) from 50 to
54 years and 23% (n = 56) from 55 to 60 years.
Fig. 2. AUDIT scores classified by point ranks and age
ranges of effective respondents (n = 246). The mean proportion of respondents in Zones I, II and III/IV is 56.1%,
30.1% and 13.8%, respectively. AUDIT, alcohol use disorders identification test.

Actual trend of alcohol dependence
The age-classified AUDIT scores of the respondents
are shown in Table 1. The mean score ± SD was
7.9 ± 5.4 points, the lowest being 0 points and thehighest being 27 points. The age-ranged AUDITscores were further classified into 3 ranks: Zone I(0–7 points), Zone II (8–14 points) and Zone III/IV(15–40 points) (Fig. 2). The proportions of subjects
in Zones I, II and III/IV were 56.1, 30.1 and 13.8%,
respectively. In the coefficient of Spearman’s rank
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T. Hosoda et al.

correlation, there was no correlation between age
and AUDIT scores (P = 0.071).

related to the workplace environment (P = 0.003)
and the rank of work (P = 0.019).

Alcoholism related to occupational stress,
depression and other factors

Discussion

Table 2 shows items correlated with the AUDITscore on Spearman’s rank correlation. The AUDITscore was significantly correlated with the following
items: presence of living children (r = –0.154, P =0.03), tobacco dependence screener (r = 0.153, P =0.039), K10 (r = 0.140, P = –0.031), workplace environment (r = 0.127, P = 0.047), rewarding work (r =0.161, P = 0.011) and complaints regarding the body(r = 0.140, P = 0.028). Table 3 shows the results ofmultiple regression analysis with the AUDIT score
and other items. The AUDIT score was significantly

The present survey revealed that the proportionof respondents with an AUDIT score ≥ 8 and ≥15 points was 43.9 and 13.8%, respectively. In ageneral Japanese adult population, the proportionof men with lifetime drinking, weekly drinking
and daily drinking was 95.1, 64.4 and 36.2%, respectively (Osaki et al., 2005). In this population,
the proportion of those with an AUDIT score ≥12 and ≥ 15 points was 11.1 and 5.1%, respectively(Osaki et al., 2005). They also reported that, in
2008, the proportion of male regular employees with an AUDIT score ≥ 12 points was 11.8%(Osaki et al., 2011). The AUDIT score was higher
in the present survey than the above-mentioned
studies, which indicated that persons with drinking problems or alcohol dependence were prevalent in the present subjects. A positive correlation
was reported between alcoholism and depression(National Hospital Kurihama Medical and Addiction Center, http://www.kurihama-med.jp/english.
html), and the univariate analysis performed in thepresent survey revealed that the AUDIT score hada relationship with the K10 score, but did not revealthat the AUDIT score had a relationship with the
CES-D score. Since the present survey was crosssectional, it is impossible to specify a cause-andeffect relationship between alcohol problem anddepression. Based on these findings, we consideredit necessary to further investigate the relationshipbetween alcoholism anxiety disorder and depression
in the present subjects. Anxiety disorder contains
acute stress disorder and posttraumatic stress disorder, and so we considered it necessary to further
investigate the relationship between alcoholism andthem. In addition, the AUDIT score had a relationship with the presence of living children: personnel
living with children have to take care of or play withchildren on off-duty days or holidays, which makes
their opportunity of alcohol drinking less and theTable 2. Items showing significant relationships
with AUDIT scores (nonparametric test) on univariate analysis
Item
r
		
Presence of living children
Tobacco dependence screener
K10
Brief job stress questionnaire
Workplace environment
Rewarding work
Complaints regarding the body

P value(each side)–0.1540.153
0.140

0.030*
0.039*
0.031*

0.127
0.161
0.140

0.047*
0.011*
0.028*

AUDIT, alcohol use disorders identification test.
r, coefficient of Spearman’s rank correlation.
*P < 0.05.
Table 3. Results of multiple regression analysis
of each item and the AUDIT scores
ItemStandardized partial
regression coefficient
( )

P
value

Workplace environment
Rank of work

0.281
–0.2230.003**
0.019*

AUDIT, alcohol use disorders identification test.
* P < 0.05.
** P < 0.001.
Coefficient of multiple correlation, R, 0.366.
Coefficient of determination (adjusted for degrees of
freedom), 0.116.

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Alcoholism and health status in firefighters

AUDIT score lower. The reason of no association
between the AUDIT score and marriage seemed
to be derived from the fact that 89.9% of the subjects were married. The association of the AUDITscore and tobacco dependence screener score andhigher smoking rates of alcohol-dependent patientswere reported (Nakajima et al., 2004). In the present survey, we observed high AUDIT scores, andsuspected even higher tobacco dependence screener
score. The multiple regression analysis showed a relationship between the AUDIT score and workplaceenvironment surrounding them. Workplace environment, a job stressor, reflects the level of first aid
at the time of emergency or rescue, and the level ofoffice work when personnel are on standby. For thisreason, from the present survey, we suspected that ahigher AUDIT score indicates poorer workplace environment. Similar results obtained in another study(Murphy et al., 1999) also indicated that higher AUDIT scores would be associated with lower ranks ofwork, possibly because many young personnel areengaged in fire fighting and prevention, as well as
first aid. Such personnel are mostly on duty for 24 ha day, thereby increasing the length of time to consume alcohol. It is now necessary to conduct investigations for personnel in other Japanese fire fighting organizations to clarify their drinking states,and examine whether or not similar results will beobtained.
The present survey was conducted in personnel in a Japanese local fire fighting organization. It
is unclear whether the results are applicable to fire
department personnel throughout Japan. Also, since
this survey was cross-sectional, we could not clarify
the subjects’ drinking states in the past. As a pilot
study, we first clarified the state of alcohol dependence in personnel in a Japanese local fire fightingorganization, and examined other related factors.

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Acknowledgments: We acknowledge the cooperation of
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Management Society of the Greater Western Region of
Tottori Prefecture, Japan, and those in charge of the investigation.

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Received July 8, 2012; accepted August 10, 2012
Corresponding author: Takenobu Hosoda, DMD, CSW, PhD

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