The relationship between smoking and stress hormones in health technician students

Oya Sayın

doi:10.18614/dehm.1873863

The relationship between smoking and stress hormones in health technician students

Abstract

BACKGROUND Smoking is a common coping mechanism for university students dealing with increasing exam stress. The aim of this study was to examine the effects of smoking on exam stress in health technician students by measuring salivary cortisol and adrenaline levels, recognized as stress biomarkers, and to evaluate the relationship between smoking and exam scores. METHODS The study included 64 students (mean age: 21.09 ± 2.05 years) from Dokuz Eylül University’s Vocational School of Health Services during the 2023–2024 academic year. Thirty-three smokers (19 female, 14 male) and 31 non-smokers (24 female, 7 male) were included in the study. Data were collected with a form for sociodemographic information, a smoking status questionnaire, the State–Trait Anxiety Inventory Scale (STAI), and saliva samples. Cortisol and adrenaline levels in saliva samples were evaluated by enzyme-linked immunosorbent assay. RESULTS The salivary cortisol levels of non-smokers were lower compared to those of smokers (74.43 ± 35.98 vs. 94.35 ± 33.09 ng/mL, respectively; p = 0.024). The salivary adrenaline levels of non-smokers were higher compared to those of smokers (928.75 ± 172.57 vs. 727.39 ± 233.96 pg/mL, respectively; p < 0.001). The mean exam score was higher for non-smokers (73.97 ± 2.60) compared to smokers (63.84 ± 3.39) (p = 0.022). However, there was no significant difference between the groups in terms of the cognitive, psychosocial, or physiological subdimensions of the STAI or mean test achievement score (p > 0.05 for all). CONCLUSION Non-smoker students had lower cortisol and higher adrenaline levels, positively affecting their exam scores. These findings suggest that smoking status may affect physiological stress markers and exam scores, but not necessarily perceived state anxiety levels.

Keywords

References

1. Şahbaz Y, Yeldan İ. Sigara İçen ve İçmeyen Üniversite Öğrencilerinde Anksiyete, Depresyon, Algılanan Yorgunluk, Dikkat Eksikliği ve Hiperaktivite Bozukluğu Düzeylerinin Karşılaştırılması. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 2022;11(3):1086-1094.
2. Celikel FC, Celikel S, Erkorkmaz U. Smoking determinants in Turkish university students. Int J Environ Res Public Health 2009;6(8):2248-2257.
3. Senol Y, Donmez L, Turkay M, Aktekin M. The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study. BMC Public Health 2006;6:128.
4. Sönmez Cİ, Başer DA, Aydoğan S, Uludağ, G, Dinçer D, Topaluğurlu B. Düzce Üniversitesi Tıp Fakültesi öğrencilerinin sigara içme sıklığı ve sigara ile ilgili bilgi tutum ve davranışları. Konuralp Medical Journal 2017;9(2):160-166.
5. Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology 2017;83:25-41.
6. Gunnar MR, Talge NM, Herrera A. Stressor paradigms in developmental studies: what does and does not work to produce mean increases in salivary cortisol. Psychoneuroendocrinology 2009;34(7):953-967.
7. Adam EK. Emotion-cortisol transactions occur over multiple time scales in development: implications for research on emotion and the development of emotional disorders. Monographs of the Society for Research in Child Development. 2012;77(2):17–27.
8. Adam EK, Heissel JA, Zeiders KH, Richeson JA, Ross EC, Ehrlich KB, et al. Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: A 20-year prospective study. Psychoneuroendocrinology 2015;62:279- 291.

9. Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci 2009;10(6):434-445.
10. Davis EP, Sandman CA. The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Dev. 2010;81(1):131-148.
11. Heim C, Newport DJ, Mletzko T, Miller AH, Nemeroff CB. The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology 2008; 33(6):693-710.
12. De Quervain D, Schwabe L, Roozendaal B. Stress, glucocorticoids and memory: implications for treating fear-related disorders. Nat Rev Neurosci 2017;18(1):7-19.
13. Hatungil R. Stres ve Demansta Hipotalamus-Hipofiz-Adrenal ekseninin rolü. MersinÜniversitesi Sağlık Bilimleri Dergisi 2008;1(3):1-7.
14. .Langer K, Wolf OT, Jentsch VL. Delayed effects of acute stress on cognitive emotion regulation. Psychoneuroendocrinology 2021;125:105101.
15. Ouda S, Alaki S, Safi M, Nadhreen A, Johani K. Salivary stress biomarkers–Are they predictors of academic assessment exams stress. J Clin Exp Pathol 2016;15:276-279.
16. Şahin A. Durumluk sınav kaygısı ölçeği (DuSKÖ): Geçerlik ve güvenirlik çalışması. Trakya Eğitim Dergisi, 2019;9(1), 78-90.
17. World Health Organization. Tobacco 2023 https://www.who.int/news-room/fact- sheets/detail/tobacco.
18. TUIK 2022. Türkiye Sağlık Araştırması,2022.
https://data.tuik.gov.tr/Bulten/Index?p=Turkiye-Saglik-Arastirmasi-2022-49747.
19. Villatte A, Marcotte D, Potvin A.. Correlates of depression in first-year college students. Canadian Journal of Higher Education 2017;47(1):114-136.
20. Kennedy B, Dillon E, Mills PJ, Ziegler MB. Catecholamines in human saliva Life Sci 2001 May 25;69(1):87-99.
21. Chiappin S, Antonelli G, Gatti R, Palo E. Saliva specimen: a new laboratory tool for diagnostic and basic investigation. Clin Chim Acta 2007 Aug;383(1-2):30-40.
22. Norsham Juliana , Sofwatul Mokhtarah Maluin, Nadia Mohd Effendy, Izuddin Fahmy Abu , Sahar Azmani. Cortisol Detection Methods and the Hormone's Role in Evaluating Circadian Rhythm Disruption. Int J Mol Sci 2025;19:26(18):9141.
23. Gozansky WS, Lynn JS, Laudenslager ML, Kohrt WM. Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic--pituitary--adrenal axis activity. Clin Endocrinol 2005;63(3):336-41.
24. Sekar M, Sriramprabha R, Sekhar PK, Bhansali S, Ponpandian N, Pandiaraj M, Viswanathan C. Wearable Sensor Platforms for the Electrochemical Detection of Cortisol. J Electrochem Soc 2020;167:067508.
25. Mioˇcevi´c O, Cole CR, Laughlin MJ, Buck RL, Slowey PD, Shirtcliff EA. Quantitative Lateral Flow Assays for Salivary. Biomarker Assessment: A Review. Front Public Health 2017; 14:5:133.
26. Choi MH. Clinical and Technical Aspects in Free Cortisol Measurement. Endocrinol Metab 2022;37(4):599-607.
27. Bozovic D, Racic M, Ivkoviç N . Salivary cortisol levels as a biological marker of stress reaction. Med Arch 2013;67(5):374-7.
28. Kim YJ, Kim JH, Hong AR, Park KS, Kim SW, Shin CS, Kim SY. Stimulated Salivary Cortisol as a Noninvasive Diagnostic Tool for Adrenal Insufficiency. Endocrinol Metab. 2020;35:628–635.
29. Ludberg U, Frankenhaeuser M. Pituitary-adrenal and sympathetic-adrenal correlates of distress and effort. J Psychosom Res 1980;24(3-4):125-30.
30. Frankenhaeuser M. A biopsychosocial approach to work life issues Int J Health Serv 1989;19(4):747-58.
31. Cool J, Zappetti D. The physiology of stress. Medical student well-being: An essential guide 2019;1-15.
32. Tennison LR, Rodgers LS, Beker D, Vorobjeva KI, Creed ET, Simonenko A. Cortisol and symptoms of psychopathology in Russian and American college students. Int J Psychol 2010;1;45(3):165-73.
33. Parrott AC. Does cigarette smoking cause stress? Am Psychol 1999;54(10):817-820.
34. Steptoe A, Ussher M. Smoking, cortisol and nicotine withdrawal. Psychopharmacology (Berl) 2006;185(2):195-203.
35. Benowitz NL. Nicotine addiction. N Engl J Med 2010;362(24):2295-2303.
36. Benowitz NL. Neurobiology of nicotine addiction: implications for smoking cessation treatment. Am J Med 2008;121(4):S3-S10.
37. Aleidi S, Elayah E, Zraiqat D, Abdallah R, Montaha AI. Factors affecting the academic performance of medical, dental, and pharmacy students in Jordan. Jordan Journal of Pharmaceutical Sciences 2020;13(2):169-183.
38. Attalla SM, Ruhi S, Mud CN. Effect of cigarette smoking on the academic achievement among management and science university students. Mal J Med Health Sci 2020;16(7):18-22.
39. Alqahtani JS, Aldhahir AM, Alanazi Z, Alsulami EZ, Alsulaimani MA. Impact of smoking status and nicotine dependence on academic performance of health sciences students. Subst Abuse Rehabil 2023;14:13-24.

Details

Primary Language

English

Subjects

Clinical Sciences (Other)

Journal Section

Research Article

Authors

Oya Sayın
0000-0003-0879-9091
Türkiye

Publication Date

January 28, 2026

Submission Date

November 2, 2025

Acceptance Date

December 16, 2025

Published in Issue

Year 2026 Volume: 40 Number: 1

DOI

https://doi.org/10.18614/dehm.1873863

IZ

https://izlik.org/JA67MW49BU

Cite

RIS / Bibtex

APA

Sayın, O. (2026). The relationship between smoking and stress hormones in health technician students. Developments and Experiments in Health and Medicine, 40(1), 101-109. https://doi.org/10.18614/dehm.1873863

AMA

1.Sayın O. The relationship between smoking and stress hormones in health technician students. Dev Exp Health Med. 2026;40(1):101-109. doi:10.18614/dehm.1873863

Chicago

Sayın, Oya. 2026. “The Relationship Between Smoking and Stress Hormones in Health Technician Students”. Developments and Experiments in Health and Medicine 40 (1): 101-9. https://doi.org/10.18614/dehm.1873863.

EndNote

Sayın O (January 1, 2026) The relationship between smoking and stress hormones in health technician students. Developments and Experiments in Health and Medicine 40 1 101–109.

IEEE

[1]O. Sayın, “The relationship between smoking and stress hormones in health technician students”, Dev Exp Health Med, vol. 40, no. 1, pp. 101–109, Jan. 2026, doi: 10.18614/dehm.1873863.

ISNAD

Sayın, Oya. “The Relationship Between Smoking and Stress Hormones in Health Technician Students”. Developments and Experiments in Health and Medicine 40/1 (January 1, 2026): 101-109. https://doi.org/10.18614/dehm.1873863.

JAMA

1.Sayın O. The relationship between smoking and stress hormones in health technician students. Dev Exp Health Med. 2026;40:101–109.

MLA

Sayın, Oya. “The Relationship Between Smoking and Stress Hormones in Health Technician Students”. Developments and Experiments in Health and Medicine, vol. 40, no. 1, Jan. 2026, pp. 101-9, doi:10.18614/dehm.1873863.

Vancouver

1.Oya Sayın. The relationship between smoking and stress hormones in health technician students. Dev Exp Health Med. 2026 Jan. 1;40(1):101-9. doi:10.18614/dehm.1873863