Our results indicate differences in presenteeism according to general characteristics and health problems, including smoking and drinking. Several other studies have also shown female workers to have more presenteeism than male workers [8, 10]. Many employees had health issues that significantly affected presenteeism [10–12, 25], including psychological distress and emotional ill-health [8, 11, 12, 25] and, in recent studies, drug and alcohol problems [10, 12, 25] and smoking [10, 25]. The results of our study support these findings of earlier studies.
Businesses and governments are concerned about employee health because it affects employers’ medical costs and productivity. Hence, recent studies have investigated relations between workers’ health problems and presenteeism as related to productivity. Zakrzewska [26] reported that presenteeism costs more than absenteeism and disability, so it is reasonable to link workers’ health problems to presenteeism. However, most studies only link presenteeism to physical health problems [8, 25, 27], mental stress [8, 10, 11, 12], and work environment stressors [28]. Some have addressed links with health behaviors such as smoking [12, 16], alcohol use [12], obesity, and physical activity [10, 16, 21].
Though all employees can occasionally be unproductive, research suggests that smoking status alone negatively impacts productivity beyond the work time lost due to smoking breaks [16]. Some people might work intensely despite poor health conditions; however, previous studies have demonstrated smoking and drinking among workers affects their productivity [10, 11, 12], and loss of productivity may lead to absenteeism and presenteeism [13]. In recent studies, binge drinking was associated with presenteeism [29], and higher levels of alcohol consumption were associated with higher levels of impaired work performance (i.e., presenteeism) [19]. It is reasonable to assume that presenteeism might occur when people work through a hangover or smoke at work and, therefore, excessive drinking and heavy smoking can impact presenteeism.
In this study, alcohol drinking and smoking were found to be related to presenteeism. These findings are consistent with previous studies [14, 16, 19, 30]. The multiple logistic regression analysis from our study revealed that heavy smoking and high-risk alcohol drinking significantly affected presenteeism. After adjusting for general characteristics and the variable “health problems,” we found that the influence of heavy smoking on presenteeism increased. The longer employees were exposed to tobacco smoking in the workplace, or the more health problems they had, the greater the odds of presenteeism. There are several possible explanations for such results. Health status has a critical influence on work ability [7], and health risks are related to reduced productivity [8, 9]. Furthermore, smoking among workers affects productivity [10-12], may lead to presenteeism [13], and causes health problems related to presenteeism such as cancer [31] and cardiovascular diseases [32–35]. Similarly, alcohol drinking causes chronic liver diseases and cancer [36].
This study’s results have several implications. Smoking or drinking increases presenteeism, even after adjusting for physical illnesses, which implies costs to employers. Other recent studies have also found that presenteeism was associated with alcohol consumption [19, 29] and smoking [20], and several studies suggest that heavy drinking increases absenteeism and leads to declines in productivity, which can be more harmful to productivity than absenteeism [14]. Further, research suggests that high costs are incurred due to smokers’ absenteeism, presenteeism, smoking breaks, healthcare costs, and pension benefits [16].
Changes are needed to improve the health of workers who smoke and drink. The WHO states that one of the most effective ways to reduce tobacco consumption is to raise tobacco prices, but South Korea has the highest smoking rate and the lowest tobacco prices among the 41 OECD countries [3, 37]. Our society should pay more attention to heavy smoking and anti-smoking intervention programs, and based on our study, it would be wise to target heavy smokers in the workplace. Smoke-free workplace programs encourage smokers to quit and improve their overall health and productivity [24]. A recent study showed that when heavy smokers were part of a smoking cessation program, their success rates became higher than non-heavy smokers [30]. There is little information on whether changes in work structure can reduce the harmful effects of alcohol in the workplace [38]; however, mandatory screening programs are effective for industries such as transportation. Furthermore, investments in social welfare policies outside the workplace can decrease alcohol-related absences and increase productivity [14].
Though our study yielded important results, it had some limitations. First, this cross-sectional study could only confirm the associations between factors; in other words, it could not prove that smoking and drinking are direct causes of presenteeism. Second, errors regarding health problems may have occurred from using participants’ responses instead of doctors’ diagnoses. Nonetheless, this research is significant in being the first to investigate the effects of both smoking and drinking on presenteeism. The results of this study suggest that smoking and drinking, which have mainly been treated as health risk factors, may also be related to national productivity. In addition, this research, based on a national survey, can serve as a basic guide for future researchers about the impacts of heavy smoking and high-risk alcohol use in the workplace and the necessity of implementing relevant programs.