Impact of Stress on Changes in Smoking Behavior: The Moderating Role of Social Support

Background: While stress is a key predictor of changes in smoking behavior, previous studies have largely focused on personal stress.Using an ecological perspective, this study categorizes stress into three levels: personal, organizational, and societal.This study aimed to investigate how social support differentially moderates the relationship between these multilevel stressors and changes in smoking behavior.Methods: Data from a nationwide sample of 1,500 Korean adults were analyzed.The dependent variable was change in smoking behavior (increased/initiated versus no change/decreased).A hierarchical logistic regression analysis was performed to test the interaction effects between multilevel stress and social support, controlling for demographic variables.Results: Although the main effects of stress were not significant, the interaction effects with social support varied distinctly by stress type.First, a significant buffering effect was found for societal stress, indicating that higher social support attenuates the risk of increased smoking under high societal stress.Second, the interaction between organizational stress and social support showed a positive trend, suggesting that high social support within an organization might act as a mechanism that reinforces or facilitates smoking behavior. Conclusion:This study demonstrates that social support is not a universally protective factor but functions differently-either as a "buffer" or an "amplifier"-depending on the context of stress.These findings emphasize the need for context-specific smoking cessation interventions.Furthermore, strategies addressing organizational stress should consider group norms and peer interactions that may inadvertently promote smoking.