The relationship between smoking and stress hormones in health technician students

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.