Epidemiology and Health

Original Articles

Patterns and predictors of smoking relapse among inpatient smoking intervention participants: a 1-year follow-up study in Korea: Seung Eun Lee, Chul-Woung Kim, Hyo-Bin Im, Myungwha Jang; Epidemiol Health. 2021;43:e2021043. Published online June 9, 2021; DOI: https://doi.org/10.4178/epih.e2021043

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Abstract

OBJECTIVES
This study aimed to identify relapse patterns in smokers who participated in an inpatient treatment program and to investigate factors related to relapse.

METHODS

The participants comprised 463 smokers who participated in an inpatient treatment operated by the Daejeon Tobacco Control Center from 2015 to 2018. Participants received high-intensity smoking cessation intervention for 5 consecutive days, including pharmacotherapy and behavioral support, and continued with follow-up for 1 year to determine whether they maintained smoking cessation after discharge from inpatient treatment. Kaplan-Meier and Cox proportional hazard models were used in the analysis.

RESULTS

Participants’ relapse rate within 1 year was 72.8%, and 59.8% of participants smoked again within 6 months after participation. A higher number of counseling sessions was significantly associated with a lower risk of relapse (hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.17 to 0.32 for ≥9 vs. ≤5 counseling sessions). Conversely, higher relapse rates were significantly associated with the use of nicotine replacement therapy (NRT) (HR, 1.91; 95% CI, 1.43 to 2.55 for use vs. no use), and higher levels of baseline expired carbon monoxide (CO) (HR, 1.58; 95% CI, 1.21 to 2.06 for expired CO concentrations of 10-19 ppm vs. expired CO concentrations <10 ppm).

CONCLUSIONS

High-intensity smoking cessation interventions in hospital settings can be effective for smoking cessation in smokers with high nicotine dependence. In addition, the results suggest that for quitters to maintain long-term abstinence, they should receive regular follow-up counseling for 1 year after completing a high-intensity smoking cessation intervention.

Summary

Korean summary
• 한국은 국가금연정책의 일환으로 중증고도흡연자를 위해 고강도의 입원형 금연 중재 프로그램을 운영하고 있다. • 고강도 금연 중재를 받은 후 첫 6개월은 재흡연이 가장 빈번히 일어나는 시기였다. • 장기 금연을 유지하기 위해서는 고강도 금연 중재 후에도 1년간 지속적인 추후 상담이 이루어져야 한다.

Key Message
• South Korea operates a high-intensity inpatient treatment program for heavy smokers. • Relapse typically occurred in the first 6 months after completing the intervention. • Continuous 1 year follow-up counseling is important for long-term abstinence.

Citations

Citations to this article as recorded by

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European Addiction Research.2024; 30(2): 103. CrossRef
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Research in Community and Public Health Nursing.2023; 34: 307. CrossRef
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Medicine.2022; 101(31): e29595. CrossRef

Prevalence and Risk Factors of Green Tobacco Sickness among Korean Tobacco Harvesters, 2003.: Kwan Lee, Hyun Sul Lim; Korean J Epidemiol. 2005;27(1):129-139.

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Abstract PDF: Abstract
OBJECTIVES
This study was carried out to understand the prevalence and risk factors of green tobacco sickness (GTS) among Korean tobacco harvesters.
METHODS
The authors conducted a questionnaire among the tobacco harvesters (842 persons from 449 out of 500 tobacco harvesting households) in Cheongsong-gun for 4 days from Sep 1 to 4, 2003.
RESULTS
The study subjects contained 440 males and 402 females. The prevalence of GTS in 2003 was 39.2%, and was significantly higher in females (53.4%) than in males (25.6%, p<0.01). The incidence density of GTS according to the number of workdays in 2003 was 11.5 spells/100 person-days. The GTS symptoms reported by the tobacco harvesters in 2003 were nausea in 320 cases (97.0%), dizziness in 311 cases (94.2%), headache in 264 cases (80.0%) and vomiting in 209 cases (63.3%) etc. Through multiple logistic regression, the factors significantly associated with GTS were found. Odds ratio for smoking, age over sixty(compared with under forties), and working over 10 hours(compared with under 10 hours) were respectively 0.23 (95% CI: 0.16~0.33), 0.46 (95% CI: 0.23~0.93), and 1.53 (95% CI: 1.12~2.10).
CONCLUSIONS
Our studies before this, there were significant recall bias by time lag between harvesting period and survey time. We tried to study promptly after harvesting tobacco leaves to solve this recall bias. More extensive epidemiologic studies, and educations for harvesters are expected.; Summary

Epidemiological Characteristics and Changes of Prevalence for Green Tobacco Sickness among Korean Tobacco Harvesters.: Joo Sub Lee, Sung Han Bae, Hyun Sul Lim, Kwan Lee; Korean J Epidemiol. 2004;26(1):39-49.

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Abstract PDF: Abstract
PURPOSE
This study was carried out to investigate the epidemiological characteristics and changes of prevalence for green tobacco sickness (GTS) for 2 years.
METHODS
The author conducted a questionnaire survey on the tobacco harvesters (875 persons from 478 out of 555 tobacco harvesting households surveyed last year) in Cheongsong-gun for 4 days from May 26 to 29, 2003.
RESULTS
The study subjects comprised 456 males and 419 females. The prevalence of GTS in 2002 was 50.5%, which was significantly higher than the 43.0% in 2001 (p<0.01). The incidence density of GTS in 2002 was 11.3 spells/100 person?working-days, which was lower than the 12.1 spells in 2001. Regardless of risk factors such as smoking, workingdays, and working hours, the prevalence of GTS in 2002 was higher than that in 2001. Among various GTS symptoms reported by the tobacco harvesters in 2002, cases of nausea were increased, while diarrhea, dyspnea and cough were decreased compared with 2001. The degree of GTS symptoms in 2002 was increased in 198 cases (64.5%), and decreased in 42 cases (13.7%). The proportion of harvesters who underwent treatment from their local medical facilities in 2002 was significantly decreased compared with that in 2001.
CONCLUSIONS
In Korea, there are many tobacco-harvesting households, most of which may be stricken with GTS. It is very important for doctors to diagnose the disease exactly and to develop prevention methods for GTS. I expect that more extensive epidemiological studies including the incidence and associated risk factors will be needed. In addition, surveillance system and measurements of urinary cotinine should be conducted.; Summary

Green Tobacco Sickness on Tobacco Harvesters in a Korean Village.: Hyun Sul Lim, Kwan Lee; Korean J Epidemiol. 2002;24(1):29-36.

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Abstract PDF: Abstract
PURPOSE
This study was conducted to understand the proportion and the risk factors of green tobacco sickness (GTS).
METHODS
The authors conducted a questionnaire among tobacco harvesters; 94 people from 59 households at a village in Youngduk-gun from Feb 1 to Feb 3, 2002.
RESULTS
The study group contained 49 females and 45 males. The mean durations of employment and the length of the working day were 23.3 14.2 years and 11.8 2.7 hours, respectively. The symptoms related to tobacco harvest were dizziness in 64 cases (68.1%), headache in 46 cases (48.9%), nausea in 45 cases (47.9%), sore eyes in 37 cases (39.4%), and vomiting in 36 cases (38.3%). The experience of GTS up until 2001 was 70.2%. The proportion of GTS in 2001 was 67.0% and was significantly higher in females (84.9%, p<0.01). The proportion of GTS by work days in 2001 was 16.4 spells/100 person days. The proportion of non-smokers was significantly higher than smokers (p<0.01). Therefore, smoking was negatively associated with GTS. The use of gloves and wristlets significantly increased the proportion of GTS (p<0.05). Through multiple logistic regression, significantly associated factors with GTS were found to be smoking (OR=0.18, 95% CI: 0.06-0.54), wearing of gloves (OR=9.20, 95% CI: 1.27-66.52), and sweating (OR= 3.52, 95% CI: 1.08-11.47). Of those who reported GTS in 2001, 65.6% underwent treatment from the local medical facilities. The distribution of the medical facilities utilized was pharmacies 39.3%, and medical health centers 26.2%.
CONCLUSIONS
: In Korea, there are many tobacco harvesters, and most may be stricken with green tobacco sickness. In the future it is hoped that more extensive epidemiological studies will be conducted; Summary

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