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Association between smoking status and subclinical coronary atherosclerosis in asymptomatic Korean individuals
Hyeji Lee, Jinhee Ha, Kyung Sun Park, Young-Jee Jeon, Sangwoo Park, Soe Hee Ann, Yong-Giun Kim, Yongjik Lee, Woon Jung Kwon, Seong Hoon Choi, Seungbong Han, Gyung-Min Park
Epidemiol Health. 2024;46:e2024064.   Published online July 16, 2024
DOI: https://doi.org/10.4178/epih.e2024064
  • 842 View
  • 51 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In this study, we sought to evaluate the association between smoking status and subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in asymptomatic individuals.
METHODS
We retrospectively analyzed 9,285 asymptomatic participants (mean age, 53.7±8.0 years; n=6,017, 64.8% male) with no history of coronary artery disease (CAD) who had undergone self-referred CCTA. Of these participants, 4,333 (46.7%) were considered never smokers, 2,885 (31.1%) former smokers, and 2,067 (22.3%) current smokers. We assessed the degree and characteristics of subclinical coronary atherosclerosis using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%.
RESULTS
Compared with never-smokers, former smokers exhibited no significant differences in the probabilities of obstructive CAD, any coronary plaque, calcified plaque, or mixed plaque, as determined using adjusted odds ratios (aORs; p>0.05 for all). However, the risk of non-calcified plaque was significantly higher in former smokers (aOR, 1.34; 95% confidence interval [CI], 1.00 to 1.78; p=0.048). Current smokers had significantly higher rates of obstructive CAD (aOR, 1.46; 95% CI, 1.10 to 1.96; p=0.010), any coronary plaque (aOR, 1.41; 95% CI, 1.20 to 1.65; p<0.001), calcified plaque (aOR, 1.32; 95% CI, 1.13 to 1.55; p=0.001), non-calcified plaque (aOR, 1.72; 95% CI, 1.28 to 2.32; p<0.001), and mixed plaque (aOR, 2.00; 95% CI, 1.39 to 2.86; p<0.001) compared to never smokers.
CONCLUSIONS
This cross-sectional study revealed a significant association between current smoking and subclinical coronary atherosclerosis, as detected on CCTA. Additionally, former smoking demonstrated an association with non-calcified plaque, indicating elevated cardiovascular risk.
Summary
Korean summary
- 현재흡연은 무증상 관상동맥 죽상경화증의 독립적인 예측 인자이다. - 과거흡연은 초기 죽상경화증과 취약성을 반영하는 비석회화 플라크와 관련이 있다. - 무증상 관상동맥 죽상경화증을 예방하기 위해 적절한 금연 전략이 필요하다.
Key Message
- Current smoking is an independent predictor of subclinical coronary atherosclerosis. - Former smoking is associated with non-calcified plaque reflecting the early atherosclerosis and vulnerability. - Appropriate strategies for smoking cessation are needed to prevent subclinical coronary atherosclerosis.
Impact of electronic cigarette use on the increased risk of diabetes: the Korean Community Health Survey
Wonseok Jeong, Seungju Kim
Epidemiol Health. 2024;46:e2024029.   Published online February 13, 2024
DOI: https://doi.org/10.4178/epih.e2024029
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  • 131 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Only a few studies have solely investigated the health impacts of electronic cigarettes on diabetes while considering the impact of conventional cigarettes. Therefore, this study aimed to examine the effect of electronic cigarette smoking on diabetes in Korean dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers.
METHODS
Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. The main independent variable was smoking behavior. Participants were categorized according to their smoking behavior, as dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. The dependent variable, the presence of diabetes, was defined by a doctor’s diagnosis. Multiple logistic regression analysis was performed to examine the association between smoking behavior and diabetes. Subgroup analyses were also performed to investigate the associations among different socioeconomic groups.
RESULTS
Conventional cigarette smokers had a higher risk of diabetes than did non-smokers (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.19 to 1.26). More importantly, those who only vaped electronic cigarettes were at high risk of diabetes (aOR, 1.15; 95% CI, 1.01 to 1.31). Lastly, dual smokers had the highest aOR for diabetes among other smoking behavior groups (aOR, 1.39; 95% CI, 1.22 to 1.58). Dual smoking was associated with the highest risk of diabetes in most subgroups.
CONCLUSIONS
This study suggests that conventional cigarette use and smoking electronic cigarettes negatively impact diabetes, and using both types leads to worse health outcomes. Therefore, cessation of all types of smoking is necessary for a healthy life.
Summary
Korean summary
이 연구는 한국의 이중 흡연자, 전자담배 흡연자, 일반 담배 흡연자 및 비흡연자들 사이에서 전자담배가 당뇨병에 미치는 영향을 조사하였다. 데이터는 460,603명의 한국 성인을 대상으로 한 2021년과 2022년 한국 지역사회 건강 조사를 사용하였다. 우리는 일반 담배나 전자담배 사용이 당뇨병에 부정적인 영향을 미친다는 것을 발견했으며, 두 가지를 함께 사용하면 건강 상태가 더욱 악화될 수 있다. 이에, 건강한 삶을 유지하기 위해서는 모든 형태의 흡연을 중단하는 것이 필수적이다.
Key Message
This study investigated how smoking electronic cigarettes affects diabetes among Korean dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. We found that using traditional cigarettes or electronic cigarettes adversely affects diabetes, and the combined use of both can lead to worse health outcomes. Therefore, quitting all forms of smoking is essential for maintaining a healthy life.
Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents
Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae
Epidemiol Health. 2024;46:e2024028.   Published online February 13, 2024
DOI: https://doi.org/10.4178/epih.e2024028
  • 5,241 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure (EBP) in Korean adolescents, and that the association is dose dependent.
METHODS
This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were EBP and hypertension. Statistical analyses were conducted using SAS version 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.
RESULTS
A total of 2,518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean± standard deviation participant age was 15.3±1.7 years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2,090 (83.0%). Analysis of the 2,518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an odds of elevated blood pressure of 3.00 (95% confidence interval [CI], 1.14 to 7.89). The odds of hypertension were 3.61 (95% CI, 1.13 to 11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.
CONCLUSIONS
It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents’ blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.
Summary
Korean summary
청소년기의 고혈압은 성인기의 다양한 질병을 초래할 수 있는 주요 원인이다. 흡연과 고혈압의 관계에 관한 다수의 연구들이 있으나 상반된 결과들이 보고되었고 국내 청소년의 직 간접적 담배 연기 노출과 혈압과의 연관성은 명확하게 밝혀지지 않았다. 따라서 본 연구에서는 한국 청소년에서 담배 연기 노출과 혈압 상승과의 연관성을 확인해 보고자 하였다. 연구 결과 직접 흡연을 하는 청소년들은 비흡연군에 비하여 3배 이상 혈압이 증가하는 것으로 나타났다.
Key Message
Hypertension during adolescence is a leading cause of disease in adults. The relationship between smoking and hypertension has been studied, but findings between studies are conflicting. Nicotine is a known toxin, but the relationship between active and passive smoking and blood pressure in adolescents is not clear. So that we tested and found adolescents in Korea who were active smokers showed over 3-fold increased risk of elevated blood pressure.
Smoking-attributable mortality among Korean adults in 2019
Yeun Soo Yang, Keum Ji Jung, Heejin Kimm, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2024;46:e2024011.   Published online December 19, 2023
DOI: https://doi.org/10.4178/epih.e2024011
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Tobacco use ranks among the leading preventable causes of death worldwide. This study was conducted to calculate the mortality rate attributable to smoking in Korea for 2019 and to highlight the importance of tracking and monitoring smoking-related deaths for public health purposes.
METHODS
Population attributable risk (PAR) was used to estimate the number of deaths related to smoking in 2019. PAR percentages were applied to the estimated mortality figures for various diseases, with PAR determined based on relative risk (RR). Levin’s formula was used to calculate PAR, and RR was adjusted for age and alcohol consumption using Cox proportional hazards regression model to derive disease-specific regression coefficients. The analysis incorporated previously determined smoking rates from 1985, and use rates of novel tobacco products were not considered.
RESULTS
The findings revealed a total of 67,982 smoking-attributable deaths in Korea in 2019, 56,993 of which occurred in men and 11,049 in women. The PAR of smoking for various causes of death in adult men was highest for lung cancer at 74.9%, followed by pneumonia (29.4%), ischemic heart disease (42.3%), and stroke (30.2%). For women, the PAR for smoking-related death was highest for lung cancer (19.9%), followed by stroke (7.6%), pneumonia (5.7%), and ischemic heart disease (9.1%).
CONCLUSIONS
In countries experiencing rapid fluctuations in smoking rates, including Korea, regular studies on smoking-related mortality is imperative. Furthermore, it is necessary to investigate smoking-related deaths, including the prevalence of novel tobacco product use, to accurately gauge the risks associated with emerging tobacco products.
Summary
Korean summary
이 연구는 2019년 한국에서 흡연으로 인한 사망률을 계산하고 공중 보건 목적을 위한 흡연 관련 사망추적 및 모니터링의 중요성을 강조합니다. 연구 결과, 2019년 한국에서 흡연으로 인해 총 67,982명이 사망했으며, 이 중 남성이 56,993명, 여성이 11,049명이었습니다. 특히 남성의 경우 폐암(74.9%), 여성의 경우 폐암(19.9%)에서 흡연으로 인한 사망 위험이 가장 높게 나타났습니다.
Key Message
This study analyzed deaths attributable to smoking in Korea in 2019, revealing that a total of 67,982 individuals lost their lives due to smoking. Among these, 56,993 were men and 11,049 were women, with the highest smoking-related mortality rate observed in men due to lung cancer at 74.9%, and in women due to lung cancer at 19.9%. Through these findings, this research emphasizes the importance of tracking and monitoring smoking-related deaths for public health.
Decrease in household secondhand smoking among Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses
Hana Kim, Heewon Kang, Sung-il Cho
Epidemiol Health. 2024;46:e2024009.   Published online December 13, 2023
DOI: https://doi.org/10.4178/epih.e2024009
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Smoke-free areas have expanded and related campaigns have been implemented since 1995 in Korea. As a result, household secondhand smoke (SHS) exposure has decreased over the past 15 years. We assessed the cohort effect, the effect of a 2008 campaign on household SHS exposure, and the impact of a complete smoking ban in public places along with increased penalties, as implemented in December 2011.
METHODS
Nationally representative cross-sectional 15-wave survey data of Korean adolescents were used. The 810,516 participants were classified into 6 grade groups, 15 period groups, and 20 middle school admission cohorts. An age-period-cohort analysis, conducted with the intrinsic estimator method, was used to assess the cohort effect of household SHS exposure, and interrupted-time series analyses were conducted to evaluate the effects of the smoke-free policy and the campaign.
RESULTS
For cohorts who entered middle school from 2002 to 2008, the risk of household SHS exposure decreased among both boys and girls. Immediately after implementation of the smoke-free policy, the prevalence of household SHS exposure by period decreased significantly for boys (coefficient, -8.96; p<0.05) and non-significantly for girls (coefficient, -6.99; p=0.07). After the campaign, there was a significant decrease in household SHS exposure by cohort among boys, both immediately and post-intervention (coefficient, -4.84; p=0.03; coefficient, -1.22; p=0.02, respectively).
CONCLUSIONS
A school-admission-cohort effect was found on household SHS exposure among adolescents, which was associated with the smoke-free policy and the campaign. Anti-smoking interventions should be implemented consistently and simultaneously.
Summary
Korean summary
지난 15년 동안 한국 청소년의 가정 내 간접흡연 노출은 감소했다. 가정 내 간접흡연 노출에 대하여 중학교 입학 코호트 효과가 존재하였다. 또한, 청소년의 가정 내 간접흡연 노출 감소는 2011년 12월 공공장소에서의 금연구역 규제와 2008년 시행된 캠페인과 연관되어 있었다.
Key Message
Household secondhand smoke (SHS) exposure among Korean adolescents has decreased over the past 15 years. There was a school admission cohort effect on household SHS exposure. A complete smoking ban in public space with increased penalties in December 2011 and a campaign in 2008 to avoid SHS exposure were associated with reduced household SHS exposure among adolescents.
The association between tobacco or nicotine product use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic: a cross-sectional study in Korea
Da-eun Lee, Heewon Kang, Sung-il Cho
Epidemiol Health. 2022;44:e2022087.   Published online October 7, 2022
DOI: https://doi.org/10.4178/epih.e2022087
  • 5,664 View
  • 265 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
It is necessary to investigate tobacco or nicotine product (TNP) use which acts as a risk factor for coronavirus disease 2019 (COVID-19) infection. Especially, wearing a mask is difficult to practice while using TNP. Therefore, this study aimed to examine the association between TNP use behaviors and non-compliance with mask-wearing during the COVID-19 pandemic.
METHODS
The samples of 208,618 Korean adults from 2020 Community Health Survey in Korea were used. As an independent variable, TNP use behaviors such as TNP use status, changes in TNP use after the COVID-19 outbreak, TNP types, and attempt to quit were analyzed. Logistic regression was performed on gender-stratified participants.
RESULTS
Among men, the odds ratio (OR) of current and former TNP users were 2.00 (95% confidence interval [CI], 1.66 to 2.40) and 1.32 (95% CI, 1.09 to 1.60), respectively, compared to never users. In women, OR was 1.50 (95% CI, 1.00 to 2.26) for former users. Cigarette use was more associated with not wearing a mask than non-cigarette tobacco or nicotine product (NCTNP) use (OR, 1.53; 95% CI, 1.12 to 2.08). Men whose TNP use decreased had lower non-compliance (OR, 0.52; 95% CI, 0.36 to 0.74); while women whose TNP use increased had lower non-compliance (OR, 0.13; 95% CI, 0.07 to 0.26).
CONCLUSIONS
Current and former users were less likely to wear masks. Cigarette use was more associated with not wearing a mask than NCTNP use. Changes in TNP use showed association for men and women; however, in the opposite direction. Therefore, more attention should be paid to TNP use prevention and cessation support during the epidemic of respiratory infectious diseases. Moreover, it is necessary to identify risk factors of cigarette users in compliance with mask-wearing.
Summary
Korean summary
담배 또는 니코틴 제품 (Tobacco or Nicotine Products, TNPs) 현재사용자와 과거사용자는 비사용자 대비 마스크 미착용 연관성이 높고, 비궐련 담배 또는 니코틴 제품 (Non-Cigarette Tobacco or Nicotine Products, NCTNPs) 사용자보다는 일반담배 사용자의 마스크 미착용 연관성이 높다. 남성에서는 코로나19 유행 이전 대비 TNPs 사용이 감소했을 때, 여성에서는 증가했을 때 마스크 미착용 연관성이 낮았다. 따라서 호흡기 감염병 유행 시기에는 더욱 TNPs 사용 예방과 금연 지원에 관심을 가질 것을 제안한다.
Key Message
During the epidemic of respiratory infectious diseases, more attention should be paid to tobacco or nicotine products (TNPs) use prevention and cessation support.
The risk of gastric cancer according to changes in smoking status among Korean men
Sung Keun Park, Min-Ho Kim, Chang-Mo Oh, Eunhee Ha, Eun Hye Yang, Woo Yeon Hwang, Ann Hee You, Jae-Hong Ryoo
Epidemiol Health. 2022;44:e2022086.   Published online October 7, 2022
DOI: https://doi.org/10.4178/epih.e2022086
  • 5,643 View
  • 213 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Smoking is a risk factor for gastric cancer. Studies have shown that the risk of gastric cancer can vary by smoking status and smoking amount at a single point in time. However, few data have been reported about the effect of changes in smoking status over time on the risk of gastric cancer.
METHODS
This study collected data from the National Health Insurance Corporation in Korea on 97,700 Korean men without gastric cancer who underwent health check-ups from 2002 to 2013. The smoking status (never smoked, quit smoking, and currently smoking) of study participants was assessed in 2003-2004 and 2009, and the results were categorized into 7 groups: never-never, never-quit, never-current, quit-quit, quit-current, current-quit, and current-current. Participants were followed until 2013 to identify incident gastric cancer. A multivariate Cox proportional hazard model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident gastric cancer according to changes in smoking status and smoking amount (pack-years).
RESULTS
Compared with group 1 (never-never), participants currently smoking in 2009 (never-current, quit-current, and current-current) had higher HRs for gastric cancer (never-quit: 1.077; 95% CI, 0.887 to 1.306, never-current: 1.347; 95% CI, 0.983 to1.846, quit-quit: 1.086; 95% CI, 0.863 to 1.366, quit-current: 1.538; 95% CI, 1.042 to 2.269, current-quit: 1.339; 95% CI, 1.077 to 1.666, and current-current: 1.589; 95% CI, 1.355 to 1.864, respectively). The risk for gastric cancer was highest in heavy smokers, followed by moderate smokers.
CONCLUSIONS
In all categories of smoking status, current smoking was associated with the highest risk of gastric cancer. Heavy smoking was associated with an increased risk of gastric cancer, even in former smokers.
Summary
Korean summary
현재 흡연자의 경우 과거 흡연여부와 관계 없이 위암의 위험성이 가장 증가한다. 과거 흡연자의 경우에는 흡연량이 많은 경우에는 위암의 위험성이 증가한다. 이런 결과는 금연이나 흡연량을 줄이는 것이 위암의 위험성을 감소시키는데 매우 중요한 요인이란 것을 확인할 수 있다.
Key Message
Current smoking was associated with an increased risk of gastric cancer, regardless of previous smoking status. Although former smoking was not associated with an increased risk of gastric cancer, former smokers with a history of heavy smoking had an increased risk of gastric cancer. These results suggest that smoking cessation and reducing smoking amounts are both important factors in reducing the risk of gastric cancer.

Citations

Citations to this article as recorded by  
  • Gastric dysplasia in random biopsies: the influence of Helicobacter pylori infection and alcohol consumption in the presence of a lesion
    Ana Isabel Ferreira, Tiago Lima Capela, Vítor Macedo Silva, Sofia Xavier, Pedro Boal Carvalho, Joana Magalhães, José Cotter
    Scandinavian Journal of Gastroenterology.2024; 59(2): 125.     CrossRef
  • Lifestyle Behaviors in Patients With Gastric Cancer: Continuous Need for Alcohol Abstinence and Muscle Strength Training Education
    Ji Won Seo, Kyu Na Lee, Kyung Do Han, Ki Bum Park
    Journal of Gastric Cancer.2024; 24(3): 316.     CrossRef
  • Gastric cancer—Epidemiology, modifiable and non-modifiable risk factors, challenges and opportunities: An updated review
    Tajul Islam Mamun, Sabrina Younus, Md. Hashibur Rahman
    Cancer Treatment and Research Communications.2024; 41: 100845.     CrossRef
The associations of the national health and productivity management program with corporate profits in Japan
Yuichiro Yano, Hiroshi Kanegae, Koichi Node, Atsushi Mizuno, Akira Nishiyama, Hiromi Rakugi, Hiroshi Itoh, Kaori Kitaoka, Naoki Kashihara, Fumiaki Ikeno, Ichiro Tsuji, Kunio Okada
Epidemiol Health. 2022;44:e2022080.   Published online September 23, 2022
DOI: https://doi.org/10.4178/epih.e2022080
  • 7,358 View
  • 382 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Using a dataset from a survey on national health and productivity management, we identified health and productivity factors associated with organizational profitability.
METHODS
The Ministry of Economy, Trade and Industry conducted an annual survey on Health and Productivity Management between 2014 and 2021. We assessed the associations of organizational health and productivity management using survey questions collected in 2017 and 2018, with the rate of change in profits from 2017 and 2018 to 2020. We identified factors associated with organizational profitability using eXtreme Gradient Boosting, and calculated SHapley Additive exPlanation (SHAP) values for each factor.
RESULTS
Among 1,593 companies (n= 4,359,834 employees), the mean age of employees at baseline was 40.3 years and the proportion of women was 25.8%. A confusion matrix for evaluating model performance had an accuracy of 0.997, precision of 0.993, recall of 0.997, and area under the precision-recall curve of 0.999. The most important factors related to an increase in corporate profits were the percentage of current smokers (SHAP value, 0.121), per-employee cost of health services (0.084) and medical services (0.050); the percentage of full-time employees working in sales departments (0.074) and distribution or customer service departments (0.054); the percentage of employees who slept well (0.055); and the percentage of employees within a company who regularly exercised (0.043).
CONCLUSIONS
Employees’ lifestyle-related health risk factors and organizations’ management systems were associated with organizational profitability. Lifestyle medicine professionals may demonstrate a significant return on investment by creating a healthier and more productive workforce.
Summary
Key Message
Lifestyle medicine professionals may demonstrate a significant return on investment by creating a healthier and more productive workforce

Citations

Citations to this article as recorded by  
  • Role and Value of the Corporate Medical Director
    Gregg M. Stave, Wayne N. Burton, Richard J.L. Heron, T. Warner Hudson, J. Brent Pawlecki, David Roomes, Martin J. Sepulveda, Michael Rendel, Pamela A. Hymel
    Journal of Occupational & Environmental Medicine.2023; 65(12): e797.     CrossRef
Prediction of cancer survivors’ mortality risk in Korea: a 25-year nationwide prospective cohort study
Yeun Soo Yang, Heejin Kimm, Keum Ji Jung, Seulji Moon, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2022;44:e2022075.   Published online September 13, 2022
DOI: https://doi.org/10.4178/epih.e2022075
  • 6,883 View
  • 168 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate the factors affecting cancer survival and develop a mortality prediction model for Korean cancer survivors. Our study identified lifestyle and mortality risk factors and attempted to determine whether health-promoting lifestyles affect mortality.
METHODS
Among the 1,637,287 participants in the Korean Cancer Prevention Study (KCPS) cohort, 200,834 cancer survivors who were alive after cancer diagnosis were analyzed. Discrimination and calibration for predicting the 10-year mortality risk were evaluated. A prediction model was derived using the Cox model coefficients, mean risk factor values, and mean mortality from the cancer survivors in the KCPS cohort.
RESULTS
During the 21.6-year follow-up, the all-cause mortality rates of cancer survivors were 57.2% and 39.4% in men and women, respectively. Men, older age, current smoking, and a history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer were associated with reduced risk. The prediction model discrimination in the validation dataset for both KCPS all-cause mortality and KCPS cancer mortality was shown by C-statistics of 0.69 and 0.68, respectively. Based on the constructed prediction models, when we modified exercise status and smoking status, as modifiable factors, the cancer survivors’ risk of mortality decreased linearly.
CONCLUSIONS
A mortality prediction model for cancer survivors was developed that may be helpful in supporting a healthy life. Lifestyle modifications in cancer survivors may affect their risk of mortality in the future.
Summary
Korean summary
현재 암 생존자의 사망 위험을 평가하는 데 유용한 한국형 암 생존자 사망률 예측 모델은 없습니다. 본 연구에서는 고령, 남성, 현재 흡연, 당뇨병 병력을 포함한 생활양식 요인이 사망의 고위험 요인인 반면, 운동 습관 및 암의 가족력은 사망 위험을 감소시키는 것으로 나타났습니다. 현재 흡연과 운동 습관은 사망 위험에 영향을 미치는 수정 가능한 두 가지 요소로써, 이러한 생활습관 요인으로 구성된 예측모형은 생활습관 교정을 통해 우리나라 암 생존자의 사망률을 낮출 수 있음을 시사합니다.
Key Message
Currently, there is no Korean mortality prediction model for cancer survivors that would be useful in evaluating their risk of mortality. The present study showed that lifestyle factors, including older age, male sex, current smoking, and history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer reduced the risk of mortality. Current smoking and exercise habits are the two modifiable factors that affected the risk of mortality. The prediction model comprising these lifestyle factors implies that the risk of mortality of cancer survivors in Korea can be reduced through lifestyle modification.

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  • COVID-19 Mortality and Severity in Cancer Patients and Cancer Survivors
    Jae-Min Park, Hye Yeon Koo, Jae-ryun Lee, Hyejin Lee, Jin Yong Lee
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Weight maintenance and gain were significantly associated with lower risk of all-cause and cancer-related mortality in Korean adults who were newly diagnosed with cancer based on the Korean NHIS-HEALS cohort
    Yong-June Kim, Seung Park, Won Tae Kim, Yoon-Jong Bae, Yonghwan Kim, Hee-Taik Kang
    Medicine.2023; 102(47): e36184.     CrossRef
COVID-19: Special Article
Smoking, drinking, and physical activity among Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey
Sunhye Choi, Jinwook Bahk, Suyeon Park, Kyungwon Oh, Kyunghee Jung-Choi
Epidemiol Health. 2022;44:e2022043.   Published online April 25, 2022
DOI: https://doi.org/10.4178/epih.e2022043
  • 14,439 View
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  • 10 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to describe trends in health behaviours between 2011 and 2020 and compare the changes in these behaviours between the 2020 COVID-19 pandemic and previous periods according to socio-demographic variables.
METHODS
This study used data from the 2011 to 2020 Korea National Health and Nutrition Examination Survey. Current cigarette smoking, high-risk drinking, and inadequate physical activity levels were used as health behaviour indicators. The age-standardized prevalence, differences in prevalence between the periods, and the annual percentage change (APC) were calculated.
RESULTS
Current cigarette smoking showed a decreasing trend (APC, -2.6), high-risk drinking remained unchanged, and inadequate physical activity levels increased (APC, 3.5) during 2011-2020. There were significant differences in high-risk drinking (3.1%p; 95% confidence interval [CI], 0.3 to 5.9) and inadequate physical activity levels (4.3%p; 95% CI, 0.4 to 8.1) between 2019 and 2020 in men. Among men, increased high-risk drinking was found in those aged 40-49 years, non-single households, urban residents, and the middle and highest income groups between 2019 and 2020. The low educational group and manual workers among men aged 30-59 years also showed an increased proportion of high-risk drinking. Inadequate physical activity levels also increased among men between 2019 and 2020 in those aged 30-39 years, non-single households, urban residents, and the upper-middle-income group.
CONCLUSIONS
In the first year of the COVID-19 pandemic, Korean men’s high-risk drinking and inadequate physical activity levels increased. In addition to social efforts to reduce the spread of infectious diseases, active measures to positively change health behaviour are needed.
Summary
Korean summary
코로나 대유행 첫 해인 2020년, 한국 남성에서 고위험음주와 부적절한 신체 활동 수준이 증가하였다. 감염성 질환 대유행 시기, 확산을 차단하기 위한 사회적 노력과 더불어 건강행태에 부정적인 여파가 미치지 않도록 적극적인 대책이 필요함을 시사한다.
Key Message
In the first year of the COVID-19 pandemic, Korean men’s high-risk drinking and inadequate physical activity levels increased. Despite Korea's positive performance in various indicators during the COVID-19 pandemic, the socioeconomic and cultural effects of COVID-19 have affected people's health behaviour. In addition to social efforts to reduce the spread of infectious diseases, active measures to positively change health behaviour are needed.

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    Hye Young Shin, Ka Young Kim, Purum Kang
    Public Health Nursing.2024; 41(5): 987.     CrossRef
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    Jieun Hwang, Suyoung Jo, Heewon Kang, Eunsil Cheon, Sung-il Cho
    Tobacco Induced Diseases.2024; 22(July): 1.     CrossRef
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    Anna Han, Yean Jung Choi
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    Hohyun Seong, Sohee Kim, Hyunsook Shin, Chang Won Won, Youn-Jung Kim
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    Min-Hee Han, Bok-Mi Jung
    The Korean Journal of Community Living Science.2024; 35(3): 445.     CrossRef
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    Kyungwon Oh, Suyeon Park, Sihyun Park, Sungha Yun, Hongseok Choi, Eun Kyeong Jeong
    Epidemiology and Health.2023;[Epub]     CrossRef
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    Jhin-Yi Shin, Jaemoo Lee, Jung-Min Lee, Nam Yoon Ho
    Frontiers in Public Health.2023;[Epub]     CrossRef
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    Jae Yeol Kim, Jae-Woo Jung, Min-Jong Kang, Deog Kyeom Kim, Hayoung Choi, Young-Jae Cho, Seung Hun Jang, Chang-Hoon Lee, Yeon Mok Oh, Ji Sook Park
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    Filiz Eren, Isabelle Kousignian, Solène Wallez, Maria Melchior, Murielle Mary-Krause
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    Yoonjung Kim, Suyeon Park, Kyungwon Oh, Hongseok Choi, Eun Kyeong Jeong
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    Soo Young Kim
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Original Articles
The association of pancreatic cancer incidence with smoking status and smoking amount in Korean men
Do Jin Nam, Chang-Mo Oh, Eunhee Ha, Min-Ho Kim, Eun Hye Yang, Hyo Choon Lee, Soon Su Shin, Woo Yeon Hwang, Ann Hee You, Jae-Hong Ryoo
Epidemiol Health. 2022;44:e2022040.   Published online April 21, 2022
DOI: https://doi.org/10.4178/epih.e2022040
  • 10,609 View
  • 435 Download
  • 4 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Our study examined the dose-response relationship between smoking amounts (pack-years) and the risk of developing pancreatic cancer in Korean men.
METHODS
Of 125,743 participants who underwent medical health checkups in 2009, 121,408 were included in the final analysis and observed for the development of pancreatic cancer. We evaluated the associations between smoking amounts and incident pancreatic cancer in 4 groups classified by pack-year amounts. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incident pancreatic cancer by comparing groups 2 (<20 pack-year smokers), 3 (20-≤40 pack-year smokers), and 4 (>40 pack-year smokers) with group 1 (never smokers).
RESULTS
During 527,974.5 person-years of follow-up, 245 incident cases of pancreatic cancer developed between 2009 and 2013. The multivariate-adjusted HRs (95% CIs) for incident pancreatic cancer in groups 2, 3, and 4 were 1.05 (0.76 to 1.45), 1.28 (0.91 to 1.80), and 1.57 (1.00 to 2.46), respectively (p for trend=0.025). The HR (95% CI) of former smokers showed a dose-response relationship in the unadjusted model, but did not show a statistically significant association in the multivariate-adjusted model. The HR (95% CI) of current smokers showed a dose-response relationship in both the unadjusted (p for trend=0.020) and multivariate-adjusted models (p for trend=0.050).
CONCLUSIONS
The risk of developing pancreatic cancer was higher in current smokers status than in former smokers among Korean men, indicating that smoking cessation may have a protective effect.
Summary
Korean summary
본 연구에서는 대한민국 남성을 대상으로 흡연양 및 흡연상태에 따른 췌장암 발병을 분석하였다. 흡연양이 많을수록, 현재 흡연상태일수록 췌장암 발병이 높았고, 금연한 경우 췌장암의 발병이 낮은 것을 확인할 수 있었다.
Key Message
As a result of analyzing the incidence of pancreatic cancer according to the amount of smoking and smoking status among Korean men, it was confirmed that the more smoked and the current smoking status, the higher the incidence of pancreatic cancer, and the lower the incidence of pancreatic cancer when quitting smoking.

Citations

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  • Childhood and adulthood passive and active smoking, and the ABO group as risk factors for pancreatic cancer in women
    Anne‐Laure Vedie, Nasser Laouali, Amandine Gelot, Gianluca Severi, Marie‐Christine Boutron‐Ruault, Vinciane Rebours
    United European Gastroenterology Journal.2024; 12(4): 440.     CrossRef
  • Progress in understanding of relationship between smoking and pancreatic injury
    Xue Wei, Jian-Yu Hao
    World Chinese Journal of Digestology.2024; 32(3): 203.     CrossRef
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    Sijie He, Li Wan
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • Modifiable Pancreatic Ductal Adenocarcinoma (PDAC) Risk Factors
    Natalia Michalak, Ewa Małecka-Wojciesko
    Journal of Clinical Medicine.2023; 12(13): 4318.     CrossRef
The relationship between poor sleep quality measured by the Pittsburgh Sleep Quality Index and smoking status according to sex and age: an analysis of the 2018 Korean Community Health Survey
Jun Hyun Hwang, Soon-Woo Park
Epidemiol Health. 2022;44:e2022022.   Published online February 14, 2022
DOI: https://doi.org/10.4178/epih.e2022022
  • 13,299 View
  • 474 Download
  • 7 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Multiple studies have found that cigarette smokers are more likely to experience sleep disturbances than non-smokers. This study aimed to examine various associations between smoking and sleep quality according to sex and age, which have yet to be sufficiently examined in prior studies.
METHODS
Data analysis was conducted using a nationally representative sample of 224,986 Korean adults who participated in the 2018 Korea Community Health Survey. Sleep quality, as the dependent variable, was measured using the Pittsburgh Sleep Quality Index (PSQI), with PSQI scores indicating either good (≤4 points) or poor (>5 points) sleep quality. Multiple logistic regression analysis was performed considering socio-demographic factors, health behaviors, comorbidities, and psychological factors as covariates.
RESULTS
The overall weighted prevalence of poor sleep quality was 39.4% (95% confidence interval, 39.1 to 39.7). In the multivariate model that excluded psychological factors, poor sleep quality positively correlated to smoking for both sexes and all age groups except for male aged ≥65 years. However, in the full model that included psychological factors, statistically significant odds ratios (approximately 1.5) for poor sleep quality according to smoking status were only observed for female under 65 years of age.
CONCLUSIONS
The relationship between poor sleep quality and smoking status differed according to sex and age. In order to improve the quality of sleep, it is necessary to intervene smoking cessation along with solving psychological problems, especially female in middle age and younger.
Summary
Korean summary
한국 성인의 39.4%는 수면의 질(피츠버그 수면의 질 지수(PSQI) 기준)이 낮았다. 성별 및 연령에 따라 흡연과 수면의 질 사이의 관련성은 다르게 나타났다. 구체적으로는 65세 이하의 여성에서 흡연은 수면의 질 악화와 관련성이 있었으나, 남성 또는 65세 이상 여성에서는 흡연과 수면의 질 간 유의한 관련성을 보이지 않았다.
Key Message
In order to improve the quality of sleep, it is necessary to intervene smoking cessation along with solving psychological problems, especially female in middle age and younger.

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  • Association between consumption of tryptophan with sleep quality in King Saud University students
    Nora Alafif
    Journal of King Saud University - Science.2024; 36(2): 103046.     CrossRef
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    Adriano dos Santos, Serena Galiè
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  • The association between passive smoking and sleep quality in a Chinese hypertensive population: A cross-sectional study
    Niuniu Sun+, Yang Ni+, Yuqian Deng, Jiale Qi, Zhenjie Yu, Chang Wu, Juan He, Yibo Wu
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  • Network analysis of smoking-related sleep characteristics in Chinese adults
    Yuting Xie, Peiyuan Sun, Huang Huang, Jianjun Wu, Yue Ba, Guoyu Zhou, Fangfang Yu, Daming Zhang, Yaqun Zhang, Ranran Qie, Zhuolun Hu, Kaiyong Zou, Yawei Zhang
    Annals of Medicine.2024;[Epub]     CrossRef
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    Jing Huang, Peiwen Shi, Yuan Zhao, Huinan Zhang, Tian Gao, Xing Wang
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  • The Interactions between Smoking and Sleep
    Ioanna Grigoriou, Serafeim-Chrysovalantis Kotoulas, Konstantinos Porpodis, Dionysios Spyratos, Ioanna Papagiouvanni, Alexandros Tsantos, Anastasia Michailidou, Constantinos Mourelatos, Christina Mouratidou, Ioannis Alevroudis, Alexandra Marneri, Athanasia
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    I-Ming Chen, Tzu-Yun Lin, Yi-Ling Chien, Jennifer Yi-Ying Chen, Jen-Hui Chan, Shih-Cheng Liao, Po-Hsiu Kuo, Hsi-Chung Chen
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Social competence, leisure time activities, and smoking trajectories among adolescent boys: data from the Korean Children & Youth Panel Survey
Eunjung Park, Min Kyung Lim, Jinju Park, Tran Thi Phuong Thao, Sukyung Jeong, Eun Young Park, Jin-Kyoung Oh
Epidemiol Health. 2021;43:e2021066.   Published online September 9, 2021
DOI: https://doi.org/10.4178/epih.e2021066
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The purpose of this study was to identify the trajectories and potential predictors of tobacco use during adolescence in Korea and to develop appropriate strategies for the implementation of tobacco use prevention programs.
METHODS
The trajectory of tobacco use and associated predictors were analyzed for 1,169 male students from grade 6 (age 11-12) to grade 10 (age 15-16) in the Korean Children & Youth Panel Survey from 2012 to 2016.
RESULTS
Three trajectories of smoking experience were identified: non-smokers (class 1: n=775, 82.3%), temporary users (class 2: n=32, 3.4%), and regular users (class 3: n=135, 14.3%). When compared to non-smokers, temporary users had a higher likelihood of living with a single parent, dissatisfaction with grades, having a girlfriend, having been victimized at least once, and having at least 1 delinquent friend in grade 7 (when smoking experimentation was at its peak). Significant factors associated with regular use included having a girlfriend, committing at least 1 type of delinquent behavior, and being a non-reader. Committing at least 1 type of delinquent behavior and having at least 1 delinquent friend were associated with regular users, distinguishing them from temporary users.
CONCLUSIONS
Understanding why adolescents exhibit different trajectories of tobacco use by identifying the factors associated with each trajectory can contribute to the development of tailored prevention strategies and early cessation programs for adolescents.
Summary
Korean summary
2010-2016년 한국아동청소년패널에 포함된 남학생 흡연경험 분석을 통해 3개의 주요 흡연유형이 확인되었다 (비흡연자 82.3%, 일시 흡연자 3.4%, 지속 흡연자 14.3%). 한부모 가정, 학업성적에 대한 불만족, 이성친구를 사귀는 경우, 또래로부터 괴롭힘을 당한 경험, 1명 이상의 비행 친구가 있는 경우 일시 흡연자가 될 가능성이 높고, 비행 경험이 있는 경우, 이성 친구를 사귀는 경우, 독서를 하지 않는 경우 지속 흡연자가 될 가능성이 높았다. 청소년기 성장단계에 따른 흡연유형의 변화와 관련 요인에 대한 분석 결과는 청소년 대상 맞춤형 흡연예방 및 금연 프로그램 마련에 기여할 수 있을 것이다.
Key Message
In adolescence, significant life changes such as increasing academic workloads and various societal influences combined with growing recognition can affect their interest in trying smoking. The current study suggested that societal influence such as living with a single parent, dissatisfaction with grades, having been victimized at least once, and having at least 1 delinquent friend initiates smoking experimentation. Adolescents having a girlfriend, committing at least 1 type of delinquent behavior, and never reading have a greater possibility of smoking continuation for regular use. These findings might contribute to development of tailored prevention and early cessation programs for adolescents.
Effect of tobacco outlet density on quit attempts in Korea: a multi-level analysis of the 2015 Korean Community Health Survey
Jaehyung Kong, Sung-il Cho
Epidemiol Health. 2021;43:e2021048.   Published online August 3, 2021
DOI: https://doi.org/10.4178/epih.e2021048
  • 11,218 View
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  • 2 Web of Science
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study aimed to examine whether the regional density of tobacco outlets in Korea was associated with the likelihood of attempting to quit among smokers
METHODS
This study was designed as a secondary data analysis of a cross-sectional study. Data from the 2015 Korean Community Health Survey and tobacco outlet registrations in 17 metropolitan cities and provinces with 254 communities in Korea were used for the analysis. In total, 41,013 current smokers (≥19 years of age) were included. Multi-level logistic regression analysis was conducted to investigate regional differences associated with smokers’ attempts to quit and to evaluate the effects of individual and regional characteristics on quit attempts.
RESULTS
Higher tobacco outlet density was associated with lower odds of attempting to quit. Smokers who resided in districts with the highest tobacco outlet density were 18% less likely to attempt quitting (odds ratio, 0.82; 95% confidence interval, 0.70 to 0.98) than smokers who resided in the regions with the lowest tobacco outlet density (intraclass correlation coefficient, 0.030).
CONCLUSIONS
This study showed that quit attempts were related to community-level factors, such as tobacco outlet density, as well as other individual factors. These findings support the implementation of national policies restricting the number of tobacco outlets within communities or zones and limiting tobacco marketing in tobacco outlets.
Summary
Korean summary
본 연구는 2015년 지역사회건강조사에 응답한 19세 이상 현재 흡연자 41,013명을 대상으로 금연 시도와 관련된 개인 수준의 요인과 지역 수준의 요인을 파악하기 위하여 다수준 분석을 실시하였다. 분석결과, 개인 수준의 요인뿐만 아니라 거주하는 지역의 담배소매점 밀집도가 흡연자의 금연 시도와 유의한 관계가 있는 것으로 확인되었다. 흡연조장환경 개선을 위한 담배 공급 감소 노력의 일환으로 지역사회 수준의 담배소매점 관리 정책이 필요하다.
Key Message
This study aimed to investigate whether the environment related to tobacco retailers impacts adult smokers’ attempts to quit smoking, for the first time in South Korea, using nationwide data on tobacco retailers and current smokers. Smokers who resided in districts with the highest tobacco outlet density were 18% less likely to attempt quitting (odds ratio, 0.82; 95% confidence interval, 0.70-0.98) than smokers who resided in the regions with the lowest tobacco outlet density. These findings support the implementation of national policies restricting the number of tobacco outlets within communities or zones and limiting tobacco marketing in tobacco outlets.

Citations

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  • Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors
    Doo Woong Lee, Jieun Jang, Jaeyong Shin
    SSM - Population Health.2024; 25: 101580.     CrossRef
  • Use of geographically weighted regression models to inform retail endgame strategies in South Korea: application to cigarette and ENDS prevalence
    Heewon Kang, Eunsil Cheon, Jaeyoung Ha, Sung-il Cho
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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
  • 12,610 View
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  • 13 Web of Science
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AbstractAbstract AbstractSummary PDF
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

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  • Experiences with smoking habits and the need for cessation among habitual smokers in Japan: a qualitative study based on semi-structured interviews
    Kae Shiratani, Junko Shimasawa, Mayumi Mizutani
    BMC Primary Care.2024;[Epub]     CrossRef
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