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Globally, smoking is one of the biggest challenges in public health and is a known cause of several important diseases. Influenza is preventable via annual vaccination, which is the most effective and cost-beneficial method of prevention. However, subjects who smoke have some unhealthy behaviours such as alcohol, low physical activity, and low vaccination rate. In this study, we analyzed the relationship between smoking status and factors potentially related to the influenza vaccination coverage rate in the South Korean adult population.
The study included 13,565 participants aged >19 years, from 2010 to 2012 from the Korea National Health and Nutrition Examination Survey data. Univariate analyses were conducted to examine the association between influenza coverage rate and related factors. Multivariate analysis was obtained after adjusting for variables that were statistically significant.
The overall vaccination rate was 27.3% (n=3,703). Older individuals (P<0.0001), women (P<0.0001), non-smokers (P<0.0001), light alcohol drinkers (P<0.0001), the unemployed (P<0.0001), and subjects with diabetes mellitus (P<0.0001), hypercholesterolemia (P<0.0001), and metabolic syndrome (P<0.0001) had higher influenza vaccination coverage than the others. In multivariate analyses, current smokers and heavy smokers showed lower vaccination rates (odds ratio, 0.734; 95% confidence interval, 0.63–0.854).
In the current study, smokers and individuals with inadequate health-promoting behaviors had lower vaccination rates than the others did.
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Time to first cigarette after waking is an indicator of nicotine dependence. We aimed to identify the association between time to first cigarette and spirometry-proven obstructive respiratory impairment, especially chronic obstructive pulmonary disease, in current smokers.
We included 392 subjects who visited the comprehensive medical examination center of Hallym University Sacred Heart Hospital between July 2014 and September 2015. Subjects with lung disease or anemia were excluded. Obstructive pulmonary impairment was defined as <70% of the predicted value of forced expiratory volume in 1 second/forced vital capacity. Subjects were classified into the early (≤30 minutes) and late (>30 minutes) groups based on the time to first cigarette. Logistic regression and linear regression analyses were used for data analysis.
Ninety-eight subjects (25%) were classified into the early group. After adjusting for smoking behaviors (cigarettes per day and smoking duration), socioeconomic status (education and income), age, and physical activity, an early time to first cigarette was found to be associated with an increased risk of obstructive pulmonary impairment measured using spirometry (adjusted odds ratio, 2.84; 95% confidence interval, 1.22–6.61).
Compared to current smokers with a late time to first cigarette, those with an early time to first cigarette had a higher risk of obstructive pulmonary impairment, especially chronic obstructive pulmonary disease. Classifying smoking-related behaviors, especially time to first cigarette, may help target clinical screening for chronic obstructive pulmonary disease.
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The prevalence of metabolic syndrome (MetS) has risen rapidly worldwide, including in South Korea. Factors related to lifestyle are closely associated with the development of MetS. The aim of this study was to investigate the association between MetS and a number of factors positively influencing health, namely non-smoking, low-risk drinking, sufficient sleep, regular exercise, and the habit of reading food labels, among Korean men.
This cross-sectional study included 3,869 men from the 2007–2009 Korean National Health and Nutrition Examination Survey. Information on five factors positively influencing their health was obtained using a self-reported questionnaire. We categorized subjects into four groups, depending on the number of positive factors reported (group I, 0–1 factor; group II, 2 factors; group III, 3 factors; group IV, 4–5 factors).
Men who reported a greater number of positive health factors had better laboratory and anthropometric values than men who reported fewer positive health factors. The prevalence of MetS was 29.1, 27.2, 20.7, and 14.6% in groups I to IV, respectively. Compared to group I, odds ratios (95% confidence intervals) for MetS were 0.96 (0.78–1.19) in group II, 0.67 (0.52–0.87) in group III, and 0.52 (0.35–0.76) in group IV, after adjusting for confounding factors. Odds ratios for abdominal obesity, glucose intolerance, and hypertriglyceridemia were statistically significant.
A greater number of positive lifestyle factors influencing health were associated with a lower risk of developing MetS, in a nationally representative sample of Korean men.
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Cigarette smoking is a risk factor for cardiovascular disease (CVD) and has both beneficial and harmful effects in CVD. We hypothesized that weight gain following smoking cessation does not attenuate the CVD mortality of smoking cessation in the general Korean population.
Study subjects comprised 2.2% randomly selected patients from the Korean National Health Insurance Corporation, between 2002 and 2013. We identified 61,055 subjects who were classified as current smokers in 2003–2004. After excluding 21,956 subjects for missing data, we studied 30,004 subjects. We divided the 9,095 ex-smokers into two groups: those who gained over 2 kg (2,714), and those who did not gain over 2 kg (6,381, including weight loss), after smoking cessation. Cox proportional hazards regression models were used to estimate the association between weight gain following smoking cessation and CVD mortality.
In the primary analysis, the hazard ratios of all-cause deaths and CVD deaths were assessed in the three groups. The CVD risk factors and Charlson comorbidity index adjusted hazard ratios (aHRs) for CVD deaths were 0.80 (95% confidence interval [CI], 0.37 to 1.75) for ex-smokers with weight gain and 0.80 (95% CI, 0.50 to 1.27) for ex-smokers with no weight gain, compared to one for sustained smokers. The associations were stronger for events other than mortality. The aHRs for CVD events were 0.69 (95% CI, 0.54 to 0.88) and 0.81 (95% CI, 0.70 to 0.94) for the ex-smokers with and without weight gain, respectively.
Although smoking cessation leads to weight gain, it does not increase the risk of CVD death.
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Shift workers are increasing worldwide, and various negative health effects of shift work have been reported. This study aimed to evaluate the relationship between shift work and health behavior.
This cross-sectional study included a total of 11,680 Korean adults (6,061 men and 5,619 women) aged ≥20 years old who participated in the Fifth Korean National Health and Nutrition Examination Survey, 2010–2012. Multiple logistic regression analysis was performed to evaluate the association between shift work and health behavior after adjusting for covariates.
In men, shift work was associated with an increased risk of inadequate sleep (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.00 to 1.40) compared to day work. In women, shift work was associated with an increased risk of smoking (OR, 1.73; 95% CI, 1.34 to 2.22) and inadequate sleep (OR, 1.24; 95% CI, 1.05 to 1.47) compared to day work. In an age-stratified subgroup analysis, female shift workers aged ≥50 years old demonstrated an increased risk of smoking (OR, 5.55; 95% CI, 3.60 to 8.55), alcohol consumption (OR, 2.22; 95% CI, 1.53 to 3.23), and inadequate sleep (OR, 1.50; 95% CI, 1.10 to 2.05) compared to female day workers.
Shift work is associated with worse health behavior, and this is most evident in women aged ≥50 years. Targeted strategies to reduce the negative health effects of shift work should be implemented, with consideration of shift workers' demographic characteristics.
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White blood cell count is an independent risk factor for cardiovascular disease. Several lifestyle and metabolic factors such as cigarette smoking and obesity are known to be associated with an elevated white blood cell count. However, the joint effect of cigarette smoking and obesity on white blood cell count has not yet been fully described.
We explored the joint effect of cigarette smoking and obesity on white blood cell count using multiple logistic regression analyses after adjusting for confounding variables in a population-based, cross-sectional study of 416,065 Korean adults.
Cigarette smoking and body mass index have a dose-response relationship with a higher white blood cell count, but no synergistic interaction is observed between them (men, P for interaction=0.797; women, P for interaction=0.311). Cigarette smoking and body mass index might have an additive combination effect on high white blood cell count. Obese male smokers were 2.36 times more likely and obese female smokers 2.35 times more likely to have a high white blood cell count when compared with normal body mass index non-smokers.
Cigarette smoking and body mass index are independently associated with an elevated white blood cell count in both men and women.
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Dyslipidemia is a major risk factor contributing to cardiovascular disease and its prevalence is steadily rising. Although screening tests are readily accessible, dyslipidemia remains undertreated. Evaluating health behavior patterns after diagnosis may help improve lifestyle interventions for the management of dyslipidemia.
Data from the fifth Korean National Health and Nutrition Examination Survey 2010–2012 were used. A total of 6,624 dyslipidemia patients over 20 years old were included according to National Cholesterol Education Program-Adult Treatment Panel III guidelines. Logistic regression analysis was completed using a weighted method to determine whether awareness of dyslipidemia was associated with health behavior. Health behavior was divided into two categories: behavioral factors (smoking, alcohol consumption, exercise) and nutritional factors (adequate intake of fiber, carbohydrate, fat, protein).
There were no significant differences in health behavior among dyslipidemia patients according to awareness after adjustment for covariates, diabetes and hypertension. Awareness in women was associated with decreased smoking (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.32 to 0.94), but when adjusted for diabetes and hypertension the result was not significant (OR, 0.61; 95% CI, 0.35 to 1.06). The same pattern applied to intake of carbohydrate in men (OR, 1.28; 95% CI, 0.99 to 1.67) and protein in women (OR, 1.22; 95% CI, 0.98 to 1.50). In subgroup analysis, awareness of dyslipidemia in men without hypertension or diabetes was associated with adequate intake of carbohydrate (OR, 1.70; 95% CI, 1.06 to 2.72).
Increasing awareness alone may not be enough to improve healthy behavior in patients with dyslipidemia. Efforts including patient education and counseling through a multi-team approach may be required.
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Enquiry into smoking status and recommendations for smoking cessation is an essential preventive service. However, there are few studies comparing self-reported (SR) and cotinine-verified (CV) smoking statuses, using medical check-up data. The rates of discrepancy and under-reporting are unknown.
We performed a cross-sectional study using health examination data from Healthcare System Gangnam Center, Seoul National University Hospital in 2013. We analyzed SR and CV smoking statuses and discrepancies between the two in relation to sociodemographic variables. We also attempted to ascertain the factors associated with a discrepant smoking status among current smokers.
In the sample of 3,477 men, CV smoking rate was 11.1% higher than the SR rate. About 1 in 3 participants either omitted the smoking questionnaire or gave a false reply. The ratio of CV to SR smoking rates was 1.49 (95% confidence interval [CI], 1.38–1.61). After adjusting for confounding factors, older adults (≥60 years) showed an increased adjusted odds ratio (aOR) for discrepancy between SR and CV when compared to those in their twenties and thirties (aOR, 5.43; 95% CI, 2.69–10.96). Educational levels of high school graduation or lower (aOR, 2.33; 95% CI, 1.36–4.01), repeated health check-ups (aOR, 1.45; 95% CI, 1.03–2.06), and low cotinine levels of <500 ng/mL (aOR, 2.03; 95% CI, 1.33–3.09), were also associated with discordance between SR and CV smoking status.
Omissions and false responses impede the accurate assessment of smoking status in health check-up participants. In order to improve accuracy, it is suggested that researcher pay attention to participants with greater discrepancy between SR and CV smoking status, and formulate interventions to improve response rates.
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Varenicline is now very useful medication for cessation; however, there is only little result of researches with varenicline for cessation of hospitalized patients. This research attempted to analyze the cessation effect of medication and compliance of hospitalized patients.
This research included data for 52 patients who were prescribed varenicline among 280 patients who were consulted for cessation during their admission period. This research checked whether smoking was stopped or not after six months and analyzed their compliance, the factors for succeeding in smoking cessation.
One hundred and ninety hospitalized patients participated in smoking cessation counseling among 280 patients who included consultation from their admission departments. And varenicline was prescribed for only 80 patients after counseling. Nineteen smokers were successful in smoking cessation among 52 final participants representing the rating of success of 36.5%. The linkage between compliance of varenicline and rate of smoking successful has no statistical significance. The factors for succeeding in smoking of hospitalized patients are admission departments, diseases, and economic states.
Smoking cessation program has low inpatient compliance. Cooperation of each departments is very important for better compliance. Success rate of cessation was relatively high (36.5%). Cessation attempt during hospitalization is very effective strategy.
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Smoking is a well-known risk factor of cancer, chronic disease, and cerebrovascular disease. Hospital admission is a good time to quit smoking but patients have little opportunity to take part in an intensive smoking cessation intervention. The purpose of this study was to identify the factors of successful smoking cessation among stroke patients who undergo an intensive cessation intervention during the hospitalization period.
Thirty-nine male smokers who were admitted with stroke were enrolled in the study. They participated in a smoking cessation intervention during hospitalization. Smoking status was followed up by telephone 3 months later. Nicotine dependence, sociodemographic factors, and other clinical characteristics were assessed.
After 3 months post-intervention, the number of patients who stopped smoking was 27 (69.2%). In addition, there was no significant difference in nicotine dependence, sociodemographic factors, and clinical characteristics. Only the stages of readiness for smoking cessation were a significant predictor (odds ratio, 18.86; 95% confidence interval, 1.59–223.22).
This study shows that a patient's willingness to quit is the most significant predictor of stopping smoking after Inpatient cessation Intervention for stroke Patients.
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This study aimed to evaluate an association between smoking, smoking cessation, and periodontal disease in Korean adults.
The data were collected from 8,336 participants, aged between 20 and 64 years, who participated in the fifth Korea National Health and Nutrition Examination (2010 and 2012). Smoking status was assessed using self-administered questionnaires. Periodontal disease was defined as a community periodontal index ≥3 points. Logistic regression analysis was used to evaluate an association between smoking, smoking cessation, and periodontal disease after adjusting for age, sex, education, monthly income, diabetes, obesity, alcohol intake, and frequency of tooth brushing.
The risk of periodontal disease was higher among current smokers (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.21-1.83) than never smokers. Among current smokers, the risk of periodontal disease was increased in smokers of ≥10 cigarettes/d, ≥20 years duration, and >10 pack-years compared with never smokers (P<0.05). Among former smokers, the risk of periodontal disease after 10 years since cessation declined to 0.56 (95% CI, 0.42-0.75) compared with current smokers and was indistinguishable statistically from never smokers.
Periodontal disease is significantly associated with smoking status in Korean adults.
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Adolescent smoking is positively related to weight control attempts, especially by unhealthy methods. The co-occurrence of smoking and unhealthy weight control behaviors may cause serious health problems in adolescents. This study examined the relationship of smoking with unhealthy weight control behaviors among Korean adolescents.
This cross-sectional study involved 31,090 students of grades 7 to 12, who had tried to reduce or maintain their weight during the 30 days prior to The Tenth Korea Youth Risk Behavior Web-based Survey, 2014. Data on height, weight, weight control methods, smoking, alcohol intake, living with one's family, and perceived economic status were obtained through self-report questionnaires. ‘Unhealthy weight control behaviors’ were subcategorized into ‘extreme weight control behaviors’ and ‘less extreme weight control behaviors.’
The smoking rates were 13.3%±0.4% in boys and 3.8%±0.2% in girls. Current smokers were more likely to engage in extreme weight control behaviors (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.09 to 2.00 in boys, and OR, 2.05; 95% CI, 1.59 to 2.65 in girls) and less extreme weight control behaviors (OR, 1.23; 95% CI, 1.07 to 1.40 in boys, and OR, 1.47; 95% CI, 1.22 to 1.76 in girls) compared to non-smokers among both boys and girls.
Current smoking is independently related to a high likelihood of engaging in unhealthy weight control behaviors among Korean adolescents. This relationship is stronger for girls than for boys. Extreme weight control behaviors have a stronger relationship with current smoking than less extreme weight control behaviors.
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Morning blood pressure surge affects to cardiovascular disease risk. Short time to first cigarette (TTFC) after waking can enhance morning blood pressure surge, and accelerate atherosclerosis
We investigated that the relationship between TTFC and blood pressure. The study subjects included male current smokers (n=211) who had health check-up in Hallym University Sacred Heart Hospital from July to September, 2014. We categorized the subjects into 2 groups according to TTFC; early TTFC (TTFC <30 minutes) and late TTFC (TTFC ≥30 minutes), and the subjects who were taking antihypertensive medications or had a high blood pressure (>140 mm Hg or 90 mm Hg) were defined as hypertensive group. Multivariate logistic regression was performed to estimate the odds ratio and 95% confidence interval to investigate the association between TTFC and hypertensive group.
Compared with late TTFC, early TTFC had higher odds (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.89-7.94) for hypertensive group. After adjusting confounding factors, early TTFC was significantly associated with an increased risk of hypertension (OR, 4.43; 95% CI, 1.84-10.70).
early TTFC after waking is associated with hypertension. It suggests delaying TTFC might help to control of blood pressure among the current smokers who are not ready to immediately quit smoking.
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Korean women are known to have a very low smoking rate. However, the actual smoking rate among Korean women is higher than 10% and may continue to increase gradually. In addition, some Korean women use extreme weight control methods that have potentially harmful effects. This study was conducted to elucidate weight control methods related to cotinine-verified smoking among Korean adult women.
This cross-sectional study involved 4,189 women aged ≥19 years who had attempted weight control during the past 1 year from the Korea National Health and Nutrition Examination Survey, 2008-2011. Smoking status was assessed using both self-report questionnaires and assays of urinary cotinine, and weight control methods were investigated using self-report questionnaires.
The smoking rate based on the measurement of urinary cotinine was 12.4% ± 0.8% among Korean women. Cotinine-verified smokers were more likely to attempt fasting (odds ratio, 2.19; 95% confidence intervals, 1.03 to 4.67), taking prescription diet-pills (odds ratio, 2.37; 95% confidence intervals, 1.47 to 3.82), and taking nonprescription diet-pills (odds ratio, 3.46; 95% confidence intervals, 1.71 to 6.98), and were less likely to attempt eating less food or modifying dietary patterns (odds ratio, 0.71; 95% confidence intervals, 0.51 to 0.99) compared to non-smokers.
Korean adult women's smoking is independently related to a high likelihood of using weight control methods with potentially harmful effects, such as fasting and taking diet-pills, and a low likelihood of choosing weight control methods, including dietary modification, that require constant effort for a prolonged time.
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Hospitalization presents smokers with an opportunity to initiate smoking cessation. We studied the effect of inpatient counseling and follow-up after discharge on smoking cessation and assessed predictors of successful cessation.
This study included a total of 125 patients (118 male and 7 female) who were admitted to departments of neurology, cardiology, and pulmonology. They were referred to the smoking cessation clinic, and participated between September 2011 and February 2013. A counseling service lasting about thirty minutes was provided by the third-year family medicine residents during hospitalization. The follow-up counseling services, which were either by telephone or in-person physician counseling were provided at 1 week, 4 weeks, and 3 months. Smoking habits and nicotine dependency data were gathered using questionnaires, and patient information was collected from electronic medical records.
The average age in the study was 57.9 ± 10.2 years and duration of smoking was 35.9 ± 11.7 years. Daily tobacco consumption was 23.5 ± 13.2 cigarettes. The smoking cessation rate after 3 months was 42.4%. The only differences between patients in the successful cessation and failed groups were cause of admission (P = 0.039) and total number of counseling sessions after discharge (P < 0.001). In a multivariate analysis, smoking cessation was more likely when patients experienced more instances of follow-up after discharge (1-2 visits: odds ratio [OR], 8.186; 95% confidence interval [CI], 1.060 to 63.239; ≥3 visits: OR, 121.873; 95% CI, 14.462 to 1,027.055).
Smoking cessation counseling during hospitalization and further follow-up by telephone or outpatient counseling after discharge contributed to an increased smoking cessation rate. The smoking cessation rate also tended to increase with total counseling numbers.
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The objective of this study was to investigate the relationship between smoking and metabolic syndrome in men.
This cross-sectional study included 1,852 men over age 40 who underwent health screening from April 2009 to December 2010. We classified them into three smoking levels as non-, intermediate-, and heavy-smoker, considering their smoking status (non, ex, current) and amount (0, 1-29, ≥30 pack year [PYR]). The relationship between smoking level and metabolic syndrome was analyzed by logistic regression analysis, after covariates (age, body mass index, education, house income, alcohol intake, and physical activity) were controlled.
The proportions of non-, intermediate-, and heavy-smokers were 31.8%, 56.2%, and 12.0%, respectively. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for metabolic syndrome were 1.0, 1.58 (1.09-2.23), 1.92 (1.29-2.81) in non-, intermediate-, and heavy-smokers, respectively. For heavy-smokers compared with non-smokers, ORs and 95% CIs of a lower high density lipoprotein cholesterol, higher triglyceride, and higher fasting glucose were 2.47 (1.63-3.74), 1.71 (1.17-2.52), and 1.43 (1.02-2.00), respectively. In current-smokers, we divided into three subgroups according to PYR, and compared with 1-19 PYR, ORs and 95% CIs of 20-29 PYR and ≥30 PYR for metabolic syndrome were 2.07 (1.14-3.74) and 3.06 (1.66-5.62), respectively.
This study showed a positive dose-response relationship between smoking level and metabolic syndrome in men.
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Lung age, calculated from sex, forced expiratory volume in one second (FEV1), and height, was developed to illustrate premature changes to the lungs and could be used to motivate smoking cessation. However, this method has not been tested in association with smoking in Korea. The purpose of this study was to investigate the association of lung age with smoking and other factors in Korean males.
We reviewed the records of 1,100 healthy men who visited a health promotion center at Ewha Womans University Medical Center from January 2008 to June 2009. Lung age was calculated from FEV1 and normal predictive values of spirometry according to age in the Korean population. The difference between lung age and chronological age was evaluated in relation to smoking status, weight, body mass index, waist, muscle mass, fat mass, and exercise.
The age difference was significantly higher in current smokers than in non-smokers (12.47 ± 19.90 vs. 7.30 ± 19.52, P < 0.001). Additionally, the age difference was positively correlated with life time pack-year (β = 0.223; P < 0.001) and fat mass (β = 0.462; P < 0.001). Lung age increased 1 year for 4.48 pack-year increase or for 2.16% increase in fat mass.
We found a significant relationship between lung age and both smoking status and fat mass in healthy Korean males. Lung age may be a useful tool for motivating cessation of cigarette smoking and management of risk factors related to obesity.
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Previous studies have shown that self-reports tend to underestimate smoking status, especially among women in Korea. We therefore assessed the characteristics of Korean women smokers who falsely described themselves as non-smokers.
The subjects were 4,135 adult women aged ≥19 years who participated in the 2008 Korean National Health and Nutrition Examination Survey. Of these, 3,151 subjects answered questions about their smoking status on self-reported questionnaires and underwent assays of urinary cotinine concentration. Subgroups of false respondents (n = 131) and true respondents (n = 198) regarding smoking were determined by comparing their responses on questionnaires with their urinary cotinine levels.
Among adult Korean women, the self-reported smoking rate was 7.4% (95% confidence interval [CI], 6.4% to 8.4%); however, using urinary cotinine >100 ng/mL as a marker of smoking, the smoking rate was 11.8% (95% CI, 10.5% to 13.3%). In multivariate analysis, after adjusting for type of household, family income, and suicidal ideation, the odds ratios (ORs) of false respondents were 3.49 (95% CI, 1.41 to 8.63) for college-educated women and 2.47 (95% CI, 1.22 to 5.01) for women with high school education, relative to women with elementary school education. Married women with living spouses (OR, 2.80; 95% CI, 1.33 to 5.90) were more likely to respond falsely than unmarried women. Women who reported trying to reduce weight within 1 year (OR, 2.70; 95% CI, 1.47 to 4.93) and those who reported being less stressed (OR, 1.82; 95% CI, 1.08 to 3.07) were more likely to be false respondents.
The smoking rate determined using urinary cotinine concentration was higher than the self-reported rate among Korean women. Among smokers, those who were more educated, married, living with a husband, trying to reduce weight, and less stressed tended to describe themselves falsely as non-smokers.
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