The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 423
Slide Session
OS-050 Miscellaneous
Smoking Patterns and Nicotine Dependence of North Korean Male Defectors
Sei Won Kim1, Sang Haak Lee2
The Catholic University of Korea, Yeouido St. Mary`s Hospital, Korea1, Department of Internal Medicine, St. Paul’s Hospital, The Catholic University of Korea, Korea2
Background: Cigarette smoking in South Korea population has decreased substantial- ly. In 1995, the smoking rate of South Korean men was 73.0%, while the number was decreased to 44.9% in 2012. However, smoking rate and patterns of North Korea pop- ulation are mostly unknown. From WHO report (2009), smoking rate of North Korean men was 58%. Now in South Korea, more than 20,000 North Korean defectors settle down and we can estimate the current situation of North Korea from them.
Methods: All North Korean defectors spend their fi rst three months in South Korea in a facility learning to cope with their new home. We retrospectively analyzed the questionnaire which was done from North Korean male defectors in this facility during August 2012 to February 2014. The questionnaire consist of brief personal information, smoking history, Fagerstrom test for nicotine dependence and Kano test for social nic- otine dependence.
Results: From 272 men, there were 84.2% current smokers, 12.5% ex-smokers and 3.3% ever-smokers. Mean age was 35.8±11.3 (19~65) and start age of smoking was 18.2±4.8 (7~46). Smoking amount was 0.68±0.37 pack per day with 17.0±10.7 years of smoking. Without 12 people who didn’t answer, 78.08% had a family member smoking. Within 229 current smokers, 66.1% have ever tried to stop smoking and 65.1% answered to be interested in stop smoking. Fagerstrom test and Kano test for current smokers showed 3.35±2.26 (Cronbach’s a : 0.62) and 13.75±4.85 (Cronbach’s a : 0.68), respectively.
Conclusions: Smoking rate of North Korean men was higher than our expectation and previous data. Although the interest of smoking cessation was high, the result of Kano test suggests that one-way teaching of smoking cessation by doctors can cause resistance. Further investigation needed to fi nd diverse effi cient methods of smoking cessation for North Korean smokers.
OS-051 Miscellaneous
The Association of Cigarette Smoking and Mental Health in Korean
Jae-Woo Jung1, Jae Chol Choi1, Jong Wook Shin1, In Won Park1, Byoung Whui Choi1, Jae Yeol Kim1,2, Korean Smoking Cessation Study Group2
Chung-Ang University College of Medicine, Korea1, Korean Smoking Cessation Study Group, Korea2 Background: Many studies investigated that smoking is the major cause of various physical illnesses, but the relationship between smoking status and mental health including suicidal ideation and suicidal attempts was not studied. This study was con- ducted to evaluate whether cigarette smoking status was related with mental health including suicidal ideation and suicidal attempts in Korean adult population.
Methods: We used data from the fourth and fifth annual South Korean National Health and Nutrition Examination Survey (Korean NHANES IV) conducted in 2008, 2009, 2010, 2011 and 2012. From a total of 45,811 subjects, 32,184 adult subjects who were at least 19 years of age were included in the study population. The correlation between smoking status and mental health using questionnaires about mental health, cigarette smoking and diagnosis of major depressive disorder were analyzed. They were adjusted by age, income, education and marital state.
Results: In male, current smoker was 42.4%, former smoker 38.9% and non smoker 18.7% and in female, 5.9%, 5.6% and 88.4%. Age, quartile of income, education state and marital state were different according to smoking status (P<0.001). In male and female, perceived stress was higher and EQ-VAS in current smoker was lower than those in non smoker (P<0.001). The incidence of major depressive disorder in current smoker female was higher than that in non smoker female (8.4% vs. 4.5%, OR=1.945, 95% CI: 1.536-2.463). In female, current smoker had higher prevalence of suicidal ideation and suicidal attempts in last year compared with non smoker (OR=1.912, 95%
CI: 1.659-2.203, OR=3.930, 95% CI: 2.701-5.719, respectively).
Conclusion: In the current study, current smoking was signifi cantly related with major depressive disorder, depression symptom and suicidal ideation and attempts in Korean females.
OS-052 Miscellaneous
Effect of Second Hand Smoke Exposure on Adult Health: A Cross-Sectional Study
Young Sik Park1, Chang-Hoon Lee1, Yu-Il Kim2, Chul Min Ahn3, Ju Ock Kim4, Ju-Heon Park5, Sang Haak Lee6, Jae Yeol Kim7, Eun Mi Chun8, Tae-Hoon Jung9, Kwang-Ha Yoo10 Seoul National University Hospital, Korea1, Department of Internal Medicine, Chonnam National Univer- sity Hospital, Korea2, Department of Internal Medicine, Yonsei University College of Medicine, Korea3, Department of Internal Medicine, Chungnam National University School of Medicine, Korea4, Department of Internal Medicine, Ajou University School of Medicine, Korea5, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea6, Department of Internal Medicine, Chung- Ang University College of Medicine, Korea7, Department of Internal Medicine, Ewha Womans University School of Medicine, Korea8, Chilgok Kyungpook National University School of Medicine, Korea9, Depart- ment of Internal Medicine, Konkuk University, Korea10
Background: To assess the physical and psychological effects of exposure to second hand smoking (SHS) in adult.
Methods: The data were collected from Korean National Health and Nutrition Exam- ination Survey (KNHANES-V) from 2010 to 2012. Multiple logistic regression analysis was performed to investigate the relationship between SHS exposure and physical and psychological parameters.
Results: From KNHANES-V data, we enrolled the population aged 20 years or older years, and defi ned detailed smoking history. Among them, never smokers were recruit- ed (N=10,340). We divided total subjects into two groups according to SHS exposure:
SHS (+) and SHS (-). Serum levels of heavy metals (Pb, Hg, Cd) were signifi cantly ele- vated in SHS (+) compared to SHS (-). SHS (+) was associated with asthma and atopic dermatitis, statistically significant (P<0.05). Increased time of sleep, recognition of stress, depressive mood and thought of suicide were associated with SHS (+).
Conclusions: Exposure to second hand smoking was significantly associated with physical and mental health in adult. For the improvement of public health, second hand smoke should be regulated.
OS-053 COPD
Factors Associated with Smokers’ will for Smoking Cessation in Korea
Ah Young Leem1, Chang Hoon Han2, Chul Min Ahn3, Tae-Hoon Jung4, Yu-Il Kim5, Jae Yeol Kim6, Sang Haak Lee7, Eun Mi Chun8, Kwang-Ha Yoo9, Ji Ye Jung1, Korean Smoking Cessation Study Group10
Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospi- tal, Yonsei University College of Medicine, Korea1, Division of Pulmonology, Department of Internal Med- icine, National Health Insurance Service Ilsan Hospital, Korea2, Division of Pulmonology, Department of Internal Medicine, Kangnam Severance Hospital, Yonsei University College of Medicine, Korea3, Chilgok Kyungpook National University School of Medicine, Korea4, Department of Internal Medicine, Chonnam National University Hospital, Korea5, Department of Internal Medicine, Chung-Ang University College of Medicine, Korea6, Department of Internal Medicine, Catholic University of Korea, College of Medicine, Korea7, Department of Internal Medicine, Ewha Womans University School of Medicine, Korea8, Depart- ment of Internal Medicine, Konkuk University, Korea9, Korean Smoking Cessation Study Group, Korea10 Background: Smoking is known to increase the risk of chronic disease. Understanding of factors that contribute to smoking cessation may help to develop strategies for smoking behavior change.
Methods: Pooled cross-sectional data of 11,924 subjects from the Korea National Health and Nutrition Examination Survey II-V were analyzed. The stages of change in smoking cessation were categorized into pre-contemplation, contemplation, and preparation. Baseline characteristics, socioeconomic factors, quality of life, psychologi- cal characteristics, and tobacco-related factors were compared between the groups.
Results: The study population consisted of 32.4% in pre-contemplation, 54.4% in contemplation, and 13.1% in preparation group. While the proportion for pre-contem- plation group (37.4% to 28.4%) tended to decrease from 2001 to 2012, that of prepa- ration group (6.4% to 18.1%) tended to increase. The mean age of pre-contemplation group (48.4±16.2) is higher than comtemplation and preparation group (42.2±13.9 and 44.4±15.3; P=0.02). As levels of education and income status increased, the proportion of pre-contemplation tended to decrease, and that of preparation tended to increase.
Proportion of blue collar job in pre-contemplation group was higher than in prepa- ration group (67.9% vs 58.1%; P<0.001). In pre-contemplation group, percentage of
The Korean Academy of Tuberculosis and Respiratory Diseases
424 32nd World Congress of Internal Medicine (October 24-28, 2014)
suicidal ideation within 1 year was higher than contemplation and preparation group (19.3% vs 16.0% and 16.1%). Upon adjusting analysis, the proportion of pre-con- templation group increased with increasing age (OR=1.01; 95%CI 1.01-1.02), and smoking amount (OR=1.04; 95%CI 1.03-1.05). People of pre-contemplation group (vs.
preparation) are be less educated (OR=1.99; 95% CI 1.51-2.62), are in single marital status (OR=1.25; 95%CI 1.04-1.50), have lower prevalence of cardiovascular disease (OR=0.48; 95%CI 0.31-0.76), and do less exercise walking (OR=1.36; 95%CI 1.09-1.69) and weight training (OR=1.59; 95%CI 1.35-1.85).
Conclusions: We demonstrated a signifi cant association between the stages of change in smoking cessation and age, education, marital status, cardiovascular disease, and amount of exercise.
OS-054 Miscellaneous
Hazards of Smoking in Korean Population
Keu Sung Lee1, Seungsoo Sheen1, Ji-Ye Jung3,2, Sang Haak Lee4,2, Yu-Il Kim5,2, Jae Yeol Kim6,2, Eun Mi Chun7,2, Kwang-Ha Yoo8,2, Chul Min Ahn3,2, Tae-Hoon Jung9,2, Joo Hun Park1,2
Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Korea1, Korean Smoking Cessation Study Group, Korea2, Department of Internal Medicine, Yonsei University College of Medicine, Korea3, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea4, Department of Internal Medicine, Chonnam National University Hospital, Korea5, Department of Internal Medicine, Chung-Ang University College of Medicine, Korea6, Department of In- ternal Medicine, Ewha Womans University School of Medicine, Korea7, Department of Internal Medicine, Konkuk University, Korea8, Chilgok Kyungpook National University School of Medicine, Korea9 Background: Smoking is a major cause of many noncommunicable diseases and leads to the reduction of life span. However, there are few population based studies on how smoking is associated with our general health in Korea. Therefore, we performed this study to investigate hazards of smoking on our health and major diseases associated with smoking in Korean population.
Methods: Data of 12,762 subjects aged 40 years or older were obtained from Korea National Health and Nutrition Survey (KNHANES) V from 2010 to 2012. Demographic data, laboratory fi ndings, and major diseases were analyzed based on smoking status.
Results: Blood pressure, leukocyte count, and serum glucose level were higher in smokers, however, serum cholesterol level and body mass index were higher in non-smokers (p<0.05). Smoking was associated with higher prevalence of COPD (23.6%
vs 7.0%), diabetes mellitus (14.3% vs 10.5%), cerebral stroke (3.3% vs 2.2%), and coronary artery disease (4.7% vs. 3.5%), whereas depression (2.9% vs 6.1%) was more prevalent in non-smokers (p<0.05). Multivariate analysis after adjustment for age and sex showed that smoking was independently associated with COPD (OR = 2.37, 95%
CI = 1.93 -2.92) and diabetes mellitus (OR = 1.32, 95% CI = 1.11 - 1.58), and no smok- ing (OR = 1.52, 95% CI = 1.16 - 1.99) was with depression (p<0.05).
Conclusions: Our analyses suggest smoking has harmful effects on health in various aspects. Especially, smoking was an independent risk factor for COPD and diabetes mellitus.
OS-055 COPD
The Impact of Smoking on Airfl ow Limitation in Patients with History of Asthma and Inactive Tuberculosis
Hyun Jung Kim1, Seunghee Baek2, Hee Jin Kim3, Jae Seung Lee1, Yeon-Mok Oh1, Sang-Do Lee1, Sei Won Lee1
Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstruc- tive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Korea1, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Korea2, The Korean Institute of Tuberculosis, Korea3
Background: Although smoking is the most important and modifi able cause of chron- ic obstructive pulmonary disease (COPD), other risk factors including tuberculosis (TB) and asthma are also associated. Clinically, it is not uncommon for COPD patients to have several risk factors more than one. The aim of this study was to determine the prevalence of airfl ow limitation (FEV1/FVC<0.7) according to the risk factors, and to investigate the impact and interaction of them on airfl ow limitation.
Methods: From Korean National Health and Nutrition Examination Survey (KNHANES) between 2008 and 2012, we analyzed participants over 40 year-old with spirometry, chest X-ray (CXR) and questionnaire concerning asthma and smoking history.
Results: Of 12,631 participants, 1,548 (12.3%) had airfl ow limitation. The prevalence of airfl ow limitation in smokers (>10 pack-year), asthmatics, and those with inactive TB were 23.9%, 32.1%, and 33.6%. The prevalence increased with the number of risk factors; 86.1% had airfl ow limitation if they had all these three risk factors. Impacts of inactive TB and asthma on airfl ow limitation were equivalent to 47 and 69 pack-year history of smoking, respectively. Airfl ow limitation resulted from much less amount of smoking in those with inactive TB and asthma. Smoking and inactive TB had a potential interaction on development of airfl ow limitation with marginal signifi cance (p=0.054).
Conclusions: Asthma and inactive tuberculous lesions increase susceptibility to smok- ing in the development of airfl ow limitation. People with these risk factors should be seen as a major target population for anti-smoking campaigns to prevent COPD.
OS-056 COPD
Gender and the Prevalence of COPD in Korean Adult Smokers: A Population-Based Study
Kyung Soo Chung1, Joo Han Song1, Song Yee Kim1, Eun Young Kim1, Ji Ye Jung1, Young Ae Kang1, Moo Suk Park1, Se Kyu Kim1, Joon Chang1, Young Sam Kim1 Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Dis- eases, Yonsei University College of Medicine, Korea1
Background: The objective of this study was to investigate smoking effect on gender and the prevalence of chronic obstructive pulmonary disease (COPD).
Method: Data for this study were obtained from Korean National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2012 containing demographics, smoking histories and spirometry data. We recruited 6,159 ever-smokers (male 5,543 and female 616) aged over 40 who adequately performed spirometry according to American Tho- racic Society (ATS) guidelines. Subjects with FEV1/FVC<0.7 were defi ned as COPD. To evaluate the loss of lung function per pack-year smoked, we used susceptibility index (SI), calculated using the formula: (% predicted FEV1 - 100)/pack-years.
Results: Mean age was lower in male than female (56.7 vs. 58.0, p<0.001) and total amount of smoking expressed as a pack-year was greater in male than female (25.7 vs. 11.0, p<0.001). Total 1,453 (23.6%) subjects were diagnosed with COPD. Even though the prevalence of COPD was higher in male (24.5%) than female (5.4%) (p<0.001), female showed more loss of lung function per pack-year smoked than male (SI in female = -1.43% vs. SI in male= -0.79, p<0.001). To evaluate smoking effect precisely, 3,440 subjects (male 3,337 and female 103) who smoked more than 20 pack-years through life were selected. Mean age was also lower in male than women (57.7 vs. 63.7, p<0.001) and total amount of smoking (pack-year) was greater in male than female (36.3 vs. 31.8, p=0.0029). However the prevalence of COPD was not different between in male (29.0%) and in females (24.3%) (p=0.567). Female still showed more loss of lung function per pack-year smoked than male (SI in female = -0.56% vs. SI in male = -0.39, p=0.0003).
Conclusion: Korean female ever-smokers have a susceptibility to smoking effect on lung function decline.
