Korean Male Smokers Research Articles

Association of triglyceride/high-density lipoprotein cholesterol ratio with subclinical inflammation and 10-year cardiovascular disease risk as determined by Framingham risk scores in Korean male smokers.

Various risk factors and the multifactorial pathophysiology of cardiovascular disease (CVD) have been studied. We focused on the interaction between insulin resistance and inflammatory processes. Thus, we analyzed the association of triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio with subclinical inflammation and CVD risk in male smokers. We retrospectively reviewed medical records from the Health Promotion Center of Severance Hospital in Korea between 2015 and 2017. Subjects were currently smoking men aged 30 to 59, with leukocyte counts within the normal range, for a total of 1,566. We grouped participants into four groups using the median TG/HDL ratio and the median leukocyte count. The odds ratio (OR) of high Framingham 10-year CVD risk (≥10%) was calculated using multiple logistic regression. The median Framingham 10-year CVD risk increased significantly from Group 1 (low leukocyte count, low TG/HDL ratio) to Group 4 (high leukocyte count, high TG/HDL ratio). The OR for Group 4 was 2.46 compared with Group 1 after adjusting for various CVD risk factors. In subgroup analysis, the OR of the highest leukocyte group was 1.57 compared to the lowest leukocyte group after adjusting for other variables. In conclusion, TG/HDL ratio and subclinical inflammation were positively related to CVD risk in Korean male smokers.

Association of triglyceride/high-density lipoprotein cholesterol ratio with subclinical inflammation and 10-year cardiovascular disease risk as determined by Framingham risk scores in Korean male smokers.

Various risk factors and the multifactorial pathophysiology of cardiovascular disease (CVD) have been studied. We focused on the interaction between insulin resistance and inflammatory processes. Thus, we analyzed the association of triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio with subclinical inflammation and CVD risk in male smokers. We retrospectively reviewed medical records from the Health Promotion Center of Severance Hospital in Korea between 2015 and 2017. Subjects were currently smoking men aged 30 to 59, with leukocyte counts within the normal range, for a total of 1,566. We grouped participants into four groups using the median TG/HDL ratio and the median leukocyte count. The odds ratio (OR) of high Framingham 10-year CVD risk (≥10%) was calculated using multiple logistic regression. The median Framingham 10-year CVD risk increased significantly from Group 1 (low leukocyte count, low TG/HDL ratio) to Group 4 (high leukocyte count, high TG/HDL ratio). The OR for Group 4 was 2.46 compared with Group 1 after adjusting for various CVD risk factors. In subgroup analysis, the OR of the highest leukocyte group was 1.57 compared to the lowest leukocyte group after adjusting for other variables. In conclusion, TG/HDL ratio and subclinical inflammation were positively related to CVD risk in Korean male smokers.

Factors associated with quitting status of smoking in Korean men with and without chronic kidney disease: A national population-based study.

INTRODUCTIONAdverse effects of smoking on kidney function have been demonstrated in both general populations and in populations with chronic kidney disease (CKD). Therefore, quitting smoking can have a significant impact on the mortality and disease progression of CKD. This study examined and compared factors associated with quitting status of smoking, in patients with and without CKD, among Korean adult male smokers, using the Korea National Health and Nutrition Examination Survey from 2008 to 2019, excluding 2013.METHODSWald test with multiple logistic regression was performed to investigate factors associated with quitting smoking in both CKD and non-CKD groups, along with the interaction effects between groups.RESULTSOf the 15747 eligible individuals, 909 had CKD, of whom 703 (weighted percentage: 74.4%) were quitters. In the non-CKD group, 8393 (weighted percentage: 50.4%) succeeded in quitting. Regular exercise was the only factor associated with quitting in both groups. The adjusted odd ratios with confidence intervals were 1.29 (95% CI: 1.17–1.42) and 2.84 (95% CI: 1.52–5.31) in the non-CKD and CKD groups, respectively (interaction p=0.0153). Unlike in the CKD group, marriage and higher systolic blood pressure were also associated with quitting, and lifetime smoking amount and secondhand smoke exposure at home were negatively associated with smoking cessation in the non-CKD group.CONCLUSIONSExercise was the only factor associated with quitting smoking in the CKD group.

Factors Associated with Successful Smoking Cessation According to Age Group: Findings of an 11-Year Korea National Survey.

Previous studies suggest that factors related to smoking cessation may vary with age. This study examined the factors affecting smoking cessation by age among Korean adult male smokers using data from the Korea National Health and Nutrition Examination Survey from 2007 to 2018 (excluding 2013). Logistic regression analyses were used to investigate various factors associated with smoking cessation in three different age groups. Out of a total of 15,492 individuals, 31.5% of the 3523 individuals aged 19–39 years (young adult), 54.7% of the 7390 individuals aged 40–64 years (middle-aged), and 78.6% of the 4589 individuals aged ≥65 years (older adults) succeeded in quitting. In the young adult and middle-aged groups, being married was associated with successful quitting, and lifetime smoking was associated with unsuccessful quitting. Willpower and several comorbidities were related to successful cessation in the middle-aged and older adult groups. Skipping any meal, which suggests unhealthy behavior, was negatively related to quitting in the young adult group. We observed that factors associated with smoking cessation success or failure differed by age, which should be considered when developing smoking cessation policies and programs.

Korean male active smokers: quantifying their smoking habits and the transformation factor among biomarkers in urine and blood

Objectives The aim of the study was to investigate the correlations within the levels of biomarkers in different biological matrices, along with smoking topography variables, among active male smokers in Korea. Accordingly, we defined a transformation factor to convert level of tobacco smoke exposure and impact biomarkers from different biometrics. Methods We examined smoking topography of recruited volunteers using a self-reporting survey. The level of tobacco smoke exposure and impact biomarkers in subjects’ urine and blood were analysed. Results were used to assess the correlations between the topography survey items with biomarkers in biological matrices. The relationship between the biomarkers in urine and blood was analysed. Accordingly, we defined a transformation factor as the ratio of different biomarkers in urine and blood matrices. Results Significant correlations among smoking topography variables and biomarkers were found. Besides, a strong significant association was found among urine and blood cotinine (ρ = 0.817) and NMR (ρ = 0.905). Urine vs blood cotinine and NMR transformation factors were calculated to be 6.17 L-Blood/g-Creatinine and 10.2, respectively. Conclusions The validated transformation factor connects epidemiological cohort studies with tobacco smoking exposure risk assessment. Hence, this study might be beneficial for further habit-based smoking risk assessments to obtain successful regional cession policies.

Effect of Increasing Tobacco Prices on Stages of Smoking Cessation: A Korean Nationwide Data Analysis.

BackgroundIn 2015, tobacco prices significantly increased in Korea as part of the government’s smoking cessation policy. This study examined the changes in the stages of smoking cessation among Korean male smokers before and after the implementation of the tobacco price policy, and identified the predictors of such changes.MethodsThe study population comprised 3,533 male current smokers (age ≥19 years) who participated in the Korea National Health and Nutrition Survey in 2012, 2013, 2015, and 2016. Current smokers were defined as persons who had smoked ≥100 cigarettes during their lifetime and are continuing to smoke. In accordance with the transtheoretical model, smokers were classified into the precontemplation stage (no plan to quit), contemplation stage, and preparation stage (planning to quit within 6 months). We examined the changes in the smoking cessation stages before and after the implementation of the policy. Multivariate logistic regression analysis was conducted to identify factors related to the likelihood of continuing smoking, after adjustments for potential confounders.ResultsImmediately after the policy implementation, the percentage of smokers in the precontemplation stage decreased from 65.6% to 60.8% (P=0.014). However, this effect was temporary. Significant risk factors for remaining in the precontemplation stage were older age (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.002–1.018; P=0.004), being in the lowest income quartile (OR, 1.226; 95% CI, 1.001–1.502; P=0.049), and manual worker or unemployed status (OR, 1.256; 95% CI, 1.036–1523; P=0.020).ConclusionIncreasing tobacco prices only temporarily change the stage of smoking cessation among Korean male smokers.

Using graphic text-messaging to promote smoking cessation among first-generation Chinese and Korean male immigrants.

First-generation Chinese and Korean male immigrants in the United States are at high risk for tobacco use. This study pilot-tested a graphic, native-language text-messaging intervention to promote smoking cessation among these groups. First-generation Chinese and Korean male immigrant smokers (N = 71) were recruited from the Washington DC area. Participants were randomly assigned to one of four conditions based on a between-subjects 2 (graphic plus text or text-only messages) � 2 (quitline information or quitting tips) design. The text-messaging intervention included 30 text messages in total and lasted one month. Participants completed an expired air carbon monoxide (CO) assessment and self-reported measures at both baseline and follow-up. Results show that, from baseline to follow-up, participants' expired air CO levels decreased significantly (P = 0.001). Attitude toward quitting also became more positive (P = 0.028). Compared with text-only messages, graphic text messages produced greater positive changes in quitting attitudes (P = 0.039) and elicited greater fear response (P = 0.005). Compared with quitting tip messages, quitline information resulted in greater regret (P = 0.016) and fear (P = 0.051). These findings suggest that graphic text-messaging can be an effective method to promote smoking cessation among first-generation Chinese and Korean male immigrants.

Interactive Mobile Doctor (iMD) to Promote Patient-Provider Discussion on Tobacco Use among Asian American Patients in Primary Care: A Pilot Study.

This study examined the feasibility, acceptability, and efficacy of an interactive "Mobile Doctor" intervention (iMD) for Korean and Vietnamese American men, population groups with high smoking prevalence rates. The iMD delivers 5As (Ask, Advise, Assess, Assist, and Arrange) via tailored in-language video messages on a mobile tablet to Korean and Vietnamese male daily smokers right before a health care visit. A single-group trial was conducted with Korean- and Vietnamese-speaking patients at a federally qualified health center. Outcomes were assessed by self-reported surveys obtained postvisit and 3-month follow-up, and by examining electronic health record (EHR) progress notes from 3 consecutive primary care visits to evaluate impacts. Among 47 male daily smokers (87% participation rate), 98% were limited English proficient and 53% had no intent to quit smoking within 6 months. On average, iMD took 12.9 minutes to complete. All participants reported discussing smoking with their providers during the visit, and more than 90% thought iMD was at least somewhat helpful in their decision about quitting and in communicating with their providers. EHR-documented 5As were significantly higher at the iMD visit for Assess (38.3%), Assist (59.6%), and Arrange (36.2%) compared with other visits without iMD. At 3 months, 51% made at least 1 24-hour quit attempt since the intervention. The self-reported 7-day point prevalence abstinence was 19%. iMD is feasible and acceptable to Korean and Vietnamese male smokers, including those who were not intending to quit smoking. It is a promising tool for increasing patient-provider discussion of tobacco use and possibly smoking cessation among Asian American male smokers.

Effect of smoking on the association of HHEX (rs5015480) with diabetes among Korean women and heavy smoking men

BackgroundSeveral genome-wide association studies (GWAS) for serum fasting glucose levels have reported HHEX as possibly causal. The objective of this study was to examine the joint effect of smoking on the association of diabetes with the HHEX rs5015480 polymorphism among Korean subjects.MethodsThis replication study included a total of 4240 individuals, and multivariate linear regression and multiple logistic regression models were used. We examined the combined effect of smoking on the relationship between HHEX rs5015480 and diabetes.ResultsThe rs5015480 SNP in the HHEX gene was related to the mean FBS level (effect per allele, 1.572 mg/dL, p = 0.0122). Females with the CC genotype had a 2.68 times higher (range, 1.05–6.82 times) risk of diabetes than those with the TT/TC genotype. Although the association was stronger in female subjects (OR, 4.46; 95% CI, 1.15–17.3, p = 0.0304) among healthy individuals (N = 2461), the association between HHEX and diabetes was much stronger in male heavy smokers (OR, 4.03; 95% CI, 1.19–13.6, p = 0.0247) than in nonsmokers (p = 0.9709) and ex-smokers (p = 0.2399). The interaction of smoking was also statistically significant (P for interaction =0.0182).ConclusionsThis study clearly demonstrates that a genetic variant in HHEX influences fasting glucose levels in Korean women and male heavy smokers.

Smoking Topography among Korean Smokers: Intensive Smoking Behavior with Larger Puff Volume and Shorter Interpuff Interval.

The difference of smoker’s topography has been found to be a function many factors, including sex, personality, nicotine yield, cigarette type (i.e., flavored versus non-flavored) and ethnicity. We evaluated the puffing behaviors of Korean smokers and its association with smoking-related biomarker levels. A sample of 300 participants was randomly recruited from metropolitan areas in South Korea. Topography measures during a 24-hour period were obtained using a CReSS pocket device. Korean male smokers smoked two puffs less per cigarette compared to female smokers (15.0 (13.0–19.0) vs. 17.5 (15.0–21.0) as the median (Interquartile range)), but had a significantly larger puff volume (62.7 (52.7–75.5) mL vs. 53.5 (42.0–64.2) mL); p = 0.012). The interpuff interval was similar between men and women (8.9 (6.5–11.2) s vs. 8.3 (6.2–11.0) s; p = 0.122) but much shorter than other study results. A dose-response association (p = 0.0011) was observed between daily total puff volumes and urinary cotinine concentrations, after controlling for sex, age, household income level and nicotine addiction level. An understanding of the difference of topography measures, particularly the larger puff volume and shorter interpuff interval of Korean smokers, may help to overcome a potential underestimation of internal doses of hazardous byproducts of smoking.

Smoking Patterns of Korean Male Smokers over 9 Years

Smoking Patterns of Korean Male Smokers over 9 Years

A Qualitative Study of Attitudes towards Smoking and Anti-Smoking Measures among Korean Male Smokers in Australia

The study aims to explore how Korean male smokers living in Australia talk and feel about smoking and how they have understood and experienced tobacco control policies in Australia—including price increase, display ban, plain packaging, and graphic warning labels. A qualitative study was conducted based on in-depth face-to-face interviews with 8 Korean male smokers aged 23–40 years living in Canberra. Participants discussed social and cultural conditions in Korea under which smoking is practiced and maintained. Smoking as a means of socialising and relaxation were consistently discussed as the main reasons for continued smoking which was deeply embedded in their everyday lives as habit or part of routines. The health risks of smoking were not among the immediate or ultimate considerations influencing participants. Participants commented that price increases had affected them most but other measures had little impact on their smoking behaviours, although they acknowledged their potentials in deterring younger people. Future anti-smoking interventions in Korea should address the significant social and cultural determinants of smoking and acknowledge smokers’ own understanding of their smoking and anti-smoking measures. Appreciating smokers’ diverse representations of their own smoking and their attitudes towards health and anti-smoking measures would increase acceptance of policies and the probability that they will be successful, leading to positive outcomes.

Comments on Statistical Issues in November 2015.

In this section, we explain the definition and solution to avoid the multi-collinearity in multivariate analysis, which appeared in the articles titled, Time to first cigarette and hypertension in Korean male smokers and Barrier factors to the completion of diabetes education in Korean diabetic adult patients: Korea National Health and Nutrition Examination Surveys 2007-2012, published in September 2015 by Lee et al.1) and by Kim et al.,2) respectively.

Time to First Cigarette and Hypertension in Korean Male Smokers.

BackgroundMorning blood pressure surge affects to cardiovascular disease risk. Short time to first cigarette (TTFC) after waking can enhance morning blood pressure surge, and accelerate atherosclerosisMethodsWe 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.ResultsCompared 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).Conclusionearly 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.

P-35 * THE CHANGES OF BLOOD GLUCOSE CONTROL AND LIPID PROFILES AFTER SHORT-TERM SMOKING CESSATION IN HEALTHY MALES

The changes in blood glucose control, lipid profiles, and insulin resistance-associated hormones both before and after 2-months of smoking cessation in Korean male smokers were examined. Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the b-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance (HOMA-IR) and The HOMA b-cell function (HOMA-b) increased significantly. The QUICKI showed a significant decrease. In addition, the low-density lipoprotein cholesterol levels decreased significantly; however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant. The results of this study showed during the initial stage of smoking cessation, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Moreover, the likely explanation for this finding is the compensation of beta cells for insulin resistance.

The National "Smoking Cessation Clinics" Program in the Republic of Korea: Socioeconomic Status and Age Matter

Between 1998-2009 South Korea experienced significant progress in reducing the male smoking rate from 66.3% to 46.9%. As part of a significant government effort in the area of smoking cessation intervention, the Korean government implemented the national "Smoking Cessation Clinics (SCC) " program in 2004. Data covered 804,334 adult male smokers participating in SCC program at 253 public health centers between 2006-2009. We examined participant cessation rates with the SCC program, their characteristics and program intervention components using health insurance status as a socioeconomic status (SES) indicator. Multivariate logistic regression analyses were performed correcting for intra-class correlations within public health centers. The overall 6-month quit rate was high (46.8%). Higher odds of smoking cessation were positively associated with higher levels of behavioral counseling sessions, but not nicotine replacement therapy (NRT). Cessation rates were lower for Medicaid participants than for regular health insurance participants. Disadvantaged younger smokers were less likely to participate in the program. Older smokers were more likely to quit regardless of SES. Stress was cited as major reason for failure. SES inequalities across different age groups exist in smoking cessation among Korean adult male smokers. There is a need for intervention programs specifically targeting sub-populations of SES by different age groups.

Less Healthy Dietary Pattern is Associated with Smoking in Korean Men According to Nationally Representative Data

The relationship between smoking and nutrient intake has been widely investigated in several countries. However, Korea presents a population with a smoking rate of approximately 50% and dietary consumption of unique foods. Thus, the aim of this study was to evaluate the association of dietary patterns with smoking in Korean men using a nationally representative sample. The study subjects were comprised of 4,851 Korean men over 19 yr of age who participated in the fourth Korean National Health and Nutrition Examination Survey. Dietary data were assessed by the 24-hr recall method. The smoking group comprised 2,136 men (46.6%). Five dietary patterns were derived using factor analysis: 'sugar & fat', 'vegetables & seafood', 'meat & drinks', 'grains & eggs', and 'potatoes, fruits and dairy products.' Current smokers showed a more significant 'sugar & fat' pattern (P = 0.001) while significantly less of the 'vegetables & seafood' and 'potatoes, fruits and dairy products' patterns (P = 0.011, P < 0.001, respectively). As found in similar results from Western studies, Korean male smokers showed less healthy dietary patterns than nonsmokers. Thus, the result of this study underlines the need for health professionals to also provide advice on dietary patterns when counseling patients on smoking cessation.

Impact of norm perceptions and guilt on audience response to anti-smoking norm PSAs: The case of Korean male smokers

Objective: To examine how norm appeals and guilt influence smokers’ behavioural intention. Design: Quasi-experimental design. Setting: South Korea. Method: Two hundred and fifty-five male smokers were randomly assigned to descriptive, injunctive, or subjective anti-smoking norm messages. After they viewed the norm messages, their norm perceptions, guilt and behavioural intention were measured. Results: The study revealed several findings: (1) injunctive norm perceptions significantly affected behavioural intention; (2) descriptive norm perceptions had a non-significant impact; (3) subjective norm perceptions had an unexpected impact on behavioural intention; (4) guilt arousal strongly and directly affected behavioural intention in all three conditions; and (5) guilt arousal did not mediate the relationship between norm perceptions and guilt. Conclusion: Injunctive norms messages that smoking in the presence of others is an unacceptable behaviour in society could persuade smokers to alter their behaviours. In addition, our study suggests substantial potentials of guilt in smokers’ behaviour change.

Six-week supplementation with Chlorella has favorable impact on antioxidant status in Korean male smokers

Objective Chlorella vulgaris is a popular food supplement in Asia and is currently marketed as a nutritional supplement. However, available scientific studies do not support its effectiveness for preventing or treating any disease in humans. Because Chlorella contains numerous nutrients, including antioxidants, it is thought to exert antioxidative functions by scavenging free radicals created by various environmental factors such as smoking. The purpose of this study was to investigate whether 6 wk of Chlorella supplementation to smokers is protective against oxidative damage in a randomized, double-blinded, placebo-controlled trial. Methods Fifty-two smokers, aged 20–65 y, were given 6.3 g of Chlorella or placebo every day for 6 wk. Blood samples were drawn at the beginning and after the supplementation. Plasma antioxidant vitamin levels and lipid peroxidation levels were measured. As a marker of oxidative stress, lymphocyte DNA damage was measured. Results Chlorella supplementation increased plasma vitamin C (44.4%), α-tocopherol (15.7%), and erythrocyte catalase and superoxide dismutase activities. Although 6 wk of Chlorella supplementation resulted in a significant decrease in lymphocyte DNA damage, as measured by comet assay, placebo supplementation also decreased the measured amount of lymphocyte DNA damage. Conclusion Chlorella supplementation resulted in the conservation of plasma antioxidant nutrient status and improvement in erythrocyte antioxidant enzyme activities in subjects. Therefore, our results are supportive of an antioxidant role for Chlorella and indicate that Chlorella is an important whole-food supplement that should be included as a key component of a healthy diet.

Effect of genetic polymorphisms on smoking cessation: a trial of bupropion in Korean male smokers

Even though bupropion is first-line pharmacological agent for smoking cessation, not all the smokers successfully quit smoking by bupropion. It means other factors like genetic predisposition could contribute to the therapeutic outcome. The aim of this study is to elucidate the question of whether the abstinence rates by bupropion trial would be different depending on the genotypes. Six candidate genes, thought to be involved in the interaction of nicotine and bupropion (for example, the dopamine receptor type 2, dopamine transporter, norepinephrine transporter, serotonin transporter, catecholamine-O-methyltransferase), and the clinical outcomes of smoking behavior were investigated. The participants were 225 male smokers to whom 150 mg of bupropion SR was administered for 4 weeks. The abstinence rates of specific genotypes were also compared. The results are as follows: (a) the frequencies of the A1/A2 genotype of the dopamine receptor type 2 TaqI A gene and SLC6A3-9 genotype of the dopamine transporter 1 gene were higher in the nonabstinence group than in the abstinence group (chi2=20.40, P<0.01 for A1/A2, chi2=7.76, P=0.01 for SLC6A3-9). The frequencies of the COMTH/COMTH and A/G genotypes of the norepinephrine transporter gene were higher in the abstinence group than in the nonabstinence group (chi2=8.12,P=0.02 for COMTH/COMTH, chi2=3.04, P<0.01 for A/G). (b) Participants having specific genotypes such as homozygotes (A1/A1 or A2/A2) of DRD2 TaqI A, COMTH/COMTH, AG of NET-8, and LL of 5-HTTLPR showed a higher abstinence rate than the other participants. It can be concluded that genetic diversity might determine the effects of bupropion on smoking cessation.