Journal of Preventive Medicine and Public Health

Original Articles

Impact of Physical Activity on the Association Between Unhealthy Adolescent Behaviors and Anxiety Among Korean Adolescents: A Cross-sectional Study: Hyo-jung Lee, Jeong Pil Choi, Kunhee Oh, Jin-Young Min, Kyoung-Bok Min; J Prev Med Public Health. 2023;56(6):552-562. Published online November 15, 2023; DOI: https://doi.org/10.3961/jpmph.23.313

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Abstract Summary PDF: Objectives
Adolescents who engage in unhealthy behaviors are particularly vulnerable to anxiety. We hypothesized that participation in physical activity could influence the relationship between anxiety and unhealthy behaviors in adolescents. These behaviors include smoking, alcohol consumption, and unsafe sexual activity.
Methods
This study included 50 301 students from the first year of middle school to the third year of high school, all from Korea. The unhealthy adolescent behaviors examined included current alcohol consumption, current smoking, and unsafe sexual behavior. Anxiety levels were assessed using the Generalized Anxiety Disorder-7 questionnaire (GAD-7).
Results
The participants had a mean age of 15.19 years and an average GAD-7 score of 4.23. No significant differences were observed in GAD-7 score among exercising participants when categorized by smoking status (p=0.835) or unsafe sexual behavior (p=0.489). In contrast, participants in the non-exercise group who engaged in these behaviors demonstrated significantly higher GAD-7 scores (p<0.001 and 0.016, respectively). The only significant interaction was found between unsafe sexual behavior and exercise (p=0.009). Based on logistic regression analysis, within the non-exercise group, significant positive associations were observed between current smoking and anxiety (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.18 to 1.57), as well as between unsafe sexual behavior and anxiety (OR, 1.33; 95% CI, 1.02 to 1.73). However, within the exercise group, no significant association was found between anxiety and either smoking or unsafe sexual behavior. Furthermore, no significant interaction was observed between unhealthy behaviors and exercise.
Conclusions
These findings are insufficient to conclude that physical activity influences the relationship between unhealthy behaviors and anxiety.; Summary

Korean summary
이 연구는 신체활동이 한국 청소년들사이에서 불안과 불건강행태간의 관계에 어떠한 영향을 미치는지 조사하였다. 이 연구에서 신체활동을 하지 않는 청소년에서만 흡연 및 불안전한 성행위와 같은 불건강행태와 불안 간의 유의미한 연관성을 보였음에도 불구하고, 이러한 불건강행태와 운동 간에는 같은 방향의 유의미한 상호작용이 관찰되지 않았다. 따라서 이 연구는 신체 활동이 청소년들의 불건강행태와 불안간의 관계에 직접 미치는 영향에 대해 명확하게 결론을 내릴 수 없었다.

Key Message
Among Korean adolescents, this study found that significant associations between unhealthy behaviors such as smoking and unsafe sex, and anxiety were only observed in adolescents who did not engage in physical activity. Despite this, no significant interaction was observed between these unhealthy behaviors and exercise. Contrary to popular belief, this study concludes that the evidence is insufficient to definitively say that physical activity influences the relationship between adolescent unhealthy behaviors and anxiety.

Association Between Tobacco Smoking and Dental Caries in the Indonesian Population: Results of a National Study in 2018: Lelly Andayasari, Rofingatul Mubasyiroh, Iin Nurlinawati, Irna Sufiawati; J Prev Med Public Health. 2023;56(4):357-367. Published online July 10, 2023; DOI: https://doi.org/10.3961/jpmph.22.417

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Objectives
The 2018 Basic Health Research (RISKESDAS), conducted by the Ministry of Health of the Republic of Indonesia showed a high prevalence of dental caries (88.8%) in Indonesia and suggested that smoking tobacco was associated with an increased risk of dental caries. This study analyzed the association between tobacco smoking and dental caries in the Indonesian population.
Methods
This was a cross-sectional analysis of secondary data collected from RISKESDAS 2018. The study population included 35 391 Indonesians aged ≥10 years from all 34 provinces. The decayed, missing, and filled teeth (DMFT) index was used to measure dental caries. Smoking status was assessed qualitatively based on smoking activity, and the level of smoking exposure was assessed based on the Brinkman index. A multivariable logistic regression analysis was employed to examine the relationships of smoking status and smoking exposure levels with the DMFT index.
Results
Of the population aged ≥10 years, 36% had a DMFT≥8 (females: 37.5%, males: 33.9%). Almost one-fourth (23.4%) were current smokers, and 4.1% were ex-smokers. Furthermore, 26.4% had a Brinkman index ≥400, indicating heavy smoking. According to the multivariate analysis, current smoking status was associated with the risk of DMFT≥8 in males (adjusted odds ratio [aOR], 1.40; 95% CI, 1.27 to 1.55; p<0.001) and overall (aOR, 1.07; 95% CI, 1.00 to 1.14; p=0.037). In females, ex-smoking was associated with a 41% higher risk of DMFT≥8 (aOR, 1.41; 95% CI, 1.07 to 1.84; p=0.014). Heavy smoking was associated with a higher risk of DMFT≥8 in males (aOR, 1.38; 95% CI, 1.25 to 1.52; p<0.001) and females (aOR, 1.24; 95% CI, 1.03 to 1.50; p=0.022).
Conclusions
Tobacco smoking was associated with dental caries in the Indonesian population.

Summary

Citations

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Potential interaction of sugar intake and tobacco exposure on dental caries in adults-A cross-sectional study from the National Health and Nutrition Examination Survey
Xuewei Niu, Xiaoan Rong, Hantang Sun
Journal of Dental Sciences.2023;[Epub] CrossRef
Letter to the Editor: Tobacco Use: Strategies for Prevention in Low and Middle-income Countries
Israel Oluwasegun Ayenigbara
Journal of Preventive Medicine and Public Health.2023; 56(5): 485. CrossRef

Associations Between Indoor Air Pollutants and Risk Factors for Acute Respiratory Infection Symptoms in Children Under 5: An Analysis of Data From the Indonesia Demographic Health Survey: Ichtiarini Nurullita Santri, Yuniar Wardani, Yohane Vincent Abero Phiri, Gunchmaa Nyam, Tyas Aisyah Putri, Khoiriyah Isni, Dyah Suryani, Grace Sambo; J Prev Med Public Health. 2023;56(3):255-263. Published online April 18, 2023; DOI: https://doi.org/10.3961/jpmph.22.470

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Abstract PDF: Objectives
The study investigated the association between indoor air pollution (IAP) and risk factors for acute respiratory infection (ARI) symptoms in children under 5 years of age.
Methods
A cross-sectional study was conducted using data derived from Indonesia Demographic and Health Survey in 2017. Binary logistic regression modeling was employed to examine each predictor variable associated with ARI among children under 5 years of age in Indonesia.
Results
The study included a total of 4936 households with children. Among children under 5 years old, 7.2% reported ARI symptoms. The presence of ARI symptoms was significantly associated with the type of residence, wealth index, and father’s smoking frequency, which were considered the sample’s socio-demographic characteristics. In the final model, living in rural areas, having a high wealth index, the father’s smoking frequency, and a low education level were all linked to ARI symptoms.
Conclusions
The results revealed that households in rural areas had a substantially higher level of reported ARI symptoms among children under 5 years old. Furthermore, the father’s smoking frequency and low education level were associated with ARI symptoms.; Summary

Effectiveness of a Social Marketing Mix Intervention on Changing the Smoking Behavior of Santri in Traditional Islamic Boarding Schools in Indonesia: Ismail Ismail, Teuku Tahlil, Nursalam Nursalam, Zurnila Marli Kesuma, Syarifah Rauzhatul Jannah, Hajjul Kamil, Fithria Fithria, Kintoko Rochadi; J Prev Med Public Health. 2022;55(6):586-594. Published online November 17, 2022; DOI: https://doi.org/10.3961/jpmph.22.231

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Abstract PDF: Objectives
This study investigated the effectiveness of the social marketing mix approach in increasing students’ knowledge about smoking, promoting positive attitudes toward smoking cessation, and decreasing smoking behavior.
Methods
This quantitative research study incorporated a quasi-experimental method with a pretest-posttest non-equivalent group design. Using the purposive sampling technique, 152 smoking students were selected as participants. They were divided into 2 equal groups, with 76 students in the control group and 76 in the intervention group. The data were collected using questionnaires and analyzed with the chi-square test, independent t-test, Wilcoxon signed-rank test, and Mann-Whitney U-test.
Results
The social marketing mix intervention was effective in increasing the students’ knowledge about smoking (p<0.001), improving their attitude toward smoking cessation (p<0.001), and reducing their smoking behavior (p=0.014).
Conclusions
This approach should be implemented by local governments to reduce smoking behavior in the community, especially among teenagers, in addition to instituting a smoking ban and applying fines.; Summary

Brief Report

Reliability and Validity of a Life Course Passive Smoke Exposure Questionnaire in an Australian Cohort From Childhood to Adulthood: Chigozie Ezegbe, Costan G. Magnussen, Amanda Louise Neil, Marie-Jeanne Buscot, Terence Dwyer, Alison Venn, Seana Gall; J Prev Med Public Health. 2021;54(2):153-159. Published online March 10, 2021; DOI: https://doi.org/10.3961/jpmph.20.559

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Abstract PDF Supplementary Material

Objectives
Life course exposure to passive smoke may predict health, but there are few validated measures. We tested the reliability and validity of a retrospective life course passive smoking questionnaire.
Methods
Participants from the third follow-up of the Childhood Determinants of Adult Health study (2014-2019, ages 36-49 years) retrospectively reported mother/father/other household member smoking when living at home during childhood, including duration (years) and smoking location (never/sometimes/always inside house). The severity of exposure index (SEI; sum of mother/father/other years smoked multiplied by smoking location), cumulative years of exposure (CYE; sum of mother/father/other years), and total household smokers (THS) were derived. The reliability of retrospective passive smoking reports was examined with intraclass correlation coefficients (ICCs) using household smoking reported 34 years earlier in 1985 by participants when aged 7-15 years. Construct validity was examined by correlating retrospective passive smoking with participants’ smoking in adulthood and lung function in childhood and adulthood.
Results
Among 2082 participants (mean±standard deviation [SD], 45.0±2.5 years; 55.2% females), THS ranged from 0 to 5 (mean± SD, 0.9±1.0), CYE ranged from 0 to 106 (mean±SD, 10.5±13.9), and SEI ranged from 0 to 318 (mean±SD, 24.4±36.0). Retrospective measures showed moderate agreement with total household smokers reported in childhood (ICC, 0.58 to 0.62). The retrospective measures were weakly but significantly (p<0.05) correlated with participants’ smoking (r=0.13 to 0.15) and lung function (r= -0.05 to -0.06).
Conclusions
The retrospective passive smoking questionnaire showed reasonable reliability and validity. This measure may be useful for epidemiological studies.

Summary

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Childhood secondhand smoke exposure and respiratory disease mortality among never-smokers: the Japan collaborative cohort study for evaluation of cancer risk
Haruna Kawachi, Masayuki Teramoto, Isao Muraki, Kokoro Shirai, Kazumasa Yamagishi, Akiko Tamakoshi, Hiroyasu Iso
Journal of Public Health.2023; 45(3): 604. CrossRef

Original Articles

Factors Associated With Quitting Smoking in Indonesia: Rimawati Aulia Insani Sadarang; J Prev Med Public Health. 2021;54(2):137-144. Published online March 8, 2021; DOI: https://doi.org/10.3961/jpmph.20.293

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Abstract PDF

Objectives
The aim of this study was to identify factors associated with quitting smoking in Indonesia
Methods
Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question “do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?” Logistic regression was performed to identify factors associated with successful attempts to quit smoking.
Results
The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables.
Conclusions
Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals’ internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.

Summary

Citations

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Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change
Omid Dadras
Frontiers in Psychiatry.2024;[Epub] CrossRef
Individual-, social- and policy- factors associated with smoking cessation among adult male cigarette smokers in Hanoi, Vietnam: a longitudinal study
Thi Ngoc Phuong Nguyen, Jesper Love, Monica Hunsberger, Thi Phuong Thao Tran, Thuy Linh Nguyen, Thi Hai Phan, Ngoc Khue Luong, Van Minh Hoang, Nawi Ng
BMC Public Health.2023;[Epub] CrossRef
Quit Smoking Clinic: Factors Associated with Successful Quit Smoking in Besut District, Terengganu State of Malaysia
Nur Raihan Ismail, Hafizuddin Awang, Nurul Jannah A Rahman, Arfizah Ahmad Daud, Mohd Fariz Zulrushdi, Azmi Zainuddin, Mohd Anuar Abd Rahman, Kasemani Embong
European Journal of Medical and Health Sciences.2022; 4(6): 6. CrossRef

Age-period-cohort Analysis of Healthy Lifestyle Behaviors Using the National Health and Nutrition Survey in Japan: Tasuku Okui; J Prev Med Public Health. 2020;53(6):409-418. Published online August 13, 2020; DOI: https://doi.org/10.3961/jpmph.20.159

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Abstract PDF

Objectives
This study conducted an age-period-cohort (APC) analysis of trends in healthy lifestyle behaviors in Japan.
Methods
We used National Health and Nutrition Survey data on salt intake and prevalence of smoking, drinking, and physical activity between 1995 and 2018 in Japan. Age groups were defined from 20 years to 69 years old in 10-year increments. Cohorts were defined for each age group of each year with a 1-year shift, and cohorts born in 1926-1935 (first cohort) until 1989-1998 (last cohort) were examined. We conducted a Bayesian APC analysis, calculating estimated values for each behavior by age group, period, and cohort.
Results
Estimated salt intake decreased from cohorts born in the 1930s to the 1960s, but increased thereafter in both genders, and the magnitude of increase was larger for men. Estimated smoking prevalence increased in the cohorts starting from the 1930s for men and the 1940s for women, and then decreased starting in the cohorts born in the 1970s for both genders. Although estimated drinking prevalence decreased starting in the cohorts born in approximately 1960 for men, for women it increased until the cohorts born in approximately 1970. Estimated physical activity prevalence decreased starting in the cohorts born in the 1940s in both genders, but the magnitude of decrease was larger for women.
Conclusions
Trends in cohort effects differed by gender, which might be related to changes in the social environment for women. Improvements in dietary and exercise habits are required in more recently born cohorts of both genders.

Summary

Citations

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Tomoko Sawada, Tsutomu Yasukawa, Hiroko Imaizumi, Hisashi Matsubara, Kazuhiro Kimura, Hiroto Terasaki, Hiroto Ishikawa, Tomoya Murakami, Masaru Takeuchi, Yoshinori Mitamura, Yutaro Mizusawa, Yoshihiro Takamura, Toshinori Murata, Jiro Kogo, Masahito Ohji
Japanese Journal of Ophthalmology.2023; 67(2): 149. CrossRef
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Chien Huey Teh, Sanjay Rampal, Kuang Hock Lim, Omar Azahadi, Aris Tahir
Nicotine and Tobacco Research.2023; 25(7): 1340. CrossRef
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International Journal of Environmental Research and Public Health.2022; 19(16): 10302. CrossRef
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Tasuku Okui
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Tasuku Okui
Asia Pacific Journal of Public Health.2021; 33(1): 46. CrossRef
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Brief Report

Impact of Admission Diagnosis on the Smoking Cessation Rate: A Brief Report From a Multi-centre Inpatient Smoking Cessation Programme in Singapore: Jason Jia Hao See, Kay Choong See; J Prev Med Public Health. 2020;53(5):381-386. Published online July 17, 2020; DOI: https://doi.org/10.3961/jpmph.20.134

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Abstract PDF: Objectives
Few studies have been published regarding the relevance of the admission diagnosis to the smoking cessation rate. We studied smoking cessation rates in relation to admission diagnoses in our inpatient smoking cessation programmes.
Methods
This retrospective study included all patients recruited into our inpatient smoking cessation programmes at 2 institutions in Singapore between June 2008 and December 2016. Patients were given individualized intensive counselling and were followed up via phone interviews for up to 6-month to assess their smoking status. Multivariable logistic regression was used to analyse potential associations between admission diagnoses and 6-month abstinence.
Results
A total of 7194 patients were included in this study. The mean age was 54.1 years, and 93.2% were male. In total, 1778 patients (24.7%) were abstinent at the 6-month follow-up call. Patients who quit smoking tended to be of Chinese ethnicity, have initiated smoking at a later age, be better educated, and have lower Fagerström Test of Nicotine Dependence scores. After adjusting for these factors, patients with a cardiovascular admission diagnosis had a significantly higher probability of quitting tobacco use than patients with a respiratory or other diagnosis.
Conclusions
In patients acutely admitted to the hospital, a diagnosis of cardiovascular disease was associated with the highest quit rate. Smoking cessation interventions need to be incorporated into all cardiovascular disease treatment pathways to leverage the patient’s motivation and to improve the quit rate. In addition, patients in groups with lower quit rates may benefit from more intensive programmes to increase the rate of successful cessation.; Summary

Original Articles

Interactions of Behavioral Changes in Smoking, High-risk Drinking, and Weight Gain in a Population of 7.2 Million in Korea: Yeon-Yong Kim, Hee-Jin Kang, Seongjun Ha, Jong Heon Park; J Prev Med Public Health. 2019;52(4):234-241. Published online July 3, 2019; DOI: https://doi.org/10.3961/jpmph.18.290

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Abstract Summary PDF

Objectives
To identify simultaneous behavioral changes in alcohol consumption, smoking, and weight using a fixed-effect model and to characterize their associations with disease status.
Methods
This study included 7 000 529 individuals who participated in the national biennial health-screening program every 2 years from 2009 to 2016 and were aged 40 or more. We reconstructed the data into an individual-level panel dataset with 4 waves. We used a fixed-effect model for smoking, heavy alcohol drinking, and overweight. The independent variables were sex, age, lifestyle factors, insurance contribution, employment status, and disease status.
Results
Becoming a high-risk drinker and losing weight were associated with initiation or resumption of smoking. Initiation or resumption of smoking and weight gain were associated with non-high-risk drinkers becoming high-risk drinkers. Smoking cessation and becoming a high-risk drinker were associated with normal-weight participants becoming overweight. Participants with newly acquired diabetes mellitus, ischemic heart disease, stroke, and cancer tended to stop smoking, discontinue high-risk drinking, and return to a normal weight.
Conclusions
These results obtained using a large-scale population-based database documented interactions among lifestyle factors over time.

Summary

Korean summary
이 분석은 흡연, 음주, 체중의 동시적 변화에 대해 패널분석방법론인 고정효과 모형을 이용하여 분석하였으며, 2009년부터 2016년까지 2년 주기로 4차례 모두 건강검진을 수검받은 720만 명을 대상으로 하였다. 흡연, 음주, 체중의 동시적 변화에 대한 방향성을 탐색하여 생활습관 관련 행태가 독자적이 아닌 유기적으로 변화하는 양상을 확인하였다, 또한 당뇨병, 뇌졸중, 암이 신규로 진단되었을 때 행태 변화가 나타나는 것을 확인하였다.

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Association between Body Mass Index and Risk of Gastric Cancer by Anatomic and Histologic Subtypes in Over 500,000 East and Southeast Asian Cohort Participants
Jieun Jang, Sangjun Lee, Kwang-Pil Ko, Sarah K. Abe, Md. Shafiur Rahman, Eiko Saito, Md. Rashedul Islam, Norie Sawada, Xiao-Ou Shu, Woon-Puay Koh, Atsuko Sadakane, Ichiro Tsuji, Jeongseon Kim, Isao Oze, Chisato Nagata, Shoichiro Tsugane, Hui Cai, Jian-Min
Cancer Epidemiology, Biomarkers & Prevention.2022; 31(9): 1727. CrossRef

Factors Related to Smoking Status Among Young Adults: An Analysis of Younger and Older Young Adults in Korea: Yeji Lee, Kang-Sook Lee; J Prev Med Public Health. 2019;52(2):92-100. Published online January 22, 2019; DOI: https://doi.org/10.3961/jpmph.18.201

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Abstract Summary PDF

Objectives
Young adulthood represents a critical developmental period during which the use of tobacco may begin or cease. Furthermore, differences in smoking behaviors between younger (aged 18-24 years) and older (aged 25-34 years) young adults may exist. This study aimed to characterize patterns related to current smoking in younger and older young adults.
Methods
This study used data acquired from the Sixth Korea National Health and Nutrition Examination Survey conducted from 2013 to 2014. A total of 2069 subjects were categorized as younger (712 subjects) and older (1357 subjects) young adults. The chi-square test was used to assess the relationships between smoking status and socio-demographic, health-related, and smoking-related factors. Multivariable logistic regression models were constructed to assess the factors affecting current smoking in these age groups.
Results
The current smoking prevalence was 18.3% among the younger young adults and 26.0% among the older young adults. Sex, education level, occupation, perceived health status, alcohol consumption, and electronic cigarette use were related to current smoking in both age groups. Secondhand smoke exposure at home and stress levels showed significant relationships with smoking in younger and older young adults, respectively.
Conclusions
Strong correlations were found between the observed variables and smoking behaviors among young adults. Determining the factors affecting smoking and designing interventions based on these factors are essential for smoking cessation in young adults.

Summary

Korean summary
본 연구는 국민건강영양조사 제 6기 2013-2014년도 자료를 이용하였으며, 대상자 중 청년(18-34세)인 총 2,069명의 자료를 활용하여 전기 청년(18-24세)과 후기 청년(25-34세)인 두 연령 집단(18-24세, 25-34세)으로 나누어서 각 집단의 현재 흡연에 미치는 요인을 분석하고자 하였다. 본 연구 결과, 두 연령 집단 모두에서 성별, 대학교육 여부, 직업, 자가보고 건강수준, 음주, 그리고 평생 전자담배 사용은 현재 흡연과 유의한 관련이 있게 나타났으며, 가정실내 간접흡연 노출은 전기 청년에서만, 스트레스 정도는 후기 청년에서만 유의한 관련이 있었다. 본 연구는 전기 청년과 후기 청년에서 사회경제적 요인, 건강관련 요인, 흡연 관련 요인이 중요한 예측인자로 나타난 것을 알 수 있었으며 이에 따른 맞춤형 금연 프로그램의 적용이 필요할 것으로 시사한다.

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Sarunya Benjakul, Saroj Nakju, Wisit Thitavisiddho (Wongsai), Thawatchai Junjula
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Eduardo Antunes, Inês Amaral, Rita Basílio Simões, Ana Marta M. Flores
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Trends in Inequality in Cigarette Smoking Prevalence by Income According to Recent Anti-smoking Policies in Korea: Use of Three National Surveys: Youngs Chang, Sanghyun Cho, Ikhan Kim, Jinwook Bahk, Young-Ho Khang; J Prev Med Public Health. 2018;51(6):310-319. Published online October 30, 2018; DOI: https://doi.org/10.3961/jpmph.18.225

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Abstract PDF Supplementary Material

Objectives
This study examined trends in inequality in cigarette smoking prevalence by income according to recent anti-smoking policies in Korea.
Methods
The data used in this study were drawn from three nationally representative surveys, the Korea National Health and Nutrition Examination Survey, the Korea Community Health Survey, and the Social Survey of Statistics Korea. We calculated the age-standardized smoking prevalence, the slope index of inequality, and the relative index of inequality by income level as a socioeconomic position indicator.
Results
Smoking prevalence among men decreased during the study period, but the downward trend became especially pronounced in 2015, when the tobacco price was substantially increased. Inequalities in cigarette smoking by income were evident in both genders over the study period in all three national surveys examined. Absolute inequality tended to decrease between 2014 and 2015 among men. Absolute and relative inequality by income decreased between 2008 and 2016 in women aged 30-59, except between 2014 and 2015.
Conclusions
The recent anti-smoking policies in Korea resulted in a downward trend in smoking prevalence among men, but not in relative inequality, throughout the study period. Absolute inequality decreased over the study period among men aged 30-59. A more aggressive tax policy is warranted to further reduce socioeconomic inequalities in smoking in young adults in Korea.

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Brief Report

National Trends in Smoking Cessation Medication Prescriptions for Smokers With Chronic Obstructive Pulmonary Disease in the United States, 2007-2012: Min Ji Kwak, Jongoh Kim, Viraj Bhise, Tong Han Chung, Gabriela Sanchez Petitto; J Prev Med Public Health. 2018;51(5):257-262. Published online August 23, 2018; DOI: https://doi.org/10.3961/jpmph.18.119

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Abstract PDF

Objectives
Smoking cessation decreases morbidity and mortality due to chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation is highly effective. However, the optimal prescription rate of smoking cessation medications among smokers with COPD has not been systemically studied. The purpose of this study was to estimate the national prescription rates of smoking cessation medications among smokers with COPD and to examine any disparities therein.
Methods
We conducted a retrospective study using National Ambulatory Medical Care Survey data from 2007 to 2012. We estimated the national prescription rate for any smoking cessation medication (varenicline, bupropion, and nicotine replacement therapy) each year. Multiple survey logistic regression was performed to characterize the effects of demographic variables and comorbidities on prescriptions.
Results
The average prescription rate of any smoking cessation medication over 5 years was 3.64%. The prescription rate declined each year, except for a slight increase in 2012: 9.91% in 2007, 4.47% in 2008, 2.42% in 2009, 1.88% in 2010, 1.46% in 2011, and 3.67% in 2012. Hispanic race and depression were associated with higher prescription rates (odds ratio [OR], 5.15; 95% confidence interval [CI], 1.59 to 16.67 and OR, 2.64; 95% CI, 1.26 to 5.51, respectively). There were no significant differences according to insurance, location of the physician, or other comorbidities. The high OR among Hispanic population and those with depression was driven by the high prescription rate of bupropion.
Conclusions
The prescription rate of smoking cessation medications among smokers with COPD remained low throughout the study period. Further studies are necessary to identify barriers and to develop strategies to overcome them.

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Original Articles

Differential Association of Vitamin D Deficiency With Albuminuria by Sex in the Korean General Population: A Cross-sectional Study of the Korea National Health and Nutrition Examination Survey 2011-2012: Yongwoo Jeon, Jaeyong Shin, Jong Hyun Jhee, Youngdae Cho, Eun-Cheol Park; J Prev Med Public Health. 2018;51(2):92-99. Published online February 6, 2018; DOI: https://doi.org/10.3961/jpmph.17.005

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Objectives
Albuminuria has emerged as a biomarker for several medical conditions, and vitamin D has received attention due to its associations with various disorders. We evaluated the association between low serum vitamin D levels and prevalent albuminuria by sex in the Korean general population. Methods: We analyzed 9823 participants (4401 males, 5422 females) from the Korea National Health and Nutrition Examination Survey 2011-2012 (KNHANES V-2), and categorized them as having a normal range of vitamin D levels, vitamin D insufficiency, or vitamin D deficiency. A multivariable logistic regression model was used to compare the risk of albuminuria across these groups. Stratified analyses were conducted by smoking status, obesity, and renal function. Results: Albuminuria was found in 325 of the 4401 male participants (7.4%) and in 455 of the 5422 female participants (8.4%). Among the males, vitamin D deficiency was associated with an odds ratio (OR) for albuminuria of 1.78 (95% confidence interval [CI], 1.07 to 2.97, p<0.05). However, such an association was not found in females. The association was stronger in male current smokers (OR, 3.54; 95% CI, 1.47 to 8.50; p=0.005). Conclusions: The findings of this study suggest that sex differences exist in the association between serum vitamin D deficiency and albuminuria. Additionally, we observed that the association was stronger in current smokers than in the overall male population, but was not seen in non-smokers. Therefore, different approaches by sex and smoking status might be needed when considering using vitamin D as a biomarker for renal function.

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Association between environmental chemical exposure and albumin-to-creatinine ratio is modified by hypertension status in women of reproductive age
Gowoon Lee, Sunmi Kim, Inae Lee, Habyeong Kang, Jung Pyo Lee, Jeonghwan Lee, Young Wook Choi, Jeongim Park, Gyuyeon Choi, Kyungho Choi
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Long-term vitamin D deficiency promotes renal fibrosis and functional impairment in middle-aged male mice
Zhi-Hui Zhang, Biao Luo, Shen Xu, Zhi-Cheng Zhang, Wei-Yang Xing, Yuan-Hua Chen, Cheng Zhang, Hua Wang, Dong-Dong Xie, De-Xiang Xu
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Peer Smoking and Smoking-related Beliefs Among College Students in Bangladesh: Akiko Kamimura, Zobayer Ahmmad, Mu Pye, Bethany Gull; J Prev Med Public Health. 2018;51(1):51-58. Published online January 22, 2018; DOI: https://doi.org/10.3961/jpmph.17.146

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Abstract PDF

Objectives
Smoking is a significant public health issue in Bangladesh. The purpose of this study was to examine peer smoking and smoking-related beliefs among college students in Bangladesh.
Methods
College students at two universities in Dhaka, Bangladesh participated in a self-administered survey in May and June 2017.
Results
First, being a current or former smoker is associated with lower levels of beliefs among respondents that they would not smoke even with smoker friends or nervousness, and lower levels of intentions that they would not smoke, while current smokers and former smokers have different smoking-related beliefs. Second, having smoker friends is associated with lower levels of intentions that they would not smoke. Third, higher levels of normative beliefs that it is important not to smoke are associated with higher levels of beliefs that they would not smoke even with smoker friends or nervousness, higher levels of intentions that they would not smoke, and higher levels of avoidance of smoking.
Conclusions
Smoking-related beliefs and perceived norms in individuals’ social networks are important components in promoting tobacco cessation in Bangladesh. But it is challenging to prevent or intervene in smoking because of the high rates of smoking in this country and the high prevalence of smokers in individuals’ social networks. Future studies should examine the most effective interventions to combat smoking in high-smoking social networks, such as using mobile apps or social media, and evaluate the effectiveness of such interventions.

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Special Article

Scientific Evidence for the Addictiveness of Tobacco and Smoking Cessation in Tobacco Litigation: Sungwon Roh; J Prev Med Public Health. 2018;51(1):1-5. Published online November 29, 2017; DOI: https://doi.org/10.3961/jpmph.16.088

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Abstract PDF

Smokers keep smoking despite knowing that tobacco claims many lives, including their own and others’. What makes it hard for them to quit smoking nonetheless? Tobacco companies insist that smokers choose to smoke, according to their right to self-determination. Moreover, they insist that with motivation and willpower to quit smoking, smokers can easily stop smoking. Against this backdrop, this paper aims to discuss the addictive disease called tobacco use disorder, with an assessment of the addictiveness of tobacco and the reasons why smoking cessation is challenging, based on neuroscientific research. Nicotine that enters the body via smoking is rapidly transmitted to the central nervous system and causes various effects, including an arousal response. The changes in the nicotine receptors in the brain due to continuous smoking lead to addiction symptoms such as tolerance, craving, and withdrawal. Compared with other addictive substances, including alcohol and opioids, tobacco is more likely to cause dependence in smokers, and smokers are less likely to recover from their dependence. Moreover, the thinning of the cerebral cortex and the decrease in cognitive functions that occur with aging accelerate with smoking. Such changes occur in the structure and functions of the brain in proportion to the amount and period of smoking. In particular, abnormalities in the neural circuits that control cognition and decision-making cause loss of the ability to exert self-control and autonomy. This initiates nicotine dependence and the continuation of addictive behaviors. Therefore, smoking is considered to be a behavior that is repeated due to dependence on an addictive substance, nicotine, instead of one’s choice by free will.

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