kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2018.18.3.136 kjhp-18-138 Original Article Factors Related to Smoking Relapse among Military Personnel in Korea: Data from Smoking Cessation Clinics, 2015–2017 KwonEunjoo NahEun-Hee Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea ￭ Corresponding author: Eun-Hee Nah, MD, PhD Health Promotion Research Institute, Korea Association of Health Promotion, 350 Hwagok-ro, Gangseo-gu, Seoul 07653, Korea Tel: +82-2-2600-0107, Fax: +82-2-2690-4915 E-mail: cellonah@hanmail.net 01 2018 10 01 2018 18 3 138 146 07072018 31082018 Copyright © 2018 The Korean Society of Health Promotion and Disease Prevention 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Relapse is the common situation of smoking cessation attempts. There are few studies that analyzed the related factors of smoking relapse among military personnel. Thus, This study was performed to investigate factors related to smoking relapse among military personnel who participated smoking cessation clinics in Korea.

 Methods

The study subjects were 19,874 military personnel who enrolled smoking cessation clinic from January in 2015 to December in 2017. Smoking cessation applied to criteria exhaled carbon monoxide and urine cotinine levels. Binominal logistic regression analysis was performed to confirm related factors of smoking relapse among military personnel who succeed to quit smoking.

 Results

The smoking relapse rate of study subjects who succeeded in quitting smoking for 1-month was 15.3% after 3-months and 60.8% after 6-months follow-up. The factors associated with relapse smoking included implementing year, past year quit attempts, number or cigarettes smoked per day, regular exercise, blood pressure. Levels of nicotine dependence affected smoking relapse at 3-months follow-up.

 Conclusions

Tailored approaches are necessary to reduce the rates of smoking relapse for military personnel who succeeded to quit smoking shortly but relapse back to smoking.

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Characteristics of the study population

  Total Smoking status at 1 month Pb
Smoking cessation Smoking
Sex        
   Malea 19,874 (100.0) 16,661 (100.0) 3,213 (100.0)  
Age, y       <0.001
   <20 309 (1.5) 258 (1.5) 51 (1.6)  
   20–24 16,665 (83.9) 14,217 (85.3) 2,448 (76.2)  
   25–29 1,154 (5.8) 926 (5.6) 228 (7.1)  
   ≥30 1,746 (8.8) 1,260 (7.6) 486 (15.1)  
Type of military forces       <0.001
   Army 14,125 (71.1) 12,110 (72.7) 2,015 (62.7)  
   Navy/marine corps 1,949 (9.8) 1,577 (9.5) 372 (11.6)  
   Air forces 3,323 (16.7) 2,550 (15.3) 773 (24.1)  
   Auxiliary police, others 477 (2.4) 424 (2.5) 53 (1.6)  
Military level       <0.001
   Private 1,339 (6.7) 1,142 (6.9) 197 (6.1)  
   Lance-coporal to coporal 13,540 (68.1) 11,712 (70.3) 1,828 (56.9)  
   Sergeant 1,820 (9.2) 1,422 (8.5) 398 (12.4)  
   Military officer 3,175 (16.0) 2,385 (14.3) 790 (24.6)  
Year       <0.001
   2015 7,903 (39.8) 6,221 (37.3) 1,682 (52.3)  
   2016 5,666 (28.5) 4,652 (27.9) 1,014 (31.6)  
   2017 6,305 (31.7) 5,788 (34.8) 517 (16.1) <0.001
Past year quit attempts        
   Yes 11,225 (56.5) 13,452 (80.7) 2,495 (77.7)  
   No 8,649 (43.5) 3,209 (19.3) 718 (22.3)  
Age of initial smoking, y 17.5±3.0 17.5±3.0 17.6±3.0 0.663
Number of cigarettes smoked per day 11.9±6.0 11.6±5.9 13.0±6.0 <0.001
Smoking duration, y 5.5±5.6 5.3±5.4 6.6±6.8 <0.001
Nicotine dependence, FTND 3.1±2.2 3.0±2.1 3.4±2.1 <0.001
Body mass index, kg/m2 22.7±2.7 22.7±2.7 22.9±2.9 <0.001
Systolic blood pressure, mmHg 122.7±11.5 122.6±11.3 123.4±12.7 0.001
Diastolic blood pressure, mmHg 77.7±9.2 77.6±9.0 78.2±10.0 <0.001
Regular exercise       <0.001
   Yes 15,947 (80.2) 13,452 (80.7) 2,495 (77.7)  
   No 3,927 (19.8) 3,209 (19.3) 718 (22.3)  
High blood pressure       <0.001
   Normal 4,920 (24.8) 4,142 (24.9) 778 (24.2)  
   Borderline 12,547 (63.1) 10,576 (63.5) 1,971 (61.4)  
Abnormal 2,407 (12.1) 1,943 (11.6) 464 (14.4)  

Abbreviations: y, year; FTND, Fagerstrom Test for Nicotine Dependence. Values are presented as number (%) or mean±standard deviation.

Included 7 women.

Calculated by chi-square test and t-test.

Smoking relapse at 3, 6 months who quitted smoking at 1 month in 2015–2017

  Smoking status at 3 months Smoking status at 6 months
Smoking relapse Smoking cessation Pa Smoking relapse Smoking cessation Pa
Total 2,556 (15.3) 14,105 (84.7)   10,128 (60.8) 6,533 (39.2)  
Year     <0.001     <0.001
   2015 1,114 (17.9) 5,107 (82.1)   4,327 (69.6) 1,894 (30.4)  
   2016 646 (13.9) 4,006 (86.1)   2,687 (57.8) 1,965 (42.2)  
   2017 796 (13.8) 4,992 (86.2)   3,114 (53.8) 2,674 (46.2)  
Age, y     <0.001     <0.001
   <20 53 (20.5) 205 (79.5)   202 (78.3) 56 (21.7)  
   20–24 2,096 (14.7) 12,121 (85.3)   8,549 (60.1) 5,668 (39.9)  
   25–29 165 (17.8) 761 (82.2)   584 (63.1) 342 (36.9)  
   ≥30 242 (19.2) 1,018 (80.8)   793 (62.9) 467 (37.1)  
Type of military forces     <0.001     0.146
   Army 1,797 (14.8) 10,313 (85.2)   7,426 (61.3) 4,684 (38.7)  
   Navy/marine corps 263 (16.7) 1,314 (83.3)   941 (59.7) 636 (40.3)  
   Air forces 463 (18.2) 2,087 (81.8)   1,511 (59.3) 1,039 (40.7)  
   Auxillary police, others 33 (7.8) 391 (92.2)   250 (59.0) 174 (41.0)  
Military level     <0.001     0.003
   Private 174 (15.2) 968 (84.8)   711 (62.3) 431 (37.7)  
   Lance coporal-coporal 1,671 (14.3) 10,041 (85.7)   7,013 (59.9) 4,699 (40.1)  
   Sergeant 251 (17.7) 1,171 (82.3)   902 (63.4) 520 (36.6)  
   Military officer 460 (19.3) 1,925 (80.7)   1,502 (63.0) 883 (37.0)  
Nicotine dependence     <0.001     0.014
   Low 1,445 (14.4) 8,591 (85.6)   6,014 (59.9) 4,022 (40.1)  
   Moderate 930 (16.7) 4,652 (83.3)   3,478 (62.3) 2,104 (37.7)  
   Severe 181 (17.4) 862 (82.6)   636 (61.0) 407 (39.0)  
Past year quit attempts     <0.001     <0.001
   Yes 1,379 (14.4) 8,224 (85.6)   5,650 (58.8) 3,953 (41.2)  
   No 1,177 (16.7) 5,881 (83.3)   4,478 (63.4) 2,580 (36.6)  
Regular exercise     <0.001     <0.001
   Yes 1,954 (14.5) 11,498 (85.5)   8,016 (59.6) 5,436 (40.4)  
   No 602 (18.8) 2,607 (81.2)   2,112 (65.8) 1,097 (34.2)  
Number of cigarettes smoked per day     0.001     <0.001
   ≤5 283 (12.8) 1,930 (87.2)   1,272 (57.5) 941 (42.5)  
   6–10 1,159 (15.3) 6,425 (84.7)   4,570 (60.3) 3,014 (39.7)  
   11–20 1,049 (16.1) 5,464 (83.9)   4,057 (62.3) 2,456 (37.7)  
   ≥20 65 (18.5) 286 (81.5)   229 (65.2) 122 (34.8)  
Age of initial smoking, y     0.590     0.955
   <15 329 (15.5) 1,797 (84.5)   1,286 (60.5) 840 (39.5)  
   15–19 1,516 (15.1) 8,511 (84.9)   6,099 (60.8) 3,928 (39.2)  
   ≥20 711 (15.8) 3,797 (84.2)   2,743 (60.8) 1,765 (39.2)  
Smoking duration, y     0.001     0.030
   <5 1,294 (15.1) 7,267 (84.9)   5,250 (61.3) 3,311 (38.7)  
   5–9 949 (14.8) 5,463 (85.2)   3,822 (59.6) 2,590 (40.4)  
   ≥10 313 (18.5) 1,375 (81.5)   1,056 (62.6) 632 (37.4)  
Obesity     0.539     0.602
   Underweight 54 (14.0) 333 (86.0)   237 (61.2) 150 (38.8)  
   Normal 1,303 (15.4) 7,149 (84.6)   5,156 (61.0) 3,296 (39.0)  
   Overweight 632 (14.9) 3,620 (85.1)   2,548 (59.9) 1,704 (40.1)  
   Obesity 567 (15.9) 3,003 (84.1)   2,187 (61.3) 1,383 (38.7)  
High blood pressure     <0.001     <0.001
   Normal 554 (13.4) 3,588 (86.6)   2,428 (58.6) 1,714 (41.4)  
   Borderline 1,693 (16.0) 8,883 (84.0)   6,575 (62.2) 4,001 (37.8)  
   Abnormal 309 (15.9) 1,634 (84.1)   1,125 (57.9) 818 (42.1)  

Values are presented as number (%).

Calculated by chi-square test.

Adjusted ORs of smoking relapse at 3, 6 months who quitted smoking 1 month after smoking cessation interventiona

  Smoking relapse at 3 monthsb Smoking relapse at 6 monthsb
OR CI P OR CI P
Age, y            
   <20 1.426 (0.920–2.211) 0.113 2.266 (1.536–3.343) <0.001
   20–24 0.991 (0.726–1.354) 0.957 0.963 (0.753–1.231) 0.762
   25–29 1.049 (0.799–1.377) 0.729 1.074 (0.864–1.335) 0.519
   ≥30 1 (reference)   1    
Year            
   2017 0.738 (0.666–0.818) <0.001 0.518 (0.479–0.559) <0.001
   2016 0.746 (0.670–0.831) <0.001 0.612 (0.564–0.664) <0.001
   2015 1     1    
Nicotine dependence            
   Severe 1.150 (0.950–1.392) 0.151 0.905 (0.782–1.049) 0.185
   Moderate 1.163 (1.050–1.287) 0.004 1.030 (0.954–1.112) 0.453
   Low 1     1    
Past year quit attempts            
   No 1.143 (1.048–1.246) 0.003 1.133 (1.062–1.210) <0.001
   Yes 1     1    
Number of cigarettes smoked per day            
   ≥20 1.281 (0.926–1.772) 0.134 1.319 (1.020–1.705) 0.034
   11–20 1.212 (1.036–1.418) 0.016 1.160 (1.039–1.297) 0.009
   6–10 1.224 (1.061–1.412) 0.005 1.075 (0.974–1.187) 0.151
   ≤5 1     1    
Smoking duration, y            
   ≥10 0.979 (0.763–1.257) 0.871 1.016 (0.839–1.231) 0.868
   5–9 0.939 (0.852-.1035) 0.207 0.942 (0.877–1.012) 0.104
   <5 1     1    
Regular exercise            
   No 1.343 (1.212–1.488) <0.001 1.288 (1.186–1.399) <0.001
   Yes 1     1    
Blood pressure            
   Abnormal 1.216 (1.043–1.418) 0.012 1.008 (0.901–1.127) 0.893
   Borderline 1.178 (1.061–1.308) 0.002 1.099 (1.020–1.184) 0.013
   Normal 1     1    

Abbreviations: OR, odds ratio; CI, confidence interval.

Adjusted for type of military force, military level.

OR and 95% CI were calculated with binominal logistic regression.