Factors Related to Smoking Relapse among Military Personnel in Korea: Data from Smoking Cessation Clinics, 2015–2017

Eunjoo Kwon; Eun-Hee Nah

doi:10.15384/kjhp.2018.18.3.136

Korean J Health Promot > Volume 18(3); 2018 > Article

Kwon and Nah: Factors Related to Smoking Relapse among Military Personnel in Korea: Data from Smoking Cessation Clinics, 2015–2017

Original Article

Korean Journal of Health Promotion 2018;18(3):138-146.

Published online: January 10, 2018

DOI: https://doi.org/10.15384/kjhp.2018.18.3.136

Factors Related to Smoking Relapse among Military Personnel in Korea: Data from Smoking Cessation Clinics, 2015–2017

Eunjoo Kwon, Eun-Hee Nah

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

Received July 07, 2018 Accepted August 31, 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.

Keywords: Smoking prevention, Recurrence, Smoking cessation, Military personnel

Table 1.

Characteristics of the study population

	Total	Smoking status at 1 month		P^b
	Total	Smoking cessation	Smoking	P^b
Sex
Male^a	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.

^aIncluded 7 women.

^bCalculated by chi-square test and t-test.

Table 2.

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	P^a	Smoking relapse	Smoking cessation	P^a
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 (%).

^aCalculated by chi-square test.

Table 3.

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

	Smoking relapse at 3 months^b			Smoking relapse at 6 months^b
	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.

^aAdjusted for type of military force, military level.

^bOR and 95% CI were calculated with binominal logistic regression.

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