Gender Differences in Factors Associated with Secondhand Smoke Exposure among Cancer Patients

Article information

Korean J Health Promot. 2015;15(4):225-234

Publication date (electronic) : 2015 December 19

doi : https://doi.org/10.15384/kjhp.2015.15.4.225

Eun-Kyung Kim ¹, Jina Choo^,², Eun-Sook Choi ³

¹Department of Nursing, Suwon Science College, Hwaseong, Korea

²College of Nursing, Korea University, Seoul, Korea

³Department of Nursing, The National Cancer Center, Goyang, Korea

￭ Corresponding author：Jina Choo, PhD, DrPH College of Nursing, Korea University, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-3290-4925, Fax: +82-2-928-9107 Email: jinachoo@korea.ac.kr

Received 2015 February 24; Accepted 2015 August 09.

Abstract

Background

There is little evidence on the prevalence of secondhand smoke (SHS) exposure among cancer patients. We aimed to investigate its prevalence, and to identify gender differences in factors associated with SHS exposure among cancer patients.

Methods

Participants were 304 patients who have been treated via either inpatient or outpatient clinics in the National Cancer Center. SHS exposure was defined as an individual’s experience of SHS exposure during the past month. Gender-stratified analysis was performed by using a logistic regression analysis with potential covariates.

Results

SHS exposure was prevalent in 69.5% of the total participants, specifically in 57.1% of men and 62.7% of women; however, it did not differ significantly by gender. The prevalence of SHS exposure at home was significantly greater in women (20.7%) than in men (4.4%) (P＝0.048). Among men, age ≤50 years (Adjusted odds ratio [OR]＝3.11; confidence interval [CI]＝1.05-9.24), employed status (Adjusted OR＝3.15; CI＝1.38-7.19), and having family smokers (Adjusted OR＝0.32; CI＝0.12-0.82) were significantly associated with SHS exposure. Among women, employment status (Adjusted OR＝2.67; CI＝1.40-5.10), good self-rated health (Adjusted OR＝2.35; CI＝1.20-4.61), and having family smokers (Adjusted OR＝2.03; CI＝1.05-3.91) were significantly associated with SHS exposure.

Conclusions

Cancer patients were exposed to SHS by 69.5% during the past month. Among cancer patients, factors associated with SHS exposure differed by gender. Therefore, gender-specific strategies for preventing SHS exposure are needed for cancer patients.

Keywords: Secondhand smoke; Cancer; Gender

Table 1.

Sociodemographic, health- and smoking-related factors^a (N＝304)

Table 2.

Prevalence of SHS exposure by gender^a (N＝304)

Table 3.

SHS Exposure by general characteristics^a (N＝304)

Table 4.

Factors associated with SHS exposure by gender^a (N＝304)

References

1. Statistics Korea. Annual report on the cause of death statistics Daejeon: Statistics Korea; 2012. [Accessed December 10, 2014]. http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B34E01&conn_path=I2.

2. US Environmental Protection Agency. Respiratory health effect of passive smoking: lung cancer and other disorders. (EPA/600/6-90/006F) Washington DC: US EPA, Office of Research and Development RD-689; 1992.

3. Nelson E. The miseries of passive smoking. Hum Exp Toxicol 2001;20(2):61–83.

4. Wald NJ, Boreham J, Bailey A, Ritchie C, Haddow JE, Knight G. Urinary cotinine as marker of breathing other people's tobacco smoke. Lancet 1984;1(8370):230–1.

5. Kim MJ, Kim CH, Kim YH, Kang JH. Relationship between passive smoke and urinary cotinine level. J Korean Acad Fam Med 2007;28(5):379–82.

6. Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ 1997;315(7114):980–8.

7. Jee SH, Ohrr H, Kim IS. Effects of husbands' smoking on the incidence of lung cancer in Korean women. Int J Epidemiol 1999;28(5):824–8.

8. Ministry of Health & Welfare. Report sources Seoul: Ministry of Health & Welfare; 2011. [Accessed December 10, 2014]. http://www.mw.go.kr/front_new/index.jsp.

9. Korea Centers for Disease Control and Prevention. ｢Health Statistics 2013: Korea National Health and Nutrition Examination Survey (KNHANES Ⅵ-1)｣ Cheongwon: Korea Centers for Disease Control and Prevention; 2013. [Accessed January 10, 2015]. http://stat.mw.go.kr/front/statData/publicationView.jsp?menuId=47&topSelect=B00005&bbsSeq=13&nttSeq=21549&searchKey=&searchWord=&nPage=1.

10. Kim SS, Son H, Nam KA. The sociocultural context of Korean American men's smoking behavior. West J Nurs Res 2005;27(5):604–23. comment 624-7.

11. Choo J, Kim EK. Application of the ASE model to the assertive behavior of non-smoking college students under secondhand smoke exposure. J Korean Acad Community Health Nurs 2011;22(1):1–10.

12. Kim EK, Choo J. The Health Belief Model and assertive behavior of asking smokers not to smoke among college students. Korean J Health Promot 2011;11(3):160–8.

13. Kim EK, Choo J. Secondhand tobacco smoke exposure and associated factors among college students on campus and in the home: a preliminary study. Int J Environ Res Public Health 2012;9(1):212–22.

14. Hughes SC, Corcos IA, Hofstetter CR, Hovell MF, Seo DC, Irvin VL, et al. Secondhand smoke exposure among nonsmoking adults in seoul, Korea. Asian Pac J Cancer Prev 2008;9(2):247–52.

15. National Cancer Center. Annual report Seoul: National Cancer Center; 2012. [Accessed December 10, 2014]. http://ncc.re.kr/index.

16. Helgason AR, Lund KE. Environmental tobacco smoke exposure of young children--attitudes and health-risk awareness in the Nordic countries. Nicotine Tob Res 2001;3(4):341–5.

17. Lund KE, Helgason AR. Environmental tobacco smoke in Norwegian homes, 1995 and 2001: changes in children's exposure and parents attitudes and health risk awareness. Eur J Public Health 2005;15(2):123–7.

18. Korea Centers for Disease Control and Prevention. The fifth Korea national health and nutrition examination survey (KNHANES V-3) Cheongwon: Korea Centers for Disease Control and Prevention; 2012. [Accessed December 10, 2014]. http://knhanes.cdc.go.kr/.

19. Sim HS, Lee KS, Hong HS, Meng KH. The awareness and countermeasures against harmful effect of passive smoking in Korean adults. Korean J Pev Med 2000;33(1):91–8.

20. U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general Washington DC: U.S. Department of Health and Human Services; 2006. [Accessed June 10, 2014]. http://www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet1.html.

21. Cho JH. Second-hand smoke prevention programs in the US-with special reference to ‘smoke-free home pledge campaign'-. Health Welf Policy Forum 2006;121:90–105.

22. Evans WN, Farrelly MC, Montgomery E. Do workplace smoking bans reduce smoking? Am Econ Rev 1999;89:728–47.

23. Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household and workplace smoking restrictions and adolescent smoking. JAMA 2000;284(6):717–22.

24. Kim S, Hong G, Kim D, Hwang S, Woo B, Ahn HG, Yang W. Assessment of nicotine concentration of passive smoking in indoor environments of entertainment facilities in Kyoungbuk. J Korean Soc Indoor Environ 2012;9:53–64.

Article information Continued

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.

Table 1.

Sociodemographic, health- and smoking-related factors^a (N＝304)

Characteristics	Total (N＝304)	Male (n＝119)	Female (n＝185)	χ²	P^b
Sociodemographic factors Age, year
≤50	120 (39.5)	29 (24.4)	91 (49.2)	18.67	＜0.001
≥51	184 (60.5)	90 (75.6)	94 (50.8)
Mean±SD	53.6±12.6	57.4±13.7	51.1±11.2
Education
＜College	73 (24.0)	30 (25.2)	43 (23.2)	0.15	0.783
≥ College	231 (76.0)	89 (74.8)	142 (76.8)
Employed
Yes	167 (54.9)	58 (48.7)	109 (58.9)	3.03	0.098
No	137 (45.1)	61 (51.3)	76 (41.1)
Health-related factors Cancer of origin
Stomach	68 (22.4)	47 (39.5)	21 (11.4)	142.06	＜0.001
Colorectal	36 (11.8)	17 (14.3)	19 (10.2)
Genital	85 (28.0)	1 (0.8)	84 (45.4)
Respiratory	58 (19.1)	31 (26.1)	27 (14.6)
Hematologic	18 (5.9)	10 (8.4)	8 (4.3)
Others	39 (12.8)	13 (10.9)	26 (14.1)
Cancer treatmentc
Chemotherapy	201 (66.1)	81 (68.1)	120 (64.9)	0.33	0.620
Radiation	59 (19.4)	24 (20.2)	35 (18.9)
Surgery	169 (55.6)	57 (47.9)	112 (60.5)
Treatment duration, month	21.9±29.4	21.6±30.1	22.1±29.0
≥13	124 (40.8)	50 (42.0)	74 (40.0)	0.08	0.811
≤12	176 (57.9)	68 (57.1)	108 (58.4)
Missing	4 (1.3)	1 (0.8)	3 (1.6)
Treatment clinics
Outpatient	198 (65.1)	69 (58.0)	129 (69.7)	4.40	0.058
Inpatient	106 (34.9)	50 (42.0)	56 (30.3)
Self-rated health
Good	148 (48.7)	55 (46.2)	93 (50.3)	0.47	0.557
Bad	156 (51.3)	64 (53.8)	92 (49.7)
Smoking-related factors Smoking status
Current smoking	9 (3.0)	9 (7.5)		138.13	＜0.001
Mean±SD
Amount, pieces/d	19.4±19.4	19.4±19.4
Duration, y	22.1±10.3	22.1±10.3
Former-smoking	93 (30.6)	78 (65.5)	15 (8.1)
Mean±SD
Amount, pieces/d	20.6±12.9	21.5±12.7	15.4±13.2
Smoking duration, y	22.8±13.6	24.2±13.7	14.8±10.7
Ex-smoking duration, y	7.6±10.3	8.4±11.0	3.3±3.5
Non-smoking	202 (66.4)	32 (26.9)	170 (91.9)
SHS-related factors Having family smokers
Yes	116 (38.2)	31 (26.1)	85 (45.9)	12.14	0.001
No	188 (61.8)	88 (73.9)	100 (54.1)
Message about SHS
Yes	293 (96.4)	113 (95.0)	180 (97.3)	1.13	0.350
No	11 (3.6)	6 (5.0)	5 (2.7)
Message sources about SHS^c
TV	268 (88.2)	101 (84.9)	167 (90.3)
Radio	51 (16.8)	24 (20.2)	27 (14.6)
Internet	103 (33.9)	38 (31.9)	65 (35.1)
Newspaper/Magazine	116 (38.2)	45 (37.8)	71 (38.4)
Signboard	98 (32.2)	31 (26.1)	67 (36.2)
Health education	16 (5.3)	4 (3.4)	12 (6.5)
Anti-SHS education by healthcare professionals
Yes	89 (29.3)	49 (41.2)	40 (21.6)	13.37	＜0.001
No	215 (70.7)	70 (58.8)	145 (78.4)

Abbreviations: SHS＝secondhand smoke; SD, standard deviation.

Values are presented as n (%) unless otherwise indicated.

Calculated by chi-square test.

Multiple responses allowed.

Table 2.

Prevalence of SHS exposure by gender^a (N＝304)

Characteristics	Total (n＝304)	Male (n＝119)	Female (n＝185)	χ²/t	P^b
Exposure to SHS
Yes	184 (69.5)	68 (57.1)	116 (62.7)	0.93	0.339
No	120 (39.5)	51 (42.9)	69 (37.3)
Weekly frequency of SHS exposure
Mean±SD	4.0±4.1	4.4±6.1	3.8±2.2	0.95	0.340
Places of SHS exposure^c
Outside of public place	128 (69.5)	43 (63.3)	83 (71.5)	69.07	0.048
Inside of public place	54 (29.3)	31 (45.6)	23 (19.8)
Home	27 (14.6)	3 (4.4)	24 (20.7)

Abbreviations: SHS, secondhand smoke; SD, standard deviation.

Values are presented as n (%) unless otherwise indicated.

Calculated by chi-square test.

Multiple responses allowed.

Table 3.

SHS Exposure by general characteristics^a (N＝304)

Characteristics	SHS Exposure
	Male (n＝119)		Female (n＝185)
	Total		Total
Age, year
≤ 50	29	23 (79.3)^c	91	56 (61.5)
≥ 51	90	45 (50.0)	94	60 (63.8)
Education
≥ College	89	54 (60.7)	142	91 (64.1)
＜College	30	14 (46.7)	43	25 (58.1)
Employed
Yes	58	42 (72.4)^c	109	79 (72.5)^c
No	61	26 (42.6)	76	37 (48.7)
Self-rated health Good	55	33 (60.0)	93	68 (73.1)^c
Bad	64	35 (54.7)	92	48 (52.2)
Treatment duration, month
≥ 13	50	33 (66.0)	74	56 (75.7)
≤ 12	68	35 (51.5)	108	57 (52.8)
Treatment clinic
Outpatient	69	42 (60.9)	129	88 (68.2)^b
Inpatient	50	26 (52.0)	56	28 (50.0)
Smoking status Current/former	87	55 (63.2)^b	15	11 (73.3)
Non Family member’s smoker	32	13 (40.6)	170	105 (61.8)
Yes	31	11 (35.5)	85	60 (70.6)^b
No	88	57 (64.8)	100	56 (56.0)
SHS message
Yes	113	66 (58.4)	180	114 (63.3)
No	6	2 (33.3)	5	2 (40.0)
Anti-SHS education from healthcare teams
Yes	49	30 (61.2)	40	21 (52.5)
No	70	38 (54.3)	145	95 (65.5)

Abbreviation: SHS, secondhand smoke.

Values are presented as n (%).

P＜0.05 calculated by chi-square test.

P＜0.01 calculated by chi-square test.

Table 4.

Factors associated with SHS exposure by gender^a (N＝304)

Variables	SHS exposure
Variables	Male (n＝119)	Female (n＝185)
Age, y
≤50	3.11 (1.05-9.24)	-
≥51	1.00
Employed
Yes	3.15 (1.38-7.19)	2.67 (1.40-5.10)
No	1.00	1.00
Self-rated health
Good	-	2.35 (1.20-4.61)
Bad		1.00
Treatment clinics
Outpatient	1.60 (0.69-3.72)	1.74 (0.87-3.46)
Inpatient	1.00	1.00
Smoking status
Current/former	2.51 (0.98-6.43)	-
Non-smoking	1.00
Having family smokers
Yes	0.32 (0.12-0.82)	2.03 (1.05-3.91)
No	1.00	1.00
Anti-SHS education from healthcare teams
Yes	-	0.60 (0.37-1.78)
No		1.00

Abbreviations: CI, confidence interval; OR, odds ratio; SHS, secondhand smoke.

Values are presented as adjusted OR (95% CI) calculated by the logistic regression analysis.