Factors Associated with Smoking Cessation Intention among Current Smokers with Diabetes: Analysis of the 2013 Community Health Survey in Korea

Young-Hoon Lee; Jum Suk Ko

doi:10.15384/kjhp.2017.17.3.184

Korean J Health Promot > Volume 17(3); 2017 > Article

Factors Associated with Smoking Cessation Intention among Current Smokers with Diabetes: Analysis of the 2013 Community Health Survey in Korea

Original Article

Korean Journal of Health Promotion 2017;17(3):184-192.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.3.184

Factors Associated with Smoking Cessation Intention among Current Smokers with Diabetes: Analysis of the 2013 Community Health Survey in Korea

Young-Hoon Lee^1,², Jum Suk Ko³

¹Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea

²Jeonbuk Tobacco Control Center, Iksan, Korea

³Department of Cardiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea

Corresponding author : Jum Suk Ko, MD Department of Cardiology, Wonkwang University Hospital, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea
Tel: +82-63-859-2526, Fax: +82-63-852-8480 E-mail: nemor@hanmail.net

Received March 27, 2017 Accepted July 13, 2017

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.

요약

Background:

Smoking increases the risk of diabetic complications, but the prevalence of smoking in diabetes is similar to non-diabetes. We aimed to investigate factors associated with smoking cessation intentions (SCI) in current smokers with diabetes.

Methods:

In the 2013 Community Health Survey, information about current smokers has been collected among people who are over 30 years old with diabetes. Chi-squared test and logistic regression analysis were used to examine the association between socio-demographic indicators, health behaviors, comorbidities, smoking-related factors, diabetes-related factors and SCI. A total of 3,511 current smokers with diabetes were included in the final analysis.

Results:

Among current smokers with diabetes, 13.4% reported having SCI (within six months). In multivariate logistic regression analysis, gender, education, marital status and occupation were found to be significantly related to SCI. Moreover, lower amounts of smoking, previous attempts to smoking cessation (odds ratio [OR] 3.66, 95% confidence interval [CI] 2.94-4.56), experience of smoking cessation recommendations from acquaintances (OR 1.87, 95% CI 1.38-2.52), experience of smoking cessation education (OR 1.57, 95% CI 1.12-2.20), and experience of diabetic education (OR 1.33, 95% CI 1.06-1.66) were significantly associated with SCI in current smokers with diabetes.

Conclusion:

In order to lower the smoking rate of community-dwelling adults with diabetes, effective anti-smoking interventions are needed, taking into account SCI-related factors, including smoking cessation education and diabetes education.

Keywords: Smoking cessation, Intention, Community health planning, Diabetes mellitus

Table 1.

Smoking cessation intention of study population according to general characteristics

	N	Smoking cessation intention		P
Never or someday (row %)	N	Within 6 months (row %)	P	P
Total	3,511	86.6	13.4
Gender				0.001
Male	3,135	85.9	14.1
Female	376	92.3	7.7
Age, y				<0.001
30-39	139	72.7	27.3
40-49	539	83.5	16.5
50-59	1,124	86.5	13.5
60-69	965	87.7	12.3
≥70	744	90.1	9.9
Education level				<0.001
≤Elementary school	1,117	91.9	8.1
Middle school	644	90.2	9.8
High school	1,161	84.7	15.3
College or higher	589	76.2	23.8
Marital status				0.074
Married and living with a spouse	2,635	86.6	13.4
Divorced or separated	407	84.3	15.7
Widowed	311	90.4	9.6
Never married	158	83.5	16.5
Occupation				<0.001
Manual	1,886	88.4	11.6
Non-manual	442	75.6	24.4
Others^a	1,183	87.7	12.3
Monthly household income, million won				<0.001
<1.00	920	89.0	11.0
1.00-2.99	779	90.0	10.0
3.00-4.99	1,060	84.9	15.1
≥5.00	752	82.3	17.7
National basic livelihood security				0.589
Recipient	367	87.5	12.5
Non-recipient	3,144	86.5	13.5
Location of residence				<0.001
Rural (eup·myeon)	1,683	88.8	11.2
Urban (dong)	1,828	84.5	15.5
Drinking frequency				0.001
None	957	89.0	11.0
≤1 time per month	532	85.7	14.3
2-4 times per month	631	82.4	17.6
2-3 times per week	725	85.4	14.6
≥4 times per week	666	88.9	11.1
Stress				0.094
Rare	1,134	85.0	15.0
A little	1,583	86.7	13.3
Much	794	88.4	11.6
Hypertension				0.548
No	1,755	86.2	13.8
Yes	1,756	86.9	13.1
Dyslipidemia				0.002
No	2,630	87.6	12.4
Yes	881	83.4	16.6
Body mass index				0.296
Underweight	215	88.4	11.6
Normal	2,207	87.0	13.0
Obese	1,089	85.3	14.7

^aJob soldier, student · repeat student, housewife, unemployed.

Table 2.

Smoking cessation intention of study population according to smoking-relating factors and diabetes-relating factors

	N	Smoking cessation intention		P
	N	Never or someday (row %)	Within 6 months (row %)	P
Amounts of smoking, numbers of cigarettes				<0.001
Sometimes (not daily smoking)	220	66.8	33.2
1-9 per day	421	83.6	16.4
10-19 per day	979	85.9	14.1
≥20 per day	1,891	89.8	10.2
Experience of past quit attempts				<0.001
No	2,790	91.3	8.7
Yes	721	68.2	31.8
Experience of smoking cessation recommendations from acquaintances				0.001
Never or seldom	828	89.0	11.0
Frequently	1,211	87.9	12.1
Always	1,472	84.0	16.0
Experience of smoking cessation public advertising				<0.001
No	607	91.4	8.6
Yes	2,904	85.5	14.5
Experience of smoking cessation education				<0.001
No	3,264	87.7	12.3
Yes	247	72.1	27.9
Self-awareness of blood glucose control (n=3,484)^a				0.921
No	488	86.7	13.3
Yes	2,996	86.5	13.5
Current treatment for diabetes				0.499
No	392	85.5	14.5
Yes	3,119	86.7	13.3
Experience of diabetic education				<0.001
No	2,393	88.5	11.5
Yes	1,118	82.5	17.5
Examination of diabetic retinopathy				<0.001
No	2,597	88.2	11.8
Yes	914	81.9	18.1
Examination of diabetic nephropathy				<0.001
No	2,523	88.3	11.7
Yes	988	82.1	17.9

^a27 people without data are excluded.

Table 3.

Associating factors for smoking cessation intention using multivariate logistic regression analysis

	Unadjusted		Fully adjusted
Male (ref: female)	1.97	(1.33-2.91)	1.91	(1.18-3.09)
Age (ref: ≥70), y
60-69	1.27	(0.94-1.73)	1.00	(0.70-1.43)
50-59	1.42	(1.05-1.90)	0.98	(0.67-1.45)
40-49	1.79	(1.29-2.49)	0.98	(0.62-1.54)
30-39	3.41	(2.19-5.31)	1.66	(0.92-2.97)
Education level (ref: ≤elementary school)
Middle school	1.22	(0.87-1.71)	1.03	(0.71-1.50)
High school	2.04	(1.56-2.67)	1.58	(1.15-2.19)
College or higher	3.52	(2.64-4.68)	1.97	(1.33-2.91)
Marital status (ref: married and living with a spouse)
Divorced or separated	1.21	(0.91-1.62)	1.49	(1.05-2.10)
Widowed	0.69	(0.47-1.03)	1.35	(0.83-2.18)
Never married	1.28	(0.83-1.97)	1.13	(0.68-1.90)
Occupation (ref: manual)
Non-manual	2.46	(1.90-3.19)	1.45	(1.05-1.99)
Others^a	1.06	(0.85-1.33)	1.02	(0.77-1.36)
Monthly household income (ref: <1.00 million won)
1.00-2.99 million won	0.90	(0.66-1.23)	0.90	(0.63-1.28)
3.00-4.99 million won	1.44	(1.10-1.88)	1.06	(0.75-1.49)
≥5.00 million won	1.74	(1.32-2.30)	0.99	(0.67-1.46)
Urban (ref: rural)	1.46	(1.20-1.78)	1.05	(0.84-1.32)
Drinking frequency (ref: none)
≤1 time per month	1.35	(0.99-1.86)	1.01	(0.71-1.43)
2-4 times per month	1.73	(1.30-2.31)	1.20	(0.86-1.67)
2-3 times per week	1.39	(1.04-1.86)	1.02	(0.73-1.43)
≥4 times per week	1.01	(0.74-1.39)	1.06	(0.75-1.51)
Stress (ref: rare)
A little	0.87	(0.70-1.08)	0.93	(0.73-1.18)
Much	0.74	(0.57-0.98)	0.87	(0.64-1.18)
Dyslipidemia (ref: no)	1.40	(1.14-1.74)	1.15	(0.91-1.46)
Amounts of smoking (ref: ≥20 per day)
10-19 per day	1.45	(1.15-1.84)	1.47	(1.14-1.90)
1-9 per day	1.74	(1.29-2.34)	2.30	(1.64-3.23)
Sometimes (not daily)	4.39	(3.20-6.04)	4.33	(2.99-6.27)
Experience of past quit attempts (ref: no)	4.88	(3.98-5.99)	3.66	(2.94-4.56)
Experience of smoking cessation recommendations from acquaintances (ref: never or seldom)
Frequently	1.11	(0.84-1.47)	1.25	(0.92-1.71)
Always	1.54	(1.19-1.99)	1.87	(1.38-2.52)
Experience of smoking cessation public advertising (ref: no)	1.81	(1.33-2.44)	1.30	(0.94-1.81)
Experience of smoking cessation education (ref: no)	2.75	(2.05-3.70)	1.57	(1.12-2.20)
Experience of diabetic education (ref: no)	1.63	(1.34-1.99)	1.33	(1.06-1.66)
Examination of diabetic retinopathy (ref: no)	1.64	(1.34-2.02)	1.28	(0.97-1.69)
Examination of diabetic nephropathy (ref: no)	1.65	(1.35-2.02)	1.05	(0.80-1.38)

Abbreviation: ref, reference. Values are presented as odds ratio (95% confidence interval).

^aJob soldier, student · repeat student, housewife, unemployed.

REFERENCES

1.. Chang CM, Corey CG, Rostron BL, Apelberg BJ. Systematic review of cigar smoking and all cause and smoking related mortality. BMC Public Health 2015;15:390.

2.. Gellert C, Schöttker B, Brenner H. Smoking and all-cause mortality in older people: systematic review and meta-analysis. Arch Intern Med 2012;172(11):837-44.

3.. Mons U, Müezzinler A, Gellert C, Schöttker B, Abnet CC, Bobak M, et al. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ 2015;350:h1551.

4.. National Statistical Office. Annual report on the vital statistics in Korea [Internet]. Seoul: National Statistical Office of Korea; 2014. [Accessed March 18, 2017]. Available from:. http://kostat.go.kr/portal/korea/kor_nw/2/6/2/index.-board?bmode=read&aSeq=348539.

5.. Cho NH. Diabetes burden and prevention in Korea and the Western Pacific region. Diabetes Res Clin Pract 2014;106(Suppl 2):S282-7.

6.. American Diabetes Association. Standards of medical care in diabetes-2015 abridged for primary care providers. Clin Diabetes 2015;33(2):97-111.

7.. Hur NW, Kim HC, Nam CM, Jee SH, Lee HC, Suh I. Smoking cessation and risk of type 2 diabetes mellitus: Korea Medical Insurance Corporation Study. Eur J Cardiovasc Prev Rehabil 2007;14(2):244-9.

8.. Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2007;298(22):2654-64.

9.. Pan A, Wang Y, Talaei M, Hu FB. Relation of smoking with total mortality and cardiovascular events among patients with diabetes mellitus: a meta-analysis and systematic review. Circulation 2015;132(19):1795-804.

10.. Qin R, Chen T, Lou Q, Yu D. Excess risk of mortality and cardiovascular events associated with smoking among patients with diabetes: meta-analysis of observational prospective studies. Int J Cardiol 2013;167(2):342-50.

11.. Voulgari C, Katsilambros N, Tentolouris N. Smoking cessation predicts amelioration of microalbuminuria in newly diagnosed type 2 diabetes mellitus: a 1-year prospective study. Metabolism 2011;60(10):1456-64.

12.. Korea Center for Disease Control and Prevention. 2015 Chronic disease status and issues-chronic disease factbook [Internet]. Cheongju: Korea Center for Disease Control and Prevention; 2015. [Accessed March 20, 2017]. Available from:. http://cdc.go.kr/CDC/notice/CdcKrIntro0504.jsp?menuIds=HOME001-MNU1154-MNU0005-MNU0110&cid=65024.

13.. Myung SK, Seo HG, Cheong YS, Park S, Lee WB, Fong GT. Association of sociodemographic factors, smoking-related beliefs, and smoking restrictions with intention to quit smoking in Korean adults: findings from the ITC Korea Survey. J Epidemiol 2012;22(1):21-7.

14.. Park KY. Predictors of intention to quit smoking among woman smokers in Korea. J Korean Acad Fundam Nurs 2014;21(3):253-63.

15.. Ahn HR. Factors associated with intention to quit smoking in community-dwelling male adult smokers. J Korean Acad Community Health Nurs 2015;26(4):364-71.

16.. Jung M. Exploring socio-contextual factors associated with male smoker's intention to quit smoking. BMC Public Health 2016;16:398.

17.. Jung-Choi KH, Khang YH, Cho HJ. Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population. Tob Control 2012;21(6):536-42.

18.. Noh J. The diabetes epidemic in Korea. Endocrinol Metab (Seoul) 2016;31(3):349-53.

19.. Lee YM. Smoking cessation intention and related factors in current smokers diagnosed with coronary artery disease: a cross-sectional study using the community health survey. J Health Info Stat 2016;41(2):165-73.

20.. Ryu SY, Shin JH, Kang MG, Park J. Factors associated with intention to quit smoking among male smokers in 13 communities in honam region of Korea: 2010 community health survey. Korean J Health Educ Promot 2011;28(2):75-85.

21.. Feng G, Jiang Y, Li Q, Yong HH, Elton-Marshall T, Yang J, et al. Individual-level factors associated with intentions to quit smoking among adult smokers in six cities of China: findings from the ITC China Survey. Tob Control 2010;19(Suppl 2):i6-11.

22.. Yoon YM, Yang EK, Shin SR. Influencing factors on smoking cessation motivation of adult males. Korean J Adult Nurs 2012;24(5):520-30.

23.. Kim JS, Yu JO, Kim MS. Factors contributing to the intention to quit smoking in community-dwelling elderly smokers. J Korean Acad Community Health Nurs 2012;23(4):358-65.

24.. Cho KS. Factors associated with intentions of Korean youth smokers to smoke consistently after tobacco price increase in the future. Korean J Health Promot 2013;13(1):34-41.

25.. Hughes JR. Motivating and helping smokers to stop smoking. J Gen Intern Med 2003;18(12):1053-7.

26.. Byun SH, Ma SH, Jun JK, Jung KW, Park B. Screening for diabetic retinopathy and nephropathy in patients with diabetes: a nationwide survey in Korea. PLoS One 2013;8(5):e62991.

27.. Nagrebetsky A, Brettell R, Roberts N, Farmer A. Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials. BMJ Open 2014;4(3):e004107.