Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Evaluation of Social Nicotine Dependence Using the Kano Test for Social Nicotine Dependence (KTSND-K) Questionnaire in Korea

Kano Test for Social Nicotine Dependence(KTSND-K) 설문지를 통한 한국인의 사회적 니코틴의존성의 평가

  • Jeong, Jae Hee (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Sang Bong (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jung, Wou Young (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Byun, Min Gwang (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Moo Suk (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Se Kyu (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Chang, Joon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Yoshii, Chiharu (Division of Respiratory Disease, University of Occupational and Environmental Health) ;
  • Kim, Sung Kyu (Department of Internal Medicine, Yonsei University College of Medicine)
  • 정재희 (연세대학교 의과대학 내과학교실) ;
  • 최상봉 (연세대학교 의과대학 내과학교실) ;
  • 정우영 (연세대학교 의과대학 내과학교실) ;
  • 변민광 (연세대학교 의과대학 내과학교실) ;
  • 박무석 (연세대학교 의과대학 내과학교실) ;
  • 김영삼 (연세대학교 의과대학 내과학교실) ;
  • 김세규 (연세대학교 의과대학 내과학교실) ;
  • 장준 (연세대학교 의과대학 내과학교실) ;
  • ;
  • 김성규 (연세대학교 의과대학 내과학교실)
  • Received : 2007.03.26
  • Accepted : 2007.05.15
  • Published : 2007.05.30
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Abstract

Background: Smoking is one of the most important leading causes of morbidity and mortality. Smoking habit is recognized as nicotine dependence, which consists of physical and psychosocial dependence. To evaluate social nicotine dependence, the Kano Test for Social Nicotine Dependence (KTSND) working group developed a new questionnaire, which consists of 10 questions with a total score of 30 in Japan. We examined the social nicotine dependence among healthy adults using the new KTSND questionnaire and evaluated validity of the KTSND questionnaire in Korea. Method: We applied Korean KTSND questionnaire version 2 to employees of hospital, university students and people for medical examination and promotion test. Complete data obtained from the 741 responders were analyzed. Result: The mean age of responders was 31.8 years. Among them, males were 57.8%. Current smokers, ex-smokers, and non-smokers were 13.8%, 12.8%, and 73.4% respectively. According to smoking status, the total KTSND scores of current smokers were significantly higher than those of ex-smokers, and of non-smokers ($17.1{\pm}5.4$ versus $14.3{\pm}5.5$, and $12.3{\pm}5.5$, $p{\leq}0.001$). The total KTSND scores of males were higher than those of females, suggesting that males have a propensity for depending nicotine socially much more than females ($14.3{\pm}5.7$ and $11.7{\pm}5.4$ respectively, p<0.001). Eight of ten questions produced significantly different scores among three different smoking groups. When current smokers were sub-classified by heavy smoking index (HSI) that represented physical nicotine dependence, we did not find a significant difference of KTSND score between low HSI group (<4) and high HSI group (${\geq}4$), This finding suggested that the psychosocial dependence might play a different role from physical nicotine dependence in smoking. Most of the non-smokers (62.5%) had an experience of harmful passive smoking especially in public place. Conclusion: Our study suggested that the KTSND questionnaire could be a useful method to evaluate psychosocial aspects of smoking.

연구배경: 흡연은 많은 질병과 사망의 가장 중요한 원인이나 니코틴의존성으로 인해 금연이 어렵고 이로 인한 사회적, 의료적 손실이 증가함에도 불구하고 개선되지 못하고 있다. 이러한 니코틴의존성 중 물리적의존성과 독립적으로 관여할 것으로 생각되는 사회, 문화적 니코틴의존성을 알아보고자 연구하였다. 방 법: 2006년 5월부터 8월까지 일개 대학병원 직원과 일개 의과대학생, 일반 대학생 및 건강 검진자들을 대상으로 KTSND-K 설문지를 이용하여 흡연에 관한 의식 조사를 시행하였다. 결 과: 총 741명 중 평균 연령은 $31.8{\pm}11.6$세이었고, 남자는 428명(57.8%)이었다. 흡연력은 현재흡연자 102명(13.8%), 과거흡연자 95명(12.8%), 비흡연자 544명(73.4%)이었다. 흡연력에 따른 KTSND-K 총점은 현재흡연자, 과거흡연자, 비흡연자에서 각각 $17.1{\pm}5.4$, $14.3{\pm}5.5$, $12.3{\pm}5.5$로 흡연자일수록 의미 있게 높게 나타났다(p<0.001). 성별에 따른 총점의 차이는 남녀 각각 $14.3{\pm}5.7$, $11.7{\pm}5.4$로 남성에서 유의하게 높았다(p<0.001). 그러나 현재흡연자 중 흡연 행태 및 금연의지에 따라 각 군을 나누어 비교하였을 때 각 군간의 KTSND 총점의 차이는 보이지 않았다. 비흡연자 중 62.5%에서 간접 흡연의 피해를 느꼈으며, 간접 흡연을 경험하는 주요 장소는 주점 56.8%, 식당 32.3%, 학교 30.2%, 노래방 22.8%, 길거리 18.6% 등 공공 장소가 많았다. 결 론: KTSND-K 설문지는 한국 흡연자의 니코틴의존성 중 사회적 니코틴의존성을 평가할 수 있는 유용한 방법이 될 수 있다고 생각된다.

Keywords

References

  1. Godtfredsen NS, Holst C, Prescott E, Vestbo J, Osler M. Smoking reduction, smoking cessation, and mortality: a 16-year follow-up of 19,732 men and women from The Copenhagen Centre for Prospective Population Studies. Am J Epidemiol 2002;156:994- 1001 https://doi.org/10.1093/aje/kwf150
  2. Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and economic costs-- United States, 1995-1999. MMWR Morb Mortal Wkly Rep 2002; 51:300-3
  3. American Society of Clinical Oncology. Tobacco control: reducing cancer incidence and saving lives. J Clin Oncol 1996;14:1961-3 https://doi.org/10.1200/JCO.1996.14.6.1961
  4. Unites States Surgeon General. The health consequence of smoking: chronic obstructive pulmonary disease. Washington DC: US department of Health and Human Service; 1989
  5. A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA 2000;283:3244-54 https://doi.org/10.1001/jama.283.24.3244
  6. American Cancer Society. Cancer Facts and Figures 2007. Atlanta: American Cancer Society; 2007 [accessed on 2007 Feb 15]. Available from: http://www.cancer. org/docroot/STT/content/STT_1x_Cancer_Facts__Figur es_2007.asp
  7. The health consequence of smoking. A report of the Surgeon General. Atlanta, GA: US department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004
  8. Fries JF, Green LW, Levine S. Health promotion and the compression of morbidity. Lancet 1989;1:481-3
  9. LaCroix AZ, Lang J, Scherr P, Wallace RB, Cornoni-Huntley J, Berkman L, et al. Smoking and mortality among older men and women in three communities. N Engl J Med 1991;324:1619-25 https://doi.org/10.1056/NEJM199106063242303
  10. Rigotti NA. Clinical practice. Treatment of tobacco use and dependence. N Engl J Med 2002;346:506-12 https://doi.org/10.1056/NEJMcp012279
  11. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA 2000;284: 2606-10 https://doi.org/10.1001/jama.284.20.2606
  12. Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav 1978;3:235-41 https://doi.org/10.1016/0306-4603(78)90024-2
  13. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991;86:1119-27 https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
  14. Etter JF, Duc TV, Perneger TV. Validity of the Fagerstrom test for nicotine dependence and of the Heaviness of Smoking Index among relatively light smokers. Addiction 1999;94:269-81 https://doi.org/10.1046/j.1360-0443.1999.94226910.x
  15. Dijkstra A, Tromp D. Is the FTND a measure of physical as well as psychological tobacco dependence? J Subst Abuse Treat 2002;23:367-74 https://doi.org/10.1016/S0740-5472(02)00300-8
  16. Yoshii C, Kano M, Isomura T, Kunitomo F, Aizawa M, Harada H, et al. Innovative questionnaire examining psychological nicotine dependence, 'The Kano Test for Social Nicotine Dependence (KTSND)'. J UOEH 2006;28:45-55 https://doi.org/10.7888/juoeh.28.45
  17. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J. Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict 1989;84:791-9 https://doi.org/10.1111/j.1360-0443.1989.tb03059.x
  18. Diaz FJ, Jane M, Salto E, Pardell H, Salleras L, Pinet C, et al. A brief measure of high nicotine dependence for busy clinicians and large epidemiological surveys. Aust N Z J Psychiatry 2005;39:161-8 https://doi.org/10.1080/j.1440-1614.2005.01538.x
  19. Tonnesen P, Carrozzi L, Fagerstrom KO, Gratziou C, Jimenez-Ruiz C, Nardini S, et al. Smoking cessation in patients with respiratory disease: a high priority, integral component of therapy. Eur Respir J 2007; 29:390-417 https://doi.org/10.1183/09031936.00060806
  20. Dijkstra A, De Vries H, Kok G, Roijackers J. Self-evaluation and motivation to change: social cognitive constructs in smoking cessation. Psychol Health 1999;14:747-59 https://doi.org/10.1080/08870449908410762
  21. John U, Meyer C, Hapke U, Rumpf HJ. Nicotine dependence and lifetime amount of smoking in a population sample. Eur J Public Health 2004;14: 182-5 https://doi.org/10.1093/eurpub/14.2.182
  22. Fiore MC, Smith SS, Jorenby DE, Baker TB. The effectiveness of the nicotine patch for smoking cessation. A meta-analysis. JAMA 1994;271:1940-7 https://doi.org/10.1001/jama.271.24.1940
  23. Lerman C, Patterson F, Berrettini W. Treating tobacco dependence: state of the science and new directions. J Clin Oncol 2005;23:311-23 https://doi.org/10.1200/JCO.2005.04.058
  24. Yudkin P, Hey K, Roberts S, Welch S, Murphy M, Walton R. Abstinence from smoking eight years after participation in randomised controlled trial of nicotine patch. BMJ 2003;327:28-9 https://doi.org/10.1136/bmj.327.7405.28
  25. Wiggers LC, Oort FJ, Dijkstra A, de Haes JC, Legemate DA, Smets EM. Cognitive changes in cardiovascular patients following a tailored behavioral smoking cessation intervention. Prev Med 2005;40:812-21 https://doi.org/10.1016/j.ypmed.2004.09.028