Personal factors influencing Korean American men's smoking behavior: addiction, health, and age

A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study

BACKGROUND

Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers.

OBJECTIVE

This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke.

METHODS

We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback.

RESULTS

The result of this study will create an intervention prototype that will be used for a future randomized controlled trial.

CONCLUSIONS

Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52398.

Factors influencing smoking behaviour of online ride-hailing drivers in China: a cross-sectional analysis

BACKGROUND

Online ride-hailing is a fast-developing new travel mode. However, tobacco control policies on its drivers remain underdeveloped. This study aims to reveal the status and determine the influencing factors of ride-hailing drivers' smoking behaviour to provide a basis for the formulation of tobacco control policies.

METHODS

We derived our cross-sectional data from an online survey of full-time ride-hailing drivers in China. We used a survey questionnaire to collect variables, including sociodemographic and work-related characteristics, health status, health behaviour, health literacy and smoking status. Finally, we analysed the influencing factors of current smoking by conducting chi-square test and multivariate logistic regression.

RESULTS

A total of 8990 ride-hailing drivers have participated in the survey, in which 5024 were current smokers, accounting to 55.9%. Nearly one-third of smokers smoked in their cars (32.2%). The logistic regression analysis results were as follows: male drivers (OR = 0.519, 95% CI [0.416, 0.647]), central regions (OR = 1.172, 95% CI [1.049, 1.309]) and eastern regions (OR = 1.330, 95% CI [1.194, 1.480]), working at both daytime and night (OR = 1.287, 95% CI [1.164, 1.424]) and non-fixed time (OR = 0.847, 95% CI [0.718, 0.999]), ages of 35-54 years (OR = 0.585, 95% CI [0.408, 0.829]), current drinker (OR = 1.663, 95% CI [1.526, 1.813]), irregular eating habits (OR = 1.370, 95% CI [1.233, 1.523]), the number of days in a week of engaging in at least 10 min of moderate or vigorous exercise ≥3 (OR = 0.752, 95% CI [0.646, 0.875]), taking the initiative to acquire health knowledge occasionally (OR = 0.882, 95% CI [0.783, 0.992]) or frequently (OR = 0.675, 95% CI [0.591, 0.770]) and underweight (OR = 1.249, 95% CI [1.001, 1.559]) and overweight (OR = 0.846, 95% CI [0.775, 0.924]) have association with the prevalence of current smoking amongst online ride-hailing drivers.

CONCLUSION

The smoking rate of ride-hailing drivers was high. Sociodemographic and work-related characteristics and health-related factors affected their smoking behaviour. Psychological and behavioural interventions can promote smoking control management and encourage drivers to quit or limit smoking. Online car-hailing companies can also establish a complaint mechanism combined with personal credit.

A scoping review of men, masculinities, and smoking behavior: The importance of settings

Background: In many countries, smoking rates are higher among men than women, highlighting the importance of focusing on factors that influence smoking prevalence among men. Expressed masculinities occur within settings that can influence men’s perspectives and behaviours towards smoking.

Objectives: To provide an overview of key aspects of how masculinities underpin men’s behaviours regarding tobacco smoking.

Methods: The Health, Illness, Men and Masculinities framework was used to develop a synthesis of masculinities captured in published articles about men’s smoking behaviours. Five databases (PubMed, Medline Ovid, Embase, CINAHL and PsychINFO Ovid) and Google Scholar (up to April 2016) were searched using keywords derived from three concepts: men, smoking and health. In total, 351 articles that focused on smoking and used/implied masculinity concepts were identified. These underwent a two-stage screening process applying inclusion/exclusion criteria, first titles/abstracts and then full-text. Data from 45 selected articles were extracted and charted.

Results: Regions with high prevalence of smoking among men, such as South East Asia and the Western Pacific, had a disproportionate number of studies on masculinity and smoking, with less exploration of masculinity as a protective factor, especially for young people, and men-specific settings to support non-smoking behaviour.

Conclusions: Incorporating masculinity in future settings-based approaches to smoking-related health promotion programmes has the potential to reduce smoking prevalence among men.

Using Ecological Momentary Assessment to Identify Common Smoking Situations Among Korean American Emerging Adults

The present study provides detailed contextual information about smoking habits among young Korean American smokers with the goal of characterizing situations where they are most at risk for smoking. Relevant situational factors included location, social context, concurrent activities, time of day, affective states, and food and beverage consumption. Using ecological momentary assessment (EMA) over 7 days, participants (N = 78) were instructed to respond to smoking prompts (n = 2614) and non-smoking prompts (n = 2136) randomly scheduled throughout the day. At each prompt, participants completed a short survey about immediate contextual factors. We used multilevel models to evaluate the association between contextual factors and smoking and further explored the distribution of smoking locations and concurrent activities across each social context and reason for smoking. Compared to non-smoking events, smoking events were associated with being outside, the presence of Korean friends, socializing, consuming alcohol, and experiencing more stress relative to one's average stress level (all ps < .01). Further analyses involving only smoking events showed that when participants smoked alone, they were most commonly at home (50 %) and most often studying/working (28 %). When smoking with Korean friends, participants were most often outside (38 %) and socializing (54 %). When smoking to reduce craving, participants were most often at home (39 %) and studying/working (25 %). To our knowledge, this is the first study to provide detailed descriptions of real-time smoking contexts among young Korean American smokers. Information with this level of granularity is needed to develop effective just-in-time adaptive interventions (JITAIs) for smoking cessation.

Development and application of culturally appropriate decision aids for smoking cessation in Korea: a pragmatic clustered randomization crossover trial

INTRODUCTION

In Asian countries, reluctance to seek pharmacological intervention is a major barrier for smoking cessation. Culturally appropriate decision aids are expected to help people in the decision making for the use of smoking cessation medication.

OBJECTIVE

The aim of this study was to develop a culturally tailored decision aid for smoking cessation and evaluate its effect on the use of smoking cessation medication.

PATIENTS AND METHODS

A 7-minute video on smoking cessation information and options was developed. Physicians were randomized into intervention and control groups. The decision aid was provided to patients in the intervention group, and they watched it, while those in the control group were provided usual medical care for smoking cessation. The primary outcome was the proportion of smokers who were prescribed smoking cessation medication within 1 month after consultation. The secondary outcomes were abstinence rate and use of smoking cessation medication within 6 months. A logistic regression analysis was used to assess the effect of the decision aid on the outcomes.

RESULTS

In total, 414 current smokers (intervention group: 195; control group: 219) were enrolled. The mean age of the participants was 48.2 years, and 381 subjects (92%) were males. In total, 11.8% of the participants in the intervention group and 10.5% in the control group were prescribed smoking cessation medications within 1 month. The odds ratio was 1.02 (95% CI: 0.40-2.63) after adjustment for baseline characteristics. Within 6 months, 17.4% of the participants in the intervention group and 15% in the control group were prescribed medication (adjusted odds ratio 1.12, 95% CI: 0.59-2.13).

CONCLUSION

The culturally tailored smoking cessation decision aid developed in this study did not show a significant impact on the decision to use smoking cessation medication. Further research to develop more effective and more interactive interventions is expected.

Gender Differences in Relations of Smoking Status, Depression, and Suicidality in Korea: Findings from the Korea National Health and Nutrition Examination Survey 2008-2012

OBJECTIVE

As mental health problems may play an important role in initiating and maintaining cigarette smoking in females and there are an increasing number of female smokers, we evaluated the relationship between smoking status and mental health problems including depression and suicide ideation in women in Korea.

METHODS

We analyzed the 5-year cumulative data (19 years of age or older, n=32,184) from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted from 2008 to 2012. Logistic regression analyses were used to evaluate associations between cigarette smoking status and mental health parameters while controlling for potentially confounding variables.

RESULTS

Among current smokers, females showed higher lifetime prevalence in having a depressive episode, a doctor-diagnosed major depression, a current diagnosis of depression, or receiving treatment for depression in comparison with males. In addition, females were more likely to report on having a depressive episode, suicidal ideation and attempts, and psychiatric counselling within the previous year, as compared to males. Female former smokers showed intermediate characteristics in parameters of mental health status within the previous year, ranking between lifetime non-smokers and the current smokers.

CONCLUSION

Identifying the factors related to mental health status among current smokers can increase opportunities for an early intervention and help reduce the prevalence of smoking and increase smoking cessation rates particularly in females. Developing adaptive coping strategies other than smoking in female youth is potentially important in reducing the initiation of smoking.

Knowledge of Occupational Chemical Exposure and Smoking Behavior in Korean Immigrant Drycleaners

To examine the association between knowledge of chemical exposure at work and cigarette smoking among Korean immigrant drycleaners. A cross-sectional survey was conducted with a total of 151 Korean immigrant drycleaners (mean age = 49 years, 64 % male) from 96 drycleaning shops in a Midwestern state. The data were collected on demographic and work-related characteristics, knowledge of occupational chemical exposure, health concerns associated with chemical exposure, and smoking status. Approximately 25 % of participants were current smokers. The multivariate regression showed that greater knowledge of occupational chemical exposures was significantly associated with a lower likelihood of current smoking [odds ratio (OR) .63; 95 % confidence interval (CI) .41-.95]. Furthermore, male gender (OR 6.32; 95 % CI 1.66-24.00), shorter-term residence in the US (OR .93; 95 % CI .88-.98), and having multiple duties (OR 2.76; 95 % CI 1.01-7.51) were important covariates associated with current smoking among Korean immigrant drycleaners. Knowledge on occupational chemical exposure was significantly associated with smoking among Korean immigrant drycleaners. Smoking cessation programs for this population should consider integrated approaches that incorporate work environment factors into individual and sociocultural components.

Korean American Women's Experiences with Smoking and Factors Associated with Their Quit Intentions

This study explored Korean American women's experiences with smoking and tested the theory of planned behavior to identify factors associated with their intentions to quit smoking. It employed a mixed-methods research design, using qualitative and quantitative data. Participants were recruited via a combination of random (N = 49) and convenience (N = 45) sampling techniques. Women in this study initiated smoking at age of 23 on average, and nearly half smoked at indoor houses. They initiated smoking out of curiosity about the effect and belief that smoking would relieve their stress. Reasons for continued smoking were (a) to avoid nicotine withdrawal symptoms, (b) to cope with life stressors, including acculturative stress, and (c) to fulfill one's destiny as a lifetime smoker. Many attempted to quit due to health issues and pregnancy. Fear of disclosure and limited English proficiency were found to be major barriers to seeking help for quitting. Past-year quit attempt(s), attitudes toward quitting, and perceived family norm favoring quitting explained 25% of the variance in intentions to quit smoking (F [3,90] = 11.58, P < 0.001). Findings suggest that gender- and culture-specific intervention strategies are needed to assist Korean American women in smoking cessation.

Smoking trajectories among Koreans in Seoul and California: exemplifying a common error in age parameterization

Immigration to a nation with a stronger anti-smoking environment has been hypothesized to make smoking less common. However, little is known about how environments influence risk of smoking across the lifecourse. Research suggested a linear decline in smoking over the lifecourse but these associations, in fact, might not be linear. This study assessed the possible nonlinear associations between age and smoking and examined how these associations differed by environment through comparing Koreans in Seoul, South Korea and Korean Americans in California, United States. Data were drawn from population based telephone surveys of Korean adults in Seoul (N=500) and California (N=2,830) from 2001-2002. Locally weighted scatterplot smoothing (lowess) was used to approximate the association between age and smoking with multivariable spline logistic regressions, including adjustment for confounds used to draw population inferences. Smoking differed across the lifecourse between Korean and Korean American men. The association between age and smoking peaked around 35 years among Korean and Korean American men. From 18 to 35 the probability of smoking was 57% higher (95%CI, 40 to 71) among Korean men versus 8% (95%CI, 3 to 19) higher among Korean American men. A similar difference in age after 35, from 40 to 57 years of age, was associated with a 2% (95%CI, 0 to 10) and 20% (95%CI, 16 to 25) lower probability of smoking among Korean and Korean American men. A nonlinear pattern was also observed among Korean American women. Social role transitions provide plausible explanations for the decline in smoking after 35. Investigators should be mindful of nonlinearities in age when attempting to understand tobacco use.

Cross-national gender differences in the socioeconomic factors associated with smoking in Australia, the United States of America and South Korea

OBJECTIVES

We compared rates of smoking among those aged 45 years and older in Australia, the United States of America and South Korea, and examined cross-national gender differences in key socioeconomic differentials in smoking.

METHODS

We conducted weighted analyses on cross-sectional data from nationally representative surveys conducted in 2006.

RESULTS

Current smoking was more prevalent for males than females in all countries; the gender difference was largest in Korea. Being unpartnered increased the likelihood of smoking in all countries, while greater wealth reduced it. In Korea, these effects interacted with gender; both indicators showed larger differentials among women than men. Lower educational attainment increased the likelihood of smoking for all groups except Korean women, among whom high school educated women were less likely to smoke than the tertiary educated.

CONCLUSIONS

Our findings support a cultural interpretation of gender differences in smoking: in countries with low gender empowerment, gender differences in smoking are greater. With increasing divorce and female tertiary education rates in nations like Korea, we highlight the need for health promotion messages targeted towards older and more educated women.

It's others, not the police: smoking, reprimand, and fines among adults of Korean descent in California

OBJECTIVE

This study assesses the association of immediate social and legal reprimand and current smoking status among Californians of Korean descent.

DESIGN

Data were drawn from a population-based probability sample using a telephone survey conducted by bilingual, professional interviewers (N = 2085). About 85.0% of eligible respondents completed interviews and 86.3% of participants preferred to be interviewed in Korean.

MAIN OUTCOME MEASURE

Smoking status was measured using Centers for Disease Control and Prevention criteria, ever smoked 100 cigarettes and currently smoke every day or some days.

RESULTS AND CONCLUSION

Reports of immediate criticism by others in several settings was associated with nonsmoking, but likelihood of immediate legal penalties was unrelated. Participants were far less likely to expect legal than social sanction. Results were replicated after controlling for reinforcers of smoking and ecologically relevant variables including models of smoking, primary group social support for smoking, acculturation, sex, acculturation by sex (male) interaction, age, and education. It may be efficacious to target public health interventions encouraging appropriate social sanctions of smoking in public among persons of Korean descent, and to encourage strict enforcement of legal penalties for smoking in public places.

Does church participation facilitate tobacco control? A report on Korean immigrants

Background This study explores hypotheses linking church attendance to smoking prevalence, cessation, exposure to environmental tobacco smoke (ETS), and household smoking bans among Korean immigrants in California. Methods Data were drawn from telephone interviews with Korean adults (N = 2085) based on a probability sample during 2005–2006 in which 86% of those contacted completed interviews. Results Koreans who reported that they had attended church were less likely to be current smokers and to be exposed to ETS, and more likely to have quit smoking and to have a complete smoking ban than non-attenders after statistical controls for behavioral covariates. Discussion Whether or not participants reported attending church was associated with increased tobacco control practices. Public health interventions may profit by seeking to expand cooperation with religious congregations to facilitate efforts to promote healthy lifestyles among immigrant populations beyond the influences of church attendance.

Psychometric properties of the alcohol use disorders identification test: a Korean version

OBJECTIVE

The Alcohol Use Disorders Identification Test (AUDIT) is an important screening tool but has never been administered to Korean Americans. This study was conducted to examine the psychometric properties of a Korean version of the AUDIT referred to as AUDIT-K and to determine which cutoff score of the scale would perform better in Korean Americans.

METHOD

Translation and backtranslation of the AUDIT-K were conducted to obtain a measure consistent with the Korean cultural understanding of alcohol use. Following satisfactory interrater agreements on each item about its Korean translation, the AUDIT-K was administered to 118 Korean American men (Time 1) and to 93 of the men approximately 1 month later (Time 2). Data were analyzed for internal consistency reliability, test-retest reliability, and construct validity.

RESULTS

Approximately 47.5% of Korean American men who participated in the study were identified as having drinking problems when using the World Health Organization's recommended cutoff score of 8, whereas approximately 20.3% were found to have problems with alcohol when using the cutoff score of 12, the one recommended for Koreans. Cronbach's alpha was .82 at Time 1 and was .80 at Time 2. Test-Retest reliability assessed via the intraclass correlation coefficient for the total AUDIT scale was .85. Principal components factor analysis with varimax orthogonal rotation revealed a two-factor solution, alcohol consumption and drinking problems, resulting in 57% of the explained variance.

CONCLUSIONS

The AUDIT-K was found to be internally consistent and stable over time and should be used in primary health care settings to screen Korean American men for alcohol use disorders to facilitate early interventions.

Fatores associados ao índice de cessação do hábito de fumar em duas diferentes populações adultas (Projetos Bambuí e Belo Horizonte)

O objetivo deste trabalho foi verificar o índice de cessação do tabagismo e os fatores associados ao mesmo. O estudo foi conduzido na Região Metropolitana de Belo Horizonte e na cidade de Bambuí, em Minas Gerais, Brasil. Participaram, respectivamente, 13.261 e 1.018 adultos (> 20 anos) selecionados aleatoriamente entre os residentes das áreas de estudo. O índice de cessação do tabagismo foi igual a 40,6% (IC95%: 39,1-42,3) na Região Metropolitana de Belo Horizonte e 38,8% (IC95%: 34,4-43,1) em Bambuí. Na Região Metropolitana de Belo Horizonte, associações independentes e positivas com esse índice foram observadas para idade (> 40 anos), escolaridade (4-7 e > 8 anos de estudo), número de condições crônicas (> 2) e número de consultas médicas no último ano (1-3 e > 4); associação negativa foi observada para estado civil (não casados). Em Bambuí, foi observada associação independente e positiva com idade (> 40 anos) e negativa com número de hospitalizações no último ano (> 2). A heterogeneidade dos fatores associados à interrupção do tabagismo dificulta a identificação de grupos vulneráveis, visando estratégias de prevenção. São necessários novos estudos para um melhor entendimento dessa heterogeneidade.

Tobacco dependence, risk perceptions and self-efficacy among Korean American smokers

Psychosocial variables related to smoking cessation may differ among ethnic groups. This research focuses on Korean Americans, a group that receives little attention in smoking cessation research, yet has an elevated smoking rate when compared with that of the general US population. This article reports our findings on tobacco dependence, risk perceptions and self-efficacy and examines potential associations between these psychosocial variables and key demographic variables. One hundred Korean American adult smokers enrolled in the study and completed the psychosocial measurement. The majority of the participants (61%) were heavy smokers. The findings indicated that demographic factors were associated with key psychosocial variables that have been demonstrated to play a role in smoking cessation behaviors. In particular, younger age and higher educational level were associated with greater self-efficacy in quitting smoking. No differences in risk perception were observed by any of the demographic indicators assessed. The findings suggest that enhancing self-efficacy among older and less educated smokers may improve the efficacy of smoking cessation efforts that target Korean smokers.

The sociocultural context of korean american men's smoking behavior

The purpose of this article is to explore the sociocultural context wherein Korean male immigrants learned and maintained smoking behavior. Participants were 11 current and 11 former cigarette smokers who resided in New York City. The participants attended one of four focus groups and talked about their experiences of smoking initiation, changes in smoking behavior over time, smoking in Korea and the United States, strategies used for smoking cessation, and suggestions for a smoking cessation program. The focus group interviews were audiotaped and transcribed verbatim. Themes were identified from answers to the five topic questions and then compared across the four focus groups. Smoking is a common thread in Korean men's social world and a prime component of Korean men's gender identity. In contrast, smoking in the United States is increasingly being stigmatized.