Nicotine Dependence Evaluated by Urinary Cotinine and Heaviness of Smoking Index among Smokers, Vapers, and Dual Users: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey Data

황주삼,Cheol Min Lee,Kiheon Lee,김춘영 대한가정의학회 2021 Korean Journal of Family Medicine Vol.42 No.3

Background: Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. Methods: Data from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. Results: Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). Conclusion: In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.

금연약물치료의 최신지견

황주삼,이철민 대한가정의학회 2021 Korean Journal of Family Practice Vol.11 No.6

The use of tobacco, cigarette smoking in particular, is a leading causal factor of countless deaths and disabilities worldwide. Its widespread prevalence isa major global concern and is evidenced in various data research which suggests that an estimated 50.6 million US adults (Centers for DiseaseControl and Prevention) and 11.1 million Korean adults (Korean National Health and Nutrition Examination Survey) were using tobacco in 2019. Tobacco cessation is encouraged both nationally and globally for its clear and rapid health benefits. Today, multiple support medications exist to aidthe quitting process, nicotine replacement therapy, varenicline, and bupropion. There are, however, limitations to available pharmacotherapy. Though the current tobacco treatment guidelines have established its efficacy and safety, pharmacotherapy does not provide smoking individualswith detailed answers for common questions or case specific questions. As such, now there are strong and updated recommendations to enhancethe practice of pharmacotherapy. These includes using varenicline in place of bupropion and nicotine patches. Conditional recommendations advisecombining a nicotine patch with varenicline rather than using varenicline alone and using varenicline instead of electronic cigarettes. In groupswhere standard use of varenicline is not applicable, efficacy and safety of alternative treatment paradigms of varenicline including extending use,increasing the dose, reduce-to-quit and flexible quit date approach, have been demonstrated. Most evidence presented in this article are cited fromCochrane reviews, 2018 American College of Cardiology Expert Consensus Decision Pathway, 2020 American Thoracic Society Documents, and 2021US Preventive Services Task Force recommendation on tobacco cessation treatment. 흡연은 예방 가능한 주요 건강 위험요인으로, 2017년 전 세계적으로담배사용으로 인한 사망은 약 810만명으로 보고된다. 국내에서 흡연으로 인한 사망은 2013년 57,993명에서 2017년 61,723명으로 증가하였다. 우리나라 성인 남성 흡연율은 2019년 35.7%, 액상형 전자담배 현재 사용률은 5.1%로 확인되며, 중복사용자도 크게 증가하였다. 금연의 건강 이득은 금연 직후부터 시작되는데, 심뇌혈관 질환발생위험은 완전히 금연할 때 감소된다. 하지만 흡연자는 니코틴 의존에 의한 금단증상과 흡연욕구로 금연하기 어렵기 때문에 상담과약물치료를 통해 금연 성공률을 효과적으로 높일 수 있다. FDA 승인된 금연의 1차 치료약제로는 니코틴 대체요법, 바레니클린, 부프로피온 서방정이 있다. 최근 업데이트된 가이드라인에서는 특별한제한이 없는 경우, 단일 요법으로 바레니클린의 금연 성공률이 니코틴 패치 또는 부프로피온보다 높다고 보고한다. 바레니클린과 니코틴 대체제 복합 요법의 금연 성공률은 바레니클린 단일 요법보다높다고 보고한다. 하지만 약제에 따른 부작용과 금연 시도자의 개개인의 제한점을 고려하여 선택할 수 있겠다. 바레니클린은 표준용법 이외, 용량과 기간에 따라 장기 유지법(extending use), 점진적 금연법(reduce-to-quit), 유연한 금연법(flexible quit date), 저용량 용법(low-dose), 고용량 용법(high-dose) 등이 있으므로 금연 시도자의 개별상황에 맞추어 유연하게 선택할 수 있다. 안정된 정신 질환자에서바레니클린이 사용에 대한 안전성이 확인되었지만, 과거 신경정신과적 과거력이 있는 환자에게 처방 시 주의가 필요하다. 액상형 전자담배의 금연 효과는 근거가 불충분하므로, 완전한 금연을 위해효과와 안전성이 입증된 기존 금연치료 약물을 사용할 것을 권유한다

한국 성인 여성 음주자에서 알코올 홍조가 우울감 및 자살사고에 미치는 영향: 2019 국민건강영양조사

백수아,황주삼,오범조,박형준 대한가정의학회 2023 Korean Journal of Family Practice Vol.13 No.2

Background: As the disease burden of depression has increased, it is important to identify and manage risk factors for depression prevention and care. Among the known risk factors, alcohol flushing is also reported to increase the risk of depression. This study aimed to investigate the relationship between the alcohol flushing reaction and depressive mood, as well as suicidal ideation, in female drinkers. Methods: Data from the 2019 Korea National Health and Nutrition Examination Survey were used to calculate the risk of depressive mood and suicidal ideation based on alcohol flushing reactions among female drinkers aged 20 to 65 through multivariate logistic regression analysis, adjusting for other risk factors for depression. Subgroup analysis was also performed based on alcohol consumption status. Results: The study found that alcohol flushing reactions are associated with an increased risk of depressive mood (adjusted odds ratio [aOR], 1.31; 95% confidence interval [CI], 1.07–1.61) and suicidal ideation (aOR, 2.12; 95% CI, 1.29–3.49) in female drinkers. In the subgroup analysis, the alcohol flushing reaction in the moderate drinking group was also associated with an increased risk of depressive mood (aOR, 1.32; 95% CI, 1.06–1.63) and suicidal ideation (aOR, 2.10; 95% CI, 1.15–3.82). Conclusion: These findings suggest that alcohol flushing in female drinkers should be considered a risk stratification factor for depression management and screening.

지역안전지수와 심혈관 질환 위험인자와의 연관성: 2016–2018년 국민건강영양조사

조우현,황주삼,윤재문 대한가정의학회 2023 Korean Journal of Family Practice Vol.13 No.2

Background: Hypertension, diabetes, and dyslipidemia are the major risk factors for cardio-cerebrovascular disease, and have the highest mortality rates among the major diseases, except for cancers. According to statistics from the Korea Disease Control and Prevention Agency, the prevalence rates of hypertension, diabetes, and dyslipidemia in 2020 were 28.3%, 13.6%, and 23.9%, respectively. Studying the regional community-based risk factors for these chronic diseases is necessary for promoting public health. This study aimed to evaluate the association between the local safety level index and prevalence of these chronic diseases in the general adult population using data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES). Methods: The prevalence of hypertension, diabetes, and dyslipidemia according to the local safety level index grade was calculated using the chisquare test. Logistic regression analysis was conducted to identify whether the prevalence of hypertension, diabetes, and dyslipidemia could be predicted based on the local safety level index grade. Results: In this study, the average age of the subjects was 51.3 years, and the prevalence rates of hypertension, diabetes, and dyslipidemia were 32.5%, 12.7%, and 43.2%, respectively. Regarding the local safety level index, the prevalence of hypertension, diabetes, and dyslipidemia tended to be higher in the lower-ranked categories. However, when confounding variables were adjusted for, the local safety level index grade was not a statistically significant predictor of the prevalence of each disease. Conclusion: More research is needed to discover the potential risk factors associated with the prevalence of chronic diseases in regional communities.