Most smokers who use electronic cigarettes (e-cigarettes) to stop smoking simultaneously use conventional cigarettes (dual users). We aimed to compare the prevalence of cardiovascular risk factors among dual users, cigarette-only smokers, and never smokers in Korean men. We used data acquired from Korean National Health and Nutrition Examination Survey (2013–2017) pertaining to 7,505 male participants aged 19 years or older. About 85% of e-cigarette users were dual users. Dual users had greater nicotine dependence and higher urinary cotinine levels than cigarette-only smokers. Dual users had more psychosocial and behavioural risk factors, including perceived high stress, depressive mood, high daily intake of energy, and obesity, than never smokers and cigarette-only smokers. The prevalence of metabolic syndrome (MetS) was higher among dual users, and their multivariate-adjusted prevalence odds ratio for MetS was 2.79 (P < 0.001) compared with never smokers and 1.57 (P = 0.038) compared with cigarette-only smokers. Given that most e-cigarette users are dual users and dual users are more vulnerable to cardiovascular risk factors than cigarette-only smokers and never smokers, more active treatment for smoking cessation and intensive lifestyle interventions for dual users should be considered with priority.

Purpose: The aim of this study was to assess medication adherence and its related factors among elderly people living alone with chronic diseases using a conceptual framework with the Belief about Medicines Questionnaire and the Adherence to Refills and Medication Scale-Korean version. Participants and methods: This was a cross-sectional study conducted in 3,326 elderly people living alone, who were enrolled in Seongnam Center for Home Health Care in South Korea. They completed validated questionnaires assessing their adherence and beliefs about medication in general. Results: In attitudinal analysis using Belief about Medicines Questionnaire, 37.0% of patients were accepting of medication (high necessity with low concerns), 49.7% were ambivalent (high necessity with high concerns), 1.9% were skeptical (low necessity with high concerns), and 11.4% were indifferent (low necessity and low concerns). In multivariable analysis, we found that adherence was related to patients’ beliefs about medication; compared with patients who were accepting of medication, those in the other three attitudinal groups had significantly lower adherence (indifferent, p=0.003; skeptical, p=0.001; ambivalent, p<0.001). Also, low adherence was associated with heavy burden of drug costs (β=0.109; 95% CI 0.03, 0.19), presence of drug side effects (β=0.431; 95% CI 0.11, 0.75), dissatisfaction with medication (β=−0.626; 95% CI −0.77, −0.48), perceiving health status as poor (β=−0.151; 95% CI −0.27, −0.03), and receiving medical aid (β=0.655; 95% CI 0.42, 0.89). Gender, age group, and number of prescribed medication were not associated with medication adherence. Conclusion: To improve medication adherence of elderly living alone, it is essential to identify barriers to adherence, including their concerns and attitudes toward medications. These factors associated with adherence should be considered in further intervention studies.

Background: Despite evidence that breast cancer screening reduces morbidity and mortality, until recently most women have not undergone regular mammogram examinations in Korea. We aimed to identify factors associated with use of breast cancer screening services.Methods: The Health Promotion Knowledge, Attitude and Practice survey (HP-KAP survey) is part of the Third Korea National Health and Nutrition Examination Survey 2005 (KNHANES III), a nationwide health survey in Korea. Of 7,802 individuals who participated in the HP-KAP survey, 4,292 were female. Of these, 2,583 were women aged at least 40 years and without a history of breast cancer; these women were included in this study. Information about breast cancer screening participation was obtained from the responses to questionnaires. The overall rate of regular breast cancer screening was measured. Factors that affect participation in a breast cancer screening program were identified using multiple logistic regression analysis.Results: Among women aged at least 40 years, 30.4% complied with breast screening recommendations. Age of at least 65 years (adjusted odds ratio, aOR 0.61, 95% CI: 0.42-0.88), education level (no [ref], elementary school [aOR 1.51, 95% CI: 1.06-1.47], middle/high school [aOR 1.99, 95% CI: 1.36-2.92], university/higher [aOR 2.73, 95% CI: 1.71-4.35]), private health insurance (aOR 1.42, 95% CI: 1.71-4.35), attitude towards screening tests (aOR 0.18, 95% CI: 0.14-0.23), self-reported health status of 'fair' (aOR 1.26 95% CI: 1.00-1.58), and smoking (aOR 0.52, 95% CI: 0.35-0.79) were associated with the rate of regular breast cancer screeningConclusions: To increase the nationwide breast cancer screening rate, more attention should be given to underrepresented groups, particularly the elderly, those with a low education level, smokers, and those with a negative attitude towards screening tests. These issues highlight the need for a new emphasis in health education, promotional campaigns and public health policy aimed at these underrepresented groups.

This study aimed to investigate the association between smoking cessation, post-cessation body mass index (BMI) change and risk of myocardial infarction (MI) and stroke in men. A prospective cohort study using the National Health Insurance Service (NHIS) data set collected from 2002 to 2013 was implemented. Based on the first (2002–03) and second (2004–05) NHIS health check-up periods, 108 242 men aged over 40 years without previous diagnoses of MI or stroke were grouped into sustained smokers, quitters with BMI gain, quitters without BMI change, quitters with BMI loss, and non-smokers. Body mass index change was defined as the difference of more than 1.0 kg/m² between the two health check-up periods. The participants were followed-up from 1 January 2006 to 31 December 2013. Hazard ratios (HRs) and 95% confidence intervals (HR, 95% CI) were computed using Cox proportional hazard models adjusted for sociodemographic, health status, and family health history. Compared to the sustained smokers, the risk of MI and stroke was significantly reduced in both quitters with BMI gain (HR 0.33; 95% CI 0.16–0.70 for MI and HR 0.75; 95% CI 0.57–1.00 for stroke) and without BMI change (HR 0.55; 95% CI 0.37–0.83 for MI and HR 0.75; 95% CI 0.62–0.92 for stroke), but no significant association was found in quitters with BMI loss (HR 0.91; 95% CI 0.43–1.91 for MI and HR 0.86; 95% CI 0.57–1.31 for stroke), respectively. Non-smokers had lower risk of MI (HR 0.37; 95% CI 0.32–0.43) and stroke (HR 0.68; 95% CI 0.64–0.73) compared to the sustained smokers. Post-cessation BMI change did not significantly modify the protective association of smoking cessation with MI and stroke.

Lee EH, et al. J Korean Med Assoc. 2015 May;58(5):408-419. http://dx.doi.org/10.5124/jkma.2015.58.5.408