Effect of Active Smoking and Secondhand Smoke on Asthma in Young People in South Korea

Research Article

Clinics of Oncology

ISSN: 2640-1037

Volume 4

Effect of Active Smoking and Secondhand Smoke on Asthma in Young People in South Korea

Choi KY*

Department of Environmental Energy Engineering, Anyang University, Anyang-si 14028, Republic of Korea

*Corresponding author:

KilYong Choi, Department of Environmental Energy Engineering, Anyang University, Anyang-si 14028, Republic of Korea, Tele: 82-10-3873-8073; E-mail: bestchoi9494@gmail.com

Keywords:

Economics; Environmental development; Tobacco abuse; Control and Management; Prevention

1. Abstract

Received: 09 Mar 2021

Accepted: 24 Mar 2021

Published: 31 Mar 2021

Copyright:

©2021 Choi KY, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

Citation:

Choi KY, Effect of Active Smoking and Secondhand Smoke on Asthma in Young People in South Korea. Clin Onco. 2021; 4(4): 1-9

1.1. Objective: As South Korean society has become increasingly globalized and Westernized, smoking among young people has resulted in a greater incidence of asthma. This research seeks to measure the effects of active and passive smoking on asthma among South Korean youth.

1.2. Methods: Using the 2013 Korea Youth Community Health Survey, data were analyzed from 24,794 respondents who were in the 20 – 29 age range when they responded, some of whom may have started smoking in their teens. Respondents with asthma were identified from the results of a logistic regression analysis (SAS 9.3., SAS Inc., Cary, NC, USA) that examined the effects of smoking in relation to this condition.

1.3. Results: The chi-square test showed that the probability of smoking impacting the incidence of asthma by age (p=0.0372), and by level of education (p<0.0001) were significant. In contrast, probable incidence of asthma based on sex (p=0.1598) was not significant. Regarding smoking status and asthma diagnosis, responses of “do not smoke”, “everyday”, and “sometimes” were provided by 330 (74.3%), 99 (22.3%), and 15 (3.4%) respondents, respectively, representing a statistically significant difference (p=0.0012). As for whether smoking impacts incidence of asthma, non-smokers were diagnosed with asthma less often than smokers,

but were still impacted, suggesting that secondhand smoke is a factor.

1.4. Conclusion: These findings may signal a call to action to the national government to lead efforts to change the perception of smoking and exposure that young people experience by highlighting its negative impact on health.

2. Introduction

2.1. Importance of this Study

Young people will play key roles in society for years to come, and their health status will profoundly affect their growth and longterm development. Recently, South Korean society has become increasingly globalized and Westernized, with smoking among youth on the rise, leading to a greater incidence of asthma [1-4]. On a global basis, smoking was estimated to account for up to 5.4 million deaths in 2005, rising to 6.4 million deaths in 2015, and jumping to 8.3 million deaths in 2030 [5]. According to the World Health Organization, the number of deaths caused by lung cancer, the most common type of cancer, was estimated at 2.09 million in 2018 [6].

The South Korean smoking rate in males and females > age 20 was 79.3% in 1980, dropping to 52.3% by 2005. However, the smoking rate in adults aged 20 to 40 remained greater than 60.0% because the smoking rate among females, which was 5.8% in 2005, has

risen continually since 1980. In particular, the smoking rate among Korean females aged 20 to 30 ranked second in total rate across the country, and the trend is increasing [7].

How secondhand smoking affects youth with asthma is an intensely researched subject [8-12]. Results show that asthma is more frequent in children and adolescents than adults, and it has been reported that the disease could be more dangerous when it occurs in a susceptible population. The prevalence of asthma in youth in South Korea is estimated at 9%, and its rate is trending upward year-by-year [13, 14].

In South Korea, 12% of adolescents are smokers [15], and 38% of adolescents are exposed to secondhand smoking from parents or external factors, such as public places. Asthma plays a key role in diminishing an adolescents’ ability to attend school, perform academically, and participate in activities in their school life, so effective treatment, as well as prevention, are important goals [16]. Given this background, a study to better understand the impact of direct and secondhand smoke on asthma in young people in their twenties can provide valuable data to patients, their families, the medical community, and to government health agencies. Overall, little is known about secondhand smoking and asthma in South Korea and it is hoped that this study will encourage further research in this field. Based on a Community Health Survey from 2013, conducted by the Korea Labor Welfare Corporation [17], our study reveals the relation between active or secondhand smoking and asthma in youth in South Korea, and details how the exposure time of secondhand smoking and amount of smoking affect asthma from various angles.

2.2. Study Objectives

The present study is based on data from the 2013 Community Health Survey and is focused on active smoking, secondhand smoking factor, and asthma diagnosis. The study aims to identify:

1) General characteristics of asthma, its distribution, and its statistical significance

2) The distribution of smoking and asthma, and its statistical significance

3) The distribution of secondhand smoking and asthma, and its statistical significance

4) The external environment factors, the distribution of asthma, and its statistical significance

5) The distribution of smoking, asthma diagnosis and current asthma treatment, and its statistical significance

3. Methods

3.1. Subjects

Starting with a population analysis of 686,928 adults > 19 years of age and residing in South Korea in July 2013, a subset of adults > 19 years of age and < age 30 became the focus of this study (n = 24,794) (Figure 1). Data from the subset helped to analyze the rela-

tionship between active smoking (lifetime smoking, age at start of smoking, current smoker, and daily smoker) versus passive smoking, which referred to secondhand smoke exposure in the home, in public and in the workplace, etc. As some adults began smoking as adolescents, some younger than age 15, these factors helped to examine the relationship between smoking and asthma. The entire country of South Korea (Seoul, Gangwon, Busan, Chungbuk, Daegu, Chungnam, Incheon, Jeonbuk, Daejeon, Jeonnam, Gwangju, Gyeongbuk, Ulsan, Gyeongnam, Sejong, Jeju, Gyeonggi) was the target.

This survey was conducted using data acquired from nationally approval statistics. (approval number: 439001).

3.2. Explanation of Variables

The general characteristics of participants in the Community Health Survey included: sex, age, educational background, location, and marital status. Questions in the survey about smoking included:

• Have you ever smoked more than five packs of cigarettes in your lifetime?

• Do you smoke now?

• Have you ever stopped smoking for 24 hours or longer because you were trying to quit smoking?

Questions regarding secondhand smoking entailed:

• How many hours per day do you smell tobacco smoke in your home?

• How many hours per day are you exposed to tobacco smoke in indoor workplaces?

• In the past year, have you smelled tobacco smoke in public places (bus/taxi station, street, restaurant, entertainment spot, and internet cafe, etc.)?

• In the past one year, have you ever watched or listened to anti-smoking public service announcements (TV, radio, poster, and leaflet, etc.)?

In the survey, asthma was a dependent variable. Questions about asthma included:

• In the past one year, have you had whistling or wheezing in the chest when you breathe?

• Have you been diagnosed by a doctor as having asthma?

To analyze the relationship between external factors and disease, the survey contained a section on exercise and physical activity, which defined high intensity strenuous exercise as running, jogging, climbing, vigorous long distance cycling, vigorous swimming, soccer, basketball, skipping rope, squash, singles tennis, and lifting weights, etc. Moderate exercise (middle intensity) was defined as easy swimming, climbing, doubles tennis, volleyball, badminton, table-tennis, and carrying a light load, etc. Last, commuting or attending school was defined as walking for moving and

activity. Questions related to exercise and activity included:

• Over the past seven day’s period, how many days have you done exercise that results in you becoming extremely tired and out of breath for 10 minutes or more?

• Over the past seven day’s period, how many days have you done exercise that results in you becoming a slightly tired and

mildly out of breath for 10 minutes or more?

• Over the past seven day’s period, how many days have you walked for 10 minutes or more?

In addition to these questions, personal characteristics, such as mental health and depression were analyzed.

3.3. Statistical Analysis

Data analyses were conducted using commercially available statistical software, SAS 9.2 (SAS Inc., Cary. NC, USA). The demographic variables were sex, age, educational background, region, and marital status, using baseline data collected from the 2013 Community Health Survey. Percentage and cross-correlation analysis were used to test differences in socio-demographic characteristics between the asthma group and the non-asthma group, and asthma status between the smoking and the secondhand smoking group. To determine statistical significance (P < 0.05), Pearson chi-square statistic two-tailed test were performed. Logistic regression analysis was used to examine and to show the Odds Ratio (OR) and 95% Confidence Interval (95% CI). We used a Chi-square to test the goodness of fit of the asthma distribution of past and present according to passive smoking and active smoking,

4. Results

corrections.

4.1. General Characteristics

In this study (N=24,794), we identified the proportion of men [N=11,434 (46.12%)] and women [N=13,360 (53.88%)] diagnosed with asthma (Table 1). Using the chi-Square test, significance probability by sex (P=0.1598) was not significant. Significant findings entailed determining a diagnosis of asthma, and included those related to age (P=0.0372) and level of education (P<0.0001). In particular, of the 444 participants diagnosed with asthma, twenty year olds and twenty-two year olds had high numbers of asthma diagnoses: 25% (n = 56) and 27.7% (n = 62) respectively. Finally, among those with asthma, there was significance based on marital status (P=0.0025) (Table 1-1).

Figure 1: Sample selection process and considered gender, area, parents’ educational background and marital status as parameter

1-1: General demographic characteristics

4.2. Asthma Resulting from Direct Smoking

Direct impact on the development of asthma was found to be associated with smoking (Table 1-2). Among study participants, lifetime smokers had a high likelihood of being diagnosed with asthma (152/5,982 = 2.5%), and representing 34.2% of those diagnosed with asthma (152/444), a finding that was statistically significant (P = 0.0025). As shown in Table 2, age was not statistically significant (P=0.7961), but asthma diagnosis was high in the group that started smoking between ages 21 – 25 (27/793 = 3.4%). Finally, there was a statistically significant finding (P=0.0039) among smokers who were diagnosed with asthma and had smoked for at least 2-5 years (14/444 = 3.2%); < 1 year (13/444 = 2.9%); or > 5 years [7/444 = 1.6%), respectively.

4.3. Asthma Due to Secondhand Smoke Exposure

Non-smokers are strongly impacted by exposure to secondhand

smoke. As shown in Table 2, those who reported smoking everyday (99/4,327 = 22.3%) or sometimes (15/435 = 3.4%) had a significantly higher incidence of asthma diagnosis than non-smokers [330/17,373 = 1.9%] (p = 0.0012). Interestingly, exposure to smoke in the home resulted in few diagnoses of asthma, but of those with the diagnosis (11/22,047 = < 1%), most had exposure for less than three years (Table 3). Those with exposure for at least four years had a diagnosis rate dramatically less than 1%. This was a statistically significant finding (P=0.022). Other participants diagnosed with asthma (444/10,695 = 4.2%) were exposed in the workplace or in public places (414/20,453 = 2%). These high rates of contracting asthma through second hand smoke exposure are important data for government agencies or medical associations in South Korea to use to consider updating smoking guidelines.

Table

General demographic characteristics

Table 2: Relationship between smoking and asthma

4.4. Physical Activity and Occurrence of Asthma

Participation in various levels of physical activities for a week was found to reduce the occurrence of asthma. "Exercise and physical activity" was defined as strenuous activity for at least 10 minutes. Of those diagnosed with asthma, a higher percentage were diagnosed during the first two days (88/444 = 19.8%) than were diagnosed on each of the remaining five days. (p = 0.0233). As shown in the Online Depository Table 5, this suggests the positive impact of physical activity even after one or two days. More mild forms of exercise, such as walking lightly for more than 10 minutes over a period of seven days, also had significant results. In particular, the level reached significance (P = 0.003) from Day 5 through Day 7 with Day 5 at 15.3% (68/444); Day 6 at 5.9% (26/444), and Day 7 at 48% (214/444)

4.5. Multiple Factors Impacting Relationship Between Smoking and Asthma

As shown in Table 4, factors linked to lifetime smoking increased

risk of asthma diagnosis by an odds ratio of 1.5. This was statistically significant for both diagnosis of asthma (P=0.0008) and treatment of asthma (P = 0.0007). In the categories "do not smoke” 78.5%), "everyday smokers" 19.6%, P=0.0010), and "sometimes smokers" 2.0%, P=0.0011), asthma was diagnosed in accordance with how frequently respondents smoked.

4.6. Aggravating Factors of Asthma

Asthma exacerbations, can present serious challenges to mental health, and can be considered as linked to smoking (Figures 2-4). Symptoms can worsen, depending on the patient's psychological status and treatment. Our study found that for "The plan is for not smoking for six months” and "I do not plan to ever quit smoking", there was a risk of 1.04, and a 1.91-fold increase respectively, which was statistically significant (P=0.0068) (Figure 2). By continuing to smoke for a year, the risk of asthma increased by an adjusted OR of 1.34 (Figure 3). The adjusted OR for attempting suicide increased to 4.34 (P < 0.0001), a highly statistically significant finding (Figure 4).

* asthma DX: asthma diagnosis

** Adjusted for Age, gender, height, weight, income, and basic living security received people

*** Individual characteristic;

Table 4: Relationship between smoking and disease (asthma *DX, Current asthma treatment)

* Adjusted for age, gender, height, weight, income, and those living on basic government assistance

** Asthma exacerbation Question: Did the symptoms of asthma exacerbate over the last year?

Figure 2: Relationship between asthma exacerbation and smoking cessation attempts

* Adjusted for age, gender, height, weight, income, and those living on basic government assistance.

** Asthma exacerbation Question: Did the symptoms of asthma exacerbate over the last year?

Figure 3: Relationship between asthma exacerbation and cognition smoking in the past 1 year

Table 5: Online depository table. Relationship between external factors and asthma

5. Discussion

* Adjusted for age, gender, height, weight, income, and basic living security received people

** Asthma exacerbation Question: Did the symptoms of asthma exacerbate over the last year?

Figure 4: Relationship between asthma exacerbation and mental health

This study demonstrates the effects of exposing young people to smoking and secondhand smoke as it relates to the occurrence of asthma. The demographics involved show significant findings associated with age (P=0.0372) and level of education (P<0.0001). Also, there were significant findings based on marital status among those with asthma (P=0.0025).

Research suggests that there is an increased prevalence of asthma in young people when there is direct smoking or secondhand smoke exposure [18, 19]. In addition, many studies have illustrated that among young people, asthma is two to four times more likely to occur in smokers than in non-smokers [20, 21]. In our study, we expanded this focus to include a variety of related factors, namely the duration of secondhand smoke exposure in the home and in the workplace over a period of years. Regarding exposure in the home, those diagnosed with asthma had exposure for either < three years or at least four years, which was a statistically significant finding (P=0.022).

Using a nationally representative sample of Korean young adults from the Community Health Survey, we searched for early exposure to smoking and to secondhand smoke and its associated risk to asthma even when all covariates were controlled. The association between lifetime smoking and current smoking with current asthma treatment and doctors diagnosed asthma was stronger among young people ages 21, 23, 29 years (over 9%) as compared with people 24 to 27 years (less than 9%). The interactions between doctors diagnosing asthma and those in homes with secondhand smoke exposure were significant (P=0.022).

We reported on the interactions among lifetime smoking [(doctors diagnosed asthma: aORs of 1.50 (95% CI: 1.18–1.91)] and, current asthma treatment: (aORs of 1.51 (95% CI: 1.18–1.91)], and the status of those who do not smoke [doctors diagnosed asthma:

aORs of 1.33 (95% CI: 1.01–1.75)], and current asthma treatment: (aORs of 1.33 (95% CI: 1.01–1.75). These self-reported data could have introduced bias into the analyses.

In the questionnaire, which was designed to identify factors that can lead to disease in young people, it was reported that asthma can impact psychological as well as physical well-being. Physical activity seemed to diminish the impact of smoking to some degree, but also somewhat reduced the quality of life. This finding has also been noted in the literature [16, 24-26].

Given the impact of youth smoking on psychiatric issues, we explored the effect of creating a plan to stop smoking for one month, versus stopping for six months, versus not stopping at all. There was a risk of 1.04, and a 1.91-fold increase in asthma exacerbation, which was statistically significant (P=0.0068). In addition to the direct impact of asthma, there was an additional impact on mental health, in the form of depression and suicide attempts. Our study showed the range of smoking-related issues among individuals in their twenties.

With the impact of direct and indirect exposure to smoking among young people, it might be meaningful for South Korea to develop country-wide regulations focused on smoke exposure in that demographic, once there are substantial data from more studies to support this initiative. Using our findings, it would be helpful to include information about smoking in the home, at school, and in the workplace as a priority, due to its correlation with asthma, especially among those who started smoking during adolescence. Aligning with previous findings [23], our results correlated with long-term exposure to secondhand smoke, notably 4.3% for > 6 years of exposure, and < 1% for exposure in the home for three years.

There are limitations to our study. Our results may undervalue the negative effects of smoking on young people if the ‘‘No smoking

effect (Smoking cessation policy in South Korea, not allowed to smoke in the workplace and in public places.)’’ works. This bias occurs as youths in their twenties who have respiratory symptoms and are undergoing treatment are more likely to belong to the current smoker and lifetime smoking groups. These findings align with the impact of policy resulting from the questionnaire of the Health Insurance Corporation in Korea. A related limitation is that we did not gauge smoking and secondhand smoke dependency, which could be a significant determinant of persistent smoking among asthmatics who failed to quit in spite of ongoing respiratory symptoms.

6. Conclusion

Based on the impact of smoking on incidence of asthma, our conclusion of this study is that there is a role for government to play in helping to educate residents of South Korea on the seriousness of smoking by young people. As part of this effort, medical associations in South Korea might consider updating guidelines for discussions about the link between smoking and asthma. Asthma is prevalent in South Korean and other industrialized nations, so we believe that government efforts are needed to increase education and awareness.

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