Changes in and Factors Affecting Second-hand Smoke Exposure in Nonsmoking Korean Americans in California: A Panel Study

PURPOSE: We evaluated changes in and factors affecting second-hand smoke (SHS) exposure in a panel study of nonsmokers. METHODS: This study was based on data from a larger study of tobacco use among a representative sample of adults of Korean descent residing in California. Participants included 846 males and 1,399 females who were nonsmokers at baseline (2005-2006) and at follow-up (2007-2009). Participants were selected by probability sampling and were interviewed by telephone. RESULTS: At baseline, 50.0% were exposed to any SHS, and at follow-up 2 years later, 60.4% were exposed to any SHS (p < .001). SHS exposure at baseline was associated with acculturation, employment, spousal smoking, and having a friend who smoked (p < .001). Employment, spousal smoking, and other family members smoking were associated with SHS at follow-up (p < .001). The odds ratio of SHS in the employed group declined from 2.01 at baseline to 1.53 at follow-up, that of the group having a smoking spouse increased from 1.88 to 2.36, and that of the group having other family members smoking increased from 1.20 to 1.69. CONCLUSIONS: We showed that SHS exposure increased among Korean American nonsmokers in California, and the most important variables explaining the change in SHS exposure involved smoking among others with whom the subject is associated. These findings could be used as objective evidence for developing public health policies to reduce SHS exposure.

South Korean Military Service Promotes Smoking: A Quasi-Experimental Design

PURPOSE: The South Korean (SK) government monopolizes the tobacco industry and is accused of pushing smoking on captive military personnel. However, estimating the association between military service and smoking is difficult, since military service is required for all SK men and the few civilian waivers are usually based on smoking determinants, e.g., social status. MATERIALS AND METHODS: Using a quasi-experimental design we validly estimate the association between military service and smoking. Military service was assigned by immigration patterns to the United States, instead of an experimenter, by comparing Korean Americans who happened to immigrate before or after the age(s) of mandated service. Smoking promotion in the military was also described among SK veterans, to identify the probable mechanisms for veterans' smoking tendencies. RESULTS: Veterans were 15% [95% confidence interval (CI), 4 to 27] more likely to ever-puff and 10% (95% CI, 0 to 23) more likely to ever-smoke cigarettes, compared to a similar group of civilians. Among veterans, 92% (95% CI, 89 to 95) recalled cigarettes were free, 30% (95% CI, 25 to 35) recalled smokers were given more work breaks and 38% (95% CI, 32 to 43) felt explicit "social pressure" to smoke. Free cigarettes was the strongest mechanism for veterans' smoking tendencies, e.g., veterans recalling free cigarette distribution were 16% (95% CI, 1 to 37) more likely to ever-smoke than veterans not recalling. CONCLUSION: These patterns suggest military service is strongly associated with smoking, and differences between veterans and civilians smoking may carry over long after military service. Given military service remains entirely in government purview, actively changing military smoking policies may prove most efficacious. This highlights the importance of recent bans on military cigarette distribution, but policies eliminating other smoking encouragements described by veterans are necessary and could effectively reduce the smoking prevalence by as much as 10% in SK.

Validity of Self-reported Healthcare Utilization Data in the Community Health Survey in Korea

To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged > or = 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population.