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31 "Smoking Cessation"
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Research Paper
Interorganizational Networks for Smoking Prevention and Cessation: A Blockmodeling Approach
Park, Eun-Jun , Kim, Hyeongsu , Lee, Kun Sei , Cho, Junghee , Kim, Jin Hyeong , Jeong, Ho Jin , Lee, Ji An
J Korean Acad Nurs 2022;52(2):202-213.   Published online April 30, 2022
DOI: https://doi.org/10.4040/jkan.21192
AbstractAbstract PDF
Purpose
This study examined characteristics and patterns of interorganizational networks for smoking prevention and cessation in Korea.
Methods
We surveyed two community health centers, ninety-five hospitals or clinics, ninety- two pharmacies, and sixty-five health welfare organizations in two districts of Seoul in 2020. Data on the organizations’ characteristics of smoking cessation and interorganizational activities for information sharing, client referral, and program collaboration were collected and analyzed using network statistics and blockmodeling.
Results
Network size was in the order of information sharing, client referral, and program collaboration networks. Network patterns for interorganizational activities on information sharing, client referral, and program collaboration among four organizations were similar between the two districts. Community health centers provided information and received clients from a majority of the organizations. Their interactions were not unidirectional but mutual with other organizations. Pharmacies were involved in information sharing with health welfare organizations and client referrals to hospitals or clinics. Health welfare organizations were primarily connected with the community health centers for client referrals and program collaboration.
Conclusion
A community health center is the lead agency in interorganizational activities for smoking prevention and cessation. However, hospitals or clinics, pharmacies, and health welfare organizations also participate in interorganizational networks for smoking prevention and cessation with diverse roles. This study would be evidence for developing future interorganizational networks for smoking prevention and cessation.
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Original Articles
Structural Equation Modeling on Smoking Cessation Intention in Male Technical High School Students
Eun Su Do, Eunsuk Choi
J Korean Acad Nurs 2017;47(2):211-221.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.211
AbstractAbstract PDF
Purpose

This study was done to develop and test a structural model on smoking cessation intention in technical high school men. The conceptual model was based on the theory of reasoned action and health promotion model.

Methods

From May 29 to April 13, 2015, 413 technical high school students who smoked completed a structured questionnaire. Data were analyzed to calculate the direct and indirect effects of factors affecting smoking cessation intention. The SPSS WIN 20.0 and AMOS 21.0 programs were used.

Results

The hypothetical model was a good fit for the data. The model fit indices were χ2/df=2.36, GFI=.95, AGFI=.92, NFI=0.97, and RMSEA=.05. Self-esteem had direct and indirect effects on smoking cessation intention. Attitude, subjective norm, and self-efficacy had direct effects on smoking cessation intention. Smoking knowledge and environmental factor had indirect effects on smoking cessation intention. This model explained 87.0% of the variance in smoking cessation intention.

Conclusion

These results indicate that technical high school students' intention to stop smoking can be improved through an increase in self-esteem, negative environmental factors, attitude toward smoking cessation, subjective norm about smoking cessation, and self-efficacy for smoking cessation.

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Effects of a Strength Based I-Change Smoking Cessation Program for Smoking Middle School Boys
Jung Hee Kim, Yeon Hee Choi
J Korean Acad Nurs 2017;47(2):164-177.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.164
AbstractAbstract PDF
Purpose

This study was done to develop a strength based I-change smoking cessation program for middle school boys and identified its effects.

Methods

The study design was a nonequivalent control group pre-post test design. The participants were 97 middle school students from D city, who were in school from April 6 to September 25, 2015. The experimental group participated in the strength based I-change smoking cessation program, while the comparative group participated in a general smoking cessation program. The control group did not participate in any program. Data analyses involved χ2-test, Fishers' exact test, Bonferroni test, and Repeated measures ANOVA, with the IBM SPSS for Windows (version 20.0) program.

Results

Compared to the comparison and control groups, the experimental group showed significant improvement in knowledge, attitude, self-efficacy, behavior change. Also cotinine in urine and modeling of social influence in the experimental group significantly decreased after the strength based I-change smoking cessation program.

Conclusion

These findings indicate that the strength based I-change smoking cessation program is an effective intervention for middle school boys who smoke. The findings suggest that such programs can be used at public health centers or through school health education to decrease smoking in adolescents.

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Exploratory Study on Developing Model for Smoking Cessation Process
Hyun Soo Oh, Young Ran Kim
Journal of Nurses Academic Society 1997;27(1):71-82.   Published online March 30, 2017
DOI: https://doi.org/10.4040/jnas.1997.27.1.71
AbstractAbstract PDF

In this paper, the study model, which presents the patterns of how the changing mechanisms are adopted to the changing stages of smoking cessation, was developed modifying the integrative model of Prochaska et al.(1983) with including seven changing mechanisms which were identified by Oh and Kim(1996). Then the developed study model was exploratively tested with 155 University student between 20 and 29 years of age subjects. According to the study results, among the five mechanisms, which are significant in explaining the differences between stages, DUNCAN post-comparison showed that the least applied ones were Stimulus Control, Self Determinism, Cognitive Restructuring in the precompletion stage, and Reinforcement and Dramatic Relief, in the relapsed stage. In the contemplation stage, it was observed that Dramatic Relief is used most frequently and that the other two mechanisms, Information Management and Cognitive Restructuring, showed different results from those inferred in the study hypothesis. In the case of Information Management, it was excluded from the analysis it was not included in explaining significant difference among changing stages, but Cognitive Reconstruction turns out to be a more frequently used mechanism in the action stage rather than in the contemplation stage. Helping Relationship was also excluded in the post-comparison analysis since it was not included in explaining significant difference among changing stages and Reinforcement was a more frequently used mechanisms in the contemplation stage. Stimulus Control turns out to be the connecting mechanism which was most frequently used in both the contemplation and action stages. Self Determination was most frequently used in the action stage rather than in both the contemplation stage and action stage, differing from the presumption of the model. Lastly, subjects in the relapsed stage were utilizing Stimulus Control and Self Determination at the same level as subjects in the precontemplation stage, and the utilization of both Reinformcement and Dramatic Relief was lower than that of the precontemplation stage, that is at the lowest level. Only Cognitive Restructuring was used of the same level as the contemplation stage. The relapsed stage in this study did not represent the preparation for action stage as presumed in the model of Prochaska et. al.(1983) but did show a pattern similar to the initial stage of smoking cessation, However, since this interpretation about the relapser was based on only a small number of relapsers(n=5), this conclusion may not be reliable.

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Changing Mechanisms Corresponding to The Changing Stages of Smoking Cessation
Hyun Soo Oh, Young Ran Kim
Journal of Nurses Academic Society 1996;26(4):820-832.   Published online March 30, 2017
DOI: https://doi.org/10.4040/jnas.1996.26.4.820
AbstractAbstract PDF

The average smoking rate for Adults' in our country is 40.6%: It is 74.2% for men and 5.0% for women. Particularly, the smoking rate for men is reported higher than that of men in U. S. A. or Japan. Since the first report on the association between smoking and cancer appeared, 370 thousand smokers have succeeded in smoking cessation and over 90% of them have responded that they depended on a self-help smoking cessation approach. Despite this positive evidence about self-help approaches for smoking cessation, most studies on smoking cessation have focused on evaluation of formal treatment programs that are provided by clinics. Reports on the smoking cessation process used by smokers in our country could not be found. However, it is believed that the situation in our country would be quite similar to that in U.S.A. as far as approaches to successful smoking cessation are concerned. This study was conducted to classify the smoking stage to which they smoker belong and which changing mechanisms could be included at each changing stage (precontemplation stage, comtem-plation stage, action stage) with a sample of 155 college students between 20 and 29 years old. And it also identified which variables related both to smoking pattern and to health, which ones were significantly discriminating in the changing stages. From the results of the data analysis it was found that Self-Determination is the most influential variable as one of the changning mechanisms which can discriminate three changing stages. And as the next significant mechanisms were Reinforcement, Dramatic Relief, Cognitive Restructuring, Helping Relationship, and Information Management in that order. Among variables related to the smoking pattern, years of regular smoking, whether smoking is continued or not even when they are sick, the number of attempts to stop smoking, number of cigarettes smoked per day, and whether they have smoked over 100 cigarettes up to now, but not the time of the first cigarette after waking-up, were the significant factors to descriminate changing stages. It was confirmed that among variables related to health that, perceived control for health, confidence of health maintence ability, and self confidence in smoking cessation, were significant variables in determinating changing stages. The most influential variables among them was self-confidence in smoking cessation. Conclusively, it was shown that smoking cessation is the process of attempting to change smoking habits through the various changing processes. Also it can be shown that a few factors smoking habit, self-confidence of smoking cessation, and belief in self control of his/her health, were influential in discriminating the changing stages of the smoking habit.

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Factor Analysis on Behavior Change Mechanisms in Self-help Smoking Cessation
Hyun Soo Oh, Young Ran Kim
Journal of Nurses Academic Society 1996;26(3):678-687.   Published online March 30, 2017
DOI: https://doi.org/10.4040/jnas.1996.26.3.678
AbstractAbstract PDF

Smoking is considered to be one of the important risk factors associated with various health problems. Thirty seven million people in America quit smoking in the past decade, with 90% quitting on their own(Americal Heart Association, 1986). According to McAlister(1975), 70% of smokers reported that they adopted a self-help smoking cessation approach rather than a formal treatment program. In our country, although, auccessful exsmokers have used, are not available, concerns about smoking cessation have increased, recently, due to changes in social and political attitudes to health promotion. This study was conducted to help smokers who had made a decision to adopt a self-helf smoking cessation approach instead of depending on a formal treatment program. It provided a structurd way for sucessful smoking cessation by identifying change mechanism factors which have been commonly used by smokers. The subjects selected for this study were 155 university students between 20 and 29. Years of age the results from the analysis of the collected data showed that seven factors in the self-help change processes significant, and they are named, Stimulus Control, Self-Determination, Information Management, Reinforcement Management, Helpful Relationships, Dramatic Relief and Cognitive Restructuring. All of the factors except Self-Determination represent the same change mechanisms which are proposed by Prochaska et al. (1988). Self-Determination uniformly includes items belonging to various change processes. Therefore, it might be an transitional factor including strategies related to both cognitive and behavioral dimensions. In spite of this, noted that one item which gives meaning of Self-Determination shows the highest factor loading, it is named Self-Determination.

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Development and Test of the Hypothetical Model to Explain Smoking Cessation Behaviors Based on Triandis' Interpersonal Behavior Theory
Hyun Soo Oh
Journal of Korean Academy of Nursing 2002;32(1):16-27.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.1.16
AbstractAbstract PDF

PURPOSE: This study was conducted to develop and test the hypothetical model which explains smoking cessation behavior was established based on the Triandis' interpersonal behavior theory.
METHOD
The data were collected from the 400 university student smokers enrolled in the universities located in Seoul and Kyung-In province. The study was analyzed by path analysis with LIESREL 8 program.
RESULTS
All of the fit statistics, except the Chi-square value, it showed the hypothetical model was well fitted to the data. Benefit, affect, and social influences related to smoking cessation behavior had significant direct effect on intention to smoking cessation as shown in the study of the hypothetical model. Perceived barrier and the physiologic arousal related to smoking cessation had significant direct effects on performing smoking cessation behavior, whereas numbers of previous attempts to quit smoking and intention to smoking cessation did not.

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A study of the Stage of Change and Decisional balance: Exercise Acquisition, Smoking Cessation, Mammography Screening and Kegel's Exercise Acquisition in Korea
Sung Ok Chang, Young Joo Park, Chang Seung Park, Yeo Jin Lim
Journal of Korean Academy of Nursing 2000;30(5):1265-1278.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.5.1265
AbstractAbstract PDF

This study was carried out to assess the perception of decisional balance of Korean subjects about 4 health behaviors and to identify the influencing factor of decisional balance for exercise acquisition, smoking cessation, mammography screening and Kegel's exercise acquisition. All are representative health behaviors nurses can intervene in Korea based on the Transtheoretical model. Convenient samples of 2,484 subjects (191; exercise, 169; smoking cessation, 1903; mammography screening and 221; Kegel's exercise) were selected from cities and counties over 9 provinces throughout Korea, and the data was collected from January 1, 1999 to February 29, 2000. The research instrument were the Decisional Balance Measure for Exercise (Marcus & Owen., 1992), Smoking Cessation (Velicer et al., 1985), Mammography Screening (Rakowski et al.,1992) and Kegel Exercise (Lim, 1999) and Stage of Change Measure for Exercise (Marcus et al, 1992), Smoking Cessation (DiClemente et al., 1991), Mammography Screening (Rakowski et al.,1992) and Kegel's Exercise (Lim, 1999). The data was analyzed by the SAS Program. The results are as follows; 1. According to the stage of change measure, 2,484 subjects were distributed in each stage of change for four health behaviors: 1,233 subjects (49.8%), 745 subjects (30.2%), 113 subjects (4.7%), 156 subjects (6.5%), and 216 (8.7%) belonged to the pre- contemplation stage, contemplation stage, preparation stage, action stage and maintenance stage. They were all series of stages of change in their efforts to do health behavior. 2. Factor analysis identified 3 factors (1 of Pros, 2 of Cons) for the exercise, 4 factors for smoking cessation (2 of Pros, 2 of Cons), 2 factors (1 of Pros, 1 of Cons) for the mammogram screening and 2 factors (1 of Pros, 1 of Cons) for Kegel's exercise of decisional balance. 3. The analysis of variance and multiple comparison analysis showed that for all 4 samples, the Cons of changing the problem behaviors outweighed the Pros for subjects who were in the pre- contemplation stage, The opposite was true for subjects in action and maintenance stage. 4. Through the discriminant analysis, it was found that one factor of Pros for exercise, one factor of Cons for smoking cessation, 1 factor of Cons for mammogram screening and one factor of Cons for Kegel's exercise were the more influencing factors, than others in discriminating the stages of change.
Results
are consistent with the applications of the Transtheoretical model, which have been used to understand how people change health behaviors. This results provide some evidence that subject's report of his/her health behavior corresponds to beliefs about usefulness of related health behaviors. The results of this study have implications for patients' health education and health intervention strategies. The findings of this study give useful information for nursing educators for 4 health behaviors, especially the factors relating to decision making in the different stages of change.

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The Effect of Life Smoking Cessation Program- multidisciplinary approach
Sung Rae Shin, Dong Sup Lee, Jung Hwan Park
Journal of Korean Academy of Nursing 2000;30(1):110-121.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.1.110
AbstractAbstract PDF

This study was designed to develop the life moking cessation program with multidisciplinary approach using the Bandura's theory of self-efficacy and confirm the effect of it on the self-efficacy and smoking amount in college students. For this purpose non-equivalent control group, pretest-posttest design was used. The participating subjects in this study were 46 male college freshmen, 23 in experimental and 23 in control group. The experimental group received the 8 sessions of lecture and small group discussions for 4 weeks and a telephone coaching program for a period of 8 weeks. The control group received 5 sessions of lecture without further treatments. The data was collected from March 15 to June 11, 1999, and analysed by SAS/PC program with X2 test, simple t, paired t test. The results were as follows. 1. The score of self-efficacy was significantly increased over time in the experimental group than those of the control group. 2. The amount of urine cotinine was decreased over time in the experimental group, number of cigarettes smoked a day were significantly decreased, and they were significantly less than those of the control group. In conclusion it was found that the Life Smoking Cessation Program with Multidisciplinary Approach was an effective nursing intervention for increasing self efficacy and reducing the amount of smoking in male college students. Therefore, future smoking cessation programs should always consider the concept of self-efficacy and ways to positively reinforce it.

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The Study of the Process of Smoking Cessation in Adults
Ae Kyoung Kim
Journal of Korean Academy of Nursing 1998;28(2):319-328.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1998.28.2.319
AbstractAbstract PDF

The purpose of this study was to explore the process of smoking cessation behavior in adults with a history of smoking cessation. The subjects were 17 adults selected by theoretical sampling. The data were collected by in-depth interviews using audiotape recording over a period of six months. The data were analyzed simultaneously by a constant comparative method in which new data were continuously coded in categories and properties according to Strauss and Corbin' methodology. Analysis of the data resulted in the identification of 12 categories. The result of this study are as follows : 1. Smoking cessation in adults is caused by fear about health, environmental pressure of smoking cessation, and intention of smoking cessation. 2. Smoking cessation occurs in connection with situations of limited smoking. 3. Maintenance of smoking cessation is related to psychological stress, and environmental cues to smoking. 4. In the smoking cessation process, adults experienced either health promotion or relapse. It is suggested that the result of this study may contributed to the development of a strategy for decreasing smoking behavior among adults.

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Nicotine Dependence, Smoking-related Attitude, and Subjective Norms across the Stages of Change for Smoking Cessation among Adults Smokers in a Rural Area
Young Hee Kim, Nam Sook Seo, Hae Young Kang
Journal of Korean Academy of Nursing 2006;36(6):1023-1032.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2006.36.6.1023
AbstractAbstract PDF
Purpose

The purpose of this study was to identify nicotine dependence, smoking-related attitude, and subjective norms across the stages of change for smoking cessation among adult smokers in a rural area.

Method

The subjects were 276 current smokers (male=243, female=33). There were 3 stages of change for smoking cessation: pre-contemplation, contemplation, and preparation stage. Data was collected by an interview or self-reporting from February 12th to March 5th 2004, and analyzed with frequency, percentage, χ2-test, Fisher's exact probability test, ANOVA, and Scheffe test using the SPSS-PC program.

Result

According to the stages of change, 114(41.3%) current smokers were in pre-contemplation, 110(39.9%) in contemplation, and 52(18.8%) in the preparation stage. There was a higher percentage of males than females (χ2=8.99, p=.011) in the preparation stage. The mean score of the smoking-related attitude (F=7.43, p=.001) and subjective norm(F=27.41, p=.001) were both lowest in the pre-contemplation stage and increased positively during the stages of change for smoking cessation.

Conclusion

Based on these findings, the authors recommend that community-based smoking cessation programs should be developed by considering the intention or motives of current smokers and should be initiated in the preparation stage and primarily for male groups.

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Analysis of Smoking and Smoking Cessation Related Nursing Research in Korea and its Future Direction
Sung Rae Shin
Journal of Korean Academy of Nursing 2006;36(2):415-425.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2006.36.2.415
AbstractAbstract PDF
Purpose

The purpose of this study was to analyze the contents and trend of smoking and smoking cessation related nursing research in Korea and to suggest the directions for future research.

Method

Eight nursing professional Journals published by the Korean Academic Nursing Society and by 7 - adult, community, psychiatric, fundamental, obstetrics, pediatrics, administrative- nursing societies from beginning edition to October 2005 were selected. They were examined for the proportion of published research, participants, research designs, key words, measurement tools, and the intervention outcomes in the case of the experimental research.

Result

Of the research analyzed, 87 studies were smoking and smoking cessation related research. The Journals, which had published the most number of smoking and smoking cessation research were J of Korean Academic Society, J of Korean Adult Nursing Society, J of Korean Community Nursing Society. The most popular research design was an descriptive design. The major concepts studied were related psychosocial variables. Among 87 studies, only 11 were experimental research.

Conclusion

Research on smoking and smoking cessation in the nursing discipline are increasing. However more research to test the effectiveness of nursing intervention programs are needed.

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Effect of an Agreement on Means to Achieve Smoking Cessation Goals among College Student Smokers
In Hee Choi
Journal of Korean Academy of Nursing 2005;35(7):1362-1370.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.7.1362
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the degree of attaining a smoking cessation goal when an agreement on means to achieve smoking cessation among male college student smokers was established.

Method

This study was planned as a nonequivalent control group non-synchronized design and the sample was divided into an agreement group and a comparison group by convenience sampling in a college of G city. The data was analysed with SPSS Win10.0 using a Likelihood χ2-test, Odds ratio, Paired t-test and ANCOVA.

Result

The theory that the degree of smoking cessation will be higher in the agreement group than the Comparison group was rejected (δ = 2.567, p = .055). The theory that nicotine dependency will be lower in the agreement group than the comparison group was supported (F = 3.965, p = .049); however, the theory that the number of cigarettes smoked per day will be lower in the agreement group than the comparison group was rejected (F = 1.342, p = .252).

Conclusion

It has been shown that an agreement on means to achieve smoking cessation goals is a key factor to success in quitting smoking.

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Predictive Factors of Aspects of the Transtheoretical Model on Smoking Cessation in a Rural Community
Ok Hee Ahn, Eunja Yeun, Sung Bok Kwon, Hae Kyung Chung, Eunjung Ryu
Journal of Korean Academy of Nursing 2005;35(7):1285-1294.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.7.1285
AbstractAbstract PDF
Purpose

This study was done to evaluate the predictive value of aspects of the Transtheoretical model (TTM) of behavior change as applied to smoking cessation in a rural population.

Methods

A convenience sample was recruited from a public health center in a community. A total of 484 participants were recruited, including 319 smokers, 116 ex-smokers and 49 non-smokers. A cross-sectional and descriptive design was used in this study. Data was analyzed using descriptive statistics, frequency statistics, ANOVA and Logistic regression.

Results

The major findings were 1) The participants were assessed at baseline for their current Stage of Change resulting in a distribution with 42.1% in Precontemplation, 24.1% in Contemplation, 9.7% in Preparation, 6.2% in Active, and 17.9% in the Maintenance stage. 2) There were statistically significant differences of processes of change, decisional balance and situational temptation across the stages of change. 3) The main factors that affect smoking cessation were age, number of years smoking, age when began smoking, self-liberation and negative/affective situations, which combined explained 33.2% of the smoking cessation.

Conclusion

TTM variables measured prior to a smoking cessation program added little predictive value for cessation outcome beyond that explained by demographic and smoking history variables.

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A Study on Health-related Quality of Life, Smoking Knowledge, Smoking Attitude, and Smoking Cessation Intention in Male Smokers
Myoung Sook Kim
Journal of Korean Academy of Nursing 2005;35(2):344-352.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.2.344
AbstractAbstract PDF
Purpose

This study was conducted to examine the relationship among health-related quality of life, smoking knowledge, smoking attitude, and smoking cessation intention in male smokers.

Method

The subjects were 259 male smokers in J city. The data was collected using structured questionnaires from Nov. to Dec. of 2003. The data was analyzed by the SPSS (ver.10.0)computer program, and it included descriptive statistics, t-test, ANOVA, the Pearson correlation coefficient, and Stepwise Multiple Regression.

Result

The smoking cessation intention had a significant positive correlation among health-related quality of life (r=.159), smoking knowledge (r=.161), and smoking attitude (r=.127). These variables account for 26.8% of smoking cessation intention.

Conclusion

These results suggested that the smoking cessation program to enhance the health-related quality of life, smoking knowledge, and smoking cessation intention and to increase a negative influence on smoking attitude need to be developed. Therefore, these findings give useful information for constructing a smoking cessation program in male smokers.

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Prospective Study on the Relating Factors to the Stages of Change in Smoking Cessation and Barriers in Coronary Artery Disease Patients
Hwa Soon Kim
Journal of Korean Academy of Nursing 2005;35(1):27-36.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.1.27
AbstractAbstract PDF
Purpose

The main purpose of this study was to investigate that the stages of change in smoking cessation behavior among coronary artery disease patients for six months progressed following the stages of change suggested by the transtheoretical model.

Method

Subjects for this descriptive survey were 59 coronary disease patients who were smoking or who had stopped smoking for less than six months.

Result

In the baseline, the distribution of the subjects' stages of change was as follows: pre-contemplation stage 25.4%, contemplation stage 25.4%, preparation stage 22%, and action stage 27.1%. After six months, more subjects in the contemplation(33.3%) and preparation stages(30.8%) progressed to the action stage than those of the pre-contemplation stage(0%). Eighty-one percent of the subjects in the action stage at baseline progressed to the maintenance stage. The relationship between the numbers of smoking cessation attempts for six months and stages of change at baseline was significant(p=.001). However, the relationships between self-efficacy and nicotine dependence at baseline and progression in stages of change after six months were not significant.

Conclusion

Progression in the stages of change for six months among subjects corresponded to the stages of change suggested by the transtheoretical model. Hence, future development and evaluation of intervention programs should be tailored individually considering each patient's stage of change.

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Effectiveness of a Smoking Cessation Program for Adolescents
Soyaja Kim, Kyoung Ah Nam, Mia Seo, Hyun Hwa Lee
Journal of Korean Academy of Nursing 2004;34(4):646-654.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.4.646
AbstractAbstract
Purpose

The purpose of this study was to test the effectiveness of a comprehensive smoking cessation program for Korean adolescents.

Method

The study design was quasi-experimental with one pre and three post-tests. The three posttests were done immediately after, three months later, and six months after the completion of the program. A total of 43 high school students who smoked participated in the study with 22 in the experimental group and 21 in the control group. The smoking cessation program consisted of 9 sessions with content on enhancement of self-efficacy, stress management, correction of distorted thoughts, consciousness raising, and assertiveness training. The study variables were urine cotinine levels, self-efficacy, stress, and stages of changed behavior.

Results

Urine cotinine levels significantly decreased in the experimental group after the program (F=3.02, p=.06) but significantly increased in the control group (F=6.32, p=.004). Self-efficacy and the degree of stress did not change in either group. The stages of smoking cessation behavior tended to change when compared with raw data for the experimental group. For most participants, the stages of change had been precontemplation and contemplation, but changed to action and maintenance stage among the experimental group.

Conclusion

The program was effective in smoking cessation and influencing stages of change but did not change psychosocial factors such as self-efficacy and stress. It is suggested a program should be developed to change psychosocial variables on a long-term basis. It is also desirable to involve peers and families of adolescents who smoke when planning programs to enhance social support.

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Decisional Balances and the Process of Change in Smoking Cessation in Patients with Coronary Artery Diseases
Haeng Mi Son
Journal of Korean Academy of Nursing 2003;33(8):1171-1177.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2003.33.8.1171
AbstractAbstract PDF
Purpose

Despite many smoking cessation programs, many patients with CAD continue to smoke or re-smoke. The processes of change and self-change for smoking cessation is emphasized. The purpose of present study was to investigate decisional balances and processes of change according to stages of change for smoking cessation in the patients with CAD.

Methods

This descriptive study was performed using the self-reported questionnaires from 157 male patients with CAD who have smoking experiences. The questionnaires consisted of decisional balances toward smoking (pros/cons) and processes of change including 7 factors.

Results

45.2% of the subjects had myocardial infarction and 54.8% for angina pectoris. Major stages of change were maintenance, contemplation, and precontemplation in 62%, 14%, and 18% respectively. The mean score of pros smoking was 31.07 and cons smoking was 32.52. The mean scores of processes of change were high in all 7 factors, especially in self determination. The pros smoking in precontemplation stage was significantly higher than those in other stages. Between contemplation and precontemplation stages, processes of change showed significant differences in stimulus control, self determination, information management, and dramatic relief.

Conclusion

This study suggests that decisional balances and processes of change are stage-specific. As this study, smoking cessation program in the patients with CAD must put priority on the patients group in precontemplation and contemplation stages, and stress self determination and dramatic relief.

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Factors Associated with the Stage of Change of Smoking Cessation Behavior in Adolescents
Nam Hee Park, Jung Soon Kim, Yun Mi Lee
Journal of Korean Academy of Nursing 2003;33(8):1101-1110.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2003.33.8.1101
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the stage of change of smoking cessation behavior and investigate factors associated with the stage of smoking cessation behavior according to the transtheoretical model.

Methods

The participants, 297 smokers & quitters were selected by a stratified random sampling from 127 high school sophomore students in B city. Data were collected from April 6th to 16th, in 2002 using the structured self-report questionnaire.

Results

The subjects were distributed in each stage of change of smoking cessation behavior: there were 46 subjects (15.5%) in precontemplation, 73 subjects (24.6%) in contemplation, 67 subjects(22.3%) in preparation, 56 subjects (18.5%) in action, 55 subjects (18.5%) in maintenance. Compared to the precontemplation and contemplation, people in preparation tended to smoke daily more and smoked for a shorter time, and as precontemplation progressed to the maintenance, past 1 year smoking cessation frequency increased and friends smoking decreased. Smoking onset age was the earliest in preparation, and the latest in maintenance. Helping relationships and self relationships are used a lot in precontemplation and also in contemplation. In preparation, self liberation and helping relationships are used a lot, in action, self liberation and helping relationships, and in maintenance, self liberation and environmental reevaluation. At each stage, the score of negative affect situation was the highest, but the one of negative affect situation, positive social situation, habitual strength, weight control decreased as precontemplation progressed to the maintenance. While the score of social pros and coping pros decreased with increasing stage, the one of cons tended to increase. Through stepwise discriminant analysis, it was found that social pros, smoking onset age, delf-libration were the most influencing powers among factors associated with the stages of smoking cessation behavior.

Conclusions

This study suggested that, in developing an effective smoking cessation intervention for adolescents, all the stage of a client's cessation had to be assessed prior to applying intervention programs. In addition, the results of this study will become a pillar of smoking cessation program planning and application.

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Tobacco-Related Education in Graduate, Baccalaureate and Associate Degree Programs in Korea
Sung Rae Shin, Sarna Linda, Danao Leda
Journal of Korean Academy of Nursing 2003;33(2):256-264.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2003.33.2.256
AbstractAbstract PDF
Purpose

The purpose of this research was to find out tobacco control education taught graduate, baccalaureate and associate degree-nursing programs in Korea.

Method

A valid and reliable questionnaire previously used to assess tobacco use in medical and nursing schools in the United States was translated and revalidated. Surveys were sent out to all the graduate, baccalaureate and associate nursing programs in Korea. All 6-tobacco curricula content areas recommended by the United States National Cancer Institute and the Agency for Health Care Policy and Research was included.

Result

Majority of BSN (93.2%-75%) and AD (92.3%-64.1%) programs were teaching health hazards, cancer risk, health effects of tobacco, effects of ETS, contents of cigarette, withdrawal symptoms and high risk groups of smoking as a part of required courses. However, 87.5% (14/16) of graduate, 50.0% (22/44) in baccalaureate, 53.8% (21/39) in associate degree programs were not teaching about the 5 A's. Of those who reported teaching smoking cessation strategies, they were covered most frequently in Community Nursing (50%), Adult Health Nursing (43.8%) on the graduate level, and in Community Nursing (65.9%-BSN, 76.9%-AD) and Adult Health (54.5%-BSN, 74.4%-AD) on the undergraduate level. 31.1% (5/16) in Graduate, 18.2%(8/44) in BSN, 10.3% (4/39) in Associate Degree programs reported that there are no smoking students in their schools and rest of the schools reported either do not know or they have 1 to more than 21% of students smoking.

Conclusion

The study results identifies the quantity and level of tobacco control content in three different nursing programs and will help in developing curricular guidelines in the future. Further survey needs to be done on nursing students' knowledge, attitude and belief on smoking and smoking cessation.

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Timely Interventions can Increase Smoking Cessation Rate in Men with Ischemic Stroke
Min Jeong Lee, Eunjeong Park, Hyeon Chang Kim, Hye Sun Lee, Myoung-Jin Cha, Young Dae Kim, Ji Hoe Heo, Hyo Suk Nam
J Korean Acad Nurs 2016;46(4):610-617.   Published online August 31, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.4.610
AbstractAbstract PDF
Purpose

Smoking cessation is strongly recommended for every smoker after ischemic stroke, but many patients fail to quit smoking. An improved smoking cessation rate has been reported with intensive behavioral therapy during hospitalization and supportive contact after discharge. The aim of this study was to demonstrate the usefulness of the timely interventions for smoking cessation in men with acute ischemic stroke.

Methods

Patients who participated in the timely interventions strategy (TI group) were compared with those who received conventional counseling (CC group). In the TI group, a certified nurse provided comprehensive education during admission and additional counseling after discharge. Outcome was measured by point smoking success rate and sustained smoking cessation rate for 12 months.

Results

Participants, 157 men (86 of the TI group and 71 of the CC group), were enrolled. Mean age was 58.25 ± 11.23 years and mean initial National Institutes of Health Stroke Scale score was 4.68 ± 5.46. The TI group showed a higher point smoking success rate compared with the CC group (p= .003). Multiple logistic regression analysis showed that the TI group was 2.96-fold (95% CI, 1.43~6.13) more likely to sustain smoking cessation for 12 months than the CC group.

Conclusion

Findings indicate that multiple interventions initiated during hospital stay and regular follow-up after discharge are more effective than conventional smoking cessation counseling in men with acute ischemic stroke.

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Effectiveness of the Self-determination Theory based a Motivational Interviewing YOU-TURN Program for Smoking Cessation among Adolescents
Young Sun Ha, Yeon Hee Choi
J Korean Acad Nurs 2015;45(3):347-356.   Published online June 30, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.3.347
AbstractAbstract PDF
Purpose

In this study, the effectiveness of a motivational interviewing smoking cessation YOU-TURN program for adolescents was examined. The program was based on the self-determination theory.

Methods

The study was carried out with a nonequivalent control group pretest-posttest design. Participants in the present study were 136 high school students living in D city. The students were assigned to the experimental group (n=52) who participated in the motivational interviewing smoking cessation YOU-TURN program based on self-determination theory, or to the control group (n=84) who participated in a general smoking cessation program. Data were collected from September 1, 2013 through April 30, 2014. Collected data were analyzed using SPSS PC+ 21.0 with Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test, Repeated Measures ANOVA, and MANOVA-Wilk's Lambda.

Results

The experimental group had a significant increase in basic psychological needs, and duration of quitting-smoking in comparison with the control group. The experimental group had a significant decrease in cigarettes smoked per day and cotinine in urine in comparison with the control group.

Conclusion

The motivational interviewing YOU-TURN program, when delivered to adolescents who smoked, was effective in discouraging smoking, and can be utilized as an effective nursing intervention for adolescents who smoke.

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Effects of a Smoking Cessation Program including Telephone Counseling and Text Messaging using Stages of Change for Outpatients after a Myocardial Infarction
Jung-Hyeon Kong, Yeongmi Ha
J Korean Acad Nurs 2013;43(4):557-567.   Published online August 30, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.4.557
AbstractAbstract PDF
Purpose

This study was done to identify effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients who have had a myocardial infarction (MI).

Methods

This research was a quasi-experimental design with a nonequivalent control group pretest-posttest. The participants were 48 outpatients (experimental group=24, control group=24) recruited from one university hospital. They were randomly assigned to one of two groups: (a) an experimental group with telephone counseling (once a week) and text messaging (five times a week) using stages of change, and (b) a control group with traditional telephone counseling (once a month). Efficacy of the intervention was measured by comparing the two groups on smoking-related variables at 3 weeks and 12 weeks.

Results

At the 3-week and 12-week measurements, there were significant differences between the experimental and control groups on smoking cessation self-efficacy (p<.001), nicotine dependence (p<.001), CO levels (p<.001), and smoking cessation rates (p<.001).

Conclusion

The results indicate that the smoking cessation program including telephone counseling and text messaging using stages of change is effective for outpatients after a MI. Further attention should be paid to the intensity of the smoking cessation program and periods for long-term follow-up.

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Factors Affecting Preparation Stage to Quit Smoking in Men
Jeong-Woon Yeon, Hyeongsu Kim, Kunsei Lee, Sounghoon Chang, Heejung Choi, Eunmi Ham, Jun Pyo Myong
J Korean Acad Nurs 2012;42(3):377-384.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.377
AbstractAbstract PDF
Purpose

This study was done to investigate factors affecting preparation stage to quit smoking in men.

Methods

Based on data from the Community Health Survey conducted in Chungbuk Province in 2008, we estimated rates and odds ratio (OR) of smoking cessation intention for 2,639 men who were current smokers. Multivariate logistic regression analyses were used to identify factors affecting preparation stage to quit smoking.

Results

Among current male smokers, the rate of smoking cessation intention was 17.1%. The OR of factors affecting smoking cessation was as follows: Compared to men with middle school education, the OR for rate of smoking cessation intention in men with high school education was 1.47 (p=.018), and for college or higher, 1.55 (p=.017). Compared to being single, the OR for cohabitation after marriage was 1.61 (p=.011) and living alone after marriage, 2.23 (p=.005). The OR for attempt to quit smoking, exposure to secondhand smoke and participation in smoking education were 6.80 (p<.001), 1.32 (p=.020) and 1.69 (p=.005), respectively.

Conclusion

Results of this study show that it is necessary to decrease exposure to secondhand smoke and to increase participation in smoking cessation education targeting current smokers to move them from precontemplation or contemplation stage to preparation stage.

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Effects of a Smoking Cessation Education on Smoking Cessation, Endothelial Function, and Serum Carboxyhemoglobin in Male Patients with Variant Angina
Sook-Hee Cho
J Korean Acad Nurs 2012;42(2):190-198.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.190
AbstractAbstract PDF
Purpose

The aim of this study was to evaluate the effects of a smoking cessation education on endothelial function and carboxyhemoglobin levels in smokers with variant angina.

Methods

A nonequivalent control group pretest-posttest design was used. Participants were 60 male smokers with variant angina admitted to one hospital: the control group (30) between September and December, 2009, and the experimental group (30) between February and May, 2010. Endothelial function, as defined by flow-mediated vasodilation (FMD) of the brachial artery, and serum carboxyhemoglobin (COHb) were determined at baseline and at 3 months after the initiation of education in both groups.

Results

Three months after the program, smoking cessation was successful in 22 of the 30 smokers in the experimental group, but only in 4 of 30 smokers in the control group (p<.001). After the education, the experimental group showed a significant increase in FMD, and a significant decreased in serum COHb compared with the control group.

Conclusion

The findings indicate that this smoking cessation education program is effective for hospitalized smokers with variant angina.

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Effectiveness of a Motivational Interviewing Smoking Cessation Program on Cessation Change in Adolescents
Young Sun Ha, Yeon Hee Choi
J Korean Acad Nurs 2012;42(1):19-27.   Published online February 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.1.19
AbstractAbstract PDF
Purpose

This study examined the effectiveness of an Adolescent Motivational Interviewing Cessation program on smoking cessation change. The study was done with a nonequivalent control group pretest-posttest design.

Methods

The participants were 39 high school students from G city, who were in school from September 1 to October 30, 2009. The students were assigned to the experimental group (20) and participated in the motivational interviewing cessation program or to the control group (19) who did not participate. Data analyses involved χ2-test, independent t-test, Repeated Measures ANOVA, and utilized the SPSS program.

Results

The experimental group had significantly less daily smoking, nicotine dependence and smoking temptation in comparison to the control group. The experimental group had significantly higher stage of change in comparison to the control group.

Conclusion

The results of the study indicate that a motivational interviewing cessation program delivered to adolescents who smoke is an effective method of encouraging cessation, and can be utilized as an effective nursing intervention for adolescents who smoke.

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Effectiveness of Public Health Center Smoking Cessation Counseling Program using the Transtheoretical Model
Yun Hee Kim, Jung Soon Kim, Myoung Soo Kim
J Korean Acad Nurs 2009;39(4):469-479.   Published online August 31, 2009
DOI: https://doi.org/10.4040/jkan.2009.39.4.469
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the effectiveness of public health center smoking cessation counseling program using the transtheoretical model on the process of change, smoking temptation, decisional balance and stage change transition.

Methods

A nonequivalent control group non-synchronized design was used for this study. The study population was 115 adult smokers. The counseling program was administered to the experimental group and a smoking cessation program from the Korean Ministry of Health & Welfare was administered to the control group. Descriptive analysis, χ2-test, t-test, and ANCOVA were used with the SPSS 12.0 program to analyze the data.

Results

After treatment with this program, the experimental group showed significantly higher scores for process of change (t=4.148, p<.001), smoking temptation (t=-2.988, p=.003), and stage change transition (χ2=5.871, p=.031) compared to the control group. Experimental group members also showed significantly lower score for Pros of smoking (t=-3.151, p=.002).

Conclusion

The findings indicate that this program could have positive effect on process of change, smoking temptation, decisional balance and stage transition for adult smokers. Based on these findings, the authors suggest additional counseling program focusing on smokers in specific stages.

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Stages of Change in Smoking Cessation and Factors Related to Re-smoking after Coronary Artery Bypass Graft Surgery
Seung Hee Choi, Kyung Ja Song, Smi Choi-Kwon
Journal of Korean Academy of Nursing 2007;37(7):1159-1165.   Published online December 31, 2007
DOI: https://doi.org/10.4040/jkan.2007.37.7.1159
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate the stages of change in smoking cessation after a Coronary Artery Bypass Graft(CABG) and to identify the related factors.

Methods

The subjects (n=157) were patients who underwent a CABG in a university hospital from March 1998 to October 2005 and were smokers before the CABG. Data was collected viachart review and a telephone interview, and analyzed with descriptive statistics, χ2 test, one-way ANOVA, and Kruskal-Wallis procedure by the SPSS/PC win 12.0 program.

Results

The subjects smoked for an average of 34 years (21 cigarettes per day) before surgery. Eleven percent of the subjects were in pre-contemplation, 6.4% in contemplation, 13.5% in preparation, 4.5% in action, and 64.5% in the maintenance stage. Nicotine dependence and selfefficacy were different among the groups with different stages of change in smoking cessation. Nicotine dependence was the lowest (p=0.00) and self-efficacy was the highest (p=0.00) in the maintenance stage. The number of subjects in pre-contemplation and contemplation significantly increased 6 years after surgery(p=0.05).

Conclusions

To implement effective smoking cessation interventions for CABG patients, the intervention should be developed to accommodate individual readiness for smoking cessation, especially so for those who had a CABG more than 6 years previously.

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The Effects of a Group Smoking Cessation Program among Adult Smokers in a Rural Community
Nam Sook Seo, Young Hee Kim, Hae Young Kang
Journal of Korean Academy of Nursing 2007;37(7):1139-1148.   Published online December 31, 2007
DOI: https://doi.org/10.4040/jkan.2007.37.7.1139
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate the effects of a community-based group smoking cessation program among adult smokers in a rural community.

Method

The study design was quasi-experimental with a pre and posttest. A total of 55 adult smokers participated in the study. They were evaluated 1, 3, and 6 months after the program to identify the long-term effectiveness of the program. The program consisted of a total of 5 sessions provided twice a week. To test the effectiveness of the program, urine creatinine, expired air carbon monoxide, nicotine dependence, and smoking-related knowledge were used as dependent variables. Data was analyzed with the SPSS 10.0 program with a t-test, paired t-test, and Scheffe test.

Result

Urine creatinine, expired air carbon monoxide, and nicotine dependence were significantly decreased after the program. Also, the rates of continuous abstinence were 81.8% at posttest, 65.5% at 1 month, 54.5% at 3 months, and 54.5% at 6 months follow-up.

Conclusion

This community-based group smoking cessation program implemented by a nurse and smoking cessation counselors was effective for quitting smoking and decreasing urine creatinine and nicotine dependence. Therefore, this smoking cessation program could be recommended to induce smoking cessation as health promotion management in the rural community.

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Effects of a Smoking Cessation Program on Amount of Smoking and Nicotine Dependence and Self-efficacy of Smoking Cessation for Smoking Workers
Mi Kyung Park, Kyung Sook Kang, Nam Young Kim
Journal of Korean Academy of Nursing 2007;37(7):1073-1079.   Published online December 31, 2007
DOI: https://doi.org/10.4040/jkan.2007.37.7.1073
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the effects of a smoking cessation program on the amount of smoking and nicotine dependence and the self-efficacy of smoking cessation for smoking workers.

Methods

The total number of subjects was 38 smokers and was divided into two: 16 smokers were placed in the experimental group and 22 in the control group. A nonequivalent control group pretestposttest design was used. The smoking cessation program consisted of two sessions and was implemented for two hours daily for five days. Data was analyzed by using the SPSS/WIN 11.0 program with χ2-test, t-test or Mann-Whitney U and ANCOVA.

Results

After the treatment, those belonging to the experimental group showed a significantly decreased amount of smoking, a decreased nicotine dependency and increased self-efficacy compared to the control group.

Conclusion

The smoking cessation program was effective for diminishing the amount of smoking, decreasing nicotine dependence and improving self-efficacy. Therefore, this program is recommended as a smoking cessation strategy for adult smokers.

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