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Alcohol consumption, cigarette smoking, and subjective health in Korean elderly men
Addictive Behaviors 29 (2004) 1595 – 1603
Alcohol consumption, cigarette smoking, and subjective health in Korean elderly men Oksoo Kima,*, Sunghee Baikb a
College of Nursing Science, Ewha Womans University, Sudaemoon-gu Daehyun dong 11-1, 120750 Seoul, South Korea b Department of Nursing, Suwon Women’s College, Suwon, South Korea
Abstract The purpose of the study was to investigate the level of alcohol drinking, cigarette smoking, and subjective health in elderly Korean men and to examine the relationships among those variables. The data were collected through the questionnaire that includes general characteristics, the quantity – frequency (Q – F) method, and the Fagerstrom Tolerance Questionnaire (FTQ) scale. The prevalence of alcohol consumption was 65.2%, and 28.7% represented heavier drinkers. The prevalence of smoking was 47.0%. Among the smokers, 17.1% elderly men reported nicotine dependence in the medium range. Forty-six percent of subjects reported their health as poor or fair. In conclusion, alcohol drinking and smoking were prevalent among Korean elderly men. These findings show the need to improve strategies for educating elderly men and motivating them to incorporate healthy behaviors. D 2004 Elsevier Ltd. All rights reserved. Keywords: Alcohol drinking; Smoking; Health; Aged; Nicotine dependence
1. Introduction Approximately 7.3% of the Korean population was 65 years of age or more in 2000 (National Statistical Office, 2001). Because the population of the elderly has been increasing rapidly, health promotion of the elderly population has become one of the most important issues in Korea. Alcohol and nicotine are the major substances used by the * Corresponding author. Tel.: +82-32773703; fax: +82-32772850. E-mail address: [email protected] (O. Kim). 0306-4603/$ – see front matter D 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2004.02.037
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elderly in Korea. The Koreans’ attitude toward alcohol drinking and smoking among the elderly are very permissive; therefore, the elderly’ health can be impaired. However, there is lack of research in health risk behaviors, such as alcohol drinking and smoking, among the elderly. The previous studies showed that use of alcohol and tobacco was associated with a wide range of problems including physiological, mental, and social problems in the elderly (Abramson, Berger, Krumholz, & Vaccarino, 2001; Holroyd & Duryee, 1997). Alcohol consumption in the elderly can cause liver diseases, dementia, and insomnia and increases the risk of falls and other accidents (Lee, 2000). Ondus, Hujer, Mann, and Mion (2003) reported that estimates of alcohol abuse in the elderly population range from 4% to 20% in the community-dwelling elderly and up to approximately 25% among hospitalized older adults. In the elderly, smoking has also been associated with a general decline in physical functioning as a result of the increased incidence of chronic illnesses and cancer (Guilmette, Motta, Shadel, Mukand, & Niaura, 2001; Itoh et al., 2001). Burns (2000) reported the dramatic increase in smoking-related excess mortality with advancing age. A greatly elevated risk of developing lung cancer was associated with cigarette smoking, increasing with packs of cigarettes smoked and declining with the duration of time since quitting smoking (Risch et al., 1993). Most of the previous studies measuring smoking and drinking behaviors included young people (Camatta & Nagoshi, 1995; McCarthy et al., 1995; Miller et al., 1994). Unhealthy behaviors were prevalent among the elderly population, and smoking and drinking were more serious among men. The proportion of smokers among men is greater than in women in Korea. The Organization for Economic Cooperation and Development (OECD) stated that the smoking rate among Korean men was ranked first in the world in 1998, whereas women’s smoking rate is ranked 69th. In addition, alcohol abuse occurs more frequently among men. In general, men are heavier and more problematic drinkers than are the women in Korea. It has been reported that Korean people drink alcohol and smoke more cigarettes than do the people who live in other countries (OECD Health data, 2000). The mortality rate of middle-aged Korean men who are in their 40s is approximately three times higher than that of middle-aged Korean women who are in their 40s (National Statistical Office, 2002). Alcohol drinking and cigarette smoking is one of the most influential factors on mortality rate, and it could be extended to the older adulthood. However, few studies have focused on the alcohol drinking and cigarette smoking in Korean elderly men. Self-reported subjective health appears to be very important in predicting subsequent mortality in the elderly. Self-rated health seems to be a better predictor of mortality in elderly men than in women (Helmer, Barberger-Gateau, Letenneur, & Dartigues, 1999). In this study, it was assumed that subjective health is associated with alcohol drinking and cigarette smoking in Korean elderly men.
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The purpose of the study was to investigate the level of alcohol consumption, cigarette smoking, and subjective health in elderly Korean men and to examine the relationships among those variables.
2. Method 2.1. Participants and procedure The sample for this study was a convenience sample of 164 Korean elderly men living in the community in Seoul, Korea. The sample was derived from a larger study designed to examine health risk behaviors in elderly Korean. Data were collected from May to July 2001. The interviewers read the questionnaires to the participants because many could not read the questionnaire due to the vision problem. The participants were assured of anonymity and confidentiality. The mean age of the sample was 69.96 years, with a range of 60–89 years (Table 1). Seventy-six percent of the participants currently had spouses and 45.7% lived with their spouses. Thirteen
Table 1 Demographic characteristics (N = 164) Characteristics Age (years) 60 – 69 70 – 79 80 over Spouse Yes No Religion Protestant Catholic Buddhism Other None Educational level Less than high school High school graduate College graduate Living arrangement Living alone With spouse With adult children With spouse and adult children With others
n (%) 68 (41.5) 63 (38.4) 33 (20.1) 125 (76.2) 39 (23.8) 39 (23.8) 11 (6.7) 37 (22.5) 9 (5.5) 68 (41.5) 108 (65.9) 35 (21.3) 21 (12.8) 22 (13.4) 75 (45.7) 42 (25.7) 23 (14.0) 2 (1.2)
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percent of the participants lived alone. Fifty-nine percent of the participants had religion. 2.2. Measures Data were collected using the questionnaire including background characteristics, quantity–frequency (Q–F) typology, Fagerstrom Tolerance Questionnaire (FTQ) scale, and short form health survey. 2.2.1. Alcohol drinking The average number of alcoholic beverages consumed each week during the previous month was assessed. A drink can be a glass of wine, a can of beer, or a shot of distilled spirit (Frank, Jacobson, & Tuer, 1990). A drink of beer contains approximately the same amount of alcohol as a drink of wine or spirit. 2.2.2. Q–F typology A standard Q–F typology was utilized in this study. Q–F measures query the participants on both drinking frequency and average quantity consumed per occasion, thereby providing a measure of the total alcohol amount consumed. Generally, the quantity question asks for the typical number of drinks consumed per occasion, providing the participants with some definition of a drink. Alcohol consumption categories defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) categories was used: moderate (an individual who had consumed between 1 and 60 alcoholic drinks within the 30 days prior to being surveyed) and heavier drinker (61 or more alcoholic drinks; Heffernan, 1998). 2.2.3. Cigarette smoking The weekly average number of cigarettes within the past month was measured. 2.2.4. Nicotine dependence (FTQ) The FTQ has a scoring range of 0–11 points, with a score of 0 assumed indicative of minimum nicotine dependence. Participants who score 7 or more probably suffer from a physical addiction to nicotine and can expect severe withdrawal symptoms. The scores were divided into low (0–4 scores), medium (5–7 scores), and high (8–11 scores) ranges (Fagerstrom & Schneider, 1989). 2.2.5. Subjective health Subjective physical health was measured by the single-item short form health survey adapted from the Medical Outcomes Study (MOS) instrument (Stewart, Hays, & Ware, 1988). The participants were asked how they would rate their health at the present time and scored on a five-point scale: poor (1), fair (2), good (3), very good (4), or excellent (5). As very few
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Table 2 Alcohol drinking and cigarette smoking (N = 164) Variables Alcohol drinking Moderate (1 – 60) Heavier (61 or more) Abstainer Cigarette smoking Low (0 – 4) Medium (5 – 7) High (8 – 11) None
n (%)
Minimum
Maximum
M
S.D.
0.25
207.0
21.93
28.95
7.0
280.0
97.09
56.51
60 (36.5) 47 (28.7) 57 (34.8) 48 (29.3) 28 (17.1) 1 (0.6) 87 (53.0)
participants answered that their health was excellent (n = 3), the two levels, ‘‘excellent’’ and ‘‘very good’’, were combined. 2.3. Analysis The data were analyzed using SPSS 10.0 version (SPSS, 1999). A significance level of .05 was maintained.
3. Results 3.1. Alcohol drinking As shown in Table 2, 57 out of the 164 participants (34.8%) were abstainers, and 65.2% of the participants drank alcohol, with a mean of 21.9 drinks per week during the last month. Among the current drinkers, 36.5% were moderate drinkers and 28.7% were heavier drinkers, as defined by NIAAA categories. 3.2. Cigarette smoking As shown in Table 2, 47.0% of the participants smoked, with a mean of 97.09 cigarettes, approximately five packs per week. Table 3 Subjective health (N = 164) Category
n (%)
Excellent Very good Good Fair Poor
3 (1.8) 25 (15.2) 60 (36.6) 43 (26.3) 33 (20.1)
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Table 4 Relationship between subjective health, alcohol drinking, and smoking and FTQ (N = 164)
Subjective health Excellent/very good Good Fair Poor
Alcohol drinking
Smoking
M
M
P value .39
31.83 20.49 17.71 20.58
FTQ P value
M
.45 115.82 86.48 96.16 105.88
P value .12
1.27 1.26 1.58 1.44
FTQ = Fagerstrom Tolerance Questionnaire.
According to the FTQ, which assesses nicotine dependence, 17.1% of the current smokers reported nicotine dependence in the medium range (scores 5–7), and 29.3% of the smokers was found in low nicotine dependence (Table 2). 3.3. Subjective health status Three (1.8%) participants reported their health as excellent and 15.2% very good, 36.6% good, 26.3% fair, and 20.1% poor (Table 3). 3.4. Relationship between subjective health and alcohol drinking and cigarette smoking In Table 4, subjective health was not associated with alcohol drinking, cigarette smoking, and FTQ.
4. Discussion The purpose of the study was to investigate the alcohol drinking, cigarette smoking, and subjective health in elderly Korean men and to examine the relationships among those variables. This study reminds us of the alcohol drinking issues among Korean elderly men because it reflects the higher rate of heavy drinking, as 65.2% of the participants drank alcohol, of which 32.9% were considered to be heavy drinkers. Moore et al. (2001) reported that 40% of older adults drank, and 11% were at-risk drinkers. Moore, Endo, and Carter (2003) conducted a study with American older adults aged 60 and over as participants, of which 22% were at-risk drinkers, drinking 14 or more drinks weekly. In this study, the Korean elderly men drank alcohol, with a mean of 22 drinks per week, whereas Byun (2001) reported that Korean male college students drank with a mean of 12.43 drinks. Compared with the other study results, Korean elderly men indicate their high level of drinking, and this is because the Korean culture is lenient upon the elderly drinking, and even more lenient upon men. In contrast to the youths or middle-aged men, the elderly
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men usually drink at home, thus, this may not become a social issue or be explicated. Nonetheless, as this study shows, half of the drinkers were heavy drinkers, and that brings up the issues of health problems threatening the elderly men with excessive alcohol influence. Therefore, health professionals in charge of the elderly health need to study and apply a method to control or prevent alcohol drinking. The communities should decrease the drinking rate by attempting group education for the elderly. The elderly drinking is related to liver disease or malnutrition, requiring a further study, accordingly. In this study, the prevalence of cigarette smoking was 47.0%. The participants smoked cigarette with a mean of five packs per week during the last month. In the nicotine dependency, 29.3% were low dependents and 17.1% were medium dependents. Zhou et al. (2003) reported that 25.2% of Chinese elderly over the age of 60 were current smokers. The prevalence of current smoking among American older adults aged 65 and over declined from 1965 to 1994 (17.9% to 12.0%; Husten et al., 1997). Compared with these results, the smoking rate of the Korean elderly men are relatively high. For a long time, stomach cancer was ranked first for death by cancer in Korea. However, lung cancer had replaced stomach cancer as the Number 1 killer in 2001. Because it is relevant to cigarette smoking, an interest in quitting smoking has been on the increase. According to Sunyer, Lamarca, and Alonso (1998), quitting smoking after the age of 65 years reduced the relative risk of dying to 0.77 time in comparison with continuing to smoke. In Korea, nonsmoking campaign has predominantly operated around adolescents. According to Husten et al. (1997), the prevalence of smoking cessation among older adults rose with educational attainment, and was consistently higher for men than for women. From now on, the nonsmoking campaign would have to actively approach the elderly, too. The participants reported that 26.3% are in fair and 20.1% in poor health. Although this study reflected that the subjective health of these elderly men is not good, it was not related to the drinking or smoking. The reason why the participants consider the drinking and smoking irrelevant to their health is because they are unable to quit drinking or smoking due to such long period of habitual life styles. Considering the elders’ chronic illnesses and physiological changes in aging, the smoking and drinking effects on their health would be greater than of young adults. To maintain the health of elderly and to decrease the financial loss due to the medical bills, a study for the factors and results of drinking and smoking effects upon elders must be actively conducted. In comparison with other study results, alcohol drinking and smoking rates of the participants were higher than others. Among the drinkers, the rate of heavy drinkers was high, and it is necessary to provide education for controlling or quitting drinking. In this study, it was found that the participants did not reduce their drinking and smoking when they evaluated that they are not in good health, with a result that they were not any different from the ones who considered themselves healthy. Therefore, it is necessary to have an approach on the control of drinking and smoking from the young and middle-aged adults, along with the future studies for drinking and smoking of the elderly.
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References Abramson, J., Berger, A., Krumholz, H. M., & Vaccarino, V. (2001). Depression and risk of heart failure among older persons with isolated systolic hypertension. Arch International Medicine, 161(14), 1725 – 1730. Burns, D. M. (2000). Cigarette smoking among the elderly: Disease consequences and the benefits of cessation. American Journal of Health Promotion, 14(6), 357 – 361. Byun, Y. S. (2001). The effects of personality on drinking patterns and drinking related problems among male university students. Journal of Korean Academy Fundamental Nursing, 8(2), 270 – 278. Camatta, C. D., & Nagoshi, C. T. (1995). Stress, depression, irrational belief and alcohol use problems in a college student sample. Alcoholism, Clinical and Experimental Research, 19(1), 142 – 146. Fagerstrom, K. O., & Schneider, N. G. (1989). Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12(2), 159 – 182. Frank, S. J., Jacobson, S., & Tuer, M. (1990). Psychological predictors of young adults’ drinking behaviors. Journal of Personality and Social Psychology, 59(4), 770 – 780. Guilmette, T. J., Motta, S. I., Shadel, W. G., Mukand, J., & Niaura, R. (2001). Promoting smoking cessation in the rehabilitation setting. American Journal of Physical Medicine & Rehabilitation, 80, 560 – 562. Heffernan, K. (1998). The nature and predictors of substance use among lesbians. Addictive Behaviors, 23(4), 517 – 528. Helmer, C., Barberger-Gateau, P., Letenneur, L., & Dartigues, J. F. (1999). Subjective health and mortality in French elderly women and men. The Journals of Gerontology. Series B, Psychological Sciences and Social, 54(2), 84 – 92. Holroyd, S., & Duryee, J. J. (1997). Substance use disorders in a geriatric psychiatry outpatient clinic: Prevalence and epidemiologic characteristics. The Journal of Nervous and Mental Disease, 185(10), 627 – 632. Husten, C. G., Shelton, D. M., Chrismon, J. H., Lin, Y. C., Mowery, P., & Powell, F. A. (1997). Cigarette smoking and smoking cessation among older adult: United States. Tobacco Control, 6(3), 175 – 180. Itoh, A., Nakashima, T., Arao, H., Wakai, K., Tamakoshi, A., Kawamura, T., & Ohno, Y. (2001). Smoking and drinking habits as risk factors for hearing loss in the elderly: Epidemiological study of subjects undergoing routine health checks in Aichi, Japan. Public Health, 115(3), 192 – 196. Lee, Y. (2000). Alcohol and elderly person. Journal of Elderly Welfare, 7 – 23. McCarthy, W., Caskey, N., Jarvik, M., Gross, T., Rosenblatt, M., & Carpenter, C. (1995). Menthol vs. nonmenthol cigarettes: Effects on smoking behavior. American Journal of Public Health, 85, 67 – 72. Miller, G., Jarvik, M., Caaskey, N., Segerstrom, S., Rosenblatt, M., & McCarthy, W. (1994). Cigarette mentholation increases smoker’s exhaled carbon monoxide levels. Experimental and Clinical Psychophamacology, 2, 154 – 160. Moore, A. A., Morgenstern, H., Harawa, N. T., Fielding, J. E., Higa, J., & Beck, J. C. (2001). Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers? Journal of the American Geriatrics Society, 49(4), 421 – 430. Moore, A. A., Endo, J. O., & Carter, M. K. (2003). Is there a relationship between excessive drinking and functional impairment in older persons? Journal of the American Geriatrics Society, 51(1), 44 – 49. National Statistical Office (2001 – 2002). Annual Report on Vital Statistics. OECD Health data (2000). Regular smoking habits. http://www.oecd.org. Ondus, K. A., Hujer, M. E., Mann, A. E., & Mion, L. C. (2003). Substance abuse and the hospitalized elderly. Orthopaedic nursing/National Association of Orthopaedic Nurses, 18(4), 27 – 34. Risch, H. A., Howe, G. R., Jain, M., Burch, J. D., Holowaty, E. J., & Miller, A. B. (1993). Are female smokers at high risk for lung cancer than male smokers? American Journal of Epidemiology, 138(5), 281 – 293. Stewart, A. L., Hays, R. D., & Ware, J. E. (1998). The MOS short-form general health survey: Reliability and validity in a patient population. Medical Care, 26(7), 724 – 735. Sunyer, J., Lamarca, R., & Alonso, J. (1988). Smoking after age 65 year and mortality in Barcelona, Spain. American Journal of Epidemiology, 148(6), 575 – 580. SPSS (Statistical Package for the Social Scinces). Version 10. 1999. SPSS, Chicago, IL
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Stewart, A.L., Hays, R.D., & Ware, J.E. (1998). The MOS short-form general health survey: Reliability and validity in a patient population. Medical Care, 26 (7), 724 – 735. Zhou, H., Deng, J., Li, J., Wang, Y., Zhang, M., & He, H. (2003). Study of the relationship between cigarette smoking, alcohol drinking and cognitive impairment among elderly people in China. Age and Ageing, 32, 205 – 210.
Alcohol consumption, cigarette smoking, and subjective health in Korean elderly men Oksoo Kima,*, Sunghee Baikb a
College of Nursing Science, Ewha Womans University, Sudaemoon-gu Daehyun dong 11-1, 120750 Seoul, South Korea b Department of Nursing, Suwon Women’s College, Suwon, South Korea
Abstract The purpose of the study was to investigate the level of alcohol drinking, cigarette smoking, and subjective health in elderly Korean men and to examine the relationships among those variables. The data were collected through the questionnaire that includes general characteristics, the quantity – frequency (Q – F) method, and the Fagerstrom Tolerance Questionnaire (FTQ) scale. The prevalence of alcohol consumption was 65.2%, and 28.7% represented heavier drinkers. The prevalence of smoking was 47.0%. Among the smokers, 17.1% elderly men reported nicotine dependence in the medium range. Forty-six percent of subjects reported their health as poor or fair. In conclusion, alcohol drinking and smoking were prevalent among Korean elderly men. These findings show the need to improve strategies for educating elderly men and motivating them to incorporate healthy behaviors. D 2004 Elsevier Ltd. All rights reserved. Keywords: Alcohol drinking; Smoking; Health; Aged; Nicotine dependence
1. Introduction Approximately 7.3% of the Korean population was 65 years of age or more in 2000 (National Statistical Office, 2001). Because the population of the elderly has been increasing rapidly, health promotion of the elderly population has become one of the most important issues in Korea. Alcohol and nicotine are the major substances used by the * Corresponding author. Tel.: +82-32773703; fax: +82-32772850. E-mail address: [email protected] (O. Kim). 0306-4603/$ – see front matter D 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2004.02.037
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elderly in Korea. The Koreans’ attitude toward alcohol drinking and smoking among the elderly are very permissive; therefore, the elderly’ health can be impaired. However, there is lack of research in health risk behaviors, such as alcohol drinking and smoking, among the elderly. The previous studies showed that use of alcohol and tobacco was associated with a wide range of problems including physiological, mental, and social problems in the elderly (Abramson, Berger, Krumholz, & Vaccarino, 2001; Holroyd & Duryee, 1997). Alcohol consumption in the elderly can cause liver diseases, dementia, and insomnia and increases the risk of falls and other accidents (Lee, 2000). Ondus, Hujer, Mann, and Mion (2003) reported that estimates of alcohol abuse in the elderly population range from 4% to 20% in the community-dwelling elderly and up to approximately 25% among hospitalized older adults. In the elderly, smoking has also been associated with a general decline in physical functioning as a result of the increased incidence of chronic illnesses and cancer (Guilmette, Motta, Shadel, Mukand, & Niaura, 2001; Itoh et al., 2001). Burns (2000) reported the dramatic increase in smoking-related excess mortality with advancing age. A greatly elevated risk of developing lung cancer was associated with cigarette smoking, increasing with packs of cigarettes smoked and declining with the duration of time since quitting smoking (Risch et al., 1993). Most of the previous studies measuring smoking and drinking behaviors included young people (Camatta & Nagoshi, 1995; McCarthy et al., 1995; Miller et al., 1994). Unhealthy behaviors were prevalent among the elderly population, and smoking and drinking were more serious among men. The proportion of smokers among men is greater than in women in Korea. The Organization for Economic Cooperation and Development (OECD) stated that the smoking rate among Korean men was ranked first in the world in 1998, whereas women’s smoking rate is ranked 69th. In addition, alcohol abuse occurs more frequently among men. In general, men are heavier and more problematic drinkers than are the women in Korea. It has been reported that Korean people drink alcohol and smoke more cigarettes than do the people who live in other countries (OECD Health data, 2000). The mortality rate of middle-aged Korean men who are in their 40s is approximately three times higher than that of middle-aged Korean women who are in their 40s (National Statistical Office, 2002). Alcohol drinking and cigarette smoking is one of the most influential factors on mortality rate, and it could be extended to the older adulthood. However, few studies have focused on the alcohol drinking and cigarette smoking in Korean elderly men. Self-reported subjective health appears to be very important in predicting subsequent mortality in the elderly. Self-rated health seems to be a better predictor of mortality in elderly men than in women (Helmer, Barberger-Gateau, Letenneur, & Dartigues, 1999). In this study, it was assumed that subjective health is associated with alcohol drinking and cigarette smoking in Korean elderly men.
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The purpose of the study was to investigate the level of alcohol consumption, cigarette smoking, and subjective health in elderly Korean men and to examine the relationships among those variables.
2. Method 2.1. Participants and procedure The sample for this study was a convenience sample of 164 Korean elderly men living in the community in Seoul, Korea. The sample was derived from a larger study designed to examine health risk behaviors in elderly Korean. Data were collected from May to July 2001. The interviewers read the questionnaires to the participants because many could not read the questionnaire due to the vision problem. The participants were assured of anonymity and confidentiality. The mean age of the sample was 69.96 years, with a range of 60–89 years (Table 1). Seventy-six percent of the participants currently had spouses and 45.7% lived with their spouses. Thirteen
Table 1 Demographic characteristics (N = 164) Characteristics Age (years) 60 – 69 70 – 79 80 over Spouse Yes No Religion Protestant Catholic Buddhism Other None Educational level Less than high school High school graduate College graduate Living arrangement Living alone With spouse With adult children With spouse and adult children With others
n (%) 68 (41.5) 63 (38.4) 33 (20.1) 125 (76.2) 39 (23.8) 39 (23.8) 11 (6.7) 37 (22.5) 9 (5.5) 68 (41.5) 108 (65.9) 35 (21.3) 21 (12.8) 22 (13.4) 75 (45.7) 42 (25.7) 23 (14.0) 2 (1.2)
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percent of the participants lived alone. Fifty-nine percent of the participants had religion. 2.2. Measures Data were collected using the questionnaire including background characteristics, quantity–frequency (Q–F) typology, Fagerstrom Tolerance Questionnaire (FTQ) scale, and short form health survey. 2.2.1. Alcohol drinking The average number of alcoholic beverages consumed each week during the previous month was assessed. A drink can be a glass of wine, a can of beer, or a shot of distilled spirit (Frank, Jacobson, & Tuer, 1990). A drink of beer contains approximately the same amount of alcohol as a drink of wine or spirit. 2.2.2. Q–F typology A standard Q–F typology was utilized in this study. Q–F measures query the participants on both drinking frequency and average quantity consumed per occasion, thereby providing a measure of the total alcohol amount consumed. Generally, the quantity question asks for the typical number of drinks consumed per occasion, providing the participants with some definition of a drink. Alcohol consumption categories defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) categories was used: moderate (an individual who had consumed between 1 and 60 alcoholic drinks within the 30 days prior to being surveyed) and heavier drinker (61 or more alcoholic drinks; Heffernan, 1998). 2.2.3. Cigarette smoking The weekly average number of cigarettes within the past month was measured. 2.2.4. Nicotine dependence (FTQ) The FTQ has a scoring range of 0–11 points, with a score of 0 assumed indicative of minimum nicotine dependence. Participants who score 7 or more probably suffer from a physical addiction to nicotine and can expect severe withdrawal symptoms. The scores were divided into low (0–4 scores), medium (5–7 scores), and high (8–11 scores) ranges (Fagerstrom & Schneider, 1989). 2.2.5. Subjective health Subjective physical health was measured by the single-item short form health survey adapted from the Medical Outcomes Study (MOS) instrument (Stewart, Hays, & Ware, 1988). The participants were asked how they would rate their health at the present time and scored on a five-point scale: poor (1), fair (2), good (3), very good (4), or excellent (5). As very few
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Table 2 Alcohol drinking and cigarette smoking (N = 164) Variables Alcohol drinking Moderate (1 – 60) Heavier (61 or more) Abstainer Cigarette smoking Low (0 – 4) Medium (5 – 7) High (8 – 11) None
n (%)
Minimum
Maximum
M
S.D.
0.25
207.0
21.93
28.95
7.0
280.0
97.09
56.51
60 (36.5) 47 (28.7) 57 (34.8) 48 (29.3) 28 (17.1) 1 (0.6) 87 (53.0)
participants answered that their health was excellent (n = 3), the two levels, ‘‘excellent’’ and ‘‘very good’’, were combined. 2.3. Analysis The data were analyzed using SPSS 10.0 version (SPSS, 1999). A significance level of .05 was maintained.
3. Results 3.1. Alcohol drinking As shown in Table 2, 57 out of the 164 participants (34.8%) were abstainers, and 65.2% of the participants drank alcohol, with a mean of 21.9 drinks per week during the last month. Among the current drinkers, 36.5% were moderate drinkers and 28.7% were heavier drinkers, as defined by NIAAA categories. 3.2. Cigarette smoking As shown in Table 2, 47.0% of the participants smoked, with a mean of 97.09 cigarettes, approximately five packs per week. Table 3 Subjective health (N = 164) Category
n (%)
Excellent Very good Good Fair Poor
3 (1.8) 25 (15.2) 60 (36.6) 43 (26.3) 33 (20.1)
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Table 4 Relationship between subjective health, alcohol drinking, and smoking and FTQ (N = 164)
Subjective health Excellent/very good Good Fair Poor
Alcohol drinking
Smoking
M
M
P value .39
31.83 20.49 17.71 20.58
FTQ P value
M
.45 115.82 86.48 96.16 105.88
P value .12
1.27 1.26 1.58 1.44
FTQ = Fagerstrom Tolerance Questionnaire.
According to the FTQ, which assesses nicotine dependence, 17.1% of the current smokers reported nicotine dependence in the medium range (scores 5–7), and 29.3% of the smokers was found in low nicotine dependence (Table 2). 3.3. Subjective health status Three (1.8%) participants reported their health as excellent and 15.2% very good, 36.6% good, 26.3% fair, and 20.1% poor (Table 3). 3.4. Relationship between subjective health and alcohol drinking and cigarette smoking In Table 4, subjective health was not associated with alcohol drinking, cigarette smoking, and FTQ.
4. Discussion The purpose of the study was to investigate the alcohol drinking, cigarette smoking, and subjective health in elderly Korean men and to examine the relationships among those variables. This study reminds us of the alcohol drinking issues among Korean elderly men because it reflects the higher rate of heavy drinking, as 65.2% of the participants drank alcohol, of which 32.9% were considered to be heavy drinkers. Moore et al. (2001) reported that 40% of older adults drank, and 11% were at-risk drinkers. Moore, Endo, and Carter (2003) conducted a study with American older adults aged 60 and over as participants, of which 22% were at-risk drinkers, drinking 14 or more drinks weekly. In this study, the Korean elderly men drank alcohol, with a mean of 22 drinks per week, whereas Byun (2001) reported that Korean male college students drank with a mean of 12.43 drinks. Compared with the other study results, Korean elderly men indicate their high level of drinking, and this is because the Korean culture is lenient upon the elderly drinking, and even more lenient upon men. In contrast to the youths or middle-aged men, the elderly
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men usually drink at home, thus, this may not become a social issue or be explicated. Nonetheless, as this study shows, half of the drinkers were heavy drinkers, and that brings up the issues of health problems threatening the elderly men with excessive alcohol influence. Therefore, health professionals in charge of the elderly health need to study and apply a method to control or prevent alcohol drinking. The communities should decrease the drinking rate by attempting group education for the elderly. The elderly drinking is related to liver disease or malnutrition, requiring a further study, accordingly. In this study, the prevalence of cigarette smoking was 47.0%. The participants smoked cigarette with a mean of five packs per week during the last month. In the nicotine dependency, 29.3% were low dependents and 17.1% were medium dependents. Zhou et al. (2003) reported that 25.2% of Chinese elderly over the age of 60 were current smokers. The prevalence of current smoking among American older adults aged 65 and over declined from 1965 to 1994 (17.9% to 12.0%; Husten et al., 1997). Compared with these results, the smoking rate of the Korean elderly men are relatively high. For a long time, stomach cancer was ranked first for death by cancer in Korea. However, lung cancer had replaced stomach cancer as the Number 1 killer in 2001. Because it is relevant to cigarette smoking, an interest in quitting smoking has been on the increase. According to Sunyer, Lamarca, and Alonso (1998), quitting smoking after the age of 65 years reduced the relative risk of dying to 0.77 time in comparison with continuing to smoke. In Korea, nonsmoking campaign has predominantly operated around adolescents. According to Husten et al. (1997), the prevalence of smoking cessation among older adults rose with educational attainment, and was consistently higher for men than for women. From now on, the nonsmoking campaign would have to actively approach the elderly, too. The participants reported that 26.3% are in fair and 20.1% in poor health. Although this study reflected that the subjective health of these elderly men is not good, it was not related to the drinking or smoking. The reason why the participants consider the drinking and smoking irrelevant to their health is because they are unable to quit drinking or smoking due to such long period of habitual life styles. Considering the elders’ chronic illnesses and physiological changes in aging, the smoking and drinking effects on their health would be greater than of young adults. To maintain the health of elderly and to decrease the financial loss due to the medical bills, a study for the factors and results of drinking and smoking effects upon elders must be actively conducted. In comparison with other study results, alcohol drinking and smoking rates of the participants were higher than others. Among the drinkers, the rate of heavy drinkers was high, and it is necessary to provide education for controlling or quitting drinking. In this study, it was found that the participants did not reduce their drinking and smoking when they evaluated that they are not in good health, with a result that they were not any different from the ones who considered themselves healthy. Therefore, it is necessary to have an approach on the control of drinking and smoking from the young and middle-aged adults, along with the future studies for drinking and smoking of the elderly.
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References Abramson, J., Berger, A., Krumholz, H. M., & Vaccarino, V. (2001). Depression and risk of heart failure among older persons with isolated systolic hypertension. Arch International Medicine, 161(14), 1725 – 1730. Burns, D. M. (2000). Cigarette smoking among the elderly: Disease consequences and the benefits of cessation. American Journal of Health Promotion, 14(6), 357 – 361. Byun, Y. S. (2001). The effects of personality on drinking patterns and drinking related problems among male university students. Journal of Korean Academy Fundamental Nursing, 8(2), 270 – 278. Camatta, C. D., & Nagoshi, C. T. (1995). Stress, depression, irrational belief and alcohol use problems in a college student sample. Alcoholism, Clinical and Experimental Research, 19(1), 142 – 146. Fagerstrom, K. O., & Schneider, N. G. (1989). Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12(2), 159 – 182. Frank, S. J., Jacobson, S., & Tuer, M. (1990). Psychological predictors of young adults’ drinking behaviors. Journal of Personality and Social Psychology, 59(4), 770 – 780. Guilmette, T. J., Motta, S. I., Shadel, W. G., Mukand, J., & Niaura, R. (2001). Promoting smoking cessation in the rehabilitation setting. American Journal of Physical Medicine & Rehabilitation, 80, 560 – 562. Heffernan, K. (1998). The nature and predictors of substance use among lesbians. Addictive Behaviors, 23(4), 517 – 528. Helmer, C., Barberger-Gateau, P., Letenneur, L., & Dartigues, J. F. (1999). Subjective health and mortality in French elderly women and men. The Journals of Gerontology. Series B, Psychological Sciences and Social, 54(2), 84 – 92. Holroyd, S., & Duryee, J. J. (1997). Substance use disorders in a geriatric psychiatry outpatient clinic: Prevalence and epidemiologic characteristics. The Journal of Nervous and Mental Disease, 185(10), 627 – 632. Husten, C. G., Shelton, D. M., Chrismon, J. H., Lin, Y. C., Mowery, P., & Powell, F. A. (1997). Cigarette smoking and smoking cessation among older adult: United States. Tobacco Control, 6(3), 175 – 180. Itoh, A., Nakashima, T., Arao, H., Wakai, K., Tamakoshi, A., Kawamura, T., & Ohno, Y. (2001). Smoking and drinking habits as risk factors for hearing loss in the elderly: Epidemiological study of subjects undergoing routine health checks in Aichi, Japan. Public Health, 115(3), 192 – 196. Lee, Y. (2000). Alcohol and elderly person. Journal of Elderly Welfare, 7 – 23. McCarthy, W., Caskey, N., Jarvik, M., Gross, T., Rosenblatt, M., & Carpenter, C. (1995). Menthol vs. nonmenthol cigarettes: Effects on smoking behavior. American Journal of Public Health, 85, 67 – 72. Miller, G., Jarvik, M., Caaskey, N., Segerstrom, S., Rosenblatt, M., & McCarthy, W. (1994). Cigarette mentholation increases smoker’s exhaled carbon monoxide levels. Experimental and Clinical Psychophamacology, 2, 154 – 160. Moore, A. A., Morgenstern, H., Harawa, N. T., Fielding, J. E., Higa, J., & Beck, J. C. (2001). Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers? Journal of the American Geriatrics Society, 49(4), 421 – 430. Moore, A. A., Endo, J. O., & Carter, M. K. (2003). Is there a relationship between excessive drinking and functional impairment in older persons? Journal of the American Geriatrics Society, 51(1), 44 – 49. National Statistical Office (2001 – 2002). Annual Report on Vital Statistics. OECD Health data (2000). Regular smoking habits. http://www.oecd.org. Ondus, K. A., Hujer, M. E., Mann, A. E., & Mion, L. C. (2003). Substance abuse and the hospitalized elderly. Orthopaedic nursing/National Association of Orthopaedic Nurses, 18(4), 27 – 34. Risch, H. A., Howe, G. R., Jain, M., Burch, J. D., Holowaty, E. J., & Miller, A. B. (1993). Are female smokers at high risk for lung cancer than male smokers? American Journal of Epidemiology, 138(5), 281 – 293. Stewart, A. L., Hays, R. D., & Ware, J. E. (1998). The MOS short-form general health survey: Reliability and validity in a patient population. Medical Care, 26(7), 724 – 735. Sunyer, J., Lamarca, R., & Alonso, J. (1988). Smoking after age 65 year and mortality in Barcelona, Spain. American Journal of Epidemiology, 148(6), 575 – 580. SPSS (Statistical Package for the Social Scinces). Version 10. 1999. SPSS, Chicago, IL
O. Kim, S. Baik / Addictive Behaviors 29 (2004) 1595–1603
1603
Stewart, A.L., Hays, R.D., & Ware, J.E. (1998). The MOS short-form general health survey: Reliability and validity in a patient population. Medical Care, 26 (7), 724 – 735. Zhou, H., Deng, J., Li, J., Wang, Y., Zhang, M., & He, H. (2003). Study of the relationship between cigarette smoking, alcohol drinking and cognitive impairment among elderly people in China. Age and Ageing, 32, 205 – 210.