DBPIA-NURIMEDIA

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1 대한구강내과학회지 Vol. 35, No. 4, 2010 국내치과대학병원에서시행한단기금연진료에대한조사 단국대학교치과대학구강내과학교실 흡연은전신뿐아니라구강에서발생하는다양한질병의중요한위험인자이며, 치과의사가금연치료에참여하는것은개인의전신건강과치주치료와임플란트치료같은치과치료의예후에도큰차이를보여주는것으로알려져있다. 흡연이구강암과같은생명을위협하는비교적흔치않은질병으로부터경미한구강내증상에이르기까지구강환경에다양한영향성과관련한많은근거가있음에도불구하고, 흡연과구강건강의관련성에대한환자들의인식수준을조사한연구는적고, 금연진료에대한국내치의학계의관심과참여는더욱부족하다. 그러므로본연구는국내치과외래환자의흡연양상과치과계의금연진료현황을파악하여금연진료방향을모색해보고자하였다. 대한치과의사협회문화복지부의후원으로전국 11 개치과대학병원의구강내과, 구강외과및치주과환자중 825 명이니코틴패치를이용한 4 주금연프로그램및설문에참여하였고, 297 명이금연설문에참여하였다. 각설문지분석을통해각치과대학병원의조사현황, 치과외래환자의흡연양상을분석하였고, 치과에서시행된 4 주간의금연치료의참여목적과성공률을조사하였다. 본연구의결과에따르면, 흡연자는주로 대중 장년층이많았고, 흡연기간은연령증가에비례하며, 하루흡연량은 30 대에서가장많았다. 금연시도는 30,40 대에서금연시도비율이높았고그기간은대부분 1-3 개월이었다. 흡연의이유로는스트레스해소와습관이가장높은빈도를보였으며 Heavy Smoking Index (HSI) 는 20 대가가장낮고 (71.4%) 60 대가가장높았다 (93.7%). 흡연경고문구에대해참가자의 68% 는금연을떠올렸다. 구강질환 ( 구강점막질환, 치주질환, 치아우식증 ) 과흡연의관련성에대한실험참가자들의인식도는비교적높았지만 (50~68%) 금연성공률은일반의과진료실에비해아주낮은결과를보였다 (22.7%). 흡연관련질환예방업무에서의치과의사의중요성을고려할때, 금연치료에치과의사들이보다적극적으로참여할수있는인식의변화가필요하다. 낮은치료성공율이체계화되지못한진료내용때문임을고려할때, 5As 방법등과같은금연관련상담에대한지속적인치과의사교육과환자교육을위한다양한자료의개발을통해금연성공률을높일수있도록해야한다. 주제어 : 치의학, 흡연, 금연진료 1)Ⅰ. 서 흡연은폐암, 심장질환, 말초성혈관질환및호흡기질환의주요한위험요소일뿐만아니라 1) 구강암 교신저자 : 김기석충청남도천안시신부동산 7-1 단국대학교치과대학구강내과학교실전화 : Fax: kimks@dankook.ac.kr 원고접수일 : 심사완료일 : 론 2,3), 구강백반증 4), 치아및치은부의착색에의한심미적문제및후각과미각의변화 5,6), 타액내화학적조성의변화 7), 발치후창상치유의지연 8,9), 치아상실 10), 치아우식증과더불어구개구순열 11) 을야기할수있다. 특히치주조직과임플란트수술에대한흡연의영향은최근까지다수연구된바있다. Kinane 과 Chestnutt 11) 은흡연이혈관, 세포성및체액성면역계, 염증과정에영향을주게되고, cytokine 과 adhesion molecular network 에전반적으로영향을주어치주질환이야기되는것이라고보고한바있고, 많은연구자들에의해담배소비량, 흡연패턴, 흡연량과관련한성별간차이에따른치주영향도가보 245

2 고되었다 ) 최근에는임플란트에대한지대한관심을바탕으로임플란트의성공률과흡연의상관관계에관해보고된바있다 ) Frank와 Peter 등 20) 과 Daisuke 등 21) 은흡연이임플란트시술의중대한위험요소라는점을 systemic review와 metaanalysis를통해언급하였다. 위와같이구강내미치는영향이지대함에도불구하고 Khalaf 등 22) 의치과환자의흡연에따른구강내의변화에대한인식도조사에따르면응답자의 92.2% 에서구강건강에연관이있다고알고있으나, 응답자의 80.1% 가구강암, 치주질환, 창상치유, 치아착색, 치아우식과의관련성에대한정확한인식을갖고있지못하다고보고하였다. 이에따라세계치과연맹 (World Dental Federation) 에서는 1996년금연에대한치과의사선언이후모든치과의사는일상적인치과진료시금연을위한포괄적업무를병행하도록권장하고있다. 23) 국내에서는 1997년대한치과의사협회에서세계금연의날기념식및금연가두캠페인시작으로 2000년인터넷을통한국가단위의금연상담서비스개시, 2004년 10월 1일~12월 31일까지전국 10개보건소에서금연클리닉시범사업전개, 2006년금연상담전화 (Quitline) 본격개시, 2008년 10월 8일보건복지부내구강생활건강과재편및구강건강관리사업및금연정책관리포함, 2008년 12월 2009 년 1월에걸쳐서울, 연세, 경희, 단국, 조선대치과병원에금연클리닉이개설되어운영되고있다. 그러나국내에서의구강건강과흡연과의관계에대해교육및금연치료시행의당사자라할수있는치과의사의흡연실태와흡연인식조사에대한허 24) 등의연구에따르면치과의료인의흡연률은 29.69% 이고, 94.07% 에서정식으로금연교육을받은경험이없었다고보고하였다. 이에반해치과의료인응답자의 80% 이상에서금연진료에대해긍정적이라결과를보여치과외래환자에대한치과금연진료의환경이조성되지않았음을보여주었다. 흡연이구강암과같은생명을위협하는비교적흔치않은질병으로부터경미한구강내증상에이르기까지구강환경에다양한영향을줌에도불구하고, 흡연이구강건강에미치는영향에대한환자들의지식정도를조사한연구는미미한실정이다 ) 그러므로본연구를통해국내치과외래환자의흡연양상과치과계의금연진료현황을파악하여향후금연진료방향을모색해보고자하였다. 1. 조사대상및기간 Ⅱ. 연구방법 본연구는대한치과의사협회문화복지부의후원을통해시행되었다 년 10 월부터 2010 년 1 월까지국내 11 개의치과대학병원의구강내과, 구강외과, 치주과에내원한외래환자를대상으로하였다. 설문지참여과의총수는 23 개과였다 (Table 1). 2. 조사방법 대한치과의사협회문화복지부의후원으로 4 주간의금연패치배포, 금연 4 주프로그램및임플란트 4 주금연프로그램및금연패턴파악과관련한설문지를제작하였다 (Fig. 1,2). 대상자는설문지내용을이해할수있고, 설문에응한외래환자로하였다. 금연패치는정해진용법에따라사용하도록하였다. 조사항목으로각대학병원별흡연설문지조사현황, 치과외래환자의흡연양상및 4 주간의금연치료의목적및성공률을확인하였다. 이중치과외래환자의흡연양상의세부항목으로연령과성별, 연령대별흡연량과기간, 연령별금연시도유무, 금연기간및금연시도횟수, 연령별흡연의이유, 흡연경고문구에대한인식도, 흡연과구강상태관련성에대한인식도 ( 치주병 / 치아우식증 / 구강점막질환 ) 와더불어 Heavy smoking index (HSI) 인연령대별하루흡연량, 연령별아침기상후첫흡연까지의시간에대한설문도조사하였다. 3. 통계분석방법 본연구에사용된프로그램은 SPSS version 17.0 통계프로그램을사용하였고, 성별에따른흡연비율, 연령대에따른흡연량, 흡연기간, 금연시도유무및횟수, 하루흡연량, 첫흡연까지의시간, 흡연의이유를분석하기위해 Chi-square test 를시행하였다. Ⅲ. 연구결과 1. 각치과대학병원별흡연설문지조사현황 Table 1 은 2009 년 10 월부터 2010 년 1 월까지대한치과의사협회문화복지부의후원으로본설문조사 246

3 국내치과대학병원에서시행한단기금연진료에대한조사 Table 1. The respondents of smoking related questionnaire obtained from different Dep. of dental Hospitals. Univ. Gangneung-Wonju National Univ. Dept. Type of questionare 4-week smoking cessation program questionares Smoking-related questionnaires Oral medicine 13 0 Periodontology 30 0 Kyungpook National Univ. Oral medicine Oral Maxillofacial surgery & Periodontology 82 0 Kyunghee Univ. Oral Maxillofacial surgery 19 0 Dankook Univ. Oral medicine Oral Maxillofacial surgery & Periodontology 3 0 Pusan National Univ. Periodontology 18 7 Seoul National Univ. Yonsei Univ. Wonkwang Univ. Chonnam National Univ. Oral medicine 22 8 Periodontology Oral medicine 11 0 Oral Maxillofacial surgery 50 0 Periodontology Oral medicine Oral Maxillofacial surgery Periodontology Oral medicine Periodontology 26 1 Chonbuk National Univ. Periodontology 33 0 Oral Maxillofacial surgery 32 Chosun Univ. Periodontology 21 0 Total 에참여한대학및전문과및설문지조사현황을나타낸것이다. 총 825 명의금연 4 주프로그램설문응답자와 297 명의금연설문지에응답하였다. 2. 치과외래환자의흡연양태 1) 연령및성별비율및분포성별로는남성이전체대상자의 92% 를차지하고있었으며, 연령별분포를살펴보면 20 대가 15%, 30 대가 28%, 40 대 23%, 50 대 21%, 60 대가 13% 를나타나, 247

4 Fig week smoking cessation program questionnaire 248

5 국내치과대학병원에서시행한단기금연진료에대한조사 Fig. 2. Smoking-related questionnaire 249

Fig. 3. The distribution of smoker s sex and age Pearson's x², p=0.352 30 대에서 50 대사이의설문응답자가운데 72% 를차지하는것을볼수있다 (Fig. 3). 남녀흡연비율이연령대별로유의한차이를보이지않았다. 2) 연령별흡연기간 Fig. 4 는각연령대별흡연기간을나타내었다.

6 Fig. 3. The distribution of smoker s sex and age Pearson's x², p= 대에서 50 대사이의설문응답자가운데 72% 를차지하는것을볼수있다 (Fig. 3). 남녀흡연비율이연령대별로유의한차이를보이지않았다. 2) 연령별흡연기간 Fig. 4 는각연령대별흡연기간을나타내었다. 20 대의경우흡연기간이 10 년미만인경우가 83% (36 명중 30 명 ) 로높은비율을차지하지만, 30 대에서 6 년에서 15 년미만인경우가약 80% 이고, 40 대에의경우 16 년이상 20 년미만의비율이 76%, 50 대와 60 대에서 20 년이상흡연한경우가각각 73%, 87% 로서, 연령이증가함에따라흡연기간이긴사람의비율이높았다. 3) 연령대별하루흡연량및기상후첫흡연을하기까지걸리는시간 Heavy smoking index (HSI) 항목인연령대별하루흡연량은 20 대의경우 10 개피미만이가장많고 대에서 개피사이가많은것으로나타났다 (Fig. 5). 또한 기상후첫담배를피우기까지시간 을연령대별로확인해본결과연령대에따른통계적유의성은나타나지않았다 (Fig. 6). 4) 연령별금연시도유무및횟수와기간금연시도여부에대해살펴보면전체응답자의금연시도율은높았으나, 통계적으로연령대별유의성은없었다 (Table 2). 연령별금연시도횟수는연령이증가함에따라시도횟수가증가함을알수있었다 (Table 3). 연령이증가함에따라 4-12 개월간금연한 비율이높고, 이보다짧거나긴금연기간이상대적으로적은것으로보아장기흡연자들은약 1 년가까이금연을하는경향이있음을나타내었다 (Fig. 7). 5) 연령별흡연의이유흡연의이유는전체연령대에걸쳐스트레스해소를가장많이꼽았고, 그다음으로습관성, 즐거움, 집중력향상, 손장난등의순으로나타났다 (Fig. 8). 연령별흡연이유간에는통계적유의성이없었다. 6) 흡연경고문구에대한금연인식도및흡연과구강건강도관련성에대한인식도담배겉면에적힌흡연경고문구를보고금연을생각해본결과는응답자의 68% 에서그렇다고응답하였다. 흡연에따른구강건강도에대한인식도는구강점막질환및치주질환에대해인식도가 60%, 68% 로각각높았지만, 치아우식증과의관련성에서는응답자의 51% 는관련성이있다고답하였지만, 49% 는관련성이없다고응답하였다 (Table 4) 주간의금연치료의목적및성공률 Table 5 는설문응답자를대상으로금연프로그램참여목적및해당목적에따른 4 주후성공률을나타내었다. 치주치료에대한금연목적이가장많은비율을차지였고, 금연의목적이임플란트시술인경우금연치료성공률이가장높았으며, 전체의평균성공률은 29.4% 였다. 250

7 국내치과대학병원에서시행한단기금연진료에대한조사 Fig. 4. Duration of smoking according to age Fig. 5. Number of cigarettes per day of respondents investigated according to age 251

8 Pearson's x², p=0.169 Fig. 6. The interval between wake-up and initiate smoking measured according to age Table 2. The distribution of respondents with a trial experience of stop smoking measured according to age. Have you ever tried to stop smoking? Yes No Age 20 s 30 s 40 s 50 s 60 s Total Frequency Modified residual Frequency Modified residual Total Frequency Table 3. The distribution of respondents measured according to age and number of attempts to stop smoking. Number of attempts to stop smoking 1~2 3~4 >5 Age 20 s 30 s 40 s 50 s 60 s Frequency Modified residual Frequency Modified residual Frequency Modified residual Total Frequency Total 252

9 국내치과대학병원에서시행한단기금연진료에대한조사 Fig. 7. Period of smoking cessation according to age during stop smoking trial Fig. 8. The reasons of smoking according to age Pearson's x², p=

10 Table 4. Awareness of respondents on warning label for danger of oral diseases such as periodontal disease, dental caries and soft tissue disease. Awareness No. of "Yes" No. of "No" Warning label 160 (68%) 77 (32%) Periodontal disease 162 (68%) 75 (32%) Dental caries 121 (51%) 116 (49%) Soft tissue disease 143 (60%) 94 (40%) Table 5. The distribution of respondents measured according a purpose to participate in 4-week smoking program with nicotine patch and the result of success to stop smoking. Purpose Respondents Success Success rate(%) Periodontal treatment Periodontal implantation Tooth discoloration Oral soft tissue diseases Recovery of other diseases (except dental problem) No response Total Ⅳ. 총괄및고찰 국내 11 개치과대학병원의구강내과, 치주과, 구강외과를방문한외래환자를대상으로단기간 (2009 년 10 월 년 1 월 ) 시행한연구에서연령, 성별과이에따른분포에있어서성별간차이는크게나타났고, 대에서의흡연비율이 72% 를차지하였다. 흡연기간은연령증가와비례하고, 30 대에서하루흡연량이가장많은것으로나타났다. 조와송 31) 이보고한바에따르면전체대상자중남성이 95.3% 였으며, 40 세미만이 27.1%, 세의비율이 61.5%, 65 세이상이 11.3% 를차지하였고, 흡연기간의경우도길어질수록누적화되는경향이있다고하여본연구의결과와비슷함보였다. 이등 32) 은흡연유지와금연실패의중요한요소가니코틴의존도이며, 니코틴의존도를측정하는방법으로가장널리사용되는 Fagerstrom 의니코틴의존도설문지 (Fagerstrom Test for Nicotine Dependence, FTND) 33) 의항목중 0 점부터 3 점까지점수화되는 1 번문항 ( 하루중첫담 배를피우는시간 ) 과 4 번문항 ( 하루중흡연량 ) 의두항목은니코틴의존도를결정하는가장중요한두가지항목이라고하였고, Heartherton 등 34) 에의하면이두가지항목의점수를합한것을 heavy smoking index (HSI) 로명명하여니코틴의존도를측정할수있는하나의평가방법으로활용할수있다고한결과를토대로본연구에 HSI 를사용하였다. 그결과연령대가증가할수록높은니코틴의존도를나타내는비율이증가함을알수있었다. 김등 35) 은 Why test 설문지 36) 를사용하여흡연유형및이유에따른금연성공률을보고한바있는데, 손장난형, 즐거움과편안함형, 육체 - 심리적중독형이자극추구형, 스트레스해소형, 습관성형보다비교적높게나왔다고하였으나, 치과외래환자를대상으로한본연구에따르면스트레스해소형, 습관성, 즐거움과편안함형등의순서로다른결과를보였다. (Fig. 8) 2006 년발표된 Khalaf 22) 등의연구에서보는바와같이흡연과구강건강상태에대한관련성에대한 254

11 국내치과대학병원에서시행한단기금연진료에대한조사 인식도면에서치주질환과의연관성은상대적으로높은비율 (68%) 를나타냈으나, 구강점막질환및치아우식증과의연관성은인식하는비율이낮았다. 그주된이유로치과의료진의낮은금연인식및진료율을들수있는데, 허등 24) 의연구에서볼수있는바와같이 30% 가량의치과의료인의흡연률, 67% 이상에서의금연운동전개에대한무지및 94% 에서의금연교육을받은경험이없다는결과, 김등 37) 의치과관련종사자들의낮은금연지도활동점수 (20 점만점의 8.9 점 ), 그리고김등 38) 이연구한국내공중보건치과의사낮은금연활동업무 (5.7%) 에기인하는것으로볼수있을것이다. 미국과유럽의경우금연활동과관련한건강관리프로그램의지침을제시한바있는데 3 분이내에마치는 5 가지의간단한상담과정으로서묻고, 권고하고, 평가한후금연을위한조언및다양한처방을하거나주기적내원을도모하고금연성공에대한강화를함으로서일차적목표는매환자가흡연하는지확인하고적어도매치과내원시마다간단하게흡연관리를제공하는것이다.(the 5 As) 39) 국내의경우서등 40) 에의해금연진료와관련하여뉴질랜드지침및 Cochrane review 등을통해각금연진료지침근거등을고찰한바있으나구강내질환과관련하여각금연진료방법의효과등다양한항목에대한조사는많지않다. Table 5 에서보는바에따르면본연구에서사용된 4 주간의금연프로그램의전체성공률은 29.4% 로조와김등 31) 의의학계에서시행하고있는연구에따른 4 주간금연프로그램을진행한결과 61.3% 를보이는것에비교하여낮은수치를나타냄을보였다. 이러한결과는위에서언급한대로흡연과구강질환에대한상대적으로낮은인식도를보이는데그이유는치과관련종사자들의저조한인식및관련업무와더불어지역적, 특정진료과에국한하여진행되고, 단기간시행된조사이기때문인것으로사료된다. 치과의사는현재의의료시스템에서흡연관련질환예방업무에누구보다유리한위치에있으므로더많은치과의사에게금연관련상담에대한교육을시행해야한다. 미국및유럽지침인 the 5As 방법에따라 3 분가량동안금연교육및치료를시행하도록유도하거나, 금연치료에대한다양한지침을개발하여금연성공률을높일수있는노력이필요하다. 또한치과계의금연치료인식확대와이로인한금연성공률의상승을위해치과의사의금연상담및진료에 수가제도를확립해야하고중장기적이고다각적정책이뒷받침되어야한다. 금연에대한치의학계의노력을통해금연성공률이상승하게되면, 국민의구강보건향상은물론흡연으로인한사회경제적손실을줄일수있는방안이될수있기때문이다. 아울러향후구강내질환에대한다양한금연프로그램의효과에대한연구와함께치과계에서의금연진료필요성과정책에대한조사와연구가필요하다. Ⅴ. 결론 흡연은전신뿐아니라구강에서발생하는다양한질병의중요한위험인자이며, 치과의사가금연치료에참여하는것은개인의전신건강과치과치료의예후에도큰차이를보여주는것으로알려져있다. 본연구의결과가보여주듯이, 치과병원에서시행된 4 주간의단기금연치료에참여한치과환자들의구강질환과흡연의관련성에대한흡연자의인식도는비교적높았지만금연성공률은일반의과진료실에비해아주낮은결과를보였다. 그러나이상의결과들을통하여내린결론은다음과같다. 흡연관련질환예방업무에서의치과의사의중요성을고려할때, 금연치료에치과의사들이보다적극적으로참여할수있는인식의변화가필요하다. 낮은치료성공률이체계화되지못한진료내용때문임을고려할때, 5As 방법등과같은금연관련상담에대한지속적인치과의사교육과환자교육을위한다양한자료의개발을통해금연성공률을높일수있도록해야한다. 아울러치과계및치과외래환자의금연치료인식확대와금연성공률의상승을위해치과의사의금연상담및진료에대한수가제도를확립해야한다. 적극적인보건정책이지원된다면치과계에서의금연진료를통해국민구강보건향상과건강증진에크게기여할수있을것이다. 감사의글 본연구는대한치과의사협회문화복지부 ( 이사정애리 ) 의후원을통해시행되었으며, 전국 11 개치과대학 ( 강릉대, 경북대, 경희대, 단국대, 부산대, 서울대, 연세대, 원광대, 전남대, 전북대, 조선대 - 이상가, 나, 다순 - 의구강내과, 구강외과, 치주과진료팀 ) 의도움을받았습니다. 도와주신분들에게감사의말씀드립니다. 255

12 참고문헌 1. Halbrook JH. Nicotine addiction. In: Harrison s principles of internal medicine. 14 th ed., Mc Graw- Hill, 1998; Gross AJ, Lackland DT, Tu DS. Oral cancer and smokeless tobacco: Literature review and metaanalysis. Environment International 1995;21(4): Sadetzki S, Oberman B, Mandelzweig L et al. Smoking and risk of parotid gland tumors. A nationwide case-control study. Cancer 2008;112(9): Banoczy J, Gintner Z, Dombi C. Tobacco use and oral leukoplakia. J Dent Educ 2001;65(4): Vellappally S, Fiala Z, Smejkalova J et al. Smoking related systemic and oral disease. Acta Medica 2007;50(3): Millar WJ, Locker D. Smoking and oral health status. JCDA 2007;73(2): g. 7. Klein I, Nagler RM, Toffler R et al. Effect of cigarette smoke on oral peroxidase activity in human saliva: Role of hydrogen cyanide. Free Radical Biology & Medicine 2003;35(11): Larrazabal C, Garcia B, Penarrocha M. et al. Influence of oral hygine and smoking on pain and swelling after surgical extraction of impacted mandibular third molars. J Oral Maxillofac Surg 2010;68(1): Heng CK, Badner VM, Clemens D et al. The relationship of cigarette smoking to postoperative complication from dental extraction among female inmates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(6): Takashi H, Miki O, Keiko T et al. Relationship between smoking status and tooth loss: Findings from national database in Japan. Journal of Epidemiology 2007;17(4): Chung KC, Kowalski CP, Kim HM et al. Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip and palate. Plast reconstr surge 2000: 105(2): Kinane DF, Chestnutt IG. Smoking and periodontal disease. Crit Rev Oral Biol Med 2000;11: Calsina G, Ramon JM, Echeverria JJ. Effects of smoking on periodontal tissues. J Clin Periodontol 2002;29: Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol 2004;75(2): Thomson WM, Broadbent JM, Welch D et al. Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohort. J Clin Periodontol 2007;34(10): 박주희, 김영남, 유자혜등. 한국성인에서흡연과치주낭형성의관련성. 대한구강보건학회지 2005;29(3):293-3y Baig MR, Rajan M. Effects of smoking on the outcome of implant treatment: A literature review. Indian J Dent Res 2007;18(4): Kan YK, Rungcharassaeng K, Lozada JL et al. Effects of smoking on implant success in grafted maxillary sinuses. J Prosthet Dent 1999;82(3): Haas R, Haimbock W, Mailath G et al. The relationship of smoking on peri-implant tissue: A retrospective study. J Prosthet Dent 1996;76(6): Strietzel FP, Reichart PA, Kale A et al. Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. J Clin Periodontol 2007;34(6): Hinode D, Tanabe SI, Yokoyama M et al. Influence of smoking on osseointegrated implant failure: a meta-analysis. Clin Oral Impl Res 2006;17(4): Khalaf FA, Mohamed AM, Jassem MA et al. Dental patient awareness of smoking effects on oral health: Comparison of smokers and non-smokers. Journal of Dentistry 2006;34(3): Akerberg O: Editorial. FDI World, 1996;5: 박용덕, 김지현, 이선경. : 치과의사의흡연실태및인식조사. 대한구강보건학회지 2007;33(2): Burns JC, Williams Jr LN. A survey to determine the knowledge of military members about the hazards of tobacco use, and a resulting tobacco-hazard education project. Journal of Cancer Education 1995; 10(1): Humphris GM, Field EA. An oral cancer information leaflet for smokers in primary care: result from two randomized controlled trials. Community Dentistry and Oral Epidemiology 2004;32(2): Lawoyin JO, Aderinokun GA, Kolude B, Adekoya SM, Ogundipe BF. Oral cancer awareness and prevalence of risk behaviors among dental patients in Southwestern Nigeria. African Journal of Medical Sciences 2003;32(2): Lowry RJ, Craven MA. Smokers and drinkers awareness of oral cancer: a qualitative study using focus groups. British Dental Journal 1999;187: Powe BD, Finnie R. Knowledge of oral cancer risk factors among African Americans: do nurses have a role? Oncology Nursing Forum 2004;31(4):

13 국내치과대학병원에서시행한단기금연진료에대한조사 30. Telivuo M, Kallio P, Berg MA, Korhonen HJ, Murtomaa H. Smoking and oral health: population survey in Finland. Journal of Public Health Dentistry 1995;55(3): 조경숙, 송태민. 보건소금연클리닉의금연성공률과비용효과분석. 보건복지포럼 - 정책분석 2006; 이성기, 권혁중, 임대준등. 니코틴의존도평가검사로서 Heavy smoking index (HIS) 의유용성. 가정의학회지 2008;29: Heartherton TF, Kozlowski LT, Fecker RC et al. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnare. Br J Addict 1991;86(9): Kim CH, Seo HG. The factors associated with success of smoking cessation at smoking-cessation clinic. J Korean Acad Fam Med 2001;22(11): Kim JS, Lim SH, Lee DU et al. Smoking types and smoking cessation rate. J Korean Acad Farm Med 2004;25: American Academy of Family Physicians. familydoctor.org/handouts 37. 김동기, 김진선, 성진효. 일부지역사회에서구강건강관리인력의금연지도활동에관한조사연구. 대한구강보건학회지 2003;27(4): 김혜양, 이선경, 박용덕. 공중보건치과의사의근무현황과업무수행에관한조사연구. 대한구강보건학회지 2008;32(1): Watt R et al. Helping smokers to stop: A guide for the dental team. London, 1999, Health Education Authority. 40. 서홍관, 조홍준, 김철환등. 금연진료지침문헌고찰및근거요약. 가정의학회지 2005;26(11) Supple:

14 ABSTRACT Study on Short Term Smoking Cessation Treatment in Dental Hospitals in Korea Je-Il Song, D.D.S., Gi-Ho Lee, D.D.S.,M.S.D., Mee-Eun Kim, D.D.S.,M.S.D.,Ph.D., Ki-Suk Kim, D.D.S.,M.S.D.,Ph.D. Department of Oral Medicine, School of Dentistry and Medical Laser Research Center, Dankook University Smoking has been identified not as a major risk factor for circulatory and respiratory diseases but also as causes of various oral diseases. A number of clinical studies and regional health surveys have found an association between smoking and poor oral health status and between smoking and prognosis of dental treatments. However, there is few studies about status of smoking cessation treatment and policies in dentistry in Korea. The purpose of this study was to investigate the smoking patterns of outpatients and outcomes of short-term smoking cessation treatment in dental hospitals in Korea and, subsequently, to seek further smoking cessation services in dentistry. This study was sponsored by Korean Dental Association (KDA) and department of culture and welfare. 825 dental patients were voluntarily participated in a 4-week smoking cessation program with nicotine patch and 297 participants of them completed on smoking-related questionnaires. All participants were recruited from outpatients of 11 dental university hospitals (primarily in the department of oral medicine, oral surgery and periodontology) in Korea during 3-month period from October 2009 to January The Questionnaires included demographics, duration of smoking, heavy smoking index (HSI), number of thinking of quit smoking, duration of stop smoking and reasons to smoking, awareness of smoking effects on oral health, and their success rate after 4 weeks of nicotine patch program was investigated. The statistical analysis was carried by SPSS version 18.0 program and Chi-square test. According to the results of this study, male in their 30s to 50s were the most prevalent of all the participants and duration of smoking increased with age. Attempt rate to quit smoking (Quit smoking) was the highest in 30s and 40s with duration of quit smoking ranging 1 to 3 months. Emotional stresswas the most frequently reported reason for smoking, followed by habit and pleasure in order. All age group showed high HIS over 71% and awareness of smoking effects on oral diseases such as oral soft tissue diseases, periodontal diseases and dental caries was found relatively high (50~60%) Periodontal implant was the main reason for participation in the smoking cessation services in dental clinics and the success rate of, 4-week nicotine patch program of all the participants was 29.4%, extremely low compared to that of medical clinics. Systemic education for dentists to be able to provide interventions to quit smoking including counseling with the 5As and development of available measures for smokers is needed as considered that the low success rate of the smoking cessation services in dentistry could be explained mainly by lack of dentists strategies, experience and attention. Awareness and attention of dentists should be emphasized and their participation be encouraged by long-term, multidisciplinary policies such as establishment of insurance fee, which would made a considerable progress in preventing smoking-related oral diseases and promoting public oral health. Key words: Dentistry, Smoking, Smoking cessation program 258

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -