• The Korean Journal of Food And Nutrition
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• v.27 no.4
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• pp.725-731
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• 2014

This study aims to find the correlation the low-molecule fucoidan for cancer prevention with an accelerated formation of cotinine. In the presence of fucoidan, a nicotine to cotinine coversion was studied in established assay, direct mixture method and Hep-G2 cell line method. Fucoidan of $1{\mu}g/mL$ showed the potential effect for converting nicotine to cotinine in the direct mixture method compared to control. Increase of conversion rate at the treatment of fucoidan is exhibited as 15 times compared to control. In Hep-G2 cell treatment, fucoidan showed the potential activity for converting nicotine to cotinine as 6 times compared to control. Therefore, fucoidan was shown to be effective in the conversion of nicotine into cotinine even though it is not higher content of polyphenol and flavonoid than its of green tea extract.

• Journal of Yeungnam Medical Science
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• v.28 no.1
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• pp.45-53
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• 2011

Background: Increasing numbers of young people go to clubs. In Korea, however, no studies have been conducted regarding the exposure of club patrons to secondhand smoke. The present study was conducted to evaluate the degree of club customers' exposure to secondhand smoke. Methods: The study subjects included 10 male and 12 female non-smokers. The investigational site was a club located in Daegu. Urine samples were collected before exposure to secondhand smoke in the club and 6 hours after a 3-hour exposure. The urine cotinine levels were measured via the LC -MS/MS method. A survey was conducted to collect data regarding the subjects' smoking experiences and the degree of exposure to secondhand smoke in their daily lives. Results: The average urine cotinine level increased from 1.09 ${\mu}g/L$ to 5.55 ${\mu}g/L$ ($p$<0.05). No significant difference existed in the change in urine cotinine level between the male and female subjects. In addition, there was no significant difference in the change in urine cotinine level by the degree of exposure to secondhand smoke in daily life. Conclusions: The average urine cotinine level in all the subjects significantly increased after exposure to secondhand smoke. This is the first study on exposure to secondhand smoke in clubs; these results can be used to craft measures that reduce exposure to secondhand smoke in public places, such as clubs.

• Journal of Preventive Medicine and Public Health
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• v.40 no.4
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• pp.297-304
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• 2007

Objectives : We investigated the validity of the dipstick method (Mossman Associates Inc. USA) and the expired CO method to distinguish between smokers and non-smokers. We also elucidated the related factors of the two methods. Methods : This study included 244 smokers and 50 ex-smokers, recruited from smoking cessation clinics at 4 local public health centers, who had quit for over 4 weeks. We calculated the sensitivity, specificity and Kappa coefficient of each method for validity. We obtained ROC curve, predictive value and agreement to determine the cutoff of expired air CO method. Finally, we elucidated the related factors and compared their effect powers using the standardized regression coefficient. Results : The dipstick method showed a sensitivity of 92.6%, specificity of 96.0% and Kappa coefficient of 0.79. The best cutoff value to distinguish smokers was 5-6ppm. At 5 ppm, the expired CO method showed a sensitivity of 94.3%, specificity of 82.0% and Kappa coefficient of 0.73. And at 6 ppm, sensitivity, specificity and Kappa coefficient were 88.5%, 86.0% and 0.64, respectively. Therefore, the dipstick method had higher sensitivity and specificity than the expired CO method. The dipstick and expired CO methods were significantly increased with increasing smoking amount. With longer time since the last smoking, expired CO showed a rapid decrease after 4 hours, whereas the dipstick method showed relatively stable levels for more than 4 hours. Conclusions : The dipstick and expired CO methods were both good indicators for assessing smoking status. However, the former showed higher sensitivity and specificity and stable levels over longer hours after smoking, compared to the expired CO method.

• Research in Community and Public Health Nursing
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• v.12 no.3
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• pp.716-731
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• 2001

The purpose of this study was to test the effect of a self-efficacy promotion smoking cessation program for middle school students. This program was redesigned on the basis of Shin Sung Rye( 1997)' s Self-Efficacy Promoting Program for this study. The design of this paper was quasi-experimental. equivalent control group pre-post test. time series design. The subjects of this study were 53 smoker adolescents in D Middle School in the city of Busan. The results were summarized as follows: 1) The Hypothesis 1 was accepted: The self efficacy of the experimental group was higher than that of the control group after 1 week (expected efficacy t=2.20, p<.05. expected outcomes t=-2.58. p<.05) 4 weeks after education (expected efficacy t=- .19. p<.001, expected outcomes t=-2.586. p<.05). 2) The Hypothesis 2 was accepted: The amount of smoking of the experimental group was reduced more than that of the control group after 1 week (t=2.05, p<.05) and after 4 weeks (t=2.03. p<.05). 3) The Hypothesis 3 was accepted: The positive urine cotinine of the experimental group was less than that of the control group after 1 week after education($x^2$=8.57. p<.01) after 4 weeks ($x^2$=22.49. p<.001). In conclusion. a self-efficacy promotion smoking cessation program for middle school students was an effective smoking cessation program and then it will be valuable for stopping the smoking among the adolescents.

• Research in Community and Public Health Nursing
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• v.32 no.3
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• pp.268-280
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• 2021

Purpose: The study is examined the effects of the smoking cessation program of life skills training using flipped learning for male middle school students. Methods: The study was a nonequivalent control group non-synchronized design. The Smoking Cessation Program of life skills training using flipped learning is a Smoking Cessation Program that applied 5 stages of flipped learning such as before class, introductory class, during class, after class, and during work. Participants were 32 male students attending a middle school in D city, with 16 in the control group and 16 in the experiment group. Data collection was conducted from February 26, 2019 to May 14, 2019 for the control group, and from May 28, 2019 to August 19, 2019 for the experiment group. The collected smoking knowledge, smoking attitude, self-efficacy, basic psychological needs, and urine cotinine were analyzed by x² test, independent t-test, two-way repeated measured ANOVA, and Fishers exact test using the SPSS 25.0 program. Results: The experimental group showed higher smoking knowledge, smoking attitude, self-efficacy, basic psychological need, and urine cotinine negative response than the control group, and there were significant differences. Conclusion: These findings indicate that the Smoking Cessation Program of life skill training using flipped learning is an effective intervention for cessation of middle school male students, and it has a positive effect on the increase in urine cotinine, and a physiological indicator of the cessation effect, and is effective in the success of smoking cessation.

• Health Policy and Management
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• v.30 no.4
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• pp.505-512
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• 2020

Background: In monitoring exposure to environmental smoke (ETS), biomarkers can overcome the subjectivity and inaccuracy of self-reporting measurements, and have the advantage of reflecting ETS exposure in all places. This study aims to evaluate the effectiveness of ETS exposure measurement using biomarkers such as urine cotinine. Methods: This study used the Korea National Health and Nutrition Survey data from 2009 to 2018. A total of 28,574 non-smokers with urine cotinine data were selected for the study. The cotinine concentration and ETS exposure rate using urine cotinine was estimated and then compared with the self-reporting measurements. The degree of agreement among measurements of ETS exposure was confirmed. Results: As a result of measuring ETS exposure with urine cotinine, 23,594 (83.8%) out of 28,574 subjects were classified as to exposure groups. This estimate differs significantly from measurements made by self-reporting. In addition, the average concentration of cotinine in non-smokers has decreased to a 10th level over the past 10 years. Based on the biomarker, the sensitivity of the self-reporting was 8.5%-29.0%, the specificity was 16.4%-19.5%, and the kappa value was 2.0%-5.8%. Conclusion: The findings of our study show that self-reporting measurement does not well reflect the extent to which non-smoker's exposure to smoking materials. Whereas cotinine concentration has decreased significantly over the past 10 years, the ETS exposure rate has not reduced. It strongly suggests the need for intervention in the group of non-smokers exposed to low concentrations of smoke. Therefore, an assessment using biomarkers such as cotinine-based measurement should be made in the Health Plan 2030.

• Journal of Environmental Health Sciences
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• v.47 no.4
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• pp.320-329
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• 2021

Background: Smoking exposure may be objectively assessed through specific biomarkers. The most common biomarker for smoking is cotinine concentration in urine, and setting an optimal cut-off point can accurately classify smoking status. Such a cut-off point for Korean adolescents has never been studied. Objectives: The aim of this study was to determine a cut-off point for urinary cotinine concentration for the discrimination of smoking in adolescents. Methods: Participants were adolescents aged 13~18 years who participated in the third cycle of the Korean National Environmental Health Survey. We used urine samples to confirm the level of cotinine concentrations. Smoking status was determined by self-reported questionnaire. We identified the optimal cotinine cut-off point for discriminating smoking status using receiver operating characteristic curve analysis. Results: Of the 904 participants, 28 (3.1%) were smokers, among whom 20 (71.4%) were male. The median urinary cotinine concentrations in smokers was 218 ㎍/L (male: 215 ㎍/L, female: 303 ㎍/L), and that in non-smokers was 1.31 ㎍/L (male: 1.46 ㎍/L, female: 1.18 ㎍/L). We found significant differences in urinary cotinine concentration according to smoking status and sex (p<0.001). Urinary cotinine concentrations performed well for identifying smoking adolescents [area under the curve: 0.954 (male: 0.963, female: 0.908)]. The cut-off that optimally distinguished smokers from non-smokers was 39.85 ㎍/L (sensitivity: 89.3%, specificity: 97.4%). Male [39.85 ㎍/L (sensitivity: 90.0%, specificity: 94.9%)] had a different optimal cut-off point than female [26.26 ㎍/L (sensitivity: 87.5%, specificity: 99.6%)]. Conclusions: This study determined a cut-off point for urinary cotinine of 39.85 ㎍/L (male: 39.85 ㎍/L, female: 26.26 ㎍/L) to distinguish smokers from non-smokers in adolescents.

• Journal of Environmental Health Sciences
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• v.48 no.4
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• pp.216-226
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• 2022

Background: The amount of smoking in adolescence increases with a younger age of smoking initiation and affects physical health. To establish and evaluate smoking-related policies, it is important to determine actual smoking status. Validation of self-reported questionnaires can identify the accuracy of the questionnaire data reflecting smoking status. Objectives: The purpose of this study was to evaluate the validity of self-reported smoking status and identify factors affecting the accuracy of self-reported smoking in South Korean adolescents. Methods: This study investigated the consistency between cotinine concentrations and self-reported questionnaire data through the analysis of urine samples collected from 922 adolescents aged 13~18 among the participants of Cycle 3 of the Korean National Environmental Health Survey. Smoking status was classified using the cotinine cut-off point of 39.85 ㎍/L in adolescents, and factors affecting the accuracy were analyzed through multiple logistic regression analysis. Results: The smoking rates according to the self-reported questionnaire and cut-off point-based cotinine concentrations among adolescents were 3.1% and 5.1%, respectively. The results found 97.1% consistency between self-reported smokers and smokers according to cotinine concentration. Factors affecting the discrepancy showed a significant relationship, including gender, secondhand smoke, and use of e-cigarettes. Conclusions: The results can be used as basic data to establish a smoking policy for adolescents through continuous monitoring and improvement of questionnaire items of factors affecting the discrepancy.

• Journal of Preventive Medicine and Public Health
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• v.34 no.3
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• pp.269-276
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• 2001

Objectives : To evaluate the internal burden and hazardous effects associated with smoking in middle and high school students. Methods : We analysed urinary cotinine(U-cotinine) concentrations and the frequency of Sister Chromatid Exchanges (SCE). A comparison was done of U-cotinine concentrations and the frequency of SCE in peripheral lymphocytes across school levels (middle vs. high) and smoking types (direct: daily & occasional smoking, indirect; usual indirect & non-smoking), in 122 males. Results : The middle school student group comprised 6.8% daily smokers, 15.9% occasional smokers, 40.9% daily indirect smokers, and 35.4% nonsmokers, while the high school student group comprised 18.0%, 20.5%, 35.7%, and 21.8%, respectively. The U-cotinine concentration and the frequency of SCE among the middle school students were $79.11{\mu}g/l$ and 2.0 per cell, respectively, which were significantly lower than the $146.85{\mu}g/l$ (p=0.078) and 2.6 per cell (p=0.005) of the high school students. Among the 40 direct smokers, these two biomarkers were $236.66{\mu}g/l$ and 2.59 per cell, significantly higher than the $67.33{\mu}g/l$ (p=0.0001) and 2.1 per cell (p=0.003) among indirect smoking groups. The variation in individual U-cotinine concentration ranged widely in both the indirect and direct smoking groups. Conclusion : Urinary cotinine concentrations and the frequency of Sister Chromatid Exchange seem to objectively and effectively evaluate student exposure whether it was direct or indirect smoking. Consequently, these biomarkers may be useful in monitoring the objective efficacy of anti-smoking programs in adolescent populations.

• The Journal of the Korean life insurance medical association
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• v.24
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• pp.49-78
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• 2005

Ⅰ. 연구(硏究) 배경(背景) 및 목적(目的) o 우리나라 보험시장의 세대가입율은 86%로 보험시장 성숙기에 진입하였으며 기존의 전통적인 전업채널에서 방카슈랑스의 도입, 온라인전문보험사의 출현, TM 영업의 성장세 等멀티채널로 진행되고 있음 o LTC(장기간병), CI(치명적질환), 실손의료보험 등(等)선 진형 건강상품의 잇따른 출시로 보험리스크 관리측면에서 언더라이팅의 대비가 절실한 시점임 o 상품과 마케팅 等언더라이팅 측면에서 매우 밀접한 영역의 변화에 발맞추어 언더라이팅의 인수기법의 선진화가 시급히 요구되는 상황하에서 위험을 적절히 분류하고 평가하는 선진적 언더라이팅 기법 구축이 필수 적임 o 궁극적으로 고객의 다양한 보장니드 충족과 상품, 마케팅, 언더라이팅의 경쟁력 강화를 통한 보험사의 종합이익 극대화에 기여할 수 있는 방안을 모색하고자 함 Ⅱ. 선진보험시장(先進保險市場)Risk 세분화사례(細分化事例) 1. 환경적위험(環境的危險)에 따른 보험료(保險料) 차등(差等) (1) 위험직업 보험료 할증 o 미국, 유럽등(等) 대부분의 선진시장에서는 가입당시 피보험자의 직업위험도에 따라 보험료를 차등 적용중(中)임 o 가입하는 보장급부에 따라 직업 분류방법 및 할증방식도 상이하며 일반사망과 재해사망,납입면제, DI에 대해서 별도의 방법을 사용함 o 할증적용은 표준위험율의 일정배수를 적용하여 할증 보험료를 산출하거나, 가입금액당 일정한 추가보험료를 적용하고 있음 - 광부의 경우 재해사망 가입시 표준위험율의 300% 적용하며, 일반사망 가입시 $1,000당 $2.95 할증보험료 부가 (2) 위험취미 보험료 할증 o 취미와 관련 사고의 지속적 다발로 취미활동도 위험요소로 인식되어 보험료를 차등 적용중(中)임 o 할증보험료는 보험가입금액당 일정비율로 부가(가입 금액과 무관)하며, 신종레포츠 등(等)일부 위험취미는 통계의 부족으로 언더라이터가 할증율 결정하여 적용함 - 패러글라이딩 년(年)$26{\sim}50$회(回) 취미생활의 경우 가입금액 $1,000당 재해사망 $2, DI보험 8$ 할증보험료 부가 o 보험료 할증과는 별도로 위험취미에 대한 부담보를 적용함. 위험취미 활동으로 인한 보험사고 발생시 사망을 포함한 모든 급부에 대한 보장을 부(不)담보로 인수함. (3) 위험지역 거주/ 여행 보험료 할증 o 피보험자가 거주하고 있는 특정국가의 임시 혹은 영구적 거주시 기후위험, 거주지역의 위생과 의료수준, 여행위험, 전쟁과 폭동위험 등(等)을 고려하여 평가 o 일반사망, 재해사망 등(等)보장급부별로 할증보험료 부가 또는 거절 o 할증보험료는 보험全기간에 대해 동일하게 적용 - 러시아의 경우 가입금액 $1,000당 일반사망은 2$의 할증보험료 부가, 재해사망은 거절 (4) 기타 위험도에 대한 보험료 차등 o 비행관련 위험은 세가지로 분류(항공운송기, 개인비행, 군사비행), 청약서, 추가질문서, 진단서, 비행이력 정보를 바탕으로 할증보험료를 부가함 - 농약살포비행기조종사의 경우 가입금액 $1,000당 일반사망 6$의 할증보험료 부가, 재해사망은 거절 o 미국, 일본등(等)서는 교통사고나 교통위반 관련 기록을 활용하여 무(無)사고운전자에 대해 보험료 할인(우량체 위험요소로 활용) 2. 신체적위험도(身體的危險度)에 따른 보험료차등(保險料差等) (1) 표준미달체 보험료 할증 1) 총위험지수 500(초과위험지수 400)까지 인수 o 300이하는 25점단위, 300점 초과는 50점 단위로 13단계로 구분하여 할증보험료를 적용중(中)임 2) 삭감법과 할증법을 동시 적용 o 보험금 삭감부분만큼 할증보험료가 감소하는 효과가 있어 청약자에게 선택의 기회를 제공할수 있으며 고(高)위험 피보험자에게 유용함 3) 특정암에 대한 기왕력자에 대해 단기(Temporary)할증 적용 o 질병성향에 따라 가입후 $1{\sim}5$년간 할증보험료를 부가하고 보험료 할증 기간이 경과한 후에는 표준체보험료를 부가함 4) 할증보험료 반환옵션(Return of the extra premium)의 적용 o 보험계약이 유지중(中)이며, 일정기간 생존시 할증보험료가 반환됨 (2) 표준미달체 급부증액(Enhanced annuity) o 영국에서는 표준미달체를 대상으로 연금급부를 증가시킨 증액형 연금(Enhanced annuity) 상품을 개발 판매중(中)임 o 흡연, 직업, 병력 등(等)다양한 신체적, 환경적 위험도에 따라 표준체에 비해 증액연금을 차등 지급함 (3) 우량 피보험체 가격 세분화 o 미국시장에서는 $8{\sim}14$개 의적, 비(非)의적 위험요소에 대한 평가기준에 따라 표준체를 최대 8개 Class로 분류하여 할인보험료를 차등 적용 - 기왕력, 혈압, 가족력, 흡연, BMI, 콜레스테롤, 운전, 위험취미, 거주지, 비행력, 음주/마약 등(等) o 할인율은 회사, Class, 가입기준에 따라 상이(최대75%)하며, 가입연령은 최저 $16{\sim}20$세, 최대 $65{\sim}75$세, 최저보험금액은 10만달러(HIV검사가 필요한 최저 금액) o 일본시장에서는 $3{\sim}4$개 위험요소에 따라 $3{\sim}4$개 Class로 분류 우량체 할인중(中)임 o 유럽시장에서는 영국 등(等)일부시장에서만 비(非)흡연할인 또는 우량체할인 적용 Ⅲ. 국내보험시장(國內保險市場) 현황(現況)및 문제점(問題點) 1. 환경적위험도(環境的危險度)에 따른 가입한도제한(加入限度制限) (1) 위험직업 보험가입 제한 o 업계공동의 직업별 표준위험등급에 따라 각 보험사 자체적으로 위험등급별 가입한도를 설정 운영중(中)임. 비(非)위험직과의 형평성, 고(高)위험직업 보장 한계, 수익구조 불안정화 등(等)문제점을 내포하고 있음 - 광부의 경우 위험1급 적용으로 사망 최대 1억(億), 입원 1일(日) 2만원까지 제한 o 금융감독원이 2002년(年)7월(月)위험등급별 위험지수를 참조 위험율로 인가하였으나, 비위험직은 70%, 위험직은 200% 수준으로 산정되어 현실적 적용이 어려움 (2) 위험취미 보험가입 제한 o 해당취미의 직업종사자에 준(準)하여 직업위험등급을 적용하여 가입 한도를 제한하고 있음. 추가질문서를 활용하여 자격증 유무, 동호회 가입등(等)에 대한 세부정보를 입수하지 않음 - 패러글라이딩의 경우 위험2급을 적용, 사망보장 최대 2 억(億)까지 제한 (3) 거주지역/ 해외여행 보험가입 제한 o 각(各)보험사별로 지역적 특성상 사고재해 다발 지역에 대해 보험가입을 제한하고 있음 - 강원, 충청 일부지역 상해보험 가입불가 - 전북, 태백 일부지역 입원급여금 1일(日)2만원이내 o 해외여행을 포함한 해외체류에 대해서는 일정한 가입 요건을 정하여 운영중(中)이며, 가입한도 설정 보험가입을 제한하거나 재해집중보장 상품에 대해 거절함 - 러시아의 경우 단기체류는 위험1급 및 상해보험 가입 불가, 장기 체류는 거절처리함 2. 신체적위험도(身體的危險度)에 따른 인수차별화(引受差別化) (1) 표준미달체 인수방법 o 체증성, 항상성 위험에 대한 초과위험지수를 보험금삭감법으로 전환 사망보험에 적용(최대 5년(年))하여 5년(年)이후 보험 Risk노출 심각 o 보험료 할증은 일부 회사에서 주(主)보험 중심으로 사용중(中)이며, 총위험지수 300(8단계)까지 인수 - 주(主)보험 할증시 특약은 가입 불가하며, 암 기왕력자는 대부분 거절 o 신체부위 39가지, 질병 5가지에 대해 부담보 적용(입원, 수술 등(等)생존급부에 부담보) (2) 비(非)흡연/ 우량체 보험료 할인 o 1999년(年)최초 도입 이래 $3{\sim}4$개의 위험요소로 1개 Class 운영중(中)임 S생보사의 경우 비(非)흡연우량체, 비(非)흡연표준체의 2개 Class 운영 o 보험료 할인율은 회사, 상품에 따라 상이하며 최대 22%(영업보험료기준)임. 흡연여부는 뇨스틱을 활용 코티닌테스트를 실시함 o 우량체 판매는 신계약의 $2{\sim}15%$수준(회사의 정책에 따라 상이) Ⅳ. 언더라이팅 기법(技法) 선진화(先進化) 방안(方案) 1. 직업위험도별 보험료 차등 적용 o 생 손보 직업위험등급 일원화와 연계하여 3개등급으로 위험지수개편, 비위험직 기준으로 보험요율 차별적용 2. 위험취미에 대한 부담보 적용 o 해당취미를 원인으로 보험사고(사망포함) 발생시 부담보 제도 도입 3. 표준미달체 인수기법 선진화를 통한 인수범위 대폭 확대 o 보험료 할증법 적용 확대를 통한 Risk 헷지로 총위험지수 $300{\rightarrow}500$으로 확대(거절건 최소화) 4. 보험료 할증법 보험금 삭감 병행 적용 o 삭감기간을 적용한 보험료 할증방식 개발, 고객에게 선택권 제공 5. 기한부 보험료할증 부가 o 위암, 갑상선암 등(等)특정암의 성향에 따라 위험도가 높은 가입초기에 평준할증보험료를 적용하여 인수 6. 보험료 할증법 부가특약 확대 적용, 부담보 병행 사용 o 정기특약 등(等)사망관련 특약에 할증법 확대, 생존급부 특약은 부담보 7. 표준체 고객 세분화 확대 o 콜레스테롤, HDL 등(等)위험평가요소 확대를 통한 Class 세분화 Ⅴ. 기대효과(期待效果) 1. 고(高)위험직종사자, 위험취미자, 표준미달체에 대한 보험가입 문호개방 2. 보험계약자간 형평성 제고 및 다양한 고객의 보장니드에 부응 3. 상품판매 확대 및 Risk헷지를 통한 수입보험료 증대 및 사차익 개선 4. 본격적인 가격경쟁에 대비한 보험사 체질 개선 5. 회사 이미지 제고 및 진단 거부감 해소, 포트폴리오 약화 방지 Ⅵ. 결론(結論) o 종래의 소극적이고 일률적인 인수기법에서 탈피하여 피보험자를 다양한 측면에서 위험평가하여 적정 보험료 부가와 합리적 가입조건을 제시하는 적절한 위험평가 수단을 도입하고, o 언더라이팅 인수기법의 선진화와 함께 언더라이팅 인력의 전문화, 정보입수 및 시스템 인프라의 구축 등이 병행함으로써, o 보험사의 사차손익 관리측면에서 뿐만 아니라 보험시장 개방 및 급변하는 보험환경에 대비한 한국 생보언더라이팅 경쟁력 강화 및 언더라이터의 글로벌화에도 크게 기여할 것임.