본 연구는 폐결핵 환자의 일반적 특성, 질병관련 특성, 흡연관련 특성과 우울, 스트레스 및 금연관련 자기효능감을 파악하고, 흡연행위에 영향을 미치는 요인을 규명하기 위한 서술적 조사연구이다.
연구대상은 전남 M시 국립결핵병원에 등록하여 외래진료를 통해 관리를 받고 있는 폐결핵 환자로 하였다. 목포국립병원 생명윤리 심의위원회의 승인을 받은 후 2016년 1월부터 3월까지 자료를 수집하였다. 자료수집은 자기기입식 구조화된 설문지를 사용하였다. 설문지는 대상자의 특성 38문항, 우울 21문항, 스트레스 8문항, 금연관련 자기효능감 11문항으로 총 78문항으로 구성되었다. 수집된 자료 중 130부를 최종자료로 분석하였다. 자료분석은 SPSS 21.0프로그램을 이용하여 실수, 백분율, 평균, 표준편차, 기술통계 분석, 카이제곱 교차분석, 독립표본 t-검증, 상관분석, 이분형 로지스틱 회귀분석을 이용하여 분석하였다.

연구결과를 요약하면 다음과 같다.
1. 본 대상자의 일반적 특성에서 남성이 여성보다 많았고, 60세 이상이 43.9%로 가장 많았다. 직업이 없는 경우가 50.8%였으며, 소득수준이 100만원 미만인 경우가 60.8%였다. 대상자의 질병관련 특성에서 결핵치료 횟수는 2회 25.4%, 3회 이상 14.6%였다. 결핵치료 중단경험이 있는 대상자는 36.9%, 결핵 완치가 가능할 것으로 기대하는 대상자는 72.3%, 결핵 가족력이 있는 대상자는 16.2%였다. 대상자의 흡연관련 특성에서 흡연자는 43.8%였다. 친구 중 흡연자가 있는 경우는 66.2%, 가족 중 흡연자가 있는 경우는 51.5%이었으며 금연교육을 경험한 적이 없는 경우가 72.3%였다.

2. 대상자의 우울, 스트레스 및 금연관련 자기효능감 정도에서 평균으로 우울은 20.82점, 스트레스는 22.87점, 그리고 금연관련 자기효능감은 42.75점이었다.

3. 대상자의 흡연유무에 따른 일반적 특성은 성별, 연령, 동거 유무, 직업 유무, 소득 수준, 음주 상태에서 유의한 차이가 있었다. 질병관련 특성은 결핵치료 횟수, 결핵치료 중단 경험에서 유의한 차이가 있었고, 흡연관련 특성은 친구 중 흡연자 유무에서 유의한 차이가 있었으며, 주요 변수인 우울, 스트레스 및 금연관련 자기효능감 중에서는 우울과 금연관련 자기효능감에 따라 유의한 차이가 있었다.

4. 본 연구의 상관분석 결과, 우울은 흡연, 스트레스, 금연관련 자기효능감과 각각 유의한 양의 상관관계가 있었다. 금연관련 자기효능감과 흡연, 스트레스는 각각 유의한 음의 상관관계가 있었다.

5. 폐결핵 환자의 흡연행위에 영향을 미치는 요인으로는 성별, 직업 유무, 우울, 금연관련 자기효능감이 영향을 미치는 것으로 나타났으며, 흡연 위험비는 여성에 비해 남성이 67.36배, 무직에 비해 직업이 있는 경우가 17.51배, 우울이 높을수록 1.16배, 금연관련 자기효능감이 낮을수록 1.46배 더 높았다.

본 연구결과를 종합해보면 폐결핵 환자 중 흡연율은 높은 수준이며, 이러한 흡연행위에 가장 큰 영향을 미치는 요인은 성별, 직업유무, 우울, 금연관련 자기효능감임을 확인할 수 있었다. 따라서, 남성 폐결핵 환자들을 대상으로 흡연행위에 영향을 미치는 심리적 요인인 우울을 감소시키고, 금연관련 자기효능감을 강화시킬 수 있는 금연 프로그램의 개발?적용 및 금연 교육의 기회를 확산하여 폐결핵 환자들이 스스로 금연을 선택하고 실행, 유지하게 된다면 결핵의 재발방지와 이환 후 결핵치료에 있어 좋은 예후를 기대할 수 있을 것으로 사료된다.

This study is descriptive research to understand general characteristics, disease-related characteristics, smoking-related characteristics, depression, stress and smoking-related self-efficacy of patients with pulmonary tuberculosis and investigate and reveal the factors affecting their smoking behavior.
The subjects of the study were patients with pulmonary tuberculosis who registered in a National Tuberculosis Hospital in M. City, Jeollanam-do and received administration through outpatient care. After obtaining approval from the Bioethics Committee of the Mokpo National Tuberculosis Hospital, data were collected from January through March 2016. For the data collection, a self-administered structured questionnaire was used. The questionnaire consisted of 78 questions in total: 38 questions about the subjects’ characteristics; 21 questions about their depression; 8 questions about their stress; and 11 questions about their smoking-related self-efficacy. 130 copies of the collected data were analyzed as the final materials. For a data analysis, real number, percentage, mean, standard deviation, descriptive statistics analysis, Chi-square cross-tabulation analysis, independent sample t-test, correlation analysis, and binomial logistic regression analysis were conducted, using SPSS 21.0.

The results of the study are summarized as follows:
1. In the general characteristics of the subjects of this study, there were more men than women, and most of them (43.9%) were those over 60. For occupational status, 50.8% of them did not have a job, and for income level, 60.8% made less than one million won. In the subjects’ disease-related characteristics, the number of times of tuberculosis treatment was two times in 25.4% and more than three times in 14.6%. 36.9% had an experience of tuberculosis treatment discontinuation; 72.3% expected that they could completely cure tuberculosis; and 16.2% had a family history of tuberculosis. In the subjects’ smoking-related characteristics, 43.8% were smokers. 66.2% had a friend who was a smoker; 51.5% had a family member who was a smoker; and 72.3% had no experience of smoking prevention education.
2. In the degrees of the subjects’ depression, stress and smoking-related self-efficacy, the average depression was 20.82 points; the average stress was 22.87 points; and the average smoking-related self-efficacy was 42.75 points.
3. For the subjects’ general characteristics according to their smoking status, there were significant differences in sex, age, living with family, occupational status, income level and drinking status. For their disease-related characteristics, there were significant differences in the number of times of tuberculosis treatment and the experience of tuberculosis treatment discontinuance; for their smoking-related characteristics, there was a significant difference in whether they had a smoker among their friends; and of the main variables, depression, stress and smoking-related self-efficacy, there were significant differences according to depression and smoking-related self-efficacy.
4. As a result of a correlation analysis of this study, depression had a significant positive correlation with smoking, stress, and smoking-related self-efficacy, respectively. Smoking-related self-efficacy, smoking, and stress had a significant negative correlation with each other, respectively.
5. Factors affecting the smoking behavior of the patients with pulmonary tuberculosis were sex, occupational status, depression and smoking-related self-efficacy: Smoking risk ratio was 67.36 times higher in men than in women; 17.51 times higher in patients with a job than in those without one; 1.16 times higher in those with higher depression; and 1.46 times higher in those with lower smoking-related self-efficacy.

To sum up the results of this study, the smoking ratio of the patients with pulmonary tuberculosis was at a high level, and the biggest factors affecting their smoking behavior included sex, occupational status, depression and smoking-related self-efficacy. Therefore, with male patients with pulmonary tuberculosis, reducing depression, a psychological factor affecting their smoking behavior, developing and applying a smoking prevention program that could enhance their smoking-related self-efficacy, spreading opportunity of smoking prevention education, so that the patients choose, practice and maintain quitting smoking themselves, it is judged that the prevention of the recurrence of tuberculosis and a good prognosis can be expected in the treatment of tuberculosis after the contraction.