Present situation and direction of antismoking policies in Korea

A brief history of processes of determining the health consequences of smoking is given. The role and importance of the World Health Organization Framework Convention on Tobacco Control in directing the methods and principles of anti-smoking policy and regulations to be followed by the 167 countries that ratified the Convention are delineated. Evaluation of the progress done by the Korean Institute of Health and Welfare ten years after the ratification of the Convention indicates that Korea is the 24th out of 25 Organization for Economic Cooperation and Development member countries, and that the price of cigarettes was 98th among the 167 participating countries. The prevalence rate of smoking in Korea belongs to one of the highest, men in particular. Anti-smoking policy and regulations in Korea should be strongly reemphasized.

The Korean Prediction Model for Adolescents' Future Smoking Intentions / 예방의학회지

OBJECTIVES: The purpose of this study was to develop a prediction model for future smoking intention among Korean adolescents aged 13 to 15 in order to identify the high risk group exposed to future smoking. METHODS: The data was collected from a total of 5940 students who participated in a self-administrated questionnaire of a cross-sectional school-based survey, the 2004 Korea Global Youth Tobacco Survey. Chi-square tests and logistic regression analyses were carried out to identify the relevant determinants associated with intentions of adolescents' future smoking. Receiver Operation Characteristic (ROC) assessment was applied to evaluate the explanation level of the developed prediction model. RESULTS: 8.4% of male and 7.2% of female participants show their intentions of future smoking. Among non-smoking adolescents; who have past smoking experience [odds ratio (OR) 2.73; 95% confidence interval (CI) 1.92 - 3.88]; who have intentions of smoking when close friends offer a cigarette (OR 31.47; 95% CI = 21.50 - 46.05); and who have friends that are mostly smokers (OR 5.27; 95% CI = 2.85 - 9.74) are more likely to be smokers in the future. The prediction model developed from this study consists of five determinants; past smoking experience; parents smoking status; friends smoking status; ownership of a product with a cigarette brand logo; and intentions of smoking from close friends' cigarette offer. The area under the ROC curve was 0.8744 (95% CI=0.85 - 0.90) for current non-smokers. CONCLUSIONS: For efficiency, school-based smoking prevention programs need to be designed to target the high risk group exposed to future smoking through the prediction model developed by the study, instead of implementing the programs for all the students.

Socioeconomic Costs of Alcohol Drinking in Korea

BACKGROUND: The purpose of this study was to estimate socioeconomic costs caused by alcohol drinking in Korea as of 2004 in an effort to raise the awareness of the gravity of problems associated with alcohol drinking and the necessity of active intervention by family physicians. METHODS: The costs were classified as direct costs, indirect costs and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by the reduction and loss of productivity and the loss of workforce. Other costs consisted of property loss, administration costs and costs of alcohol beverage. RESULTS: The annual costs, which seemed to be attributable to alcohol drinking, were estimated to be 200,990 hundred million won (2.9% of GDP). In the case of the former, the amount included 38.83% for reduction of productivity, 26.92% for loss of the workforce, 22.24% for alcoholic beverage, 5.34% for direct medical costs, 2.29% for loss of productivity, 1.87% for direct non- medical costs, 1.54% for administration costs and 0.97% for loss of property. CONCLUSION: Our study confirms that compared with the cases of Japan (1.9% of GNP), Canada (1.09% of GDP), France (1.42% of GDP) and Scotland (1.19% of GDP), alcohol drinking incurs substantial socioeconomic costs to Koreans. An active intervention by family physicians is suggested.

Medical Expenditure of National Health Insurance Attributable to Smoking among the Korean Population / 예방의학회지

OBJECTIVES: The purpose of this study was to determine the population-attributable risk (PAR) and estimate the total medical expenditure of the Korean National Health Insurance (KNHI) due to smoking. METHODS: We used data from the Korean Cancer Prevention Study of 1,178,138 Koreans aged 30 to 95. These data were available from 1992 to 2003 and covered a long-term follow-up period among the Korean population. RESULTS: The total medical expenditure of KNHI related to smoking increased by 27% from $324.9 million in 1999 to $413.7 million in 2003. By specific diseases, smokingattributable KNHI medical expenditure was the highest for lung cancer ($74.2 million), followed by stroke ($65.3 million), COPD ($50.1 million), CHD ($49 million) and stomach cancer ($30 million). A total of 1.3 million KNHI patients were suffering from smoking-related diseases in 2003. We predicted rises in total KNHI medical expenditure related to smoking to $675.1 million (63% increase compared with that of 2003) and in the total number of KNHI patients suffering from smoking-related diseases to about 2.6million (an approximate 100% increase compared with those in 2003) in 2015. CONCLUSIONS: We found a substantial economic burden related to the high smoking prevalence in South Korea.

Smoking-Attributable Mortality Among Korean Adults: 1981-2003 / 한국역학회지

OBJECTIVES: Cigarette smoking has been widely recognized as a major risk factor for lung cancer and other diseases in Western countries. In Korea, male cigarette smoking prevalence is among the world's highest and smoking has also become a strong risk factor for lung cancer and cardiovascular diseases. The objectives of the study were to calculate the smoking-attributable mortality in Korea and to predict future smoking-attributable mortality based on the observed data. METHODS: Number of smoking-attributable deaths were calculated by applying the percentages of population attributable risks (PARs) to the estimated number of deaths by diseases. In this study, PARs were obtained by using relative risks from Korean Cancer Prevention Study and population smoking prevalence. RESULTS: Among adult male, the smoking-attributable mortality (40,087) represents 30.75% of total 2003 mortality, whereas the smoking-attributable mortality (6,120) for adult females was 5.70%. Smoking was supposed to be responsible for 37.29% of all male cancer and 26.73% of all male cardiovascular diseases, whereas smoking for 4.68% of all female cancer and 5.93% of all female cardiovascular diseases in Korea. CONCLUSION: Smoking actually represents a remarkable burden of avoidable deaths in Korea. Smoking-attributable mortality appears to continue increasing in the last years.

Smoking and cause of death in Korea: 11 years follow-up prospective study / 한국역학회지

OBJECTIVE: In Korea, male smoking prevalence is among the world's highest and mortality rates from smoking-caused cancers, particularly lung cancer, are escalating. This cohort study examined the effects of cigarette smoking on the risk of mortality from all causes, cancers and cardiovascular diseases(CVD), and characterized the relationship of the risk with the amount and duration of cigarette smoking. METHOD: A eleven-year prospective cohort study was carried out of on 1,207,592 Koreans, 30 to 95 years of age. The study population includes participants in a national insurance program, who completed a questionnaire on smoking and other risk factors. The main outcome measures were death from all causes, cancer and CVD, obtained through record linkage. At baseline, 482,997 men(60.0%) and 19,755(5.3%) women were current cigarette smokers. RESULTS: In multivariate Cox proportional hazards models, controlling for age, alcohol drinking, exercise, and obesity, current smoking among men increased the risks of mortality from all cause death (relative risk[RR], 1.56; 95% confidence interval[CI], 1.52~1.59), all cancer (1.75, 1.68~1.82), and CVD(1.46, 1.38~1.55). Similar results were found for mortality among women. Smoking also increased the risks of mortality for cancer of the lung(4.60, 4.09~5.33) and other cancers, including larynx, bile duct, esophagus, liver, stomach, pancreas, bladder, and also leukemia. Current smoking among women increased the risk of lung cancer mortality(RR=2.83, 95% CI 2.38~3.36). CONCLUSION: In Korea, smoking is an independent risk factor for death from all causes, CVD and a number of major cancers. The findings affirm the need for aggressive tobacco control in Korea in order to minimize the epidemic of smoking-caused disease.

Effects of smoking on the mortality of lung cancer in Korean men

Few studies have examined the effects of smoking on the morbidity and mortality of lung cancer in Korean men. In Korea, where the prevalence of smoking is among the highest in the world, the morbidity and mortality of lung cancer are rapidly escalating. The objectives of this study were to prospectively examine the effects of smoking on lung cancer and to determine the combined effects of the amount, duration and age that smoking was started. The design was a prospective cohort study with a follow-up period of six years (1993-1998). The subjects included a total of 305,687 Korean men from 35 to 64 years of age who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1992. The main outcome measures were deaths from lung cancer. As a baseline, 58.2% were current cigarette smokers. Between 1993 and 1998, 891 lung cancer events (34.4/100,000 people per year) occurred. In multivariate Cox proportional hazards models controlling for age, exercise and alcohol use, current smoking increased the risk of lung cancer (risk ratio [RR], 5.6; 95% confidence interval [CI], 4.2 - 7.3). There were significant dose-response relationships to the amount, duration of smoking and age that smoking was started. Compared with nonsmokers, the RR from current smokers who smoked 20 cigarettes per day for over 30 years was 8.2 (5.9 - 11.3), the RR from current smokers who smoked for over 30 years and were less then 19 years of age when they started smoking was 7.8 (5.2 - 11.9), and the RR for those who smoke 20 cigarettes per day and were less than 19 years of age when they started smoking was 8.3 (5.9 -11.6). This study demonstrates that in Korea smoking is a major independent risk factor for lung cancer, and that the risk increases with an increased amount, longer duration, and younger starting age.

Medical education in Je Joon Won / 의사학

Medical education in Je Joong Won was proposed and initiated by Dr. HN Allen. In his proposal of building a new hospital, submitted to the king in 1885, he expressed his wish to teach Western medicine to young Koreans at the hospital. The king welcomed his proposal and the plan was soon realized. Je Joon Won, the first modern hospital in Korea, opened on April 10th, 1885. The following year, on March 29th, Dr. Allen began medical school attached to the hospital. Many applicants were recruited by the government and 16 students were selected through the entrance examination. At first, they were taught English and finally 12 students out of them were selected after three months of teaching. The selected students were taught arithmetic, physics, chemistry, anatomy and physiology. The medical education at this period cannot be evaluated entirely successful since none of the 12 students was presumed to have worked as a practitioner.

The Changing Pattern of Cigarette Smoking of Students in Junior and Senior High Schools in Korea: 1988-1997 / 한국역학회지

In order to examine the actual condition of smoking, the change of knowledge and the attitude on smoking of the students attending junior and senior high schools in Korea, the survey was performed six times ranging from 1988 to 1997. The first two years, the survey was performed only for male students. Since 1991, both male and female students were surveyed. The students in junior and senior high school were selected by a random sampling method and surveyed by mail. In this survey, the number of classes of Junior and senior high schools in Korea was a sampling unit, and the classes were selected in proportion to the number of classes of each city and each county. The total number of respondents was 3,437 in 1988, 3,055 in 1989, 6,087 in 1991(2,923 of male, 3,164 of female), 7,067 in 1993(3,162 of male, 3,905 of female), 5,412 in 1995(2,598 of male, 2,814 of female), 4,754 in 1997(2,281 of male, 2,473 of female). The results obtained from the data analysis are as follows; 1.The ratio of smokers among male junior high school students has increased from 1.8% in 1988 to 3.9% in 1997. The ratio of smokers among female junior high school students has increased from 1.2% in 1991 to 3.9% in 1997. The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% in 1997. The ratio of smokers among male senior high school students has increased from 23.9% in 1988 to 35.3% 1997. And the ratio of smokers among female senior high school students has increased from 3.0% in 1991 to 8.7% in 1997. Especially the ratio of smokers among female junior high school students is same as that of male in 1997. 2. With respect to areas, the number of current smokers and the experienced ones was higher in the county than in the city in 1988. But in 1997, the number of current smokers and the experienced one is higher in the city than in the county. 3. In respect of whether or not there is a smoker among the member of a family, the odds ratio of smoking among the male senior high school students was 1.70 in 1988 and 1.94 in 1997. the odds ratio of smoking among female senior high school students was 1.43 in 1991 and 1.98 in 1997. This result showed that the effect of family smoking on adolescent smoking has not decreased.

Reward System for the Full-time Faculty Member in Medical School / 한국의학교육

No abstract available.

Self Rated Health and Mortality in Elderly Kangwha Cohort, 8-year follow up / 한국역학회지

The effect of self rated health on all cause mortality was. examined in a community residents sample of 2, 848 men and 3, 534 women aged 55 years or over who has been followed for eight years, 1985-1993. This longitudinal study, conducted in Kangwha County, Keanggido, began in 1985 with baseline examinations of physical and life style characteristics. The results indicate that the self-rated health has a profound and independent effect on all cause mortality during the study period. Cox's hazard model estimates that persons with 'poor' self-rated health has 1.7 times (CI 1.2-2. 6) higher risk of all cause mortality than persons with 'excellent' self-rated health and persons with 'worst' one has 4.2 (CI 2.6-6.2) in male. Estimates for women are similar to those of men. Further researchs to investigate the effects on cause specfic mortality and effects to reveal the work mechanism of self-rated health are highly expected.

Smoking and total mortality: Kangwha cohort study, 6-year follow-up

The relationship between smoking and total mortality was examined in a community residents population sample of 2,848 men and 3,543 women aged 55 years or over in Kangwha County, Korea during 1985-1991. A total of 1,436 deaths occurred during a 6-year follow-up among the 1.3 fold-higher in current smokers than in non-smokers among men. The relative risk of total mortality was highest for the 55-59 year old age group both in ex-smokers and in current smokers. PAR for total mortality attributed by smoking were estimated to be 26% for ex-smokers and 25% for current smokers in men. The biggest RR (2.1) and PAR (49%) were observed among those who smoked less than 19 cigarettes per day compared to non-smokers in males. Smokers who began to smoke at age 18 or before showed RR 1.8, and PAR 38% in men. Smoking was the most important variable related with total mortality second only to hypertensiveness not including preventable ones among men in multivariate analyses. Men who began to smoke at nineteen years of age or before had RR 1.5 for total cancer mortality. Women showed the similar picture as males in risk factors composition and in relative risks, with a low association strength, however.

The effect of smoking on health service utilization

This study involved direct observation of the differences in prevalence of disease and utilization of medical care by smokers, non-smokers, and ex-smokers. The data was collected from the 1989 Korean National Health Survey (1989 KNHS). A total of 5,201 individuals ages 20 to 59 were randomly selected from the whole Korean population using the three-stage stratified random sampling. Based on the logistic regression, the following results were obtained. Compared with the non-smokers, the relative risks for an acute disease were 1.9 and 1.7 for male ex-smokers and female current smokers, respectively. Smoking behavior significantly increased utilization of health services such as admissions (RR = 2.5 for current smokers) among females, outpatient visits (RR = 2.1 for ex-smokers, RR = 2.3 for age began to smoke was less than 18 years) among males and (RR = 1.5 for current smokers) among females. Furthermore, the utilization of outpatient services for ex-smokers who were self-concerned about their health was 3.4 times higher than the non-smokers. Based on the weighted least square regression model the days of medication for male current smokers and ex-smokers were significantly longer than non-smokers. These effects persisted after controlling for major identified confounding factors. Thus, the results of this study confirmed that smoking is an important cause of diseases and a major contributing factor to the use of health services.

The Change In Blood Pressure And Factors Affecting The Change In Blood Pressure For Korean Children: A Six-Year Follow-Up Study / 예방의학회지

For the purposes of analyzing the distribution and the change in blood pressure according to age and determining the factors affecting the change in blood pressure, a follow-up study had been conducted for 6 years from 1986 to 1991 for 430 primary school children age 6 years old in 1986 in Kangwha County, Korea. The mean blood pressure increased according to age. Specifically mean systolic blood pressure increased from 97.3 mmHg for male and 96.4mmHg for female(at 6 years of age) to 108.8mmHg for male and 112.1mmHg for female(at 11 years of age). Mean diastolic blood pressure increased from 60.0mmHg for male and 61.8mmHg for female(at 6 years of age) to 72.9mmHg for male 73.8mmHg for female(at 11 years of age). The average annual increase in blood pressure was 2.3mmHg(in systolic blood pressure) and 2.4mmHg(in diastolic blood pressure) for female, respectively. To determine the factors affecting the change in blood pressure, the stepwise regression analysis was conducted. Children were divided into the three groups(low, middle, and upper) according to the level of systolic and diastolic blood pressure at the age of 6, and the regression analysis was performed in each group. For the change in systolic blood pressure, the changes in weight and skinfold thickness or initial skinfold thickness for male, and the change in weight for female were selected as significant factors for children in middle and upper group. For the change of blood pressure in diastolic blood pressure, no variables was significant.

Smoking and female lung cancer by morphological types, a case-control study / 한국역학회지

No abstract available.

A study on time-series changes of visual acuity and related factorsfor high school students in Seoul / 한국역학회지

No abstract available.

The Change of Children's Blood Pressure and Factors Affecting the Level of Blood Pressure In Children / 예방의학회지

To show the distribution and change of blood pressure according to age and find factors affecting the level of blood pressure in primary school children, a follow-up study was conducted from 1986 to 1989 on 401 first grade children attending primary school in Kangwha county in 1986 and their parents. The blood pressure of the children was significantly increased according to age. The average annual increase was 1.8mmHg in systolic blood pressure and 2.5mmHg in diastolic blood pressure. The level of blood pressure did not show any significant difference in both sexes. Among children who were at or above the 80th percentile of blood pressure in the first grade, 35 and 30% of them have remained at the same level of systolic and diastolic blood pressure respectively in the fourth grade. But we could not find any significance in the tracking of blood pressure of children who were at or above the 90th percentile of blood pressure in the first grade. Weight and pulse rate were shown to significant factors affecting systolic blood pressure in children of both sexes and mother's blood pressure and skinfolds thickness were also affected systolic blood pressure in girls. The variables significantly affecting diastolic blood pressure were arm circumference and pulse rate for boys and height and pulse rate for girls.

Incidence and survival of cancer in Kangwha County (1983-1987)

To measure incidence and survival rates of cancer in Kangwha County, 663 cancer patients registered in the Kangwha County Cancer Registry Program for the past 5 years (1983-1987) were analyzed. The average annual cancer incidence rate per 100,000 population was 183.0 in males and 99.5 in females. The common cancers were stomach (37.3%), lung (14.8%), and liver cancer (11.1%) in males and stomach (25.6%), cervix uteri (20.9%), and liver cancer (9.7%) in females. The median survival times of all cancer patients after diagnosis and onset of the first symptom were 8.4 +/- 0.8 months and 15.0 +/- 1.1 months respectively. Female cancer patients survived significantly longer than male cancer patients. The median survival times of the stomach, lung, and liver cancer in males were 7.7 +/- 0.9, 4.9 +/- 0.9, and 2.3 +/- 0.4 months respectively. In females, the median survival times of the stomach and liver cancer patients were 9.2 +/- 1.5 and 2.5 +/- 0.5 months. The 5 year survival rate of cervical cancer was 67.1%. Those cancer patients who received anticancer therapy survived significantly longer than cancer patients without treatment.

Incidence and survival of cancer in Kangwha County (1983-1987)

To measure incidence and survival rates of cancer in Kangwha County, 663 cancer patients registered in the Kangwha County Cancer Registry Program for the past 5 years (1983-1987) were analyzed. The average annual cancer incidence rate per 100,000 population was 183.0 in males and 99.5 in females. The common cancers were stomach (37.3%), lung (14.8%), and liver cancer (11.1%) in males and stomach (25.6%), cervix uteri (20.9%), and liver cancer (9.7%) in females. The median survival times of all cancer patients after diagnosis and onset of the first symptom were 8.4 +/- 0.8 months and 15.0 +/- 1.1 months respectively. Female cancer patients survived significantly longer than male cancer patients. The median survival times of the stomach, lung, and liver cancer in males were 7.7 +/- 0.9, 4.9 +/- 0.9, and 2.3 +/- 0.4 months respectively. In females, the median survival times of the stomach and liver cancer patients were 9.2 +/- 1.5 and 2.5 +/- 0.5 months. The 5 year survival rate of cervical cancer was 67.1%. Those cancer patients who received anticancer therapy survived significantly longer than cancer patients without treatment.

Familial Aggregation of Blood Pressure

To examine the familial aggregation of blood pressure, household interviews and health examination surveys were conducted from July 9 to August 18, 1986 on 469 families with first grade children who attended primary schools in Kangwha County. Blood pressure, height, weight, pulse rate and the arm circumference of 1972 family members from three generations were measured, followed by an interview concerning preference for salty foods and any prescribed hypertensive drugs. Based on the binomial goodness-of-fit test and analysis of variance, familial aggregation of blood pressure was identified. The genetic component of blood pressure was estimated to be approximately 22.3% of the total variance in systolic blood pressure and 21.4% in diastolic blood pressure by using a mixed model two way ANOVA. Significant correlations were found in systolic and diastolic blood pressures among almost all family members. Correlations of blood pressure between siblings were higher in families with hypertensive parents than with normotensive parents. A shared environment and the degree of sharing also influenced blood pressure. There is a need of a follow-up study on children's blood pressure since the familial aggregation varied with the age of the children.