Comparison of the risks of combustible cigarettes, e-cigarettes, and heated tobacco products

E-cigarettes (ECs) and heated tobacco products (HTPs) have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than combustible cigarettes (CCs). In general, the levels of harmful and potentially harmful constituents (HPHCs) are lower in ECs and HTPs than in CCs, although the levels of some heavy metals and HPHCs are higher in ECs and HTPs than in CCs. ECs and HTPs showed possible adverse effects on respiratory and cardiovascular system function, which could result in chronic respiratory and cardiovascular system diseases in animals. An analysis of biomarkers showed that ECs had possible adverse health effects on the respiratory and cardiovascular systems, in addition the effects of HTP on respiratory and cardiovascular systems were not significantly different than those of CC. Epidemiological studies identified positive associations between EC use and asthma, chronic obstructive pulmonary disease, and myocardial infarction. Only one epidemiologic study reported a positive association between ever using HTPs and asthma, allergic rhinitis, and atopic dermatitis among adolescents. Modelling studies of ECs did not show consistent findings regarding the health effects compared with those of CCs. A modeling study of HTPs, performed by tobacco industry, has been criticized for many unfounded assumptions. Lower levels of HPHCs in ECs and HTPs, compared with those in CCs, cannot be directly translated into health benefits because the relationship between exposure and effects is non-linear for cardiovascular diseases and because the duration of exposure is more important than the level of exposure in determining lung cancer mortality. In summary, there is no definite health benefit in using ECs or HTPs instead of CCs, for the individual or the population; hence, tobacco control measures should be the same for ECs, HTPs, and CCs. ECs and HTPs have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than CCs.

Comparison of the risks of combustible cigarettes, e-cigarettes, and heated tobacco products

E-cigarettes (ECs) and heated tobacco products (HTPs) have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than combustible cigarettes (CCs). In general, the levels of harmful and potentially harmful constituents (HPHCs) are lower in ECs and HTPs than in CCs, although the levels of some heavy metals and HPHCs are higher in ECs and HTPs than in CCs. ECs and HTPs showed possible adverse effects on respiratory and cardiovascular system function, which could result in chronic respiratory and cardiovascular system diseases in animals. An analysis of biomarkers showed that ECs had possible adverse health effects on the respiratory and cardiovascular systems, in addition the effects of HTP on respiratory and cardiovascular systems were not significantly different than those of CC. Epidemiological studies identified positive associations between EC use and asthma, chronic obstructive pulmonary disease, and myocardial infarction. Only one epidemiologic study reported a positive association between ever using HTPs and asthma, allergic rhinitis, and atopic dermatitis among adolescents. Modelling studies of ECs did not show consistent findings regarding the health effects compared with those of CCs. A modeling study of HTPs, performed by tobacco industry, has been criticized for many unfounded assumptions. Lower levels of HPHCs in ECs and HTPs, compared with those in CCs, cannot be directly translated into health benefits because the relationship between exposure and effects is non-linear for cardiovascular diseases and because the duration of exposure is more important than the level of exposure in determining lung cancer mortality. In summary, there is no definite health benefit in using ECs or HTPs instead of CCs, for the individual or the population; hence, tobacco control measures should be the same for ECs, HTPs, and CCs. ECs and HTPs have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than CCs.

Comparison of the risks of combustible cigarettes, e-cigarettes, and heated tobacco products

E-cigarettes (ECs) and heated tobacco products (HTPs) have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than combustible cigarettes (CCs). In general, the levels of harmful and potentially harmful constituents (HPHCs) are lower in ECs and HTPs than in CCs, although the levels of some heavy metals and HPHCs are higher in ECs and HTPs than in CCs. ECs and HTPs showed possible adverse effects on respiratory and cardiovascular system function, which could result in chronic respiratory and cardiovascular system diseases in animals. An analysis of biomarkers showed that ECs had possible adverse health effects on the respiratory and cardiovascular systems, in addition the effects of HTP on respiratory and cardiovascular systems were not significantly different than those of CC. Epidemiological studies identified positive associations between EC use and asthma, chronic obstructive pulmonary disease, and myocardial infarction. Only one epidemiologic study reported a positive association between ever using HTPs and asthma, allergic rhinitis, and atopic dermatitis among adolescents. Modelling studies of ECs did not show consistent findings regarding the health effects compared with those of CCs. A modeling study of HTPs, performed by tobacco industry, has been criticized for many unfounded assumptions. Lower levels of HPHCs in ECs and HTPs, compared with those in CCs, cannot be directly translated into health benefits because the relationship between exposure and effects is non-linear for cardiovascular diseases and because the duration of exposure is more important than the level of exposure in determining lung cancer mortality. In summary, there is no definite health benefit in using ECs or HTPs instead of CCs, for the individual or the population; hence, tobacco control measures should be the same for ECs, HTPs, and CCs. ECs and HTPs have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than CCs.

Evaluation of the tobacco control policies of the Moon Jae-in government

Tobacco use is the most important preventable cause of mortality in South Korea and worldwide. This study aimed to evaluate the tobacco control policies of the Moon Jae-in government, which was established in May 10, 2017. Before the Moon Jae-in government, the tobacco tax was raised by the Park Geun-hye government from 2,500 won to 4,500 won (80% increase), but the price of cigarettes was still much lower in Korea than in other high-income countries. Cigarette smoking has been prohibited in all restaurants and bars since 2015; however, smoking rooms are allowed. Only large buildings are smoke-free. Pictorial warnings on cigarette packages were introduced in December 2016; however, they cover only 30% of the main packaging. Smoking cessation services provided by health care facilities have been subsidized by public health insurance since 2015. However, the advertisement, promotion, and sponsorship of tobacco are not further regulated. Since the beginning of the Moon Jae-in government, there has been no further strengthening of major tobacco control policies except for limited expansion of smoke-free public places and introduction of a lung cancer screening program. The first government-level tobacco control policies by the Moon Jae-in government, announced in May 2019, included increasing the size of the pictorial warnings and introducing standardized packaging by 2025, along with incremental expansion of smoke-free public places with prohibition of smoking rooms. These moves are positive; however, they do not include increasing tobacco taxes and regulating advertisement, promotion, and sponsorship of tobacco, which together are the backbone of tobacco control policies. The Moon Jae-in government should strengthen comprehensive tobacco control policies, ncluding tobacco taxes and banning tobacco advertisement, promotion, and sponsorship, to protect public health.

Cigarette Smoking Preferentially Affects Intracranial Vessels in Young Males: A Propensity-Score Matching Analysis / 신경중재치료의학

PURPOSE: Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors. MATERIALS AND METHODS: All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups. RESULTS: Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup. CONCLUSION: In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.

Evaluation of the tobacco control policies of the Moon Jae-in government

Tobacco use is the most important preventable cause of mortality in South Korea and worldwide. This study aimed to evaluate the tobacco control policies of the Moon Jae-in government, which was established in May 10, 2017. Before the Moon Jae-in government, the tobacco tax was raised by the Park Geun-hye government from 2,500 won to 4,500 won (80% increase), but the price of cigarettes was still much lower in Korea than in other high-income countries. Cigarette smoking has been prohibited in all restaurants and bars since 2015; however, smoking rooms are allowed. Only large buildings are smoke-free. Pictorial warnings on cigarette packages were introduced in December 2016; however, they cover only 30% of the main packaging. Smoking cessation services provided by health care facilities have been subsidized by public health insurance since 2015. However, the advertisement, promotion, and sponsorship of tobacco are not further regulated. Since the beginning of the Moon Jae-in government, there has been no further strengthening of major tobacco control policies except for limited expansion of smoke-free public places and introduction of a lung cancer screening program. The first government-level tobacco control policies by the Moon Jae-in government, announced in May 2019, included increasing the size of the pictorial warnings and introducing standardized packaging by 2025, along with incremental expansion of smoke-free public places with prohibition of smoking rooms. These moves are positive; however, they do not include increasing tobacco taxes and regulating advertisement, promotion, and sponsorship of tobacco, which together are the backbone of tobacco control policies. The Moon Jae-in government should strengthen comprehensive tobacco control policies, ncluding tobacco taxes and banning tobacco advertisement, promotion, and sponsorship, to protect public health.

Environmental Tobacco Smoke Can Be an Important Risk Factor for Children's Behavioral Problems, and Policies to Reduce Exposure Are Urgently Required

No abstract available.

Current status of tobacco control policies in Korea compared with international treaty and its implementation

The Framework Convention on Tobacco Control (FCTC) entered into effect in 2005 and has been ratified by 181 parties. The major tobacco control policies included in the FCTC are increased tobacco taxes; smoke-free public places; bans on tobacco advertisements, promotion, and sponsorship; regulations of tobacco packaging and labeling; regulations and disclosure of tobacco component and emissions; public awareness campaigns about the adverse health effects of tobacco use; treatment of tobacco use and dependence; and bans on tobacco sales to minors. Since the FCTC was ratified, tobacco control policies have been strengthened worldwide, but with different effects for different policies. A high level of performance was achieved in 55% of the signatory countries for warnings about the hazards of tobacco and in 30% for monitoring tobacco control policies, but tobacco tax increases, smoke-free polices, and bans on tobacco advertisement, promotion, and sponsorship achieved high levels of success in only about 10% of the countries. Korea recently strengthened some tobacco control policies, including tobacco tax increases, mass media campaigns, pictorial warnings on tobacco packs, smoke-free bars and restaurants, and reimbursement for smoking cessation services provided by health care facilities. However, the price of cigarettes remains very low considering the nation's income level, and tobacco advertisements, promotion, and sponsorship are only partially restricted. Workplace smoke-free policies are limited to large companies. Only monitoring of tobacco control policies and smoking cessation services are at a high level in Korea. Comprehensive tobacco control polices need to be strengthened, and physicians should play a leading role.

The Seoul Healthy First Step Project: Introduction and Expansion, Program Content and Performance, and Future Challenges

With the motto ‘Equity from the Start for a Healthy Future’, the Seoul Healthy First Step Project (SHFSP) was launched in 2013 in an attempt to support women with young children, to improve the health and development of babies, and eventually to close the gap in child development. The SHFSP contains both universal components (universal risk assessment of mothers and universal home visitation after birth) and selective components (prenatal and postnatal sustained home visits, mothers' groups, and community service linkage), thereby taking a proportionate universality approach. For sustained home visits, the SHFSP introduced the Maternal and Early Childhood Sustained Home-visiting (MECSH) program from Australia, which has been proven to be effective in improving maternal and childhood outcomes. Between 2013~2017, the SHFSP has paid 58,327 visits to roughly 38 thousand families with babies. In 2017, the SHFSP covered 19.6% of families with newborn babies in Seoul. The SHFSP conducted internal satisfaction surveys of universal and sustained visitation service recipients, in which an overwhelming majority of mothers provided positive feedback. A performance assessment conducted in 2016 by an external organization showed that 93% of SHFSP service recipients were satisfied with the home visitations. Considering the popular support for the program from mothers and families in Seoul (the most affluent area in Korea) and the lack of a national home visiting program to promote early childhood health and development, this program should be expanded nationally in the near future.

Current status of tobacco control policies in Korea compared with international treaty and its implementation

The Framework Convention on Tobacco Control (FCTC) entered into effect in 2005 and has been ratified by 181 parties. The major tobacco control policies included in the FCTC are increased tobacco taxes; smoke-free public places; bans on tobacco advertisements, promotion, and sponsorship; regulations of tobacco packaging and labeling; regulations and disclosure of tobacco component and emissions; public awareness campaigns about the adverse health effects of tobacco use; treatment of tobacco use and dependence; and bans on tobacco sales to minors. Since the FCTC was ratified, tobacco control policies have been strengthened worldwide, but with different effects for different policies. A high level of performance was achieved in 55% of the signatory countries for warnings about the hazards of tobacco and in 30% for monitoring tobacco control policies, but tobacco tax increases, smoke-free polices, and bans on tobacco advertisement, promotion, and sponsorship achieved high levels of success in only about 10% of the countries. Korea recently strengthened some tobacco control policies, including tobacco tax increases, mass media campaigns, pictorial warnings on tobacco packs, smoke-free bars and restaurants, and reimbursement for smoking cessation services provided by health care facilities. However, the price of cigarettes remains very low considering the nation's income level, and tobacco advertisements, promotion, and sponsorship are only partially restricted. Workplace smoke-free policies are limited to large companies. Only monitoring of tobacco control policies and smoking cessation services are at a high level in Korea. Comprehensive tobacco control polices need to be strengthened, and physicians should play a leading role.

Results of an Inpatient Smoking Cessation Program: 3-Month Cessation Rate and Predictors of Success / 가정의학회지

BACKGROUND: Hospitalization presents smokers with an opportunity to initiate smoking cessation. We studied the effect of inpatient counseling and follow-up after discharge on smoking cessation and assessed predictors of successful cessation. METHODS: This study included a total of 125 patients (118 male and 7 female) who were admitted to departments of neurology, cardiology, and pulmonology. They were referred to the smoking cessation clinic, and participated between September 2011 and February 2013. A counseling service lasting about thirty minutes was provided by the third-year family medicine residents during hospitalization. The follow-up counseling services, which were either by telephone or in-person physician counseling were provided at 1 week, 4 weeks, and 3 months. Smoking habits and nicotine dependency data were gathered using questionnaires, and patient information was collected from electronic medical records. RESULTS: The average age in the study was 57.9 +/- 10.2 years and duration of smoking was 35.9 +/- 11.7 years. Daily tobacco consumption was 23.5 +/- 13.2 cigarettes. The smoking cessation rate after 3 months was 42.4%. The only differences between patients in the successful cessation and failed groups were cause of admission (P = 0.039) and total number of counseling sessions after discharge (P or =3 visits: OR, 121.873; 95% CI, 14.462 to 1,027.055). CONCLUSION: Smoking cessation counseling during hospitalization and further follow-up by telephone or outpatient counseling after discharge contributed to an increased smoking cessation rate. The smoking cessation rate also tended to increase with total counseling numbers.

A Study Design to Evaluate Association between Smoking and Intracranial Atherosclerotic Stenosis / 신경중재치료의학

PURPOSE: Smoking is a well known risk factor for stroke. The cerebral arteries may be uniquely susceptible to the atherosclerotic effects of smoking, such that it has a different risk profile for stroke compared with other atherosclerosis risk factors. It remains uncertain whether smoking is associated specifically with intracranial (IC) or extracranial (EC) atherosclerotic cerebrovascular disease. The aim of this study design will be to evaluate the association between smoking and severe IC stenosis, adjusting for other atherosclerosis risk factors, particularly age distribution. STUDY DESIGN: This is a retrospective cohort study design. Participants are patients (n=1714) with severe atherosclerotic stenosis undergoing cerebral catheter angiography because of stroke or transient ischaemic attack. All atherosclerotic steno-occlusive lesions are described in terms of location (anterior versus posterior circulation, IC versus EC, or intradural versus extradural). The atherosclerotic or stroke risk factors for analysis include age, gender, smoking history, number of lesions (single versus multiple), cardiac disease, diabetes mellitus, hypertension, family history, dyslipidemia, history of previous stroke, alcohol intake, metabolic syndrome and body mass index. Statistical analysis includes univariate analysis followed by multivariate logistic regression. The relationship between IC atherosclerotic stenosis and smoking will be assessed. Differences in risk factor distribution is analysed according to age at intervals of 10 years. Significant risk factors associated with IC atherosclerotic stenosis will also be assessed by multivariate logistic regression analysis. SUMMARY: This is an analytical study design that intends to measure the association between IC or EC atherosclerotic stenosis and smoking and other risk factors. We anticipate that it will have the power to detect any relationship between smoking and IC atherosclerotic lesions especially in younger patients.

The Status and Future Challenges of Tobacco Control Policy in Korea / 예방의학회지

Tobacco use is the most important preventable risk factor for premature death. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the first international public health treaty, came into force in 2005. This paper reviews the present status of tobacco control policies in Korea according to the WHO FCTC recommendations. In Korea, cigarette use is high among adult males (48.2% in 2010), and cigarette prices are the lowest among the Organization for Economic Cooperation and Development countries with no tax increases since 2004. Smoke-free policies have shown incremental progress since 1995, but smoking is still permitted in many indoor public places. More than 30% of non-smoking adults and adolescents are exposed to second-hand smoke. Public education on the harmful effects of tobacco is currently insufficient and the current policies have not been adequately evaluated. There is no comprehensive ban on tobacco advertising, promotion, or sponsorship in Korea. Cigarette packages have text health warnings on only 30% of the main packaging area, and misleading terms such as "mild" and "light" are permitted. There are nationwide smoking cessation clinics and a Quitline service, but cessation services are not covered by public insurance schemes and there are no national treatment guidelines. The sale of tobacco to minors is prohibited by law, but is poorly enforced. The socioeconomic inequality of smoking prevalence has widened, although the government considers inequality reduction to be a national goal. The tobacco control policies in Korea have faltered recently and priority should be given to the development of comprehensive tobacco control policies.

Equity in health care: current situation in South Korea

Health care has contributed improvement of health, however, it may aggravate health inequity if there is socioeconomic disparities in access to health care service or quality in health care. Health care interventions may cause health inequalities if there is difference in effectiveness among different socioeconomic groups (SEG) because of difference in access, diagnostic accuracy, provider and consumer compliance. In Korea, there are disparities in access to health care between urban and rural population due to geographical maldistribution of medical personnels and facilities. Health care financing was regressive due to reliance on health insurance contribution. Private insurance is more prevalent among higher income group. Health care utilization is more common among lower SEG, however differences nearly disappeared or changed to favor higher SEG when need is considered. This trend is more serious in elderly and for tertiary hospitals. Preventive services including hepatitis B vaccination and cancer screening showed inequality favoring higher SEG, however influenza vaccination among elderly showed opposite and national cancer screening program has reduced the gap. Quality of health care was worse among lower SEG with shorter survival for cancer patients after diagnosis or surgery, patients with myocardial infarction, ischemic and hemorrhagic stroke, hip fracture and burn among lower SEG. Moreover, checkup for diabetes complications and hypertension treatment were less complete among lower SEG. Every health policy should be equity sensitive. Monitoring on health care service equity should be introduced and measures to correct distal and proximal causes of health care inequity should be introduced.

The Incidence of Thyroid Cancer Is Affected by the Characteristics of a Healthcare System

The aim of this study was to investigate the associations between the incidence of thyroid cancer and the characteristics of healthcare systems in OECD countries and to demonstrate that the increasing incidence of thyroid cancer is mainly due to overdiagnosis. We used a random effects panel model to regress the incidence of thyroid cancer on the characteristics of healthcare systems (i.e., share of public expenditure on health, mode of health financing, existence of referral system to secondary care, mode of payment to primary care physicians), controlling for macro context variables (i.e., GDP per capita, educational level) on a country level. Data were derived from 34 OECD countries for 2002 and 2008. The share of public expenditure on health was negatively associated with the incidence of thyroid cancer. However, it had no statistically significant effect on the mortality of thyroid cancer and on the incidence of stomach and lung cancer. In the case of colorectal cancer, it had a positive effect on the incidence rate. The upward trend of the incidence of thyroid cancer is closely related to the healthcare system that permits overdiagnosis. Increases in the proportion of public financing may help reduce the overdiagnosis of thyroid cancer.

Changes in Contribution of Causes of Death to Socioeconomic Mortality Inequalities in Korean Adults / 예방의학회지

OBJECTIVES: This study aimed to analyze long-term trends in the contribution of each cause of death to socioeconomic inequalities in all-cause mortality among Korean adults. METHODS: Data were collected from death certificates between 1990 and 2004 and from censuses in 1990, 1995, and 2000. Age-standardized death rates by gender were produced according to education as the socioeconomic position indicator, and the slope index of inequality was calculated to evaluate the contribution of each cause of death to socioeconomic inequalities in all-cause mortality. RESULTS: Among adults aged 25-44, accidental injuries with transport accidents, suicide, liver disease and cerebrovascular disease made relatively large contributions to socioeconomic inequalities in all-cause mortality, while, among adults aged 45-64, liver disease, cerebrovascular disease, transport accidents, liver cancer, and lung cancer did so. Ischemic heart disease, a very important contributor to socioeconomic mortality inequality in North America and Western Europe, showed a very low contribution (less than 3%) in both genders of Koreans. CONCLUSIONS: Considering the contributions of different causes of death to absolute mortality inequalities, establishing effective strategies to reduce socioeconomic inequalities in mortality is warranted.

Relationship between Overweight and Socioeconomic Factors in Korean Adolescents: Using Data from the 2007 Korean Youth's Risk Behavior Web-based Study / 가정의학회지

BACKGROUND: Overweight in Korean adolescents has continuously increased over the past few years and it is recognized as a public health problem. We investigated the relationship between socioeconomic status and overweight in Korean adolescents. METHODS: The data was obtained from the 2007 Korean Youth's Risk Behavior Web-based Study. We included adolescents aged 12 to 18 yearswho were > or = 5th percentile of the BMI cut-off point based on the Korean child growth curve. Logistic regression analysis was performed to examine the association between socioeconomic status and overweight. RESULTS: The adjusted odds ratios for overweight were 1.116 (95% confidence interval [CI],1.021 to 1.220), 1.390 (95% CI, 1.242 to 1.555) in girls having middle and low grade family affluence scale (FAS), respectively, compared in girls having high grade FAS (P < 0.05). However, in boys, there was no significant relationship between FAS and overweight. In both gender, perceived household economic status and parental education level were negatively related to overweight in adolescents (P < 0.05). CONCLUSION: Lower socioeconomic status increased the risk of overweight in Korean adolescents. Efforts to reduce socioeconomic disparities in adolescents should be initiated for overweight prevention.

Socioeconomic Factors Associated with Initiating and Quitting Cigarette Smoking Among Korean Men / 가정의학회지

BACKGROUND: The prevalence of current cigarette smoking is the net result of different processes over the entire life course, namely initiation, continuation and cessation of smoking. This study examined the association of socioeconomic indicators with initiating and quitting smoking among South Korean men. METHODS: We analyzed a total of 2,798 men aged 25-64 who participated in the Korean National Health and Nutrition Examination Survey in 2005. Odds ratios (ORs) with 95% confidence intervals (CIs) for smoking initiation and cessation according to socioeconomic position indicators were calculated with logistic regression. Socioeconomic position was measured by education, occupation, income and marital status. RESULTS: Greater rates of ever initiation of smoking were observed among lower educated men (OR = 1.51; 95% CI = 1.09-2.09) after controlling for other socioeconomic factors. Independent associations were found among men who performed manual labor (OR = 1.55; 95% CI = 1.12-2.14). After simultaneous adjustment for socioeconomic factors, lower likelihood of quitting smoking was detected among men who were in the middle third and the lower third income group (OR = 0.72; 95% CI = 0.55-0.92, OR = 0.60; 95% CI = 0.46-0.79, respectively), who performed manual labor (OR = 0.66; 95% CI = 0.50-0.86) or who were not married (OR for never-married = 0.65; 95% CI = 0.42-0.99 and OR for divorced or widowed = 0.56; 95% CI = 0.36-0.87, respectively). CONCLUSION: For Korean men, educational attainment was a strong predictor of ever initiating smoking, however, smoking cessation was independently related to income and marital status. To be effective, tobacco control interventions should consider these different social determinants in initiating and quitting smoking.

Effect of Smoking Cessation on Mortality after Percutaneous Coronary Intervention

BACKGROUND: Smoking is one of the known major risk factors of coronary artery disease and previous studies have shown that the risk of mortality declines after cessation of smoking. The goal of this study was to determine the influence of smoking on mortality after percutaneous coronary intervention, which has still not been established in Korea. METHODS: Patients who had undergone successful percutaneous coronary intervention at Asan Medical Center between January 1996 and June 1997 were classified into nonsmokers (n=306), ex-smokers (n=178), and current smokers (n=360). According to subsequent smoking status, current smokers were divided into quitters (n=152), persistent smokers (n=173), and unknown status (n=35). The data of the death Roll was from the National Statistical Office. RESULTS: The maximum follow-up was 119 months (mean+/-SD=100+/-26.5). The total smoking rate was 42.7%. The mortality rates of nonsmokers, ex-smokers and current smokers were 17.6%, 20.8%, and 17.2%, respectively. In analyses adjusted for base line characteristics, the relative risk of death among current smokers was 1.57 (95% confidence interval [CI], 0.98 to 2.53) and among ex-smokers was 1.37 (95% CI, 0.80 to 2.35) compared with nonsmokers. The persistent smokers had a greater relative risk of death from all causes (relative risk, 2.20 [95% CI, 1.08 to 4.48]) as compared with the quitters. CONCLUSION: The persistent smokers were at greater risk for death than the quitters. Therefore, patients undergoing percutaneous intervention should be encouraged to stop smoking.

Change of Smoking Attitude in High School Students of Korea after Increase in Cigarette Tax

BACKGROUND: Increasing cigarette tax is known to be effective in stopping smoking and preventing initiation of smoking in adolescents. This study was designed to investigate the change of smoking attitudes in high school students after increase in cigarette tax in 2004. METHODS: A self-questionnaire study was performed in high school students in Seoul and Chungnam province in June, 2004. The number of respondents was 1,424 consisting of 883 males and 541 females. The factors related to smoking cessation or reduction of smoking amount after increase in cigarette tax were analysed. RESULTS: Among the total 1,424 subjects, 199 (14.0%) students smoked before the increase in cigarette tax. The smoking rate of males and females were 19.5% and 5.0%, respectively. Thirty nine percent of smokers quit smoking or reduced the smoking amount after increase in tax, among them 28.6% of the smokers (27.9% and 33.0% for males and females, respectively) reported quitting smoking. Female smokers and smokers in preparation stage of Prochaska model reported quitting smoking or reducing the smoking amount than male smokers and smokers in pre-consideration stage (OR 6.85:95% CI=1.78~26.33, OR 6.62:95% CI= 2.20~19.95, respectively). CONCLUSION: Increase of cigarette tax was effective in quitting the smoking and reducing the smoking amount in adolescents in Korea.