School-Based Tobacco Control and Smoking in Adolescents: Evidence from Multilevel Analyses.

Since 2015, universal comprehensive school-based tobacco control programs have been provided in all primary and secondary schools in Korea. This study explored the association of school-level tobacco control with adolescent smoking, and the interactions to investigate whether gender moderates the impact of school tobacco control programs and school-level norms. Both school- and individual-level data were drawn from the 2015 School-Based Tobacco Prevention Program Survey. Multilevel logistic regression analyses were performed using data from 4631 students (ages 10-18 years) who were nested in 62 secondary schools in Seoul, Korea. Students who participated in more prevention programs were less likely to smoke (OR = 0.47, 95% CI 0.30-0.74). The effect of the programs was significantly moderated by gender. For boys, exposure to a greater number of programs decreased the risk of smoking (OR = 0.32, 95% CI 0.18-0.57) but not for girls. At the school level, the school norm regarding tobacco control regulations was negatively associated with smoking (OR = 0.28, 95% CI 0.11-0.76), and its effect was significant for girls only (OR = 0.35, 95% CI 0.17-0.76). This study highlights how the school environment is associated with adolescent smoking behavior, and the effects of programs and norms are different by gender. The findings suggest the need to develop strategies to enhance school-based tobacco control programs and the school norm considering gender differences.

Ambient temperature and mortality: an international study in four capital cities of East Asia.

Extreme ambient temperature has been associated with increased daily mortality across the world. We describe the ambient temperature-mortality association for four capital cities in East Asia, Seoul, Beijing, Tokyo, and Taipei, and identify a threshold temperature for each city and the percent increase in mortality. We adapted generalized linear modeling with natural cubic splines (GLM+NS) to examine the association between daily mean apparent temperature (AT) and total mortality, as well as mortality due to respiratory (RD) and cardiovascular (CVD) causes in a threshold model. We conducted a time-series analysis adjusting for day of the week and long-term time trend. The study period differed by city. The threshold temperature for all seasons was estimated to be 30.1-33.5 degrees C, 31.3-32.3 degrees C, 29.4-30.8 degrees C, and 25.2 degrees -31.5 degrees C for Seoul, Beijing, Tokyo, and Taipei, respectively, on the same day. For the mean daily AT increase of 1 degrees C above the thresholds in Seoul, Tokyo, and Taipei, estimated percentage increases in daily total mortality were 2.7 (95% confidence interval (CI)=2.2-3.1), 1.7 (95% CI=1.5-2.0), and 4.3 (95% CI=2.9-5.7), respectively. Beijing provided no total mortality counts. Estimated percentage increases were 2.7-10.5 for RD mortality, 1.1-9.3 for CVD mortality in 4 cities. This study identified increased mortality due to exposure to elevated AT. The importance of effects of AT and city-specific threshold temperatures suggests that analyses of the impact of climate change should take regional differences into consideration.