Journal of Preventive Medicine and Public Health

Perspective

Firefighters as a Key Alliance Group to Advocate for Tobacco Control Policies in Korea: Heewon Kang, Susan Park, Sung-il Cho; J Prev Med Public Health. 2026;59(1):105-108. Published online December 14, 2025; DOI: https://doi.org/10.3961/jpmph.25.528

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Abstract Summary PDF: Tobacco control is a public health priority. However, Korea has recently experienced a reversal in its long-term decline in smoking prevalence. To address this trend, it is essential to broaden advocacy networks by engaging new stakeholders. We propose that firefighters represent a strategic yet under-represented partner in tobacco control because their professional interests closely align with tobacco-related policy goals. First, cigarette butts have consistently been the leading cause of fire incidents, and tobacco use directly undermines firefighters’ core mission to protect life and public safety. Moreover, firefighters face elevated health risks due to occupational exposure to harmful substances, and tobacco use and exposure to tobacco smoke can further compound these risks. Additionally, a portion of tobacco tax revenue is allocated to fire service funding, creating a direct fiscal linkage between tobacco control and firefighting resources. A logical next step is to promote collaboration through intergovernmental partnerships between public health authorities and national fire services. This collaboration includes targeted health promotion initiatives that assess tobacco use among firefighters and provide cessation support. Broader strategies, such as mass media campaigns and coordinated advocacy for increases in tobacco taxes, should also be jointly implemented. Such an alliance could improve firefighters’ well-being, reduce fire-related risks, and strengthen the overall tobacco control response.; Summary

Korean summary
담배 사용이 화재 위험과 소방관의 건강에 미치는 영향을 바탕로, 소방관을 담배규제 정책 옹호를 위한 핵심 협력 집단으로 제안한다. 담배꽁초로 인한 화재, 소방관의 직업적 건강 위험, 그리고 담뱃세의 소방 재정 기여라는 구조적 연계를 통해 공중보건과 소방 안전 간의 공동 이익을 실현할 수 있다. 공중보건과 소방 조직 간의 협력은 담배 사용 감소와 화재 예방을 동시에 달성할 수 있는 전략적 기회가 될 수 있을 것이다.

Key Message
This perspective argues that firefighters represent a strategic yet underutilized alliance group for advancing tobacco control in Korea. Tobacco use directly contributes to fire incidents, exacerbates firefighters’ occupational health risks, and is fiscally linked to fire services through earmarked tobacco taxes. Strengthening collaboration between public health authorities and fire services could reduce smoking prevalence, improve firefighter well-being, and enhance fire safety, creating mutually reinforcing public health and safety gains.

Original Article

Prevalence, Sources, and Correlates of Second-hand Smoke Exposure Among Non-smoking Pregnant Women in India: Farheen Ahmed, Nilesh Gawde, Sulabha Parasuraman; J Prev Med Public Health. 2025;58(2):136-145. Published online December 4, 2024; DOI: https://doi.org/10.3961/jpmph.24.278

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Abstract Summary PDF: Objectives
Second-hand tobacco smoke (SHS) is a risk factor for adverse health outcomes, particularly among pregnant women. This study aimed to address the research gap concerning the prevalence and correlates of SHS exposure at home and in public settings among non-smoking pregnant women in India.
Methods
The dataset from the Global Adult Tobacco Survey (2016-17), India, was utilised to evaluate the prevalence of SHS exposure in pregnant women both at home and in public spaces. Multivariable logistic regression analysis was employed to identify the determinants of SHS exposure among this population.
Results
The prevalence of SHS exposure at home was 36.9%, while exposure outside the home was 26.5%. Among non-smoking pregnant women, 10.0% were exposed to SHS on public transport. The risk of SHS exposure at home was significantly higher in the North (adjusted odds ratio [aOR], 5.33; 95% confidence interval [CI], 2.45 to 11.60), Central (aOR, 4.46; 95% CI, 1.98 to 10.02), and Northeast (aOR, 4.18; 95% CI, 1.78 to 9.81) regions compared to the South. Pregnant women aged 25-34 (aOR, 0.61; 95% CI, 0.39 to 0.93) and those aged 35 and above (aOR, 0.48; 95% CI, 0.27 to 0.86), as well as those with secondary (aOR, 0.50; 95% CI, 0.30 to 0.85) or higher education (aOR, 0.30; 95% CI, 0.15 to 0.58), had lower odds of SHS exposure at home. For SHS exposure outside the home, the North region (aOR, 2.53; 95% CI, 1.19 to 5.36), employment status (aOR, 1.99; 95% CI, 1.13 to 3.47), and belonging to scheduled tribes (aOR, 3.20; 95% CI, 1.25 to 8.21) were associated with higher odds.
Conclusions
The prevalence of SHS exposure among pregnant non-smoking women was notably high both at home and in external environments.; Summary

Key Message
Our secondary analysis of GATS-2 India data (2016-17) showed that the prevalence of Second-hand Tobacco smoke (SHS) exposure at home was high (36.9%) among non-smoking pregnant women in India. Among pregnant women, younger age, lower education levels, and residing in the country's North, Central, and Northeast regions were significantly associated with higher odds of SHS exposure at home. Overall, about a quarter (26.5%) of pregnant women reported SHS exposure outside their home. Tribal women, employed ones, and those residing in the North region were at higher risk of SHS exposure outside their homes during their pregnancies.

Perspective

Epidemiological Model for Conventional Tobacco Control Measures and Tobacco Endgame Policies: Heewon Kang, Sung-il Cho; J Prev Med Public Health. 2023;56(5):481-484. Published online September 26, 2023; DOI: https://doi.org/10.3961/jpmph.23.239

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Abstract Summary PDF Supplementary Material

Epidemiological models, also known as host-agent-vector-environment models, are utilized in public health to gain insights into disease occurrence and to formulate intervention strategies. In this paper, we propose an epidemiological model that incorporates both conventional measures and tobacco endgame policies. Our model suggests that conventional measures focus on relationships among agent-vector-host-environment components, whereas endgame policies inherently aim to change or eliminate those components at a fundamental level. We also found that the vector (tobacco industry) and environment (physical and social surroundings) components were insufficiently researched or controlled by both conventional measures and tobacco endgame policies. The use of an epidemiological model for tobacco control and the tobacco endgame is recommended to identify areas that require greater effort and to develop effective intervention measures.

Summary

Korean summary
이 연구는 기존의 담배규제와 관련된 역학 모형을 확장하여 담배 수요를 줄이기 위한 조치인 MPOWER 정책과 담배 종결전의 주요 정책을 아우르는 개념적 모형을 제시하였다. 각 정책을 개념적 모형 내 배치한 결과, MPOWER 정책은 모형 내 구성요소 간의 연결을 끊는 것을 목표로 하는 반면, 종결전 정책은 모형 내 요소들을 영구적으로 변화시키거나 제거하려는 특성을 가지고 있는 것으로 나타났다. 담배규제정책이 개체, 병원체, 벡터 및 환경 요소에 대한 균형 잡힌 포트폴리오를 갖추고 있는지 평가하기 위해 이 개념적 모형을 활용할 수 있다.

Key Message
We extended the conceptual epidemiological model for tobacco control by incorporating measures to reduce the demand for tobacco (MPOWER measures) and key endgame policies. The model suggests that MPOWER measures focus on disconnecting the relationships between model components, while endgame policies aim to permanently change or eliminate the components themselves. This model can be used to examine whether a country or jurisdiction's tobacco control policy maintains a balanced portfolio across agent, host, vector, and environmental factors.

Citations

Citations to this article as recorded by

Firefighters as a Key Alliance Group to Advocate for Tobacco Control Policies in Korea
Heewon Kang, Susan Park, Sung-il Cho
Journal of Preventive Medicine and Public Health.2026; 59(1): 105. CrossRef
Public support for tobacco endgame policies in South Korea: Findings from the 2020 International Tobacco Control Korea Survey
Heewon Kang, Wonjeong Yoon, Hong Gwan Seo, Sungkyu Lee, Sujin Lim, Gil-yong Kim, Su Young Kim, Steve S Xu, Mi Yan, Anne C K Quah, Janet Chung-Hall, Lorraine V Craig, Coral E Gartner, Geoffrey T Fong, Sung-il Cho
Tobacco Control.2025; 34(e1): e33. CrossRef
Extent and Characteristics of Illegal Tobacco Sales on Social Media X
Heewon Kang, Naeun Kang, Gil-yong Kim, Hun Min Jang, Woojin Jeong, Susan Park
Journal of the Korean Society for Research on Nicotine and Tobacco.2025; 16(1): 17. CrossRef
Prosociality and public support for tobacco control policies among South Korean adults: A cross-sectional study
Jaeyoung Ha, Heewon Kang, Ichiro Kawachi, Jieun Hwang, Sung-il Cho
SSM - Population Health.2025; 30: 101809. CrossRef
Decrease in household secondhand smoking among Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses
Hana Kim, Heewon Kang, Sung-il Cho
Epidemiology and Health.2023; 46: e2024009. CrossRef

Original Articles

Association Between Tobacco Smoking and Dental Caries in the Indonesian Population: Results of a National Study in 2018: Lelly Andayasari, Rofingatul Mubasyiroh, Iin Nurlinawati, Irna Sufiawati; J Prev Med Public Health. 2023;56(4):357-367. Published online July 10, 2023; DOI: https://doi.org/10.3961/jpmph.22.417

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Abstract PDF

Objectives
The 2018 Basic Health Research (RISKESDAS), conducted by the Ministry of Health of the Republic of Indonesia showed a high prevalence of dental caries (88.8%) in Indonesia and suggested that smoking tobacco was associated with an increased risk of dental caries. This study analyzed the association between tobacco smoking and dental caries in the Indonesian population.
Methods
This was a cross-sectional analysis of secondary data collected from RISKESDAS 2018. The study population included 35 391 Indonesians aged ≥10 years from all 34 provinces. The decayed, missing, and filled teeth (DMFT) index was used to measure dental caries. Smoking status was assessed qualitatively based on smoking activity, and the level of smoking exposure was assessed based on the Brinkman index. A multivariable logistic regression analysis was employed to examine the relationships of smoking status and smoking exposure levels with the DMFT index.
Results
Of the population aged ≥10 years, 36% had a DMFT≥8 (females: 37.5%, males: 33.9%). Almost one-fourth (23.4%) were current smokers, and 4.1% were ex-smokers. Furthermore, 26.4% had a Brinkman index ≥400, indicating heavy smoking. According to the multivariate analysis, current smoking status was associated with the risk of DMFT≥8 in males (adjusted odds ratio [aOR], 1.40; 95% CI, 1.27 to 1.55; p<0.001) and overall (aOR, 1.07; 95% CI, 1.00 to 1.14; p=0.037). In females, ex-smoking was associated with a 41% higher risk of DMFT≥8 (aOR, 1.41; 95% CI, 1.07 to 1.84; p=0.014). Heavy smoking was associated with a higher risk of DMFT≥8 in males (aOR, 1.38; 95% CI, 1.25 to 1.52; p<0.001) and females (aOR, 1.24; 95% CI, 1.03 to 1.50; p=0.022).
Conclusions
Tobacco smoking was associated with dental caries in the Indonesian population.

Summary

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V. Mehta, A. Mathur, M. Bhadania, K. S. Dash, S. Tripathy, T. Noor, S. Ghose
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Tobacco Control Stakeholder Perspectives on the Future of Tobacco Marketing Regulation in Indonesia: A Modified Delphi Study: Putu Ayu Swandewi Astuti, Mary Assunta, Becky Freeman; J Prev Med Public Health. 2021;54(5):330-339. Published online August 26, 2021; DOI: https://doi.org/10.3961/jpmph.21.181

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Abstract PDF Supplementary Material

Objectives
Tobacco control in Indonesia is very lenient compared to international standards. This study explored the perspectives of tobacco control stakeholders (TCSs) on the likelihood of advancing tobacco marketing regulation in Indonesia.
Methods
Data were collected from TCSs who were members of the Indonesia Tobacco Control Network group in a modified Delphi study. We collected the data in 2 waves using a questionnaire that comprised a set of closed and open-ended questions. For this paper, we analysed 2 of the 3 sections of the questionnaire: (1) tobacco advertising, promotions, and sponsorship (TAPS) bans, and (2) marketing and retailing regulations. We conducted a descriptive analysis of the scores using Stata/IC.13 and summarised the comments for each item.
Results
The TCSs viewed the measures/strategies across all aspects of TAPS and tobacco marketing regulation as highly desirable, but provided varied responses on their feasibility. They rated political feasibility lower than technical feasibility for most measures. Advancing TAPS measures and prohibition of selling to minors were considered more attainable by sub-national governments, while prohibition of tobacco corporate social responsibility was considered as the least feasible measure in the next 5 years.
Conclusions
Despite little optimism for substantial national-level change, there is a positive expectation that sub-national governments will strengthen their tobacco control regulation. It is paramount that the government reduce tobacco industry leverage by implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. Extending advocacy networks beyond tobacco control groups and framing tobacco control more effectively are necessary steps.

Summary

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Factors Associated With Quitting Smoking in Indonesia: Rimawati Aulia Insani Sadarang; J Prev Med Public Health. 2021;54(2):137-144. Published online March 8, 2021; DOI: https://doi.org/10.3961/jpmph.20.293

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Abstract PDF

Objectives
The aim of this study was to identify factors associated with quitting smoking in Indonesia
Methods
Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question “do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?” Logistic regression was performed to identify factors associated with successful attempts to quit smoking.
Results
The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables.
Conclusions
Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals’ internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.

Summary

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Brief Reports

Monitoring Compliance and Examining Challenges of a Smoke-free Policy in Jayapura, Indonesia: Wahyuti Wahyuti, Suci Hasairin, Sherly Mamoribo, Abdillah Ahsan, Dian Kusuma; J Prev Med Public Health. 2019;52(6):427-432. Published online November 22, 2019; DOI: https://doi.org/10.3961/jpmph.19.240

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Abstract PDF

Background
In Indonesia, 61 million adults smoked in 2018 and 59 million were exposed to secondhand smoke at offices or restaurants in 2011. The Presidential Decree 109/2012 encouraged local governments to implement smoke-free policy (SFP) with Jayapura city enacted a local bill (1/2015) in 2015. Objective: This study aims to evaluate the compliance and explore the challenges in implementing. Methods: We conducted a mixed-methods study. The quantitative method assessed the compliance to six criteria (as per the bill) including having signage, no smoking activity, no selling, no advertisement, no smoke, and no ashtray at SFP facilities. We surveyed 192 facilities including health facilities, educational facilities, places of worship, government offices, and indoor/outdoor public facilities. The qualitative method explored challenges in implementing through by interviewing 19 informants (government officers, students and community). Results: The compliance rate to all six criteria was 17% overall, ranging from 0% at outdoor public facilities to 50% at health facilities. We found no spatial patterning as shown by similar compliance rates between SFP facilities within and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included (a) limited budget for enforcement, (b) lack of support from local non-government organizations and universities, (c) lack of public awareness at facilities, and (c) lack of examples from local leaders. Conclusion: The overall compliance was low in Jayapura city due to many challenges. This provides lessons learnt for tobacco control policy in the areas that are least developed and farthest from the central government.

Summary

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Decrease in household secondhand smoking among Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses
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National Trends in Smoking Cessation Medication Prescriptions for Smokers With Chronic Obstructive Pulmonary Disease in the United States, 2007-2012: Min Ji Kwak, Jongoh Kim, Viraj Bhise, Tong Han Chung, Gabriela Sanchez Petitto; J Prev Med Public Health. 2018;51(5):257-262. Published online August 23, 2018; DOI: https://doi.org/10.3961/jpmph.18.119

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Abstract PDF

Objectives
Smoking cessation decreases morbidity and mortality due to chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation is highly effective. However, the optimal prescription rate of smoking cessation medications among smokers with COPD has not been systemically studied. The purpose of this study was to estimate the national prescription rates of smoking cessation medications among smokers with COPD and to examine any disparities therein.
Methods
We conducted a retrospective study using National Ambulatory Medical Care Survey data from 2007 to 2012. We estimated the national prescription rate for any smoking cessation medication (varenicline, bupropion, and nicotine replacement therapy) each year. Multiple survey logistic regression was performed to characterize the effects of demographic variables and comorbidities on prescriptions.
Results
The average prescription rate of any smoking cessation medication over 5 years was 3.64%. The prescription rate declined each year, except for a slight increase in 2012: 9.91% in 2007, 4.47% in 2008, 2.42% in 2009, 1.88% in 2010, 1.46% in 2011, and 3.67% in 2012. Hispanic race and depression were associated with higher prescription rates (odds ratio [OR], 5.15; 95% confidence interval [CI], 1.59 to 16.67 and OR, 2.64; 95% CI, 1.26 to 5.51, respectively). There were no significant differences according to insurance, location of the physician, or other comorbidities. The high OR among Hispanic population and those with depression was driven by the high prescription rate of bupropion.
Conclusions
The prescription rate of smoking cessation medications among smokers with COPD remained low throughout the study period. Further studies are necessary to identify barriers and to develop strategies to overcome them.

Summary

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Special Article

Scientific Evidence for the Addictiveness of Tobacco and Smoking Cessation in Tobacco Litigation: Sungwon Roh; J Prev Med Public Health. 2018;51(1):1-5. Published online November 29, 2017; DOI: https://doi.org/10.3961/jpmph.16.088

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Smokers keep smoking despite knowing that tobacco claims many lives, including their own and others’. What makes it hard for them to quit smoking nonetheless? Tobacco companies insist that smokers choose to smoke, according to their right to self-determination. Moreover, they insist that with motivation and willpower to quit smoking, smokers can easily stop smoking. Against this backdrop, this paper aims to discuss the addictive disease called tobacco use disorder, with an assessment of the addictiveness of tobacco and the reasons why smoking cessation is challenging, based on neuroscientific research. Nicotine that enters the body via smoking is rapidly transmitted to the central nervous system and causes various effects, including an arousal response. The changes in the nicotine receptors in the brain due to continuous smoking lead to addiction symptoms such as tolerance, craving, and withdrawal. Compared with other addictive substances, including alcohol and opioids, tobacco is more likely to cause dependence in smokers, and smokers are less likely to recover from their dependence. Moreover, the thinning of the cerebral cortex and the decrease in cognitive functions that occur with aging accelerate with smoking. Such changes occur in the structure and functions of the brain in proportion to the amount and period of smoking. In particular, abnormalities in the neural circuits that control cognition and decision-making cause loss of the ability to exert self-control and autonomy. This initiates nicotine dependence and the continuation of addictive behaviors. Therefore, smoking is considered to be a behavior that is repeated due to dependence on an addictive substance, nicotine, instead of one’s choice by free will.

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Original Articles

Using Focus Group Interviews to Analyze the Behavior of Users of New Types of Tobacco Products: Jinyoung Kim, Sungkyu Lee; J Prev Med Public Health. 2017;50(5):336-346. Published online September 18, 2017; DOI: https://doi.org/10.3961/jpmph.17.052

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Objectives
To characterize the usage patterns of new types of tobacco products (NTTPs) to develop effective strategies for the regulation of NTTPs in Korea. Methods: We conducted focus group interviews to identify the NTTP usage patterns of research subjects. The NTTPs were limited to electronic cigarettes (e-cigarettes), waterpipe tobacco, and rolling tobacco. We categorized 30 research subjects into 4 groups. The e-cigarette group was divided into adult and adolescent groups. Each group contained 7-8 subjects. An interview lasting approximately 2 hours was conducted with each group. Results: Ninety percent of NTTP users used an NTTP in combination with conventional cigarettes. Subjects mostly bought NTTPs online, unlike how they bought cigarettes. Additionally, a great deal of information, such as how to use NTTPs and descriptions of NTTP products, was exchanged through online or offline societies. The primary reason why the subjects used NTTPs was that NTTPs offer a greater range of flavors and aromas than cigarettes. Moreover, NTTPs were felt to be less repulsive than cigarettes. NTTPs were not used as a cigarette substitute; rather, they were mostly used in places and situations where traditional cigarette smoking was not allowed. Conclusions: Based on the results of this study, the government should conduct studies on the effects of the combined use of NTTPs and cigarettes on the human body, obtain and provide accurate data regarding NTTP use, and develop and implement polices to ban NTTP advertising, which may arouse adolescents’ curiosity, and the addition of flavoring substances to tobacco products.

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Youth use of e‐liquid flavours—a systematic review exploring patterns of use of e‐liquid flavours and associations with continued vaping, tobacco smoking uptake or cessation
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Assessment of Tobacco Habits, Attitudes, and Education Among Medical Students in the United States and Italy: A Cross-sectional Survey: Grayson W. Armstrong, Giacomo Veronese, Paul F. George, Isacco Montroni, Giampaolo Ugolini; J Prev Med Public Health. 2017;50(3):177-187. Published online April 14, 2017; DOI: https://doi.org/10.3961/jpmph.15.061

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Objectives
Medical students represent a primary target for tobacco cessation training. This study assessed the prevalence of medical students’ tobacco use, attitudes, clinical skills, and tobacco-related curricula in two countries, the US and Italy, with known baseline disparities in hopes of identifying potential corrective interventions.
Methods
From September to December 2013, medical students enrolled at the University of Bologna and at Brown University were recruited via email to answer survey questions assessing the prevalence of medical students’ tobacco use, attitudes and clinical skills related to patients’ smoking, and elements of medical school curricula related to tobacco use.
Results
Of the 449 medical students enrolled at Brown and the 1426 enrolled at Bologna, 174 Brown students (38.7%) and 527 Bologna students (36.9%) participated in this study. Italian students were more likely to smoke (29.5% vs. 6.1%; p<0.001) and less likely to receive smoking cessation training (9.4% vs. 80.3%; p<0.001) than their American counterparts, even though the majority of students in both countries desired smoking cessation training (98.6% at Brown, 85.4% at Bologna; p<0.001). Additionally, negative beliefs regarding tobacco usage, the absence of formal training in smoking cessation counseling, and a negative interest in receiving specific training on smoking cessation were associated with a higher risk of not investigating a patient’s smoking status during a routine history and not offering tobacco cessation treatment to patients.
Conclusions
Medical curricula on tobacco-related health hazards and on smoking cessation should be mandatory in order to reduce smoking among medical students, physicians, and patients, thereby improving tobacco-related global health.

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Tobacco Use Among Students Aged 13-15 Years in South Korea: The 2013 Global Youth Tobacco Survey: Sunhye Choi, Yoonjung Kim, Jihye Lee, Mina Kashiwabara, Kyungwon Oh; J Prev Med Public Health. 2017;50(1):60-65. Published online January 11, 2017; DOI: https://doi.org/10.3961/jpmph.16.079

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Abstract PDF

Objectives
We examined the prevalence of tobacco use and exposure to secondhand smoke among middle-school students in Korea using the Global Youth Tobacco Survey (GYTS) in 2013.
Methods
The GYTS in Korea was conducted between July and August 2013 by the Korea Centers for Disease Control and Prevention. Data were collected using a self-administered anonymous questionnaire from a nationally representative sample of middle-school students aged 13-15 years in sampled classrooms.
Results
The GYTS in Korea was completed by 4235 students aged 13-15 years in 43 middle schools. Approximately one in five of the students (17.8%) reported that they had tried cigarettes in the past, while 5.2% reported currently being cigarette smokers. Current cigarette smoking was higher in boys (7.5%) than in girls (2.6%). Of the students, 29.7% had been exposed to secondhand smoke at home, 47.4% inside enclosed public places, and 53.9% in outdoor public places. Of the current cigarette smokers, 25.7% bought their cigarettes from a store despite a law prohibiting this. Additionally, 58.0% of students noticed point-of-sale tobacco advertisements or promotions, 66.8% of current cigarette smokers wanted to stop smoking, and 70.9% of students had been taught about the dangers of tobacco use in school.
Conclusions
These findings provide an opportunity to develop, implement, and evaluate a comprehensive tobacco control policy. The results suggest that youth have relatively easy access to cigarettes and are regularly exposed to secondhand smoke in public places, as well as to point-of-sale tobacco advertisements and promotions. Strict enforcement of the ban on tobacco sales to youth, expanding smoke-free areas, and advertising bans are needed to reduce tobacco use among youth.

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Special Articles

Proving Causation With Epidemiological Evidence in Tobacco Lawsuits: Sun Goo Lee; J Prev Med Public Health. 2016;49(2):80-96. Published online March 31, 2016; DOI: https://doi.org/10.3961/jpmph.16.002

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Recently, a series of lawsuits were filed in Korea claiming tort liability against tobacco companies. The Supreme Court has already issued decisions in some cases, while others are still pending. The primary issue in these cases is whether the epidemiological evidence submitted by the plaintiffs clearly proves the causal relationship between smoking and disease as required by civil law. Proving causation is difficult in tobacco lawsuits because factors other than smoking are involved in the development of a disease, and also because of the lapse of time between smoking and the manifestation of the disease. The Supreme Court (Supreme Court Decision, 2011Da22092, April 10, 2014) has imposed some limitations on using epidemiological evidence to prove causation in tobacco lawsuits filed by smokers and their family members, but these limitations should be reconsidered. First, the Court stated that a disease can be categorized as specific or non-specific, and for each disease type, causation can be proven by different types of evidence. However, the concept of specific diseases is not compatible with multifactor theory, which is generally accepted in the field of public health. Second, when the epidemiological association between the disease and the risk factor is proven to be significant, imposing additional burdens of proof on the plaintiff may considerably limit the plaintiff’s right to recovery, but the Court required the plaintiffs to provide additional information such as health condition and lifestyle. Third, the Supreme Court is not giving greater weight to the evidential value of epidemiological study results because the Court focuses on the fact that these studies were group-level, not individual-level. However, group-level studies could still offer valuable information about individual members of the group, e.g., probability of causation.

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Vincent L. Cannataro, Jeffrey D. Mandell, Jeffrey P. Townsend, Melissa Wilson
Molecular Biology and Evolution.2022;[Epub] CrossRef

The Tobacco Industry’s Abuse of Scientific Evidence and Activities to Recruit Scientists During Tobacco Litigation: Sungkyu Lee; J Prev Med Public Health. 2016;49(1):23-34. Published online January 27, 2016; DOI: https://doi.org/10.3961/jpmph.15.063

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Abstract PDF Supplementary Material

South Korea’s state health insurer, the National Health Insurance Service (NHIS), is in the process of a compensation suit against tobacco industry. The tobacco companies have habitually endeavored to ensure favorable outcomes in litigation by misusing scientific evidence or recruiting scientists to support its interests. This study analyzed strategies that tobacco companies have used during the NHIS litigation, which has been receiving world-wide attention. To understand the litigation strategies of tobacco companies, the present study reviewed the existing literature and carried out content analysis of petitions, preparatory documents, and supporting evidence submitted to the court by the NHIS and the tobacco companies during the suit. Tobacco companies misrepresented the World Health Organization (WHO) report’s argument and misused scientific evidence, and removed the word “deadly” from the title of the citation. Tobacco companies submitted the research results of scientists who had worked as a consultant for the tobacco industry as evidence. Such litigation strategies employed by the tobacco companies internationally were applied similarly in Korean lawsuits. Results of tobacco litigation have a huge influence on tobacco control policies. For desirable outcomes of the suits, healthcare professionals need to pay a great deal of attention to the enormous volume of written opinions and supporting evidence that tobacco companies submit. They also need to face the fact that the companies engage in recruitment of scientists. Healthcare professionals should refuse to partner with tobacco industry, as recommended by Article 5.3 of the WHO Framework Convention on Tobacco Control.

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We must win the tobacco litigation for public health
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Review

Cancer Control Programs in East Asia: Evidence From the International Literature: Malcolm A. Moore; J Prev Med Public Health. 2014;47(4):183-200. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.183

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Abstract PDF

Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East.

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Original Article

Airborne Nicotine Concentrations in the Workplaces of Tobacco Farmers: Seok-Ju Yoo, Sung-Jun Park, Byoung-Seok Kim, Kwan Lee, Hyun-Sul Lim, Jik-Su Kim, In-Shik Kim; J Prev Med Public Health. 2014;47(3):144-149. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.144

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Abstract PDF

Objectives

Nicotine is a natural alkaloid and insecticide in tobacco leaves. Green tobacco sickness (GTS) is known as a disease of acute nicotine intoxication among tobacco farmers. Until now, GTS has been recognized globally as a disease that results from nicotine absorption through the skin. However, we assumed that GTS might also result from nicotine inhalation as well as absorption. We aimed to measure the airborne nicotine concentrations in various work environments of Korean tobacco farmers.

Methods

We measured the nicotine concentrations in the tobacco fields, private curing barns, and joint curing barns of farmers from July to October 2010. All sampling and analyses of airborne nicotine were conducted according to the National Institute for Occupational Safety and Health manual of analytic methods.

Results

The airborne nicotine concentrations (geometric mean [geometric standard deviation]) in the tobacco field were 83.4 mg/m³ (1.2) in the upper region and 93.3 mg/m³ (1.2) in the lower region. In addition, the nicotine concentration by personal sampling was 150.1 mg/m³. Similarly, the nicotine concentrations in the private curing barn, workers in curing barns, the front yard of the curing barn, and in the joint curing barn were 323.7 mg/m³ (2.0), 121.0 mg/m³ (1.5), 73.7 mg/m³ (1.7), and 610.3 mg/m³ (1.0), respectively.

Conclusions

The nicotine concentration in the workplaces of tobacco farmers was very high. Future studies should measure the environmental concentration of nicotine that is inhaled by tobacco farmers.

Summary

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Special Articles

The Status and Future Challenges of Tobacco Control Policy in Korea: Hong-Jun Cho; J Prev Med Public Health. 2014;47(3):129-135. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.129

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Abstract PDF

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.

Summary

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Public Health Challenges of Electronic Cigarettes in South Korea: Sungkyu Lee, Heejin Kimm, Ji Eun Yun, Sun Ha Jee; J Prev Med Public Health. 2011;44(6):235-241. Published online November 14, 2011; DOI: https://doi.org/10.3961/jpmph.2011.44.6.235

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Abstract PDF

Electronic cigarettes (e-cigarrettes) were recently introduced and advertised as a smoking cession device in South Korea. As the social norm to quit smoking has gained hold in the country, the number of e-cigarette users is growing rapidly. This phenomenon should be urgently considered, because of the lack of research that has been conducted to examine the safety of e-cigarettes and its efficacy as a smoking cessation aid.

This paper raises several public health concerns on e-cigarettes in South Korea. Uncertain regulations of the government on e-cigarettes are contributing to an increase of e-cigarette users and allowing the e-cigarette industry to circumvent existing regulations. The aggressive marketing activity of this industry is also a core factor that is responsible for the rapid increase of e-cigarette use, in particular among the youth. Following the enforcement of tobacco control, some cigarette smokers may be encouraged to purchase e-cigarettes in order to circumvent the regulations, even though the dual use of e-cigarette and cigarette may be more harmful.

Until there is clear evidence of the e-cigarette's safety, it is recommended that the industry's marketing and promotional activities be banned and closely monitored, and public campaigns be initiated to educate the public regarding e-cigarettes.

Summary

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Original Articles

Prevalence and Risk Factors of Green Tobacco Sickness among Korean Tobacco Harvesters.: Hyun Sul Lim, Kwan Lee, Si Hyun Nam; J Prev Med Public Health. 2004;37(1):37-43.

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Abstract PDF: OBJECTIVE
This study was carried out to understand the prevalence and risk factors of green tobacco sickness (GTS) among Korean tobacco harvesters. METHODS: The authors conducted a questionnaire among the tobacco harvesters (1, 064 persons from 555 out of 723 tobacco harvesting households) in Cheongsong-gun for 4 days from May 7 to 10, 2002. RESULTS: The study subjects were 550 males and 514 females. The recognition and experience of GTS up until 2001 were 96.4% and 61.9%, respectively. The prevalence of GTS in 2001 was 42.5%, and was significantly higher in females than in males (59.0% vs. 26.6%, p< 0.01). The incidence density of GTS according to the number of workdays in 2001 was 12.3 spells/100 person' days. The GTS symptoms reported by the tobacco harvesters in 2001 were dizziness in 441 cases (97.6%), nausea in 414 (91.6%), headache in 349 (77.2%) and vomiting in 343 (75.9%). The use of gloves, hat and wristlets, sweating at work and the number of working hours significantly increased the prevalence of GTS (p< 0.05). Multiple logistic regression analysis was used to determine the factors significantly associated with GTS. Odds ratios for smoking, working over 10 hours and sweating at work were 0.26 (95% CI: 0.19-0.35), 1.64 (95% CI: 1.26-2.14) and 1.60 (95% CI: 1.14-2.25), respectively. Of those who reported GTS in 2001, 311 cases (68.8%) underwent treatment from their local medical facilities. CONCLUSION: In Korea, there are many tobaccoharvesting households, and most may be stricken with GTS. More extensive epidemiological studies, including heincidence and associated risk factors, are expected and a surveillance system including measurements of cotinine in urine should be conducted.; Summary

Maternal Exposure to Environmental Tobacco Smoke (ETS) and Pregnancy Outcome (low birth weight or preterm baby) in Prospective Cohort Study.: Bo Eun Lee, Yun Chul Hong, Hye Sook Park, Jong Tae Lee, Jeong Youn Kim, Young Joo Kim, Sang Hyun Kim, Kang Jung Goo, Joo Oh Kim, Eun Hee Ha; Korean J Prev Med. 2003;36(2):117-124.

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Abstract PDF: OBJECTIVES
This study was performed to examine the relationship between maternal exposure to environmental tobacco smoke (ETS) and pregnancy outcomes (low birth weight or preterm baby) in a prospective cohort study. METHODS: We made a pregnant women's cohort, and followed the pregnancy outcomes, between May 1st 2001 and August 31st 2002. We surveyed 2, 250 women who visited our hospital during their 35th gestational week, with a self-administered questionnaire. The final total of mother-infant pairs analyzed in this study was 1, 712. We used a multiple logistic regression analysis to analyze the effect of maternal ETS on the incidence of preterm or low birth weight, and a linear regression analysis for the birth weight and gestational age. RESULTS: Higher exposure to ETS (> or =1 hours/day) during pregnancy was more negatively associated with the gestational age and birth weight, than no exposure to ETS (no or less than 1hour). Maternal exposure to ETS was associated with preterm baby (adjusted odds ratio (AOR) 1.7; 95% confidence interval (CI) 0.9, 3.3) and low birth weight (AOR 2.3; 95% CI 0.9, 5.5). In addition, we found that maternal ETS may reduce the birth weight by 70g after adjusting for potential confounding factors. CONCLUSIONS: This study suggests that maternal exposure to ETS during pregnancy may increase the frequency of low birth weights and preterm births.; Summary

Lifestyle.: Hee Choul Ohrr; Korean J Prev Med. 1993;26(4):469-479.

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Abstract PDF: This article reviewed the historic and epidemiologic reasons for the emergence of health promotion with a special focus on lifestyle. Health effects of tobacco, alcohol, physical exercise, and nutrition were briefly presented by reviewing recent researches. Social environments supposed to limit the application of health promotion strategies are also mentioned.; Summary

English Abstract

Changes in Smoking Status among Current Male Smokers and Factors Associated with Smoking Cessation Success.: Jin Seok Lee, Yangjung Kim, Won Nyon Kim, Seung Sik Hwang, Yong Ik Kim; J Prev Med Public Health. 2006;39(4):339-345.

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Abstract PDF: OBJECTIVES
This study (a) investigated the rate of smoking cessation sucess for current male smokers, and (b) identified the factors that are associated with the smoking cessation success. METHODS: Data were collected from four follow-up surveys of 700 current male smokers. The follow-up period was from December 2004 to June 2005. Success of smoking cessation was defined as "maintaining a smoking cessation status for six months". The demographic and socioeconomic factors included age, the household income level and, occupation. The smoking behavioral factors were composed of the amount of smoking, the duration of smoking, the age of initiating smoking, the willingness to quit, the frequency of trying to quit smoking and the smoker`s attitude toward the anti-smoking policies. RESULTS: The proportion of quitters increased from 6.6% to 11.0% during the follow-up period. The majority of quitters answered that the increase of tobacco price acted as cue to achieve smoking cessation. The agestandardized experience and success rate of smoking cessation were 16.0% (95% C.I.=13.0% to, 19.0%) and 4.5% (95% C.I.=3.0% to, 6.0%), respectively. On the multivariate analysis, success for smoking cessation was associated with the willingness to quit smoking, low prior tobacco consumption, and agreement on the tobacco price increase. CONCLUSIONS: The results of this study suggest that the recent anti-smoking policies provided an opportunity to quit smoking. The results of this study can be used to establish evidence for further anti-smoking policies.; Summary

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