Epidemiology and Health

Original Articles

Association between secondhand smoke exposure and incidence of metabolic syndrome: analyses of Korean Genome and Epidemiology Study (KoGES) data: Seungmi Choi, Sanghyuk Bae; Epidemiol Health. 2025;47:e2025041. Published online July 29, 2025; DOI: https://doi.org/10.4178/epih.e2025041

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Secondhand smoke exposure remains a major public health concern and is linked to various chronic diseases, including metabolic syndrome (MetS). Although smoking rates have declined, exposure to secondhand smoke remains common and poses significant health risks to non-smokers. This study investigated the association between secondhand smoke exposure and the incidence of MetS using longitudinal data from a community-based cohort in Korea.
METHODS
We utilized data from the Korean Genome and Epidemiology Study, collected biennially between 2001 and 2020. Of 10,030 adults aged 40-69 years, a total of 3,042 never-smokers without pre-existing MetS were included. Secondhand smoke exposure was assessed through self-reported questionnaires. Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.
RESULTS
During follow-up, 638 participants in the secondhand smoke exposure group developed MetS. Those exposed to secondhand smoke had a significantly higher risk of developing MetS compared to the non-exposed group (HR, 1.15; 95% CI, 1.02 to 1.27). Among MetS components, secondhand smoke exposure was significantly associated with increased risks of hypertension (HR, 1.13; 95% CI, 1.00 to 1.28) and hyperglycemia (HR, 1.19; 95% CI, 1.03 to 1.37). Although home exposure was not significantly associated with MetS risk, workplace exposure to secondhand smoke demonstrated a dose-response relationship according to exposure frequency and duration.
CONCLUSIONS
Our findings suggest that secondhand smoke exposure may increase the risk of developing MetS. These results underscore the importance of strengthening regulations on secondhand smoke in public places and raising social awareness of its detrimental effects on non-smokers.; Summary

Korean summary
40–69세 한국 성인 비흡연자 3,042명을 대상으로 한 지역사회 기반 코호트 연구에서, 간접흡연 노출은 대사증후군 발생 위험을 높이는 것으로 나타났다. 특히 고혈압과 고혈당 위험이 증가했으며, 직장 내 간접흡연 노출은 노출 빈도와 기간에 따른 용량-반응 관계를 보였다. 이러한 결과는 비흡연자를 보호하기 위한 간접흡연 규제 강화와 사회적 인식 제고의 필요성을 강조한다.

Key Message
In a community-based Korean cohort of 3,042 never-smokers aged 40–69 years, secondhand smoke exposure was associated with a higher risk of developing metabolic syndrome. Risks were particularly elevated for hypertension and hyperglycemia, and workplace exposure showed a dose-response relationship. These findings highlight the need for stronger regulations and public awareness to protect non-smokers from secondhand smoke.

Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents: Hyerin Park, Hyunsuk Jeong, Hyeon Woo Yim, Sanghyuk Bae; Epidemiol Health. 2024;46:e2024028. Published online February 13, 2024; DOI: https://doi.org/10.4178/epih.e2024028

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
To test the hypothesis that tobacco exposure is associated with elevated blood pressure (EBP) in Korean adolescents, and that the association is dose dependent.

METHODS

This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were EBP and hypertension. Statistical analyses were conducted using SAS version 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable.

RESULTS

A total of 2,518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean± standard deviation participant age was 15.3±1.7 years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2,090 (83.0%). Analysis of the 2,518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an odds of elevated blood pressure of 3.00 (95% confidence interval [CI], 1.14 to 7.89). The odds of hypertension were 3.61 (95% CI, 1.13 to 11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders.

CONCLUSIONS

It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents’ blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.

Summary

Korean summary
청소년기의 고혈압은 성인기의 다양한 질병을 초래할 수 있는 주요 원인이다. 흡연과 고혈압의 관계에 관한 다수의 연구들이 있으나 상반된 결과들이 보고되었고 국내 청소년의 직 간접적 담배 연기 노출과 혈압과의 연관성은 명확하게 밝혀지지 않았다. 따라서 본 연구에서는 한국 청소년에서 담배 연기 노출과 혈압 상승과의 연관성을 확인해 보고자 하였다. 연구 결과 직접 흡연을 하는 청소년들은 비흡연군에 비하여 3배 이상 혈압이 증가하는 것으로 나타났다.

Key Message
Hypertension during adolescence is a leading cause of disease in adults. The relationship between smoking and hypertension has been studied, but findings between studies are conflicting. Nicotine is a known toxin, but the relationship between active and passive smoking and blood pressure in adolescents is not clear. So that we tested and found adolescents in Korea who were active smokers showed over 3-fold increased risk of elevated blood pressure.

Citations

Citations to this article as recorded by

Early effects of cigarette smoke on adolescent endothelial functions: a novel endocan/cotinine ratio approach
Elanur Yolal Karimov, Elnur Karimov, Kazım Okan Dolu, Mustafa Özçetin, Ayşe Kılıç
International Journal of Adolescent Medicine and Health.2026;[Epub] CrossRef
Blood Pressure and Salivary Cotinine Levels in Young Adults Using Heated Tobacco Products: A Case–Control Study in Poland
Małgorzata Znyk, Hanna Jerczyńska, Leokadia Bąk-Romaniszyn, Dorota Kaleta
Healthcare.2026; 14(5): 600. CrossRef
JSH2024 smoke-free declaration “Stop All Tobacco Products”
Kimika Arakawa, Yuichi Akasaki, Ako Fukami, Satoko Sakata, Ken Sugimoto, Hirochika Ryuno, Mai Kabayama, Mitsuru Ohishi, Koichi Node
Hypertension Research.2025; 48(2): 449. CrossRef
Current status of elevated blood pressure and hypertension among adolescents in Asia: a systematic review
Binish Islam, Tasiu Ibrahim Ibrahim, Wang Tingting, Mingyang Wu, Qin Jiabi
Journal of Global Health.2025;[Epub] CrossRef
Global, regional, and national trends in the epidemiology of aortic aneurysms among women of childbearing age, 1990–2021, with predictions through 2036
Wei Wang, Yong Shi, Xinyao Li, Tianxiang Gu, Enyi Shi
BMC Public Health.2025;[Epub] CrossRef

Associations of breastfeeding duration and the total number of children breastfed with self-reported osteoarthritis in Korea women 50 years and older: a cross-sectional study: Dajeong Ham, Sanghyuk Bae; Epidemiol Health. 2023;45:e2023044. Published online April 13, 2023; DOI: https://doi.org/10.4178/epih.e2023044

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Abstract

OBJECTIVES
Osteoarthritis is the most common joint disease, with a higher prevalence among women than men. The present study aimed to examine the associations of breastfeeding duration and the total number of children breastfed with osteoarthritis in Korean women aged 50 years and older.

METHODS

In this cross-sectional study, we used representative data from the Korea National Health and Nutrition Examination Survey, phases 5 through 7 (2010-2018). Our analysis included 10,102 women aged ≥50 years. Osteoarthritis experience was defined as whether a physician had ever diagnosed osteoarthritis. Breastfeeding duration was categorized as 1-6 months, 7-24 months, and ≥25 months. The total number of children breastfed was categorized as 1-2, 3-4, and ≥5. The covariates were health behavior characteristics and risks of diseases (smoking, drinking, physical activity, body mass index, diabetes, hypertension, oral contraceptive use, and menopause) as well as socioeconomic characteristics (income, educational level, and occupation). A multiple logistic regression model was used to investigate associations between osteoarthritis and aspects of breastfeeding experience.

RESULTS

Compared to the non-breastfeeding group, the breastfeeding group had an odds ratio (OR) of 1.55 (95% confidence interval [CI], 1.18 to 2.03) for osteoarthritis. Those who reported breastfeeding for >25 months had an OR of 1.56 (95% CI, 1.19 to 2.06).

CONCLUSIONS

The advantages of breastfeeding are already well known, but the present study suggests that women who breastfeed children for a longer time may have a higher risk of osteoarthritis after middle age.

Summary

Korean summary
골관절염은 가장 흔한 관절 질환이며 유병률은 여성에서 더 높다. 본 연구는 국민건강영양조사의 50세 이상 여성 10,130명을 대상으로 모유수유경험과 골관절염의 유병율 사이의 연관성을 분석하였다. 모유 수유의 이점은 이미 잘 알려져 있지만, 모유 수유 기간이 길수록 골관절염에 걸릴 가능성이 더 높음을 관찰하였다.

Key Message
Osteoarthritis is one of the most common disorders in elderly women and identifying risk factors may contribute to screening and early treatment. In the present article, we analyzed the association of breastfeeding and related factors with prevalent osteoarthritis in Korea National Health and Nutrition Examination Survey. The advantages of breastfeeding are already well known, but we observed that the longer the breastfeeding duration was the more likely the woman has osteoarthritis.

Citations

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Comparative Analysis of Breastfeeding and Infant Formulas: Short‐ and Long‐Term Impacts on Infant Nutrition and Health
Kalmee Pramoda Kariyawasam, Geeshani Somaratne, Sumali Dilrukshi Dillimuni, Umani Walallawita
Food Science & Nutrition.2025;[Epub] CrossRef
Joint Tissues: Convergence and Divergence of the Pathogenetic Mechanisms of Rheumatoid Arthritis and Osteoarthritis
Marina O. Korovina, Anna R. Valeeva, Ildar F. Akhtyamov, Wesley Brooks, Yves Renaudineau, Gayane Manukyan, Marina I. Arleevskaya
International Journal of Molecular Sciences.2025; 26(17): 8742. CrossRef
Association of Reproductive Factors with Osteoarthritis and the Mediating Effect of Body Mass Index Among Postmenopausal Women
Renyang Liu, Yang Hu, Ximing Zhang, Jun Li
Journal of Women's Health.2025; 34(11): 1399. CrossRef
Designing a Knee Self-care Checklist for Menopause Women with Knee Osteoarthritis
Masoomeh Dashtian, Sedighe Sadat Tavafian, Kambiz Karimzade Shirazi, Parviz Yazdanpanah
Journal of Education and Community Health.2024; 11(1): 25. CrossRef

Systematic Review

Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies: Jee Yeon Hong, Young Jun Kim, Sanghyuk Bae, Mi Kyung Kim; Epidemiol Health. 2023;45:e2023011. Published online December 30, 2022; DOI: https://doi.org/10.4178/epih.e2023011

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality.

METHODS

Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79).

CONCLUSIONS

A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.

Summary

Korean summary
식이로부터 배출되는 GHG양은 메타분석의 고정 효과 모델과 확률 효과 모델 모두에서 만성 질환 발병률 및 사망 위험과 유의미한 양의 상관 관계를 보여주었습니다. 동물성 식단은 더 높은 GHG 배출량을 나타냈으나, 특정 만성질환에 대한 연구의 수가 적었고 질환 별 하위군 분석에서 유의미한 결과를 보이지 않았습니다. 결론적으로 온실가스 배출량이 많은 식단은 모든 원인으로 인한 사망 위험이 더 큰 것으로 나타났습니다.

Key Message
Daily food consumption contributes a large part of greenhouse gas (GHG) emissions, however, no review study was conducted. This study is the first review paper that reviews the relationship between greenhouse gas (GHG) emissions from daily diet and chronic disease risk and all-cause mortality. GHG emissions from the daily diet were significantly positively associated with disease risk and mortality. Animal-based diets contributed most to diet-derived GHG emissions. Men tended to have diets with higher GHG emissions compared to women. At times when the response to climate change is urgent, this study can help many policymakers and health officials.

Citations

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Adherence to healthy and sustainable diets and health-related behaviors in a Spanish online university setting
Maria Pilar Giner, Barbara Pilar González-Serrano, Alba Pardo, Alicia Aguilar-Martínez, Clara Gomez-Donoso, Paula Sol Ventura, Laura Esquius, Marina Bosque-Prous, Anna Bach-Faig
Frontiers in Nutrition.2026;[Epub] CrossRef
Development of the Food Systems–Related Greenhouse Gas Emissions Factor Database Using the Korea National Health and Nutrition Examination Survey (2016–2018)
Jee Yeon Hong, Mi Kyung Kim
Environmental Health Perspectives.2025;[Epub] CrossRef
Association between dietary environmental pressures and major chronic diseases: assessment from the prospective NutriNet-Santé cohort
Emmanuelle Kesse-Guyot, Aurélien Chayre, Elie Perraud, Sylvaine Berger, Annabelle Richard, Justine Berlivet, Mathilde Touvier, Benjamin Allès, Serge Hercberg, Denis Lairon, Philippe Pointereau, Hélène Fouillet, Julia Baudry, Christian Couturier, François
The Lancet Regional Health - Europe.2025; 59: 101481. CrossRef
The Role of a Sustainable Planetary Health Diet in the Prevention of Non-Communicable Diseases and Cause-Specific Mortality: A Narrative Review
Dorota Różańska, Bożena Regulska-Ilow
Foods.2025; 14(22): 3909. CrossRef
The bounds of meta-analytics and an alternative method
Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P. Singh
Epidemiology and Health.2024; 46: e2024016. CrossRef
Association between Diet-Related Greenhouse Gas Emissions and Mortality among Japanese Adults: The Japan Collaborative Cohort Study
Daiki Watanabe, Kotatsu Maruyama, Akiko Tamakoshi, Isao Muraki
Environmental Health Perspectives.2024;[Epub] CrossRef

Original Articles

Effect modification of consecutive high concentration days on the association between fine particulate matter and mortality: a multi-city study in Korea: Hyungryul Lim, Sanghyuk Bae, Jonghyuk Choi, Kyung-Hwa Choi, Hyun-Joo Bae, Soontae Kim, Mina Ha, Ho-Jang Kwon; Epidemiol Health. 2022;44:e2022052. Published online June 9, 2022; DOI: https://doi.org/10.4178/epih.e2022052

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Although there is substantial evidence for the short-term effect of fine particulate matter (PM2.5) on daily mortality, few epidemiological studies have explored the effect of prolonged continuous exposure to high concentrations of PM2.5. This study investigated how the magnitude of the mortality effect of PM2.5 exposure is modified by persistent exposure to high PM2.5 concentrations.

METHODS

We analyzed data on the daily mortality count, simulated daily PM2.5 level, mean daily temperature, and relative humidity level from 7 metropolitan cities from 2006 to 2019. Generalized additive models (GAMs) with quasi-Poisson distribution and random-effects meta-analyses were used to pool city-specific effects. To investigate the effect modification of continuous exposure to prolonged high concentrations, we applied categorical consecutive-day variables to the GAMs as effect modification terms for PM2.5.

RESULTS

The mortality risk increased by 0.33% (95% confidence interval [CI], 0.16 to 0.50), 0.47% (95% CI, -0.09 to 1.04), and 0.26% (95% CI, -0.08 to 0.60) for all-cause, respiratory, and cardiovascular diseases, respectively, with a 10 μg/m3 increase in PM2.5 concentration. The risk of all-cause mortality per 10 μg/m3 increase in PM2.5 on the first and fourth consecutive days significantly increased by 0.63% (95% CI, 0.20 to 1.06) and 0.36% (95% CI, 0.01 to 0.70), respectively.

CONCLUSIONS

We found increased risks of all-cause, respiratory, and cardiovascular mortality related to daily PM2.5 exposure on the day when exposure to high PM2.5 concentrations began and when exposure persisted for more than 4 days with concentrations of ≥35 μg/m3. Persistently high PM2.5 exposure had a stronger effect on seniors.

Summary

Korean summary
한국의 7개 대도시를 배경으로 수행한 본 시계열 연구를 통하여 2006년부터 2019년까지의 기간 동안에 초미세먼지의 단기 노출이 일별 사망률을 증가시키며, 교호작용모형을 통해 일평균 35 μg/m3 이상의 고농도 지속기간이 처음 시작되는 날과 넷째 지속일에 이러한 사망효과가 커짐을 보고하였다. 이러한 고농도 지속기간의 교호작용은 65세 이상 연령군에서 더욱 두드러졌다.

Key Message
With our Korean multi-city study design from 2006 to 2019, the short-term effects of PM2.5 on mortality were greater when the high PM2.5 concentration duration began during the day and lasted for approximately 4 days, and the elderly may be more affected by persistently high PM2.5.

Citations

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Estimating Health and Economic Benefits from PM2.5 Reduction in Fishery-Based Communities: A Sector-Specific Approach to Sustainable Air Quality Management in the Philippines
James Roy Lesidan, Nadine Grace Caido, Oliver Semblante, Floro Junior Roque, Jejomar Bulan, Jumar Cadondon, Maria Cecilia Galvez, Edgar Vallar
Sustainability.2025; 17(3): 1316. CrossRef

Age-specific effects of ozone on pneumonia in Korean children and adolescents: a nationwide time-series study: Kyoung-Nam Kim, Youn-Hee Lim, Sanghyuk Bae, In Gyu Song, Soontae Kim, Yun-Chul Hong; Epidemiol Health. 2022;44:e2022002. Published online December 28, 2021; DOI: https://doi.org/10.4178/epih.e2022002

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The aim of this study was to estimate the age-specific effects of 8-hour maximum ozone levels on pneumonia in children and adolescents.

METHODS

We performed quasi-Poisson regression analyses for individuals of 0-4 years, 5-9 years, 10-14 years, and 15-19 years of age using nationwide time-series data from the Korea (2011-2015). We constructed distributed lag linear models employing a generalized difference-in-differences method and controlling for other air pollutants.

RESULTS

A 10.0-parts per billion increase in 8-hour maximum ozone levels was associated with a higher risk of hospital admissions due to pneumonia at 0-4 (relative risk [RR], 1.02; 95% confidence interval [CI], 1.01 to 1.03) and 5-9 years of age (RR, 1.06; 95% CI, 1.04 to 1.08), but not at 10-14 (RR, 1.01; 95% CI, 0.98 to 1.04) or 15-19 years of age (RR, 1.01; 95% CI, 0.97 to 1.06). The association between ozone and hospital admissions due to pneumonia was stronger in cool seasons (from November to April) than in warm seasons (from May to October), but was similar between boys and girls.

CONCLUSIONS

Short-term exposure to ozone was associated with a higher risk of pneumonia at 0-4 years and 5-9 years of age, but not at 10-14 years or 15-19 years of age. Our findings can help identify vulnerable periods, determine the target populations for public health interventions, and establish air pollution standards.

Summary

Korean summary
-어린이와 청소년에서 대기오염물질인 오존에 단기 노출되었을 때 폐렴으로 인한 입원 위험이 증가하는지를 건강보험공단 청구자료를 이용하여 구축한 시계열자료로 분석하였다. -0-4세, 5-9세 군에서는 오존 단기 노출 시 폐렴으로 인한 입원 위험이 증가하였으나 10-14세, 15-19세 군에서는 입원 위험 증가가 관찰되지 않았다.

Key Message
• The effects of ozone levels on hospital admissions for pneumonia were evaluated. • We used quasi-Poisson time-series models and a difference-in-differences method. • Ozone levels increased hospital admissions for pneumonia at ages 0–4 and 5–9 years. • Evidence for the effects of ozone levels on pneumonia was not found at older ages.

Citations

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Short-term effects of ambient ozone on pediatric pneumonia hospital admissions: a multi-city case-crossover study in China
Huan Wang, Huan-Ling Zeng, Guo-Xing Li, Shuang Zhou, Jin-Lang Lyu, Qin Li, Guo-Shuang Feng, Hai-Jun Wang
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Pengjie Wang, Qingqing Meng, Yufeng Zhao, Zhiguo Yu, Ping Gu, Jingyang Jiang, Xiaohui Su, Jixin Guan, Rui Zhang, Xiaoyan Wang, Liangbing Hu
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Kyoung-Nam Kim, Ji Hoon Sohn, Sung Joon Cho, Hwo Yeon Seo, Soontae Kim, Yun-Chul Hong
BMJ Open.2022; 12(9): e058286. CrossRef

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