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Original Articles
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
  • 1,608 View
  • 99 Download
AbstractAbstract AbstractSummary PDFSupplementary 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.
Tobacco consumption, sales, and output as monitoring indicators in the era of the tobacco endgame: a Korean example
Hana Kim, Hee-kyoung Nam, Heewon Kang
Epidemiol Health. 2023;45:e2023030.   Published online February 27, 2023
DOI: https://doi.org/10.4178/epih.e2023030
  • 3,727 View
  • 138 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The consumption, sales, and output of tobacco products each suggest different areas of intervention for tobacco control. In the era of the tobacco endgame, as increasingly stronger supply-side measures are implemented, multifaceted indicators that assess both supply and/or demand are required. We aimed to estimate the consumption of cigarette and heated tobacco products (HTPs) and sought agreement between the various indicators.
METHODS
The annual cigarette and HTP consumption in 2014-2020 was calculated using the frequency and intensity of cigarette use from representative surveys of adults and adolescents by sex and age. Sales and output data were acquired from governmental sources. Spearman correlation coefficients and Bland–Altman plots were used to compare the indicators.
RESULTS
Tobacco output, cigarette sales, and cigarette consumption were greatest in 2014. The HTP consumption calculated for 2020 was 292.28 million packs. Cigarette consumption and sales correlated significantly, as did tobacco output and tobacco sales. A Bland–Altman plot comparing the difference between cigarette consumption and sales showed that this difference was largest in 2014, immediately before cigarette prices increased. With the exception of a single year, all cigarette consumption values were within the limits of agreement for cigarette sales and tobacco output.
CONCLUSIONS
Our analyses showed agreement between demand-side (tobacco consumption) and supply-side (sales and output) indicators. We recommend using all indicators to monitor the impacts of tobacco control on both demand and supply sides. The systematic use of various indicators is critical to achieve the end of the tobacco epidemic.
Summary
Korean summary
공급 제한 중심의 담배 종결전 정책 채택을 고려하는 국가가 증가하고 있다. 이에 따라, 흡연율과 같은 전통적인 지표 외에 공급 측면의 지표가 필요한 상황이다. 담배 소비량, 판매량 및 반출량을 비교 분석한 결과, 지표 간 일치도가 높았으나 정책이 강화되는 시점에 지표 간 격차가 증가하는 것을 확인할 수 있었다. 담배규제 및 종결전 정책 모니터링을 위해 수요 및 공급 측면 지표 모두를 활용할 필요가 있다.
Key Message
The tobacco endgame, which aims to put an end to the tobacco epidemic once and for all, provides supply-focused measures, in addition to the traditional demand-focused measures based on MPOWER strategies. Thus, new supply-focused indicators are required to supplement the traditional demand-side indicators such as tobacco use prevalence and consumption. Our analysis showed that consumption, sales, and output were generally in good agreement. Yet, substantial gaps were identified when tobacco control measures were strengthened. Each indicator is imperfect in isolation, and we suggest to use all consumption, sales, and output indicators in the national health objectives (e.g. Health Plan 2030).
Smokeless tobacco consumption and its association with tobacco control factors in the Western Pacific Region: results from the Global Youth Tobacco Survey 2015-2019
Chandrashekhar T. Sreeramareddy, Anusha Manoharan
Epidemiol Health. 2022;44:e2022103.   Published online November 8, 2022
DOI: https://doi.org/10.4178/epih.e2022103
  • 2,871 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We estimated the prevalence of smokeless tobacco (ST) consumption and its associations with tobacco control factors among school-going youth in 18 Western Pacific Region (WPR) countries.
METHODS
We analyzed school-based Global Youth Tobacco Survey (2014-2019) microdata from 18 WPR countries and estimated weighted prevalence rates of ST consumption, cigarette smoking, and dual use. We used multilevel binary logistic regression to examine the associations of ST consumption and dual use with demographic variables, exposure to pro-tobacco and anti-tobacco factors, national income, and MPOWER indicators.
RESULTS
Data from 58,263 school-going youth were analyzed. The prevalence of past 30-day ST consumption was highest in Kiribati (42.1%), the Marshall Islands (26.1%), Micronesia (21.3%), Palau (16.0%), and Papua New Guinea (15.2%). In adjusted multilevel models, ST consumption and dual use were significantly associated with sex, age, parental smoking, pro-tobacco factors, national income, and MPOWER score. For each unit increase in score for cessation programs, we observed approximately 1.4-fold increases in the odds of youth ST consumption (adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.15 to 1.66) and dual use (aOR, 1.47; 95% CI, 1.16 to 1.86). Similarly, for each unit increase in score for health-related warnings, the odds of both ST consumption (aOR, 0.47; 95% CI, 0.42 to 0.53) and dual use (aOR, 0.35; 95% CI, 0.30 to 0.42) decreased by approximately 60%.
CONCLUSIONS
The prevalence of youth ST consumption was substantial in the Pacific Islands, exceeding that of cigarette smoking in some countries. Implementing MPOWER measures for ST products could help reduce ST consumption.
Summary
Key Message
The prevalence of smokeless tobacco consumption, and cigarette smoking is considerably high among the school going youth in five pacific island nations of Western Pacific Region. Exposure to pro-tobacco factors and parental smoking were positively associated with youth smokeless tobacco consumption as well as dual use (both smokeless tobacco and cigarettes smoking) Closer monitoring and strict tobacco control policies are needed to prevent further escalation of smokeless tobacco consumption.
Prediction of cancer survivors’ mortality risk in Korea: a 25-year nationwide prospective cohort study
Yeun Soo Yang, Heejin Kimm, Keum Ji Jung, Seulji Moon, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2022;44:e2022075.   Published online September 13, 2022
DOI: https://doi.org/10.4178/epih.e2022075
  • 4,520 View
  • 141 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate the factors affecting cancer survival and develop a mortality prediction model for Korean cancer survivors. Our study identified lifestyle and mortality risk factors and attempted to determine whether health-promoting lifestyles affect mortality.
METHODS
Among the 1,637,287 participants in the Korean Cancer Prevention Study (KCPS) cohort, 200,834 cancer survivors who were alive after cancer diagnosis were analyzed. Discrimination and calibration for predicting the 10-year mortality risk were evaluated. A prediction model was derived using the Cox model coefficients, mean risk factor values, and mean mortality from the cancer survivors in the KCPS cohort.
RESULTS
During the 21.6-year follow-up, the all-cause mortality rates of cancer survivors were 57.2% and 39.4% in men and women, respectively. Men, older age, current smoking, and a history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer were associated with reduced risk. The prediction model discrimination in the validation dataset for both KCPS all-cause mortality and KCPS cancer mortality was shown by C-statistics of 0.69 and 0.68, respectively. Based on the constructed prediction models, when we modified exercise status and smoking status, as modifiable factors, the cancer survivors’ risk of mortality decreased linearly.
CONCLUSIONS
A mortality prediction model for cancer survivors was developed that may be helpful in supporting a healthy life. Lifestyle modifications in cancer survivors may affect their risk of mortality in the future.
Summary
Korean summary
현재 암 생존자의 사망 위험을 평가하는 데 유용한 한국형 암 생존자 사망률 예측 모델은 없습니다. 본 연구에서는 고령, 남성, 현재 흡연, 당뇨병 병력을 포함한 생활양식 요인이 사망의 고위험 요인인 반면, 운동 습관 및 암의 가족력은 사망 위험을 감소시키는 것으로 나타났습니다. 현재 흡연과 운동 습관은 사망 위험에 영향을 미치는 수정 가능한 두 가지 요소로써, 이러한 생활습관 요인으로 구성된 예측모형은 생활습관 교정을 통해 우리나라 암 생존자의 사망률을 낮출 수 있음을 시사합니다.
Key Message
Currently, there is no Korean mortality prediction model for cancer survivors that would be useful in evaluating their risk of mortality. The present study showed that lifestyle factors, including older age, male sex, current smoking, and history of diabetes were high-risk factors for mortality, while exercise habits and a family history of cancer reduced the risk of mortality. Current smoking and exercise habits are the two modifiable factors that affected the risk of mortality. The prediction model comprising these lifestyle factors implies that the risk of mortality of cancer survivors in Korea can be reduced through lifestyle modification.

Citations

Citations to this article as recorded by  
  • COVID-19 Mortality and Severity in Cancer Patients and Cancer Survivors
    Jae-Min Park, Hye Yeon Koo, Jae-ryun Lee, Hyejin Lee, Jin Yong Lee
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Weight maintenance and gain were significantly associated with lower risk of all-cause and cancer-related mortality in Korean adults who were newly diagnosed with cancer based on the Korean NHIS-HEALS cohort
    Yong-June Kim, Seung Park, Won Tae Kim, Yoon-Jong Bae, Yonghwan Kim, Hee-Taik Kang
    Medicine.2023; 102(47): e36184.     CrossRef
Effect of tobacco outlet density on quit attempts in Korea: a multi-level analysis of the 2015 Korean Community Health Survey
Jaehyung Kong, Sung-il Cho
Epidemiol Health. 2021;43:e2021048.   Published online August 3, 2021
DOI: https://doi.org/10.4178/epih.e2021048
  • 9,003 View
  • 328 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study aimed to examine whether the regional density of tobacco outlets in Korea was associated with the likelihood of attempting to quit among smokers
METHODS
This study was designed as a secondary data analysis of a cross-sectional study. Data from the 2015 Korean Community Health Survey and tobacco outlet registrations in 17 metropolitan cities and provinces with 254 communities in Korea were used for the analysis. In total, 41,013 current smokers (≥19 years of age) were included. Multi-level logistic regression analysis was conducted to investigate regional differences associated with smokers’ attempts to quit and to evaluate the effects of individual and regional characteristics on quit attempts.
RESULTS
Higher tobacco outlet density was associated with lower odds of attempting to quit. Smokers who resided in districts with the highest tobacco outlet density were 18% less likely to attempt quitting (odds ratio, 0.82; 95% confidence interval, 0.70 to 0.98) than smokers who resided in the regions with the lowest tobacco outlet density (intraclass correlation coefficient, 0.030).
CONCLUSIONS
This study showed that quit attempts were related to community-level factors, such as tobacco outlet density, as well as other individual factors. These findings support the implementation of national policies restricting the number of tobacco outlets within communities or zones and limiting tobacco marketing in tobacco outlets.
Summary
Korean summary
본 연구는 2015년 지역사회건강조사에 응답한 19세 이상 현재 흡연자 41,013명을 대상으로 금연 시도와 관련된 개인 수준의 요인과 지역 수준의 요인을 파악하기 위하여 다수준 분석을 실시하였다. 분석결과, 개인 수준의 요인뿐만 아니라 거주하는 지역의 담배소매점 밀집도가 흡연자의 금연 시도와 유의한 관계가 있는 것으로 확인되었다. 흡연조장환경 개선을 위한 담배 공급 감소 노력의 일환으로 지역사회 수준의 담배소매점 관리 정책이 필요하다.
Key Message
This study aimed to investigate whether the environment related to tobacco retailers impacts adult smokers’ attempts to quit smoking, for the first time in South Korea, using nationwide data on tobacco retailers and current smokers. Smokers who resided in districts with the highest tobacco outlet density were 18% less likely to attempt quitting (odds ratio, 0.82; 95% confidence interval, 0.70-0.98) than smokers who resided in the regions with the lowest tobacco outlet density. These findings support the implementation of national policies restricting the number of tobacco outlets within communities or zones and limiting tobacco marketing in tobacco outlets.

Citations

Citations to this article as recorded by  
  • Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors
    Doo Woong Lee, Jieun Jang, Jaeyong Shin
    SSM - Population Health.2024; 25: 101580.     CrossRef
  • Use of geographically weighted regression models to inform retail endgame strategies in South Korea: application to cigarette and ENDS prevalence
    Heewon Kang, Eunsil Cheon, Jaeyoung Ha, Sung-il Cho
    Tobacco Control.2023; : tc-2023-058117.     CrossRef
Preventable causes of cancer in Texas by race/ethnicity: tobacco smoking
Franciska J. Gudenkauf, Aaron P. Thrift
Epidemiol Health. 2021;43:e2021046.   Published online July 13, 2021
DOI: https://doi.org/10.4178/epih.e2021046
  • 9,212 View
  • 258 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Tobacco smoking is classified as carcinogenic to humans (International Agency for Research on Cancer Group 1). We aimed to estimate the percentage and number of incident cancer cases diagnosed in Texas in 2015 that were attributable to tobacco smoking, and we examined differences in the proportions of smoking-attributable cancers between the major racial/ethnic subgroups of the population.
METHODS
We calculated population-attributable fractions for cancers attributable to tobacco smoking using prevalence data from the Texas Behavioral Risk Factor Surveillance System and relative risks associated with smoking status from pooled analyses of cohort studies or meta-analyses. Cancer incidence data were collected from the Texas Cancer Registry.
RESULTS
We estimated that 19,000 excess cancer cases or 18.4% of all cancers diagnosed in 2015 in Texans aged ≥ 25 years were caused by tobacco smoking. Males had a higher overall proportion of cancers attributable to tobacco smoking than females (male, 23.3%, 11,993 excess cases; female, 13.5%, 7,006 cases). Approximately 20% of cancer cases in non-Hispanic Whites and non-Hispanic Blacks were attributable to tobacco smoking compared to 12.8% among Hispanics.
CONCLUSIONS
Despite ongoing public health campaigns combatting tobacco use, this preventable behavior still contributes significantly to cancer incidence in Texas. Racial/ethnic differences in smoking prevalence and smoking-attributable cancer incidence should be considered when designing cancer prevention programs.
Summary
Key Message
Tobacco smoking remains a major contributor to cancer burden in the United States, particularly among men, non-Hispanic whites and non-Hispanic Blacks due to historically higher smoking rates.
Substance abuse behaviors among university freshmen in Iran: a latent class analysis
Kourosh Kabir, Ali Bahari, Mohammad Hajizadeh, Hamid Allahverdipour, Mohammad Javad Tarrahi, Ali Fakhari, Hossein Ansari, Asghar Mohammadpoorasl
Epidemiol Health. 2018;40:e2018030.   Published online July 2, 2018
DOI: https://doi.org/10.4178/epih.e2018030
  • 11,896 View
  • 208 Download
  • 7 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Substance abuse behaviors among university freshmen in Iran are poorly understood. This study aimed to identify, for the first time, subgroups of university freshmen in Iran on the basis of substance abuse behaviors. Moreover, it examined the effects of socio-demographic characteristics on membership in each specific subgroup.
METHODS
Data for the study were collected cross-sectionally in December 2013 and January 2014 from 4 major cities in Iran: Tabriz, Qazvin, Karaj, and Khoramabad. A total of 5,252 first-semester freshmen were randomly selected using a proportional cluster sampling methodology. A survey questionnaire was used to collect data. Latent class analysis (LCA) was performed to identify subgroups of students on the basis of substance abuse behaviors and to examine the effects of students’ socio-demographic characteristics on membership in each specific subgroup.
RESULTS
The LCA procedure identified 3 latent classes: the healthy group; the hookah experimenter group; and the unhealthy group. Approximately 82.8, 16.1, and 2.1% of students were classified into the healthy, hookah experimenter, and unhealthy groups, respectively. Older age, being male, and having a family member or a close friend who smoked increased the risk of membership in classes 2 and 3, compared to class 1.
CONCLUSIONS
Approximately 2.1% of freshmen exhibited unhealthy substance abuse behaviors. In addition, we found that older age, being male, and having a close friend or family member who smoked may serve as risk factors for substance abuse behaviors.
Summary

Citations

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    Neda Soleimanvandiazar, Salah Eddin Karimi, Mahboobeh Kamali, Marziyeh Moradi, Leila Janani, Saeed Ghanbari, Azadeh Mottaghi, Mojtaba Piri, Leila Ghalichi, Marzieh Nojomi
    Journal of Substance Use.2023; 28(6): 809.     CrossRef
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    Amrita Gill, Erica Felker-Kantor, Colette Cunningham-Myrie, Lisa-Gaye Greene, Parris Lyew-Ayee, Uki Atkinson, Wendel Abel, Simon G. Anderson, Katherine P. Theall
    PeerJ.2023; 11: e14297.     CrossRef
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    Hamid Sharif-Nia, Tahereh Heidari, Mehran Zarghami, Azar Ramezani Toyeh, Parvin Ghasemi Mianaee, Vahid Ganji, Hamideh Azimi Lolaty
    Journal of Nursing and Midwifery Sciences.2023;[Epub]     CrossRef
  • Latent Classes of Substance Use in Young Adults – A Systematic Review
    Martha Charlotta de Jonge, Andrea Johanna Bukman, Lonneke van Leeuwen, Simone Arianne Onrust, Marloes Kleinjan
    Substance Use & Misuse.2022; 57(5): 769.     CrossRef
  • Prevalence of hookah smoking among Iranian pupils and university students: An updated systematic review and meta‐analysis
    Hamid Zaheri, Yosra Raziani, Nesa Khademi, Yousef Moradi, Hossein Shahriari, Reza Ghanei‐Gheshlagh
    The Clinical Respiratory Journal.2022; 16(6): 425.     CrossRef
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    Tassia T. S. Macedo, Fernanda C. Mussi, Debra Sheets, Ana C. P. Campos, Ana L. Patrão, Caren L. M. Freitas, Melissa A. S. Paim
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Review
Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer
Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Haji Bahadar, Fatima Ismail Hassan, Mohammad Abdollahi
Epidemiol Health. 2017;39:e2017009.   Published online March 9, 2017
DOI: https://doi.org/10.4178/epih.e2017009
  • 37,615 View
  • 739 Download
  • 110 Web of Science
  • 116 Crossref
AbstractAbstract PDF
Abstract
Smokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as <i>paan</i> and <i>gutkha</i>, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by PubMed, Scopus, and Google Scholar. The continuous chewing of <i>paan</i> and swallowing of <i>gutkha</i> trigger progressive fibrosis in submucosal tissue. Generally, OSMF occurs due to multiple risk factors, especially smokeless tobacco and its components, such as betel quid, areca nuts, and slaked lime, which are used in <i>paan</i> and <i>gutkha</i>. The incidence of oral cancer is higher in women than in men in South Asian countries. Human oral epithelium cells experience carcinogenic and genotoxic effects from the slaked lime present in the betel quid, with or without areca nut. Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eventually, oral cancer.
Summary

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Methods
The causality between smoking and lung cancer among groups and individuals: addressing issues in tobacco litigation in South Korea
Young-Ho Khang
Epidemiol Health. 2015;37:e2015026.   Published online May 31, 2015
DOI: https://doi.org/10.4178/epih/e2015026
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  • 2 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This article discusses issues on the causality between smoking and lung cancer, which have been raised during the tobacco litigation in South Korea. It should be recognized that the explanatory ability of risk factor(s) for inter-individual variations in disease occurrence is different from the causal contribution of the risk factor(s) to disease occurrence. The affected subjects of the tobacco litigation in South Korea are lung cancer patients with a history of cigarette smoking. Thus, the attributable fraction of the exposed rather than the population attributable fraction should be used in the tobacco litigation regarding the causal contribution of smoking to lung cancer. Scientific evidence for the causal relationship between smoking and lung cancer is based on studies of individuals and groups, studies in animals and humans, studies that are observational or experimental, studies in laboratories and communities, and studies in both underdeveloped and developed countries. The scientific evidence collected is applicable to both groups and individuals. The probability of causation, which is calculated based on the attributable fraction for the association between smoking and lung cancer, could be utilized as evidence to prove causality in individuals.
Summary
Korean summary
이 글에서는 우리나라 담배소송 과정에서 제기된 흡연과 폐암의 인과성에 대하여 논하였다. 질병 발생의 개인 간 변이에 대한 위험 요인의 설명력과 질병발생에 미치는 위험요인의 인과적 기여도는 다르다는 점을 지적하였다. 개인에서의 흡연과 폐암의 인과성에 대한 정보로 인과확률이 활용될 수 있음을 강조하였다.

Citations

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    Jan Dul
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    Journal of the Korean Medical Association.2018; 61(8): 466.     CrossRef
  • Tobacco and epidemiology in Korea: old tricks, new answers?
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Editorial
Epidemiological evidence in law: a comment on Supreme Court Decision 2011Da22092, South Korea
Alex Broadbent
Epidemiol Health. 2015;37:e2015025.   Published online May 31, 2015
DOI: https://doi.org/10.4178/epih/e2015025
  • 15,547 View
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  • 4 Web of Science
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AbstractAbstract PDF
Abstract
This paper offers a commentary on three aspects of the Supreme Court’s recent decision (2011Da22092). First, contrary to the Court’s finding, this paper argues that epidemiological evidence can be used to estimate the probability that a given risk factor caused a disease in an individual plaintiff. Second, the distinction between specific and non-specific diseases, upon which the Court relies, is shown to be without scientific basis. Third, this commentary points out that the Court’s finding concerning defect of expression effectively enables tobacco companies to profit from the efforts of epidemiologists and others involved in public health to raise awareness of the dangers of smoking.
Summary

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Perspective
Strategies for an effective tobacco harm reduction policy in Indonesia
Fariz Nurwidya, Fumiyuki Takahashi, Hario Baskoro, Moulid Hidayat, Faisal Yunus, Kazuhisa Takahashi
Epidemiol Health. 2014;36:e2014035.   Published online December 10, 2014
DOI: https://doi.org/10.4178/epih/e2014035
  • 18,231 View
  • 199 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Abstract
Tobacco consumption is a major causative agent for various deadly diseases such as coronary artery disease and cancer. It is the largest avoidable health risk in the world, causing more problems than alcohol, drug use, high blood pressure, excess body weight or high cholesterol. As countries like Indonesia prepare to develop national policy guidelines for tobacco harm reduction, the scientific community can help by providing continuous ideas and a forum for sharing and distributing information, drafting guidelines, reviewing best practices, raising funds, and establishing partnerships. We propose several strategies for reducing tobacco consumption, including advertisement interference, cigarette pricing policy, adolescent smoking prevention policy, support for smoking cessation therapy, special informed consent for smokers, smoking prohibition in public spaces, career incentives, economic incentives, and advertisement incentives. We hope that these strategies would assist people to avoid starting smoking or in smoking cessation.
Summary

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  • Factors Affecting Secondhand Smoke Avoidance Behavior of Vietnamese Adolescents
    Ja-yin Lee, Hyunmi Ahn, Hyeonkyeong Lee
    International Journal of Environmental Research and Public Health.2018; 15(8): 1632.     CrossRef
Original Article
The Role of the Epidemiological Causality of the Association between Smoking and Lung Cancer.
Kyung Hwan Lee, Hyun Hee Kang
Korean J Epidemiol. 2005;27(2):28-37.
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  • 23 Download
AbstractAbstract PDF
Abstract
It is generally accepted that acknowledgment of the causality of the association between smoking and lung cancer plays a crucial role in imposing liability on tobacco manufacturers in tobacco-related cases. However, acknowledgment of the epidemiological causality of the association is merely a precondition to putting liability on tobacco manufacturers; it does not play a crucial role. Smokers smoke manufactured tobacco by their right to choose according to their self-decision; therefore, it is not reasonable to place all liability concerning lung cancer on tobacco manufacturers. This paper studies the dual structure of the causality of the association between tobacco manufacturing and smoking as well as smoking and lung cancer. It can be understood that tobacco manufacturers must be held liable for lung cancer caused by smoking when there was intentional concealment or insufficient provision of information on the harmfulness of tobacco and the addictiveness of nicotine. The epidemiological causality of the association is the minimum scientific and legal precondition to placing liability on tobacco manufacturers for lung cancer caused by smoking. However, striving for protection and promotion of national health by, for instance, promoting antismoking programs, the epidemiological causality of the association adequately plays a social role when viewed from a public health perspective.
Summary
Controlled Clinical Trial
Application of Epidemiology to the Tobacco Lawsuit Cases in KOREA.
Hong Gwan Seo, Hyung Joon Jhun
Korean J Epidemiol. 2005;27(2):20-27.
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AbstractAbstract PDF
Abstract
Over the half of last century, epidemiology has witnessed that tobacco causes lung cancer. Therefore, lung cancer lawsuits against tobacco companies have been raised in many countries. However, a discrepancy between epidemiology dealing with population-based causal association and lawsuit dealing with individual-based evidence has happened. This article discusses application of epidemiology to the tobacco lawsuit cases in Korea. Epidemiological studies such as double blind randomized controlled clinical trials and cohort studies give clinicians important information on decision-making for the treatment of an individual patient and predicting prognosis. Epidemiological data have also been applied to the diagnosis of a worker's claim on occupational disease or work-related disorder. Illegality is generally recognized in the court when direct causal relationship between offending action(s) and damage(s) is proved and the damaged must prove illegality of the offender(s). The probability theory was emerged to reduce the responsibility especially when a plaintiff has a difficulty in proving causal relationship and illegality due to long-term duration or complexity or poor condition of the plaintiff such as environmental lawsuit cases. In relation to the probability theory, a theory was raised that a causal relationship is proved legally if an epidemiological causal relationship between offending action(s) and damage(s) is proved. Based on these evidences and theories, we show our opinion that epidemiological data are applicable to the individuals such as tobacco lawsuit cases in Korea.
Summary
Original Articles
Prevalence and Risk Factors of Green Tobacco Sickness among Korean Tobacco Harvesters, 2003.
Kwan Lee, Hyun Sul Lim
Korean J Epidemiol. 2005;27(1):129-139.
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AbstractAbstract PDF
Abstract
OBJECTIVES
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 (842 persons from 449 out of 500 tobacco harvesting households) in Cheongsong-gun for 4 days from Sep 1 to 4, 2003.
RESULTS
The study subjects contained 440 males and 402 females. The prevalence of GTS in 2003 was 39.2%, and was significantly higher in females (53.4%) than in males (25.6%, p<0.01). The incidence density of GTS according to the number of workdays in 2003 was 11.5 spells/100 person-days. The GTS symptoms reported by the tobacco harvesters in 2003 were nausea in 320 cases (97.0%), dizziness in 311 cases (94.2%), headache in 264 cases (80.0%) and vomiting in 209 cases (63.3%) etc. Through multiple logistic regression, the factors significantly associated with GTS were found. Odds ratio for smoking, age over sixty(compared with under forties), and working over 10 hours(compared with under 10 hours) were respectively 0.23 (95% CI: 0.16~0.33), 0.46 (95% CI: 0.23~0.93), and 1.53 (95% CI: 1.12~2.10).
CONCLUSIONS
Our studies before this, there were significant recall bias by time lag between harvesting period and survey time. We tried to study promptly after harvesting tobacco leaves to solve this recall bias. More extensive epidemiologic studies, and educations for harvesters are expected.
Summary
Epidemiological Characteristics and Changes of Prevalence for Green Tobacco Sickness among Korean Tobacco Harvesters.
Joo Sub Lee, Sung Han Bae, Hyun Sul Lim, Kwan Lee
Korean J Epidemiol. 2004;26(1):39-49.
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AbstractAbstract PDF
Abstract
PURPOSE
This study was carried out to investigate the epidemiological characteristics and changes of prevalence for green tobacco sickness (GTS) for 2 years.
METHODS
The author conducted a questionnaire survey on the tobacco harvesters (875 persons from 478 out of 555 tobacco harvesting households surveyed last year) in Cheongsong-gun for 4 days from May 26 to 29, 2003.
RESULTS
The study subjects comprised 456 males and 419 females. The prevalence of GTS in 2002 was 50.5%, which was significantly higher than the 43.0% in 2001 (p<0.01). The incidence density of GTS in 2002 was 11.3 spells/100 person?working-days, which was lower than the 12.1 spells in 2001. Regardless of risk factors such as smoking, workingdays, and working hours, the prevalence of GTS in 2002 was higher than that in 2001. Among various GTS symptoms reported by the tobacco harvesters in 2002, cases of nausea were increased, while diarrhea, dyspnea and cough were decreased compared with 2001. The degree of GTS symptoms in 2002 was increased in 198 cases (64.5%), and decreased in 42 cases (13.7%). The proportion of harvesters who underwent treatment from their local medical facilities in 2002 was significantly decreased compared with that in 2001.
CONCLUSIONS
In Korea, there are many tobacco-harvesting households, most of which may be stricken with GTS. It is very important for doctors to diagnose the disease exactly and to develop prevention methods for GTS. I expect that more extensive epidemiological studies including the incidence and associated risk factors will be needed. In addition, surveillance system and measurements of urinary cotinine should be conducted.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.