Gender and tobacco epidemic in South Korea: implications from age-period-cohort analysis and the DPSEEA framework
Sung-il Cho,
Rockli Kim,
S V Subramanian,
Jong-Tae Lee,
Min-Jeong Shin,
Kyungwon Oh,
Sera Kim,
Garam Byun,
Garam Jo,
Dahyun Park,
Hannah Oh,
Sungha Yun
Affiliations
Sung-il Cho
Department of Public Health Science, Seoul National University Graduate School of Public Health, Seoul, Korea (the Republic of)
Rockli Kim
Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
S V Subramanian
Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Jong-Tae Lee
School of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
Min-Jeong Shin
Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
Kyungwon Oh
Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
Sera Kim
Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
Garam Byun
Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
Garam Jo
Division of Cardiovascular Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju, Republic of Korea
Dahyun Park
Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
Hannah Oh
Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
Sungha Yun
Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
Objectives To understand a 20-year trend of gender-specific smoking prevalence among adults in South Korea.Design Age-period-cohort analysis using the intrinsic estimator method was applied to examine the separate contribution of age, period and cohort effect on smoking prevalence. The Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework was used to explain the observed smoking trends by mapping potential determinants and to address policy implications.Setting General adult population in South Korea.Participants 34 828 men and 43 632 women who aged 19–78 years, were not currently pregnant and were without a prior diagnosis of cardiovascular disease or cancer.Outcome measures Gender-specific current smoking prevalence using the 1998–2017 Korea National Health and Nutrition Examination Survey.Results Our results showed gender-specific age and birth cohort effects. More specifically, the smoking prevalence peaked at their mid-20s (prevalence rate ratio (PRR): 1.54, 95% CI: 1.49 to 1.59) and cohort born in 1959–1963 (PRR: 1.63, 95% CI: 1.57 to 1.70) and then decreased in men. On the other hand, in women, the smoking prevalence consistently increased until their mid-40s (PRR: 1.53, 95% CI: 1.27 to 1.84) and in recent birth cohort groups (PRR in 1994–1998 cohort: 1.55, 95% CI: 1.13 to 2.13). The period effects declined from 1998−2002 to 2003–2007, following increasing fluctuations in both genders. The smoking-DPSEEA framework showed the absence of policy actions to target female smokers and emphasised a proactive approach that tackles the upstream causes for smoking in women.Conclusions Men and women are clearly in different phases of the smoking epidemic in Korean population, and gender-tailored policies should be implemented.
