Effectiveness of government anti-smoking policy on non-smoking youth in Korea: a 4-year trend analysis of national survey data

Abstract

Objectives: Since the Health Promotion Act was introduced in Korea in 1995, anti-smoking policies and regulations have undergone numerous revisions, and non-smoking areas have gradually been expanded. The purpose of this study was to examine the impact of a partial legislative ban on adolescent exposure to secondhand smoke using objective urinary cotinine levels in a nationwide representative sample.

Methods: Urine cotinine levels were measured in the Korea National Health and Nutrition Examination Survey from 2008 to 2011. This study was a trend analysis of 4 years of national survey data from 2197 Korean youth aged 10-18 years. Among non-smokers, the 75th percentile urinary cotinine level was estimated. We also considered the number of household smokers.

Results: The 75th percentile urine cotinine level of non-smokers showed a significant decreasing trend from 2008 to 2011, from 15.47 to 5.37 ng/mL, respectively. Urine cotinine did not decline significantly in non-smokers living with smokers during the study period. The results did not show a statistically significant reduction in smoking rate in adolescents from 2008 to 2011, although there was a trend towards a decrease (p=0.081).

Conclusions: Based on urine cotinine levels, government-initiated anti-smoking policies have only been effective among highly exposed non-smoking adolescents during the study period. Further study needs to evaluate whether or not the legislative ban affects domestic smoking exposure.

Keywords: cotinine; environmental tobacco smoke (ETS); vernment-initiated policy.

Figure 1

Representative Korean anti-smoking policies including smoke-free air policies over the past decade. In 1995, the first non-smoking area designation was implemented in large buildings, theatres, stores, hospitals, schools, gyms and public transportation as a partial smoking ban (separate smoking areas). In 1999, non-smoking areas were created in public baths and ceremony halls. In 2003, non-smoking areas were expanded to game rooms, large restaurants, comic book stores, government buildings and nursery schools. The WHO Framework Convention on Tobacco Control (FCTC) began in 2005 and in 2006, and factories, local government buildings and indoor workplaces were added to the list of buildings with non-smoking areas. A fourth expansion was implemented to include elevators, aisles in buildings, restrooms and other public spaces in 2008. In 2011, to reduce passive smoking, a complete smoking ban was applied in schools, kindergartens, daycare centres and medical facilities, with penalties for both facility managers and individual smokers, and other public places were added to the partial ban list. The sixth expansion measure in 2012 included small restaurants in the complete smoking ban; finally, in 2015, smoking was prohibited in all stores. *A new education policy, The Student Human Rights Ordinance, came into effect starting in Gyeonggi-do (a rural area).

Figure 2

Analysis of urinary cotinine in non-smoking youths from 2008 to 2011. (a) The 75th percentile urine cotinine level of non-smokers showed a significant decreasing trend from 2008 to 2011. When subgroups were divided by (b) age, (c) sex, (d) residence area, (e) household monthly income and (f) household smoker, the 75th percentile urinary cotinine level was significantly decreased in the 10–12-year subgroup, both sexes, all residence area subgroups except the rural area subgroup, middle and high income subgroups and the no household smoker subgroup. Data are presented as the 75th percentile urine cotinine levels; p values for trend were calculated through linear regression.