Bo Yoon Jeong

Policy effects of secondhand smoke exposure in public places in the republic of korea: Evidence from pm2.5 levels and air nicotine concentrations

OBJECTIVE The purpose of this study was to evaluate secondhand smoke (SHS) exposure inside selected public places to provide basic data for the development and promotion of smoke-free policies. METHODS Between March and May 2009, an SHS exposure survey was conducted. PM2.5 levels and air nicotine concentrations were measured in hospitals (n=5), government buildings (4), restaurants (10) and entertainment venues (10) in Seoul, Republic of Korea, using a common protocol. Field researchers completed an observational questionnaire to document evidence of active smoking (the smell of cigarette smoke, presence of cigarette butts and witnessing people smoking) and administered a questionnaire regarding building characteristics and smoking policy. RESULTS Indoor PM2.5 levels and air nicotine concentrations were relatively higher in monitoring sites where smoking is not prohibited by law. Entertainment venues had the highest values of PM2.5(μg/m3) and air nicotine concentration(μg/m3), which were 7.6 and 67.9 fold higher than those of hospitals, respectively, where the values were the lowest. When evidence of active smoking was present, the mean PM2.5 level was 104.9 μg/m3, i.e., more than 4-fold the level determined by the World Health Organization for 24-hr exposure (25 μg/m3). Mean indoor air nicotine concentration at monitoring sites with evidence of active smoking was 59-fold higher than at sites without this evidence (2.94 μg/m3 vs. 0.05 μg/m3). The results were similar at all specific monitoring sites except restaurants, where mean indoor PM2.5 levels did not differ at sites with and without active smoking evidence and indoor air nicotine concentrations were higher in sites without evidence of smoking. CONCLUSION Nicotine was detected in most of our monitoring sites, including those where smoking is prohibited by law, such as hospitals, demonstrating that enforcement and compliance with current smoke-free policies in Korea is not adequate to protect against SHS exposure.

Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: A comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data

OBJECTIVE We assessed the extent to which self-reported exposure to SHS underestimates the actual exposure to SHS and what factors are associated with a tolerance for SHS exposure in the Korean setting where the smoke-free policy is incomplete. METHODS Information on socio-demographic characteristics, alcohol drinking and smoking was collected for 7948 nonsmokers aged ≥ 19 years from the fourth Korea National Health and Nutrition Examination Survey, 2008-2009. Self-reported and cotinine verified SHS exposures were compared. Potential factors associated with cotinine verified but not self-reported SHS exposures were assessed using a logistic regression model. RESULTS Self-reported SHS exposure significantly underestimated the actual SHS exposure as determined by cotinine verification (kappa coefficient: 0.1066). At younger age, frequent alcohol drinking in females and a longer smoking duration in males were positively associated with cotinine verified exposure but not with the self-reported SHS exposure; they were also positively associated with cotinine verified exposure irrespective of self-reported SHS exposure. CONCLUSIONS Our findings show a tolerance for smoking in Korea. The current partial ban on smoking does not fully protect people from exposure to SHS. Smoking should be banned in all public places. In addition, efforts to de-normalize smoking in the Korean culture need to be strengthened.

User satisfaction as a tool for assessment and improvement of quitline in the Republic of Korea

INTRODUCTION There is a lack of studies on Quitline user satisfaction and its potential value to aid in understanding user demand and improve Quitline services. This study evaluated Quitline user satisfaction and its impact on smoking cessation, in order to assess the services quality and performance in the Republic of Korea. METHODS Between 2007 and 2009, 3,054 Quitline users were invited to participate in an investigation of user satisfaction and its impact on successful smoking cessation. Information on gender, age, education level, body mass index, nicotine dependency, the presence of a quit supporter and alcohol consumption were collected upon Quitline registration. Multiple logistic regression analysis was applied to identify the impact of user satisfaction on cessation maintenance, and an importance-performance (IP) analysis was used to identify the aspects of Quitline that need improvement. RESULTS Satisfaction was highest among Quitline users who maintained smoking cessation for 1 year. Quitline users who were satisfied with the contents of counseling and the coaching protocol had an increased probability of successful smoking cessation. According to the IP analysis, coaching skill was the key driver of user satisfaction, while service accessibility, the contents of counseling, and the coaching protocol were factors that need to be improved with some urgency. CONCLUSION The present study revealed low user satisfaction for the contents of counseling and the coaching protocol, which would need to be improved with some urgency to increase Quitline performance in Korea. Continued evaluation of Quitline user satisfaction could be a useful tool to understand user demand and implement improvements accordingly.

Factors Related to Relapse After 6 Months of Smoking Cessation Among Men in the Republic of Korea: A Cross-Sectional Study

Abstract We identified factors associated with relapse after 6 months of smoking cessation (late relapse) among males of the Republic of Korea. Of the 222,707 smokers who visited public health center-based smoking cessation clinics (SCCs) between January 1, 2009 and mid-December 2009, we included 1720 individuals who successfully completed a 6-month smoking cessation program at an SCC. These participants were selected via a random stratified sampling design and completed an SCC user satisfaction survey between December 31, 2009 and January 6, 2010. Multiple logistic regression was used to identify factors associated with late relapse, and path analysis was employed to explore relationships among these factors. The frequency of late relapse was 21.6% (n = 372). Residence in a metropolitan area, low socioeconomic status, and the use of nicotine replacement therapy (NRT) were associated with statistically significant increases in late relapse, whereas greater access to counseling and more satisfaction with the SCC were associated with reduced late relapse. The path analysis showed that a greater number of cigarettes smoked daily and a younger age at smoking initiation exerted significant indirect effects on late relapse when NRT was employed. Residence in a metropolitan area indirectly prevented late relapse as counseling frequency increased. NRT use, counseling frequency, and SCC user satisfaction were affected by both smoking behavior and socioeconomic status. Relapse prevention efforts should concentrate on increasing both counseling frequency and SCC user satisfaction. Future studies should focus on the effect of NRT on the maintenance of long-term cessation at the population level in real-world settings.

Towards smoke-free cars in the Republic of Korea: Evidencefrom environmental and biochemical monitoring of thirdhandsmoke exposure in taxis

INTRODUCTION To evaluate the level of tobacco smoke exposure in taxis in Korea using tobacco specific environmental markers. METHODS From June to September 2012, cross-sectional measurements of air nicotine levels and dust nicotine-derived nitrosamine ketone (NNK) concentrations were conducted in 17 taxis in Goyang, Korea. Field investigators completed an observational questionnaire on building characteristics, smoking policies and evidence of smoking. Descriptive statistics including geometric means (GMs) ± standard deviations were produced for air nicotine levels and dust NNK concentrations. RESULTS There was no evidence of active smoking in the 17 taxis monitored, despite the fact that 10 drivers were current smokers. The overall GMs of air nicotine and dust NNK concentration were 0.42 μg/m3 and 6.78 pg/mg, respectively. These levels were 3.4-fold and 2.6-fold higher in taxis whose drivers were current smokers compared to the taxis of nonsmokers (GM of air nicotine: 0.65 μg/m3 vs 0.19 μg/m3; GM of dust NNK: 10.07 pg/mg vs 3.85 pg/mg). CONCLUSIONS The present study shows that air nicotine and dust NNK were detected in all taxis regardless of whether the taxi driver was smoking or not, which indicates the potential for exposure to SHS or THS. It suggests that an appreciable level of SHS and TSH exposure might occur if the environment is not completely smoke-free and enforcement is lacking. ABBREVIATIONS THS: third-hand smoke, SHS: second-hand smoke, FCTC: Framework Convention Alliance for Tobacco Control, NNK: 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, LOD: limit of detection, GM: geometric mean, GSD: geometric standard deviation.

Awareness of and Attitudes toward Human Papillomavirus Vaccination among Adults in Korea: 9-Year Changes in Nationwide Surveys

Purpose Human papillomavirus (HPV) vaccination has been included in the National Immunization Program in Korea since 2016. We aimed to evaluate changes in the awareness of and attitudes toward HPV vaccination, among adults in Korea since the first introduction of the vaccines in 2007. Materials and Methods A nationwide population-based survey was conducted in 2016 for 1,200 nationally representative Korean men and women; the data obtained were compared with the data from the nationwide survey conducted in 2007. Results A significant increase in the awareness of HPV infection (35.8%) and vaccination (36.9%) was observed in 2016 from 13.3% and 8.6% in 2007, respectively. Willingness to be vaccinated against HPV decreased from 55.0% in 2007 to 25.8% in 2016, and the proportion of respondents expressing uncertainty increased from 28.3% in 2007 to 43.3% in 2016. Only 12.1% of men and 22.0% of women knew about the free national HPV vaccination program for girls, launched in June 2016. Younger women, with higher income level, awareness of the HPV vaccine, and perception of the seriousness of infections had a higher willingness to be vaccinated. A high education level, awareness of HPV infection and vaccination, and perception of the seriousness of infection were positively associated with the willingness of respondents to vaccinate their daughters. Conclusion Raising the awareness of HPV infection and vaccination with appropriate knowledge is necessary for the successful implementation of the national HPV vaccination program.

Public opinions on disclosure of tobacco components: Results of a nationwide cross-sectional survey in Republic of Korea

AbstractThis study aimed to explore public views on disclosure of tobacco components in an effort to develop a comprehensive regulatory system facilitating implementation of the Framework Convention on Tobacco Control (FCTC) Articles 9 and 10 in Korea.In all, 1200 representative Koreans 19 years old or older were enrolled and information on their general characteristics, smoking status, awareness of the effects of smoking on health, and views on the public disclosure of tobacco components was collected by telephone using a structured questionnaire. Factors associated with acceptance of the need for public disclosure of tobacco components were identified via multivariate analysis.Most participants considered it necessary to publicly disclose tobacco components (95.9%) and were aware of the risk to health posed by smoking (76.0%). The prevalent view was that tobacco companies should be legally required to publicly disclose details of the components of cigarettes, their levels per cigarette, and their effects on health. The most effective means of disclosure were considered to be the mass media, printed materials, and labels on cigarette packs. Females and never-smokers (odds ratio [OR]: 4.39, 95% confidence interval [95% CI]: 1.76–10.94) more readily accepted the need for public disclosure, whereas those of lower educational level and/or who were less aware of the harm to health posed by smoking (OR: 0.05, 95% CI: 0.01–0.18) were less likely to be accepting.The attitude of the general population ensures that FCTC Articles 9 and 10 will be successfully implemented in Korea. Further public consultation on the details of disclosure would be useful for the development of a comprehensive regulatory system.

Scientific Evidence Supporting Policy Change: A Study on Secondhand Smoke Exposure in Non-smoking Areas of PC Rooms in Korea

Purpose The objective of this study was to measure secondhand smoke (SHS) exposure in personal computer (PC) rooms with the purpose of determining the strength of scientific evidence supporting the legislative ban on smoking in PC rooms located in the Republic of Korea. Materials and Methods From June to September 2012, particulate matter (PM2.5) and air nicotine concentration (ANC) were measured in the smoking and non-smoking areas of PC rooms in Goyang City, Korea. In 28 randomly sampled PC rooms, field investigators completed an observational questionnaire on building characteristics, smoking policies, and evidence of smoking. The geometric means (GM) of PM2.5 and ANC in smoking and non-smoking areas were compared. Results Evidence of smoking was identified in both the smoking and non-smoking areas of all PC rooms. The GMs of PM2.5 and ANC in both areas were high and did not differ significantly (174.77 μg/m3 and 48.95 μg/m3 in smoking areas; 93.38 μg/m3 and 41.30 μg/m3 in non-smoking areas). Overall PM2.5 concentrations were 5.5-fold higher than those listed in the World Health Organization guidelines. Conclusion This study supported previous reports that a partial smoking ban did not protect individuals from SHS exposure. Furthermore, the results from our study suggest how research can support policy. Countries in which smoke-free policies are not yet comprehensive may find our results useful.

Consequences of Incomplete Smoke-Free Legislation in the Republic of Korea: Results from Environmental and Biochemical Monitoring: Community Based Study

Purpose In some countries with high smoking prevalence, smoke-free legislation has only been implemented in specific public places, as opposed to a comprehensive ban on smoking in all public places. The purpose of this study was to provide valid data on second-hand smoke (SHS) exposure that reflect the consequences of incomplete smoke-free legislation, and provide a rationale for expanding this legislation. Materials and Methods Indoor and outdoor environmental exposure (fine particulate matter [PM2.5], air nicotine, and dust 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone [NNK]) was monitored in 35 public places where smoking is prohibited by law in Goyang, Republic of Korea. Biomarkers of SHS exposure (urinary cotinine, hair nicotine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) were measured in 37 non-smoking employees. Geometric means and standard deviations were used in comparison of each measure. Results Considerable exposure of SHS was detected at all indoor monitoring sites (PM2.5, 95.5 μg/m3 in private educational institutions; air nicotine, 0.77 μg/m3 in large buildings; and dust NNK, 160.3 pg/mg in large buildings); environmental measures were higher in private or closed locations, such as restrooms. Outdoor measures of SHS exposure were lowest in nurseries and highest in government buildings. Biochemical measures revealed a pattern of SHS exposure by monitoring site, and were highest in private educational institutions. Conclusion The evidence of SHS exposure in legislative smoke-free places in Korea suggests that incomplete smoke free legislation and lack of enforcement of it might not protect people from exposure to smoke. Therefore, active steps should be taken toward a comprehensive ban on smoking in all public places and its enforcement.