Gender and tobacco epidemic in South Korea: implications from age-period-cohort analysis and the DPSEEA framework.

ABSTRACT

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.