Smoking in South Korea has decreased overall for both men and women in the past decades. However, a high prevalence of tobacco use is still observed, especially with the rise of novel tobacco products such as e-cigarettes and heat-not-burn tobacco products. There are socioeconomic inequalities in smoking prevalence according to gender, income, education, and occupational class. Advocates call for measures to reduce the smoking rates and address smoking inequalities using a combination of monitoring and tobacco control policies. These measures include significant price hikes, mandatory warning photos on cigarette packs, advertising bans, financial incentives, medical help for quitting, and complete smoking bans in public places.
In 2021, the smoking rate for Koreans over 19 was 19.3%, a record low. That year, 31.3% of men and 6.9% of women were smokers. A 2022 study reported that this was a 50% decrease from 20 years ago.
History.
Smoking arrived in Korea through the introduction of tobacco in the early 1600s from Japan and quickly became a widespread and popular activity among the people regardless of gender, social class, and age. This was due to the appealing characteristics of tobacco in the context of Korea at that time. Namely, the favorable climate and soil for tobacco cultivation created a profitable economic sector, and smoking was thought to be a health-promoting, social, and cultural activity. Although smoking was common amongst all people, the quality of tobacco used differed across the established classes of the hierarchical system. The Dutch mariner Hendrick Hamel wrote in the 17th century that tobacco use was so prevalent that even children began smoking by age four or five. The practice became so widespread that it became said that even tigers must have smoked in Korea, which gave rise to the phrase "a long time ago, when tigers smoked pipes..." (Korean: ) to begin stories about the distant past.
Men and women both smoked until around 1880, when stigmas against women, especially young and middle-aged women, started to arise.
Prevalence of smoking.
Cigarettes.
Adults.
According to the 2017 World Health Organization (WHO) report on the global tobacco epidemic, smoking prevalence was estimated to be 49.8% among males and 4.2% among females in 2015, when both daily and non-daily smokers were included. Another survey by the Organization for Economic Cooperation and Development (OECD), which included only daily smokers, indicated a smoking prevalence of 31.1% among males and 3.4% among females in 2015.
The Korea National Health and Nutrition Examination Survey (KNHANES) tracks smoking behavior in Korean adults (aged 19 years or older). KNHANES aims to represent the Korean population through surveying approximately 10,000 individuals aged 1 year and older from 3,840 households. In this survey, adult smokers were defined as those who smoked at least five packs of cigarettes in their lifetime and currently smoke everyday or on somedays. In 2016, the cigarette smoking prevalence was 40.7% among male adults and 6.4% among female adults.
Adolescents.
The Korea Youth Risk Behavior Web-based Survey (KYRBWS) annually tracks smoking behavior in Korean adolescents, defined as individuals between the ages 12 and 18. In this survey, adolescent smokers are defined as those who had smoked on more than one day during the past 30 days. In 2015, adolescent cigarette prevalence was measured to be 7.8%. In 2013, the cigarette smoking prevalence was 14.4% among male adolescents and 4.6% among female adolescents. When the adolescent group was divided, high school students had a higher prevalence rate (20.7% males, 6.3% females) compared with middle school students (7.9% males, 2.8% females).
E-cigarettes.
E-cigarettes were introduced in the South Korean market in 2007. Whereas other countries have seen a dramatic rise in e-cigarette use among adolescents, it has remained at a stable low level in Korea. According to the 2015 KYRBWS, e-cigarette prevalence among adolescents was 4%. Adolescents make up less than 3% of e-cigarette users.
Other tobacco products.
IQOS, a heat-not-burn tobacco product from company Philip Morris International (PMI), was introduced in South Korea in May 2017 in two stores in Seoul. A month later in June, IQOS was sold by other retail outlets including CU (a convenience store chain) and "Electromart ("an electronics store chain).
Cultural environment.
General attitudes.
Compared with the past, smoking has become substantially less prevalent. Still, South Korea has a high smoking prevalence, but tobacco control measures may be a strategy to depict smoking as an undesirable or socially unacceptable activity in public places. Research has shown that smoke-free policies help to change attitudes towards smoking bans in public places. Specifically, through a process called denormalization, smoke-free policies may shift attitudes of smokers and non-smokers from smoking acceptance to regarding it as an atypical behavior.
There is a cultural reluctance to seek treatment such as medical or psychological support. 87.8% of Korean male smokers indicated that they would rather try to quit smoking by themselves than seek out smoking cessation tools.
Local smoking etiquette in South Korea is influenced by Confucianism. For instance, smokers generally refrain from or seek permission before lighting up in the presence of social superiors; a social superior could be a boss, professor, parent, grandparent, or teacher.
Social differences.
According to the 2013 KNHANES, the highest prevalence rates among both Korean male and female adults were found to be among those of either lower household income or lower education level. Another study also indicated that the “low” income quartile group showed the highest smoking rates for both males and females. Specifically, the difference in cigarette smoking prevalence between those with the highest and lowest household incomes was 11.8% among males and 5.4% among females. On the other hand, the lowest rates were found to be among those with college and higher education levels. For males, smoking was most prevalent among technicians and mechanics (51.6%), service and sale workers (51.4%), and simple laborers (49.3%). For females, smoking was most prevalent among service and sales workers (10.8%), simple laborers (8.2%), and agriculture, forestry, fishing workers (5.0%). While “rural” regions showed the highest smoking rates among males, “other urban city” showed the highest smoking rates among females.
The highest adolescent smoking rates were found to be among those of either lower household economic status or lower perceived academic records. Furthermore, smoking use was higher among students attending vocational high schools (31.6% males, 14.8% females) compared with those attending general high schools (18.2% males, 4.7% females).
Gender differences.
South Korea has a significant gender difference in its smoking rates. While its male smoking rate is the highest of all countries in the OECD, its female smoking rate is the lowest. However, the female smoking rate is thought to be underestimated due to social desirability response bias in the self-reported surveys, where participants did not want to indicate smoking activity to family members or neighbor during the survey, as well as the negative stigmas associated with smoking among women. Compared with the reported rates, the actual rates, which were measured using urinary cotinine concentration (UCC) methods, were shown to be about two times higher. This is because female smoking is viewed very negatively and socially condemned. The stigmas behind female smoking may even contribute to the reporting differences between married and other (e.g. divorced, unmarried, widowed, etc.) women who may not feel as restricted by social pressures to hide their smoking statuses. Unmarried women have a higher smoking rate. It is important for smoke-free policies to specifically address hidden female smoking activity in order to prevent the possibly increasing prevalence rates among women.
There are also adolescent gender differences in smoking initiation factors. Whereas stress was strongly correlated with smoking initiation for male adolescents, family income was a strong factor for female adolescents. For both male and female adolescents, attachment to friends, smoking friends, stigma, and self-control were common factors for smoking initiation.
Military service.
Reports suggest that persistently high rates of smoking in the military contribute to the high incidence of male smoking and negate the efficacy of anti-smoking measures. This is because as many men start smoking during their mandatory 2-year military service. Smoking is largely framed as a social activity, and cigarettes are freely distributed.
Tobacco control.
The South Korean government has enacted regulations like increasing the price or taxation of tobacco products, smoking bans, and limitations on tobacco advertisements in stores. For example, in 2016, graphical health warnings on all cigarette packages became mandatory.
Tobacco control measures have shown to be effective in decreasing smoking prevalence rates. For example, in 1980, the smoking rates of men and women were 79.3% and 12.6%, respectively. Various laws, policies, and campaigns in the following decades were able to decrease smoking rates significantly (45.0% for men and 5.3% for women). Although South Korea's tobacco control policies have improved in the past years, they can still be expanded on. For example, the cigarette costs can still be increased further, tobacco advertisements can be regulated more, and workplace smoking bans can include smaller companies. Challenges to addressing the high prevalence of smoking in South Korea include the low cost of cigarettes, social factors, inadequate anti-smoking measures, and the rise of new tobacco products.
The sociocultural and economical context of South Korea should be considered when thinking about the trends in smoking prevalence and behavior. Significant economic growth and market liberalization have allowed transnational tobacco companies to advertise and sell their products to South Korea's market, often targeting populations like women and young adults.
Tobacco control policies need to be comprehensive in order to optimize efficacy and sustainability. A study inquired smokers in Korea about the price increase that would be needed in order for them to attempt quitting. Overall, the median price to quit was $5.31, which is more than 2.3 times the typical current price of $2.27. Those who responded with a higher price to quit tended to also have less worries about the negative health effects of smoking and smoked more cigarettes per day. Furthermore, the survey found that the price to quit and prevalence of smoking were lower among those exposed to non-tax tobacco control policies compared with those who were not. Therefore, these results suggest that tax tobacco control policies need to be accompanied by non-tax tobacco control policies.
Smoke-free policies.
Between 2005 and 2010, the support for smoking bans increased. The number of smokers who supported total smoking bans in the indoor areas of workplaces doubled from 17.7% in 2005 to 34.4% in 2010. Furthermore, support for total smoke-free restaurants or bars doubled. Not only in public places but the percentage of smokers who implemented smoking bans in their private homes also significantly increased. Despite this increase, still 50% of Korean smokers reported smoking in their homes.
Exposure to secondhand smoke (SHS) is also an issue that calls for smoke-free policies. A study found that 17.8% of Korean men and women are exposed to SHS in indoor workplace areas while 21.1% are exposed in public indoor areas. The dangers associated with secondhand smoke are well known among Korean smokers. The more they were aware of the harms of SHS, the more they were likely to support a total smoking ban in workplaces.
South Korea enforced strict smoking bans in public places since July 2013, with fines of ₩100,000 won on any spotted smoker and up to ₩5 million won on shop owners not following the law. It is illegal to smoke in all bars and restaurants, cafes, internet cafes, government buildings, kindergartens, schools, universities, hospitals, youth facilities, libraries, children's playgrounds, private academies, subway or train stations and their platforms and underground pathways, large buildings, theaters, department stores or shopping malls, large hotels and highway rest areas. The strict bans came into force gradually beginning with a ban on places larger than 150 square meters in 2012, extended to 100 square meters in 2014, with a full-fledged complete nationwide ban on 1 January 2015.
Since 1 January 2015, South Korea has completely banned smoking on all bars, restaurants and cafes regardless of size, including any smoking rooms. Any spotted smoker must pay fines of 100,000 won and up to 5 million won on shop owners not obeying the law. Anyone can report a smoker via calling or sending a text message to a government hotline (in the case of Seoul, the number is 120) with their location address and authorities will raid the reported place, of which a picture of the offending smoker will be taken and fined 100,000 won. Disguised authorities also secretly check random places at random times for offending smokers. Furthermore, tobacco prices have nearly doubled to an average of ₩4,500 KRW, and it is illegal