Background: The aim of this study was to investigate long-term trends in smoking prevalence and its socioeconomic inequalities in Korea. Methods: Data were collected from 10 rounds of the Social Survey of Statistics Korea between 1992 and 2016. A total of 524,866 men and women aged 19 or over were analyzed. Age-adjusted smoking prevalence was calculated according to three major socioeconomic position indicators: education, occupational class, and income. The prevalence difference, prevalence ratio, slope index of inequality (SII), and relative index of inequality (RII) were calculated to examine the magnitude of inequality in smoking. Results: Smoking prevalence among men decreased from 71.7% in 1992 to 39.7% in 2016, while smoking prevalence among women decreased from 6.5% in 1992 to 3.3% in 2016. Socioeconomic inequalities in smoking prevalence according to the three socioeconomic position indicators were found in both men and women throughout the study period. In general, absolute and relative socioeconomic inequalities in smoking, measured by prevalence difference and prevalence ratio for education and occupational class, widened during the study period among Korean men and women. In men, the SII for income increased from 7.6% in 1999 to 10.8% in 2016 and the RII for income also increased from 1.11 in 1999 to 1.31 in 2016. In women, the SII for income increased from 0.1% in 1999 to 2.4% in 2016 and the RII for income increased from 1.39 in 1999 to 2.25 in 2016. Conclusion: Pro-rich socioeconomic inequalities in smoking prevalence were found in men and women. Socioeconomic inequalities in smoking have increased in parallel with the implementation of tobacco control policies. Tobacco control policies should be developed to decrease socioeconomic inequalities in cigarette use in Korea.

Background and Purpose— The effect of smoking reduction on cardiovascular disease outcomes has not been studied in Asian populations. Methods— A total of 475 734 Korean men aged 30 to 58 years, stratified into 9 groups based on smoking status at 2 different time points (1990 and 1992), were followed from 1992 to 2001 for the occurrence of stroke or myocardial infarction (MI) events. Results— Compared with nonreducing heavy smokers (≥20 cigarettes/d), those who quit smoking showed significantly lower risks of ischemic stroke, subarachnoid hemorrhage, and MI with hazard ratios (95% confidence intervals [CI]) of 0.66 (0.55 to 0.79), 0.58 (0.38 to 0.90), and 0.43 (0.34 to 0.53), respectively. For hemorrhagic stroke, quitters showed lower risk compared with heavy smokers, but the difference was not statistically significant (hazard ratio 0.82, 95% CI: 0.64 to 1.06). Compared with nonreducing heavy smokers, the risks of all stroke combined and MI among reducers tended to decrease, although the reductions were not statistically significant. The risks of subarachnoid hemorrhage and MI in those who reduced from moderate to light smoking tended to be lower than in nonreducing moderate (10 to 19 cigarettes/d) smokers. The association between the reduction of smoking level and the risk of stroke and MI did not change significantly when the analysis was limited to those whose smoking status in 1992 was maintained up to 1994. Conclusions— Smoking cessation was associated with a decrease in the risks of ischemic stroke, subarachnoid hemorrhage, and MI. More studies are needed to verify the likely health benefits of reducing smoking.

Tobacco use is the most important preventable risk factor for premature death. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the first international public health treaty, came into force in 2005. This paper reviews the present status of tobacco control policies in Korea according to the WHO FCTC recommendations. In Korea, cigarette use is high among adult males (48.2% in 2010), and cigarette prices are the lowest among the Organization for Economic Cooperation and Development countries with no tax increases since 2004. Smoke-free policies have shown incremental progress since 1995, but smoking is still permitted in many indoor public places. More than 30% of non-smoking adults and adolescents are exposed to second-hand smoke. Public education on the harmful effects of tobacco is currently insufficient and the current policies have not been adequately evaluated. There is no comprehensive ban on tobacco advertising, promotion, or sponsorship in Korea. Cigarette packages have text health warnings on only 30% of the main packaging area, and misleading terms such as "mild" and "light" are permitted. There are nationwide smoking cessation clinics and a Quitline service, but cessation services are not covered by public insurance schemes and there are no national treatment guidelines. The sale of tobacco to minors is prohibited by law, but is poorly enforced. The socioeconomic inequality of smoking prevalence has widened, although the government considers inequality reduction to be a national goal. The tobacco control policies in Korea have faltered recently and priority should be given to the development of comprehensive tobacco control policies.