Cigarette Smoking in South Korea: A Narrative Review

Gunter, R; Szeto, Edwin H.; Jeong, Se‐Hoon; Suh, Sooyeon; Waters, Andrew J.

doi:10.4082/kjfm.18.0015

Cited by 83 publications

(73 citation statements)

References 60 publications

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“…Four of these Asian countries (China, India, Indonesia and Japan) ranked in the top ten in smoking prevalence worldwide, while only two of the included Caucasian countries (USA and Germany) were ranked in the top ten 81,82 . Smoking is also a highly prevalent social habit in South Korea and Malaysia, 83,84 contributing to high active and passive smoking among Asians. Active smoking is a well‐known risk factor for the development of TED, and previous meta‐analysis has suggested four times higher odds of development of TED among smokers 5 .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of thyroid eye disease in Graves’ disease: A meta‐analysis and systematic review

Chin

Lee

et al. 2020

Clinical Endocrinology

112

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Objective Thyroid eye disease (TED) is a debilitating condition that frequently manifests in patients suffering from Graves’ disease (GD). This study aims to analyse the prevalence of TED among GD patients, with a focus on geographical region‐specific rates. Methods Medline and Embase were searched for articles examining TED prevalence on April 2020, and articles were retrieved and sieved. Statistical analysis was performed after Freeman‐Tukey double arcsine transformation. Thereafter, results were pooled with random effects by DerSimonian and Laird model. Results Fifty‐seven articles involving 26,804 patients were included in the review. The overall pooled prevalence of TED was 40% (CI: 0.32 to 0.48) and by continent was 38% (CI: 0.31 to 0.46) for Europe, 44% (CI: 0.32 to 0.56) for Asia, 27% (CI: 0.06 to 0.56) for North America and 58% (CI: 0.55 to 0.61) for Oceania. The prevalence of TED in Southeast Asia was 35% (CI: 0.24 to 0.47) and Middle East 48% (CI: 0.19 to 0.78). Subgroup analysis showed regions with predominantly Caucasians (37%; CI: 0.28 to 0.46) had a lower prevalence of TED compared to Asians (45%; CI: 0.33 to 0.58). The pooled prevalence of lid retraction was 57% (CI: 0.39 to 0.74), proptosis 57% (CI: 0.48 to 0.65), diplopia 36% (CI: 0.24 to 0.48) and ocular hypertension 13% (CI: 0.06 to 0.19). Conclusion A substantial proportion of patients with GD have TED and often manifest as lid retraction, proptosis and diplopia. Early detection through active screening might help to mitigate the progression of TED and its associated complications.

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Section: Discussionmentioning

confidence: 99%

Prevalence of thyroid eye disease in Graves’ disease: A meta‐analysis and systematic review

Chin

Lee

et al. 2020

Clinical Endocrinology

112

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“…A recent review of smoking and COVID-19 by Simons, et al found that a similar underrepresentation was apparent in seven other countries: Italy, Israel, Kuwait, Mexico, Spain, Switzerland, and the U.K. 4 They found only marginal under-representation in South Korea and a reversed pattern in Iran. Using sex-adjusted rates of smoking prevalence there was moderate under-representation of smokers in South Korea --18.5% of 28 hospitalized patients 5 vs a sexadjusted national rate of 28.6%, 6 and in Iran --14% of 490 hospitalized COVID-19 patients 7 vs. a sex-adjusted national rate of 24.6%. 8 Additionally, a small study from Germany found a smoking rate of 6% of 50 hospitalized patients 9 vs. a sex adjusted national rate of 24.9%.…”

Section: Introductionmentioning

confidence: 93%

National Smoking Rates Correlate Inversely with COVID-19 Mortality

Norden¹,

Avery

Norden

et al. 2020

Preprint

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IntroductionRecent studies show cigarette smokers are markedly under-represented among patients hospitalized for COVID-19 in over a dozen countries. It is unclear if this may be related to confounding factors such as age distribution, access to care, and inaccurate records. We hypothesized that these concerns could be avoided by studying smoking prevalence in relation to COVID-19 mortality. Since climate has been identified as a factor in COVID-19, we studied groups of countries with relatively comparable temperatures.MethodsThe 20 hottest and 20 coldest countries in the Johns Hopkins Mortality Analysis database with a minimum mortality rate of .3 deaths/100,000 were selected on the basis of the average temperatures of their largest city. Mortality rates were determined as of May 1, 2020 and correlated with national smoking rate adjusting for sex ratio, obesity, temperature, and elderly population.ResultsA highly significant inverse correlation between current daily smoking prevalence and COVID-19 mortality rate was noted for the group of hot countries (R=-.718, p = .0002), cold countries (R=-.567, p=.0046), and the combined group (R=-.324, p=.0207). However, after adjustments only the regression for hot countries and the combined group remained significant. In hot countries, for each percentage point increase in smoking rate mortality decreased by .147 per 100,000 population (95% CI .102-192, p=.0066). This resulted in mortality rates several-fold elevated in the countries with the lowest smoking rates relative to the highest smoking rates. In the combined group, mortality decreased by .257 per 100,000 population (95% CI .175-.339, p=.0034).DiscussionThese findings add support to the finding of an inverse relationship between current smoking and seriously symptomatic COVID-19. However, we conclude that the difference in mortality between the highest and lowest smoking countries appears too large to be due primarily to the effects of smoking per se. A potentially beneficial effect of smoking is surprising, but compatible with a number of hypothetical mechanisms which deserve exploration: 1) Studies show smoking alters ACE2 expression which may affect COVID-19 infection or its progression to serious lung pathology. 2) Nicotine has anti-inflammatory activity and also appears to alter ACE2 expression. 3) Nitric oxide in cigarette smoke is known to be effective in treating pulmonary hypertension and has shown in vitro antiviral effects including against SARS-CoV-2. 4) Smoking has complicated effects on the immune system involving both up and down regulation, any of which might alone or in concert antagonize progression of COVID-19. 5) Smokers are exposed to hot vapors which may stimulate immunity in the respiratory tract by various heat-related mechanisms (e.g. heat shock proteins). Studies of steam and sauna treatments have shown efficacy in other viral respiratory conditions. At this time there is no clear evidence that smoking is protective against COVID-19, so the established recommendations to avoid smoking should be emphasized. The interaction of smoking and COVID-19 will only be reliably determined by carefully designed prospective study, and there is reason to believe that there are unknown confounds that may be spuriously suggesting a protective effect of smoking. However, the magnitude of the apparent inverse association of COVID-19 and smoking and its myriad clinical implications suggest the importance of further investigation.

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“…In 2018, the seventh Korea National Health and Nutrition Examination Survey (KNHANES) showed that the cigarette smoking prevalence was 36.7% among male adults and 7.5% among female adults. To reduce the smoking rate, the South Korean government has implemented various anti-smoking regulations such as raising cigarette prices and tax, expansion of smoke-free areas, and banning of tobacco advertisements in stores [4]. Following the recommendation of the WHO's Framework Convention of Tobacco Control, the Ministry of Health and Welfare of South Korea have modified and complemented GHWs on the cigarette packages over a period of time [5].…”

Section: Introductionmentioning

confidence: 99%

Effects of Different Graphic Health Warning Types on the Intention to Quit Smoking

Park

Lee

Chae

2020

IJERPH

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Anti-smoking advertisements are widely used to demonstrate to smokers the harm of smoking, and graphic health warnings (GHWs) are expected to have a positive effect on the intention to quit smoking. This study investigated which type of GHW (health-related threat (H-GHW) vs. social threat (S-GHW)) is more effective. Two types of GHWs for tobacco were shown to 28 daily smokers and 25 non-smokers while measuring their eye movements using an eye tracker. The time spent fixating on the GHWs was measured as an index of attentional bias. Participants were also asked to evaluate the unpleasantness of the images. They stated their intention to quit smoking in response to each image in a separate session. Multiple regression analysis was used to identify the effects of psychosocial factors on the intention to quit smoking in smokers and the intention to remain as non-smokers in the non-smokers. Both smokers and non-smokers reported greater unpleasantness and cessation intentions in response to H-GHWs than to S-GHWs. Non-smokers found both types of GHWs more unpleasant than smokers did. No differences were found in gaze fixation on GHWs between the two groups. When smokers viewed S-GHWs, the intention to quit smoking was greater as they felt more unpleasant. For non-smokers, the intention to remain non-smokers was greater when they felt more unpleasant and when the attention to H-GHWs was lower. Different psychological factors in anti-smoking advertisements are involved in the intention to quit smoking in smokers and to maintain a non-smoking status in non-smokers. Different approaches should be used according to the types of warning (e.g., warnings emphasizing a negative influence on others or on their own health) in anti-smoking campaigns.

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Cigarette Smoking in South Korea: A Narrative Review

Cited by 83 publications

References 60 publications

Prevalence of thyroid eye disease in Graves’ disease: A meta‐analysis and systematic review

Prevalence of thyroid eye disease in Graves’ disease: A meta‐analysis and systematic review

National Smoking Rates Correlate Inversely with COVID-19 Mortality

Effects of Different Graphic Health Warning Types on the Intention to Quit Smoking

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