The smoking population is not hardening in South Korea: a study using the Korea Community Health Survey from 2010 to 2018

Abstract

IntroductionThe hardening hypothesis proposes that the proportion of hardcore smokers increases when smoking prevalence declines. To evaluate whether such hardening occurs in South Korea, we examined the association between quitting behaviours, the number of cigarettes smoked per day and the proportion of hardcore smokers and smoking prevalence among local districts in South Korea.MethodsThis study used the cross-sectional data from the Korea Community Health Survey (2010–2018) to examine local district-level associations between smoking prevalence and quit attempts, quit plans, quit ratios, cigarettes smoked per day and the proportion of hardcore smokers. Panel regression analysis was performed using the indicators of hardcore smoking (quit attempts, quit plans, quit ratios, cigarettes smoked per day and proportion of hardcore smokers) as the outcome variables, and prevalence of smoking, local districts, age and sex as predictor variables.ResultsWhen the smoking prevalence of the districts decreased by 1%, quit attempts, quit plans and quit ratios increased by 0.24% (95% CI 0.11 to 0.37), 0.37% (95% CI 0.26 to 0.47) and 1.71% (95% CI 1.65 to 1.76), respectively. Cigarette consumption decreased by 0.17 cigarettes per day (95% 0.15 to 0.19), and the prevalence of hardcore smokers decreased by 0.88% (95% CI 0.78 to 0.98) when smoking prevalence decreased by 1%.ConclusionHardening of smoking did not occur in South Korea when smoking prevalence declined, which suggests tobacco control policies in South Korea have been effective in reducing smoking prevalence without increasing the proportion of hardcore smokers.

Stellungnahme der European Respiratory Society zu neuartigen Nikotin- und Tabakprodukten, ihrer Rolle bei Tabakkontrolle und „Harm Reduction“

“…Die Tabakindustrie hat das Konzept der "Harm Reduction" irreführend ausgenutzt und suggeriert, dass eine vollständige Nikotin-und Tabakentwöhnung nicht immer möglich oder von den Konsumenten gewünscht ist [35]. Jüngste Untersuchungen haben jedoch gezeigt, dass es keine Verhärtung des Verhaltens in der Raucherpopulation gibt, sondern im Verlauf eine Verlagerung hin zu leichteren Rauchgewohnheiten zu beobachten ist [55][56][57]. Aus den Eurobarometerdaten für 2020 geht hervor, dass mehr als 51 % der derzeitigen Raucher in der Europäischen Union versucht haben, mit dem Rauchen aufzuhören, wobei die Mehrheit der Konsumenten dies ohne Hilfsmittel getan hat [51].…”

European Respiratory Society statement on novel nicotine and tobacco products, their role in tobacco control and “harm reduction”

“…The tobacco industry has misleadingly exploited the concept of "harm reduction", suggesting that complete nicotine and tobacco cessation is not always possible or desired by the users [35]. However, recent evidence has shown that there is no hardening of smoking populations, and instead indicates a shift towards lighter smoking patterns over time [55][56][57]. The 2020 Eurobarometer data revealed that over 51% of current smokers in the EU had attempted to quit, with the majority of users doing so without aids [51].…”