Stacey Kim - 007396556 HSC 400 EPIDEMIOLOGY

Journal Article Critique: Electronic Cigarette Use among Korean Adolescents

In South Korea, electronic cigarettes are marketed as a smoking cessation device. This research article by co-authors, Sungkyu Lee, PhD, Rachel A. Grana, PhD, and Stanton A. Glantz, PhD. at Center for Tobacco Control Research and Education and University of California San Francisco, assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use, current smoking, cigarettes per day, attempts to quit conventional cigarettes and ceasing to use cigarettes in South Korea. The problem being studied relates to the fact that previous studies of Korean adolescents have shown an increase of e-cigarette use between 2008 and mid-2011. The hypothesis presented is that Korean cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. The specific aim of the study is to generate awareness of e-cigarettes and develop more published research on e-cigarettes regarding safety, efficacy, regulations, and public health impacts. This study used the 2011 The Korean Youth Risk Behaviour Web-based Survey (KYRBWS) to assess the prevalence of e-cigarette use after the market was more established, as well as the relationship between e-cigarette use and current cigarette smoking, cigarettes/day, attempts to quit conventional cigarettes, and stopping smoking cigarettes. The data from the 2011 KYRBWS of 75,643 students from 400 middle and

400 high schools in the age of 13-18 years were analyzed in South Korea. An anonymous, internet-based, self-administered questionnaire was administered in class amongst the smoking students and for those who completed the survey received a small gift. The study design is a cross-sectional study in which the unit of analysis is the group of middle to high school students aged 13-18 years in South Korea. The measuring instrument was the 2011 The Korean Youth Risk Behaviour Web-based Survey which is done annually to investigate health risk behaviors. Independent variables collected were age, gender, grade, location, weekly allowance. Dependent variables were classified as non-smoker, former smoker, e-cigarette smoker, cigarette smoker, and e-cigarette & cigarette (dual) smoker. The data was analyzed based on the public use dataset available from the Korea Centers for Disease Control using SPSS and descriptive statistics were summarized using bivariate and multivariate analyses. The results of this study took into account the bivariate and multivariate analyses to examine the relationships among smoking status and selected demographic. Ecigarette use was higher for older boys who received larger weekly allowances. Students who had smoked every day in the past month had the highest use of ecigarettes. Findings from this study indicated that dual use of cigarettes and ecigarettes are high and current cigarette smokers were much more likely to use ecigarettes than non-smokers as e-cigarettes are not being use as a substitute. Ecigarettes are marketed as an alternative for those who made an attempt to quit were more likely to try e-cigarettes but less likely to no longer smoke cigarettes (40% vs

29.1%; p < .001). The odds of being an e-cigarette smoker are 1.58 times higher among Korean adolescents who had made an attempt to quit than for those who had not. The conclusions of this study were that there is a confirmed high prevalence of ecigarette and cigarette smoking among Korean adolescents in South Korea. From the sample, the highest risk group of e-cigarettes was tenth graders and 12th graders had the highest cigarette use. The reason to this is because Korean adolescents began nicotine use with e-cigarettes which became a new pathway for young people to become addicted to nicotine. The implications for practice in public health of this study are to reduce the number of student smokers in South Korea by increasing personal health and implementing regulations of cigarette and e-cigarette purchase amongst students. Strength of this study is the health awareness, as it will go against the Korean advertisements of smoking cessation aid. The weakness of the study was that it was just amongst adolescents and not the whole population of the country. I think that the study can be improved by generalizing to a greater population. But overall, the outcome of the study was well specified and I agree with the authors conclusions. As a Korean-American, it is quite shameful to hear that people from my homeland are struggling to keep their lives healthy. And from watching my Father smoke all my life, I am very aware of how difficult it is to quit. I believe the only way to resolve this issue is to regulate with strict rules and policies in South Korea because I am aware that there is no age limit when it comes to purchasing cigarettes and alcohol in most areas of the country.