# Tobacco use trends in South Korea, 2013–2023: Persistent disparities and emerging challenges in a repeated cross-sectional study

## TL;DR

This study tracks tobacco use trends in South Korea from 2013 to 2023, revealing declining cigarette use but rising use of electronic cigarettes and poly-tobacco among vulnerable groups.

## Contribution

The study provides new insights into the shifting tobacco landscape in South Korea, highlighting disparities and emerging challenges with non-combustible products.

## Key findings

- Cigarette smoking among men decreased from 42.1% in 2013 to 32.2% in 2023.
- Electronic cigarette use increased among young men aged 25–39 years.
- Poly-tobacco use rose, especially among young adults and low-income groups.

## Abstract

The emerging non-combustible tobacco products have complicated the tobacco landscape in Korea. This study aimed to assess subgroup trends in conventional cigarette (CC), electronic cigarette (EC), heated tobacco product (HTP), and poly-tobacco use in South Korea from 2013 to 2023.

We analyzed secondary data from the 2013–2023 Korea National Health and Nutrition Examination Survey, a nationally-representative cross-sectional data of adults (aged ≥19 years) (n=62935). Joinpoint regressions were used to estimate average annual percent changes (AAPCs) in tobacco use, stratified by sociodemographic and health-related characteristics. All measures were based on self-reports.

Among men, the prevalence of CC smoking declined from 42.1% in 2013 to 32.2% in 2023 (AAPC= -3.4; 95% CI: -4.6 – -2.3), with small declines among those with a lower income, less-educated, manual workers, and those with multiple risk behaviors, and severe mental illness. EC use increased modestly overall, with a significant rise among in men aged 25–39 years; HTP use showed a slight overall decline. Poly-tobacco use increased, particularly among young adults (aged 19–24 years) and middle-aged adults (aged 40–64 years) the lowest-income group, manual workers, and those with multiple risk behaviors. Among women, overall prevalence of CC, EC, and HTP use remained below 7%, but prevalence rose among young women aged 19–24 years (CC: 9.6% to 16.1%; EC: 0.7% to 5.6%; HTP: 3.1% to 5.8%), although the corresponding AAPCs were not statistically significant (CC: 4.6; 95% CI: -1.9–12.4; EC: 15.1; 95% CI: -0.1–39.7; HTP: 26.3; 95% CI: -21.4–125.0).

Korea's progress in reducing CC smoking has not extended to vulnerable populations, and rising EC and poly-tobacco use, particularly among young adults, present new challenges. These findings underscore the need for tailored cessation interventions for vulnerable populations and for ongoing efforts to tackle the emerging use of novel tobacco products.