국민환경보건기초조사 자료를 활용한 간접흡연 억제 정책의 효과 분석

Evaluation of the Effectiveness of Passive Smoking Suppression Policies Using Korean National Environmental Health Survey (KoNEHS) Data

Background: Tobacco smoke causes various health effects on the human body, and passive smoking by non- smokers is a social issue due to the health effects caused by unwanted exposure to tobacco smoke. Therefore analyzing the effectiveness of various passive smoking suppression policies implemented by the government is important for the development of passive smoking suppression policies and national health management in the future. Objectives: This study aimed to evaluate the effectiveness of the implementation of passive smoking suppression policies by comparing the urine cotinine concentrations of Korean non-smokers among periods divided by smoking and passive smoking regulation policies introduced from 2009 to 2020. Methods: The subjects of this study were 16,940 non-smoking Korean citizens (aged 19 or older) selected from the database of the Korean National Environmental Health Survey (KoNEHS) I-IV, from 2009 to 2020. The period for evaluating the effectiveness of smoking cessation and passive smoking suppression policies was divided into ten periods based on the revision and implementation of laws and social events as follows: 1) Designation and expansion of non-smoking areas and imposition of fines; 2) Cigarette price increases and implementation of health risk warning texts and pictures on cigarette packs; 3) The establishment and announcement of comprehensive smoking cessation measures; 4) Mandatory personal mask wearing due to COVID-19. The effect analysis was performed focusing on the change in response rate of passive smoking in questionnaires and in urinary cotinine concentration. A statistical model (generalized linear model, GLM) that adjusted for potential confounders such as age, sex, and occupation was used to calculate the adjusted results among the comparison periods. Results: The most effective policy was designation and expansion of outdoor non-smoking areas such as bus stops, subway station entrances, and streets where many people gather, with fines imposed on violators. The designation and expansion of all enclosed restaurants, bars, and cafes as non-smoking areas with fines imposed on violators was the second-most effective. However, cigarette price increases and the implementation of health risk warning texts and pictures on cigarette packs proved ineffective. Also, contrary to expectations, mandatory personal mask wearing during the pandemic had no effect on suppressing passive smoking. Conclusions: The results of this study may useful for evaluating the effectiveness of passive smoking suppression policies and developing more effective policies. Future research should include subgroup surveys based on time activity patterns and occupational classifications. In addition, it is necessary to include information about passive smoking places and smokers in questionnaires.