The International Tobacco Control Policy Evaluation Project (the ITC Project) today revealed the results of a five-year study of the effectiveness of tobacco control policies in the Republic of Korea, where smoking related diseases kill more than 55,000 people each year. Although tobacco control legislation introduced between 1995 and 2005 had a dramatic effect in reducing smoking rates, the ITC Korea Survey (the Survey) found that progress has slowed in the past five years, with the diminishing impact on smokers of comparatively small, text-only warnings on cigarette packs, the increased affordability of cigarettes, and the lack of comprehensive smoke-free laws to reduce smoking in public places and protect smokers and non-smokers from secondhand smoke.
The findings are based upon three waves of the ITC Korea Survey, involving representative samples of smokers across Korea between 2005 and 2010. The Republic of Korea ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005 and prior to that had implemented several important tobacco control policies that established and expanded smoke-free zones, toughened anti-smoking campaigns and reduced tobacco industry marketing. Additionally, Korea was one of the first countries to establish a national network of cessation clinic services in public health centers, to help smokers quit. However, since 2005 Korea has been slower to introduce further tobacco control legislation or price and tax increases on tobacco products. There is a strong association between tobacco control action and prevalence rates in Korea. From 1998 to 2007 - a period of strong tobacco control action in Korea - smoking prevalence among adult males dropped from 66 per cent in 1998 to 45 per cent in 2007. Since that time, tobacco control action slowed and smoking rates increased to 48 per cent in 2010. Similarly, female smoking rates declined from 6.5 per cent in 1998 to 5.3 per cent in 2007 but had increased to 6.3 per cent by 2010.
Korea has not yet implemented graphic pack warnings, as called for under Article 11 of the FCTC, and data from the survey show that the effectiveness of the existing text warnings decreased between 2005 and 2010. Over a third of smokers (35 per cent) read or looked closely at these warnings in 2005; this fell to 25 per cent in 2010. In 2005, 16 per cent of smokers reported that the warnings had stopped them from having a cigarette at least once; this fell to 11 per cent in 2010 and there was a similar decrease in the number of smokers who thought about quitting as a result of the warnings. In addition, Korea has not yet banned the use of misleading terms like "low tar" or "mild". As a result, a considerable percentage of smokers hold incorrect beliefs about low tar/mild cigarettes: 30 per cent believed incorrectly that smoking "light" cigarettes means the smoker takes in less tar and 28 per cent believed, again incorrectly, that "light" cigarettes are less harmful.
Price is the single biggest factor in encouraging smokers to quit, but Korea has not increased taxes on cigarette packs since 2004. As a result, the affordability of cigarettes increased between 2005 and 2010, when smokers spent on average 3.1 per cent of their income on cigarettes - this is the lowest percentage of all of the high-income countries in the ITC Project. Only a third (35%) of smokers think about the money they spend on cigarettes "often" or "very often" and there was a decrease in the number of smokers giving price as a reason to quit - from 38 per cent of smokers in 2005 to 27 per cent in 2010.
The ITC Survey also reveals that Korean smokers are very supportive of stronger tobacco control. In a clear indication of how smokers in Korea feel about their smoking, the vast majority (88 per cent) agreed that "if they had to do it over again, they would not have started smoking." In 2010, 86 per cent of smokers thought the government should do more to tackle the harm of smoking. Nearly two-thirds (62 per cent) thought the government should sue the tobacco companies to recover health care costs. Over half (55 per cent) agreed or strongly agreed that tobacco companies should be required to sell cigarettes in plain packages, a policy recently implemented in Australia. The ultimate indication of smoker support for strong tobacco control action may be that 39 per cent of smokers would approve of a complete ban on all tobacco products.
Chemin Rim, Minister of Health and Welfare, the Republic of Korea, commented: "It is estimated that social and economic costs associated with smoking exceed five trillion Won per annum in Korea and the smoking rate among male adults in Korea is still among the highest in the world. We are proud of our national facilities to help smokers quit, but our government is working to introduce stricter regulations. We need to go further in protecting citizens from the harmful effects of second-hand smoke. The ITC Project has proven in several countries the importance of graphic warnings in awakening smokers to the harms of nicotine and motivating them to quit. We have a plan to adopt these new initiatives and will require not only pictorial warnings but detailed ingredients on cigarette packs. The sponsorship of events by tobacco companies will be banned as well. We are committed to strengthening tobacco control based on the findings of this report."
Hong Gwan Seo, M.D., Ph.D., President of the Korean Association on Smoking or Health, commented: "In the years that followed the ratification of the FCTC, our country began to slow the pace of our efforts to reduce tobacco use. As a result, we have not made strong and rapid progress towards meeting the obligations of the FCTC and we have lagged behind other member countries, particularly in the implementation of comprehensive smoke-free laws, pictorial health warnings, restrictions on packaging and labelling, and increasing price and tax on cigarettes. And the consequences can be seen in the increases in smoking rates. There is an urgent need for stronger and more rapid efforts in tobacco control. Above all, since the large cigarette tax increase of 2004, there has been no increase in taxation. The ITC Korea Survey data shows that affordability of cigarettes has increased between 2005 and 2010 and as a result, smokers face very little incentive to quit smoking - a consequence that is reflected in the increase in smoking prevalence in recent years. ITC Korea Survey results show that smokers are supportive of strong tobacco control measures - more than 6 out of 7 smokers think that the government should do more to tackle the harm of smoking - so that is not a barrier to change. We are encouraged by the Ministry of Health's recent announcement of plans to implement policy changes to strengthen tobacco control, but would like to see rapid action to reduce the mortality and morbidity associated with smoking."
Professor Geoffrey T. Fong of the University of Waterloo in Canada, Chief Principal Investigator of the ITC Project, the international research collaboration that is evaluating the impact of Framework Convention on Tobacco Control policies in 22 countries, said: "Through the ITC Project, the global health community is amassing critical evidence about the policies that really have an impact on people's health. Our findings from The ITC Korea Project confirm those in other ITC Project countries that large graphic warning labels make the warnings more noticeable and increase thoughts about harms of smoking and about quitting. Korea has not introduced graphic warning labels and the existing text-only warning labels are demonstrably less effective over the course of the study period. For example, there was a 10 per cent decrease in the number of smokers reading or looking at the warning text. This is a clear illustration as to why the tobacco industry is so keen to fight large graphic warnings from the United States to Australia.
Professor Fong continued: "Similarly, the price of cigarettes has not increased in line with income growth, so smokers in Korea only spent on average 3.1 per cent of their income on cigarettes - the lowest percentage of all of the high-income countries in the ITC Project. Our data show that only a third (35% in 2010) of smokers said that they "often" or "very often" think about the money they spend on cigarettes - among the lowest of high-income ITC countries, indicating a need for changes in tax policies to reduce demand for cigarettes. The Republic of Korea should be commended for its actions in restricting advertising and promotion of cigarettes, and for being one of the first countries to establish a national, publicly-funded network of cessation support services. However, our data demonstrate that further policy change is required to encourage more smokers to take up that fantastic support. As in so many other countries, cigarettes are the single greatest cause of death and disease in Korea; we hope this report enables the government to renew its commitment to stronger tobacco control measures."
Notes for editors:
About The ITC Korea Survey
The ITC Project is an international comparative study that examines the effects of tobacco control policy measures in 22 countries by following large cohorts of smokers over time in each country. The ITC Korea Survey is a national survey conducted by researchers at the National Cancer Center, Republic of Korea in collaboration with the ITC Korea Project team centered at the University of Waterloo in Canada. The Survey was conducted in three Waves, with Wave 1 commencing in December 2005; Wave 2 in October 2008 and Wave 3 in October 2010.
The main objectives of the ITC Korea Survey are to:
1) To examine patterns of smoking behavior and opinions associated with smoking among adults in the Republic of Korea.
2) To examine the impact of tobacco control policies in the Republic of Korea.
3) To compare smoking behaviour and the impact of policies between the Republic of Korea and other ITC countries.
Funding for the ITC Korea Survey is provided by the National Cancer Center of the Republic of Korea, the Ministry of Health and Welfare, Republic of Korea, the US National Cancer Institute, the Canadian Institutes for Health Research, and the Ontario Institute for Cancer Research.
About The ITC Project
The International Tobacco Control Policy Evaluation Project (the ITC Project) is an international research collaboration involving 100 tobacco control researchers and experts from 22 countries (Canada, United States, United Kingdom, Australia, Ireland, Thailand, Malaysia, China, Republic of Korea, New Zealand, Mexico, Uruguay, France, Germany, The Netherlands, Brazil, Mauritius, Bangladesh, Bhutan, India, Kenya, and Zambia) who have come together to conduct research to evaluate the impact of tobacco control policies of the WHO Framework Convention on Tobacco Control (FCTC), the world's first health treaty. These policies include more prominent warning labels (including graphic images), comprehensive smoke-free laws, restrictions or bans on tobacco advertising, promotion, and sponsorship, higher taxes on tobacco products, removal of potentially deceptive labelling (e.g., "light" and "mild" and packaging design that lead consumers to the misperception that certain brands may be less harmful), promotion of cessation, education of public on the harms of tobacco, reduction of illicit trade, reduction of youth access, and product regulation. In each country, the ITC Project team conducts longitudinal cohort surveys and capitalizes on natural experiments to evaluate the impact of these policies over time. ITC Surveys contain over 150 measures of tobacco policy impact and have been conducted in countries inhabited by over 50% of the world's population, 60% of the world's smokers, and 70% of the world's tobacco users. Enditem
