Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population
Abstract
Background The low smoking prevalence in Asian women may be due to under-reporting. We therefore investigated gender difference in self-reported and cotinine-verified smoking prevalence rates in Korea Methods We analysed data from 5455 individuals (2387 men and 3068 women) in the 2008 Korean National Health and Nutrition Examination Survey. A urinary cotinine concentration of 50 ng/ml was the cut-off distinguishing smokers from non-smokers. Sensitivity analysis was done using different cut-offs of 25, 75 and 100 ng/ml. Results Cotinine-verified smoking rates were 50.0% for men and 13.9% for women, or 5.3% point and 8.0% point higher in absolute terms, respectively, than the self-reported rates for men and women. Ratios of cotinine-verified to self-reported smoking rates were 2.36 for women and 1.12 for men. Of the 1620 cotinine-verified smokers, 12.1% of men and 58.9% of women classified themselves as non-smokers. Women who live with a spouse or parents tend to under-report their smoking more than those who live alone or with others. Conclusion Since the number of self-reported female smokers was less than half of cotinine-verified smokers, current anti-smoking policies based on self-reported smoking prevalence rates in Korea should be further directed towards hidden female smokers. Also, biochemical verification needs to be considered with national tobacco surveys in Asian countries.
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Data on smoking tobacco use are self-reported, which might lead to underestimates in demographic groups with low social acceptability of smoking, particularly among females in Asia and Africa.
“data on smoking tobacco use are self-reported, which might lead to underestimates in demographic groups with low social acceptability of smoking, particularly among females in Asia and Africa.44”
Self-reported smoking prevalence is believed to be severely underestimating true smoking prevalence, especially in population subgroups or places where tobacco use may not be culturally acceptable.
“self-reported smoking prevalence is believed to be severely underestimating true smoking prevalence,72, 73, 74, 75 especially in population subgroups or places where tobacco use may not be culturally acceptable.”
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Biochemical verification of tobacco use and cessation
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Reitsma, M. B., Fullman, N., Ng, M., Salama, J. S., Abajobir, A., Abate, K. H., Abbafati, C., Abera, S. F., Abraham, B., Abyu, G. Y., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30819-x · Cited by 2,028 · see citing works
Self-citationReitsma, M. B., Kendrick, P. J., Ababneh, E., Abbafati, C., Abbasi-Kangevari, M., Abdoli, A., Abedi, A., Abhilash, E. S., Abila, D. B., Aboyans, V., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01169-7 · Cited by 1,759 · see citing works
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- Authors
- Jung-Choi, K.-H., Khang, Y.-H., & Cho, H.-J.
- Affiliations
- University of Ulsan (KR)
- Asan Medical Center (KR)
- Corresponding author
- Cho, Hong-Jun
- Venue
- Tobacco Control
- Publisher
- BMJ
- Published
- 2011-10-04
- Volume
- 21
- Issue
- 6
- Pages
- 536-542
- ISSN
- 0964-4563 (ISSN-L)
- 1468-3318
- OpenAlex
- W2136553371
- Cited by
- 268
- References
- 2
- Citations by year
- 2026: 20 · 2025: 14 · 2024: 12 · 2023: 16 · 2022: 21 · 2021: 29 · 2020: 19 · 2019: 19 · 2018: 25 · 2017: 17 · 2016: 16 · 2015: 14 · 2014: 15 · 2013: 22 · 2012: 8
- FWCI
- 10.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Tobacco Control (publishedVersion)
- PubMed (publishedVersion)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- women smokers, urinary cotinine, gender differences in smoking, living arrangements, anti-smoking policy, Korea, Asian women
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cotinine, Female, Health Surveys, Humans, Male, Middle Aged, Self Disclosure, Sex Factors, Smoking, Prevalence, Young Adult, Republic of Korea
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