Abstract
BackgroundFemale smoking is perceived very negatively in East Asian countries such as South Korea, Japan, and China, as well as in Islamic countries. These countries’ self-reported surveys (SRs) tend to produce results that underestimate the number of smokers, owing to the social desirability response bias. The present study seeks to assess South Korea, Europe, and the Americas, by comparing data from SRs with those from urinary cotinine samples.MethodsCurrent smoking rates were calculated using the SRs and the urinary cotinine concentration (UCC) methods according to socioeconomic factors. In order to examine response accuracy regarding current smoking status in the SRs, participants who both completed the SRs and acquired UCC results were subject to analyses of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and difference ratio (DR) with respect to gender, age, region, economic level, household status, and the presence of chronic disease.ResultsBased on self-reports, the current smoking rate among women was 7.1% (official smoking rates), while that according to the UCC was 18.2%; the rates for men were 47.8% and 55.1%, respectively. The sensitivity of males was 0.8553, the specificity 0.9768, PPV 0.9783, NPV 0.8465, and the difference ratio (DR) was 1.143. The sensitivity for females was 0.3670, the specificity 0.9956, PPV 0.9486, NPV 0.8761, and the DR was 2.6. These results exhibit a very low response alignment rate compared to males.ConclusionThis study shows that the actual female smoking rate is significantly higher than that reported officially, but also that the gap is decreasing steadily. Females exhibited a higher rate of false responses, which resulted in an underestimation of the female smoking rate.
Highlights
Female smoking is perceived very negatively in East Asian countries such as South Korea, Japan, and China, as well as in Islamic countries
The aims of this study were, first, to compare smoking rates based on self-reported survey results and urinary cotinine concentration (UCC) test results, and second, to estimate actual smoking rates by year using a biological marker
The current smoking rate of adult males according to the SRs is 47.8%, while the current smoking rate according to the UCC is 55.1%
Summary
Female smoking is perceived very negatively in East Asian countries such as South Korea, Japan, and China, as well as in Islamic countries. These countries’ self-reported surveys (SRs) tend to produce results that underestimate the number of smokers, owing to the social desirability response bias. Much greater gender differences were found in East and Southeast Asian in countries such as South Korea, Indonesia, and China, compared to Europe and the U.S [2]. In South Korea, the smoking rate of adults over the age of 19 was 79.3% for males and 12.6% for females, in 1980. South Korea has the highest male smoking rate of all countries in the Organization for Economic Cooperation and Development (OECD), but the lowest female smoking rate [4]
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