Article Text

Download PDFPDF
Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population
  1. Kyung-Hee Jung-Choi1,
  2. Young-Ho Khang2,
  3. Hong-Jun Cho3
  1. 1Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
  2. 2Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
  3. 3Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  1. Correspondence to Professor Hong-Jun Cho, Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea; hjcho{at}


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 urniary 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 absoulte 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.

  • Asia
  • cotinine
  • Korea
  • prevalence
  • smoking
  • women
  • cessation
  • disparities
  • primary healthcare
  • socioeconomic status
  • tobacco industry
  • qualitative study
  • marginalised populations
  • industry public relations/media
  • industry documents
  • ethics
  • policy makers
  • ideology
  • evaluation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.