21.1% 27.9% 30.5% 33.3% Total Male Female 402 SH Park • Smoking and adolescent health Introduction With the recent opening and westernization of our society, smoking in adolescents has increased and has become more common. Many adolescents start smoking at a young age, out of curiosity and a spirit of adventure, only to become addicted to it. Nevertheless, it is not easy to grasp trends in adolescent smoking in Korea because few systematic surveys and studies have been performed. According to surveys in 1994 and 20071,2), the overall smoking rate of adolescents in Korea changed from 21.2 to 27.9%. By gender, the rate increased from 30.5 to 33.3% in males, and from 12.2 to 21.7% in females (Fig. 1). Although the overall increase was not large, the smoking rate among female adolescents showed a relatively large increase. Habitual smoking by adolescents can be a gateway to other types of drug abuse and can cause various health problems, including frequent upper respiratory infections, delayed lung development, decreased maximum vital capacity, and lung cancer. Thus, we should pay attention to the prevention of adolescent smoking, not only for public health but also from an economic perspective, and various efforts made should include intensified anti-smoking education in schools, prohibiting the sale of cigarettes to minors in the community, and a rise in cigarette tax and price3). The smoking experience of adolescents Approximately 90% of the people who smoke for the first time are adolescents younger than 18, and the rate of smoking in adolescents is rising steadily. In general, adolescents start smoking out of curiosity, and many become habitual smokers during this period. Factors related to habitual smoking include the perception of cigarettes, a combined use of alcohol and drugs, intrafamilial linkage, and smoking by friends and parents. In particular, along with alcohol, smoking is known to be a gateway to other types of drug abuse. For these reasons, it is crucial to prevent early smoking4,5). In 1976, Kandel et al.6) surveyed high school students in New York State and reported that 72.0% of these had experience of cigarette smoking. Moreover, according to a survey by Kokkevi and Stefanis7) in 1981, 70.2% of high school students in Greece had tried cigarette smoking, and 22.3% were habitual smokers. Bachman et al.8) reported that the smoking rate of American high school students had reached a peak in 1976 and 1977 and had been decreasing steadily since then. According to Baugh et al.9), 52.3% of American adolescents between the age of 8 and 17 had tried smoking, with 50.1% of that group trying it for the first time at an age younger than 12; in each age group, males experienced smoking earlier than females. The smoking rate of American 12th grade students 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 1994 (grade 7th-12th) 2007 (grade 7th-12th) 12.2% 21.7% Female 11.1 (11.0-11.3) 12.0 (11.8-12.2) 12.7 (12.5-12.8) 13.2 (13.0-13.3) 13.6 (13.4-13.7) 13.7 (13.6-13.9) 12.9 (12.8-13.0) 12.1 (12.0-12.2) 13.5 (13.4-13.6) Fig. 1. Smoking rate by gender. Table 1. The Age at which Smoking Started Total Male Grade 7th 11.0 (10.9-11.1) 10.9 (10.7-11.0) 8th 11.9 (11.8-12.0) 11.8 (11.7-12.0) 9th 12.7 (12.5-12.8) 12.6 (12.5-12.8) 10th 13.3 (13.2-13.4) 13.3 (13.2-13.4) 11th 13.5 (13.4-13.6) 13.5 (13.4-13.6) 12th 13.8 (13.7-13.9) 13.8 (13.7-14.0) Total 12.9 (12.8-13.0) 12.9 (12.8-13.0) School level Middle school 12.0 (11.9-12.0) 11.9 (11.8-12.0) High school 13.5 (13.5-13.6) 13.6 (13.5-13.6) Values are presented as % (95% confidence interval). decreased from 63.1 in 1992 to 57.2% in 2002. According to a survey on male and female adolescents by the Center for Disease Control and Prevention in 2007, 33.3% and 21.7%, respectively, had tried smoking, and students in higher grades showed a significantly higher smoking rate. Most smoking adolescents had smoked for the first time at the age of 12 or 13, and they usually smoked while associating with their friends (Table 1). Thus, peer relations and the surrounding environment are considered important factors of the smoking experience. Among environmental factors, indiscrete salesmanship riding on the materialism of society is considered to play a role. For example, an increasing number of entertaining facilities instigating deviations and easy purchasability of cigarettes are believed to stimulate smoking in adolescents. Risk factors that increase the smoking rate among adolescents 1. Family history The frequency of adolescent smoking increases when there are many smokers in the family. Parents are particularly important