Trends in Combustible Cigarette Smoking, Electronic Cigarette Use, and Related Behaviors among Korean Adults: An 11-Year Analysis of Data from the Korea National Health and Nutrition Examination Survey (2013-2023).

BACKGROUND: Smoking remains a major preventable cause of death and disease worldwide. The proliferation of electronic cigarettes (e-cigarettes) adds complexity to tobacco control policies. This study analyzed trends in smoking prevalence, e-cigarette use, dual use, age at smoking initiation, intention to quit, motivations for use, and second-hand smoke exposure among Korean adults over 11 years (2013-2023).

METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES IX-2) collected between 2013-2023. Use of non-combustible tobacco products, including liquid-type e-cigarettes and heated tobacco products (HTPs), was assessed separately. Analyses were stratified by sex, age, and income.

RESULTS: Current smoking prevalence decreased from 23.2% in 2013 to 18.5% in 2023. The decline was greater among males (41.4% to 32.1%), and in the 30-39-year age group (30.7% to 18.3%). Liquid-type e-cigarette use increased from 1.1% to 3.3%, prominently among young males. HTP use remained stable at approximately 4.8%. Dual use of combustible cigarettes and e-cigarettes ranged from 4.7% to 6.2%. The average age at smoking initiation remained at 19.8 years, but decreased by 1.5 years among females. Intention to quit decreased to 13.1% in 2023, among females. Motivations for e-cigarette use were primarily 'no cigarette smell' (43.9%) and 'seems less harmful than cigarettes' (18.4%). Second-hand smoke exposure in workplaces and public places decreased by 6.6% and 9.4%, respectively.

CONCLUSION: While traditional smoking prevalence continues to decline, the increasing prevalence of e-cigarette use and dual use poses new public health challenges. These trends are particularly evident among young males and low-income groups.