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When crusty old Confucians will slap them in the face for smoking, then surely women will tend to smoke in private, and keep mum about it if anyone asks. That’s just common sense.

But, as discussed in previous posts in this series (Part 1, Part 2, Part 3, Newsflash, Part 4, Korea’s Hidden Smokers, How Many Teenage Girls Are Smoking?), that still seems to escape many journalists and researchers, who work under the assumption that very few Korean women smoke (officially, just 2.8% in 2010 for instance, against 42.6% of men). Whereas in reality, previous best estimates put the figure at 17% for young women, pointing to a looming health crisis.

So, how to convince the Korean government to take action? Especially when successive administrations have been accused of exaggerating their successes in reducing the male smoking rate, while ignoring the indirect evidence for rising female one?

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What’s needed is irrefutable proof. To get that, one reader suggested installing highly sensitive smoke detectors in the toilets of schools and universities, where many young women hide to smoke, while another, thinking of a rough minimum rate for teenage girls, to simply look at the number that were caught by their teachers (14% at his school). A third, probably most reliable option is to test for nicotine in their urine, via the medical tests given to every middle and high-school student, and, as explained in the recently-released article “Relationship Between BMI, Body Image, and Smoking in Korean Women as Determined by Urine Cotinine: Results of a Nationwide Survey” in the Asian Pacific Journal of Cancer Prevention (Volume 13, 2012; 1003-1010), a group of researchers from various universities have indeed focused on pee, albeit that of women aged 19 and over in the 2008-2009 Korea National Health and Nutrition Examination Survey instead.

Very readable at just 8 pages, half of which are tables or references, I highly recommend downloading the PDF (just email me for a copy if the link stops working). For readers without the time though, let me pass on the abstract here instead (click on it to make it bigger), then some highlights:

— Unfortunately, the sampling method, explained on page 1004, is very poorly explained, and I think has some crucial typos. But in sum, out of 4,600 households in the survey, 5,485 women above the age of 19 “were selected for further analysis because complete data concerning their socioeconomic and health factors and body-related variables were available.” How many 19+ women were in the original household survey though, and how and why extra information about these 5,485 of them was available (e.g., were they randomly selected for further tests?), is not provided.

— Urinary cotinine “is widely used as a biomarker for smoking because of its high sensitivity and specificity,” the level of 50 ng/mL used here being a widely accepted cut-off level for indicating active, rather than passive smokers.

— Here are the figures by age bracket, with their standard errors. Unfortunately, I lack the statistical background to understand the discrepancies between reported and “analyzed” rates sorry (for example, 158 out of 704 is actually 22.4%):

• 19-29: 158 smokers out of 704 (23.1%, 2.0%)
• 30-39: 178 smokers out of 1075 (17.3%, 1.3%)
• 40-49: 134 smokers out of 1046 (13.5%, 1.2%)
• 50-59: 97 smokers out of 1001 (9.3%, 1.0%)
• 60-69: 70 smokers out of 919 (7.5%, 1.1%)
• 70+: 87 smokers out of 740 (12.1%, 1.5%)

— Overall, 14.5% of the participants smoked, just under 1 in 7. Note that the article mentions that the reported rate in 2011 was 7.0%, which arguably more indicates how useless official figures are than a sudden dramatic jump from the 2.8% of 2010 (both figures are from the OECD).

— The article does an excellent job of breaking the figures down by age, income, occupation, and marital status, demonstrating that the notion of an “overall” or “average” female (or male) smoking rate is misguided and unhelpful anyway. Please see previous posts in the series for more discussion of that.

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— Finally, the focus of the article is on the relationship between smoking rates and the difference between subjects’ Body Mass Index (BMI) and Subjective Body Perception (SBP), and found that that was indeed:

…the most important factor determining female smoking behavior. Women with low BMI who perceived themselves as normal or fat were most likely to smoke; these results suggested that subjective body recognition plays as important a role as objective physical measures such as BMI in smoking behavior. Moreover, in women who were never married, divorced or widowed, underweight BMI was highly correlated with smoking. Thus, it is necessary to educate the public to have a correct self-body perception and a good understanding or the relationship between smoking and weight issues in order to reduce female smoking. In particular, women who were never married and had low BMI were especially susceptible to smoking and require special attention and preventative care (p. 1009).

Unfortunately, those educators will have their work cut out for them: Korea is the only developed country in the world where women in their 20s and 30s are getting thinner rather than more obese (and, accordingly, are the slimmest), yet a 2010 study would find that 2/3rds of female university students still overestimated their own weight (and, tellingly, all of those 2/3rds were actually either normal or underweight).

Update: Interestingly, the notion that cigarettes put off hunger was once used to sell cigarettes to men as well as women. I wonder when and why that stopped?