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Is Open Access

Household and School-Level Influences on Smoking Behavior among Korean Adolescents: A Multilevel Analysis

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      Trends in adolescent smoking rates in South Korea have not shown substantial progress due to a lack of effective anti-smoking interventions and policies in school settings.

      Methods and Findings

      We examined individual- and school-level determinants of adolescent smoking behavior (ever smoking, current smoking, and daily smoking) using the nationally representative fifth Korean Youth Risk Behavior Web-based Survey conducted in 2009. We found that students in coeducation schools or vocational high schools had greater risks of smoking for each type of smoking behavior than those in single-sex schools or general high schools, respectively even after controlling for individual-level factors. Higher family affluence and higher weekly allowances were associated with greater risks of ever smoking, current smoking and daily smoking even after controlling for parental education and other confounders.


      Whilst caution is required in interpreting results given the cross-sectional nature of the study, our findings suggest that in addition to raising the price of cigarettes, youth anti-smoking interventions in South Korea may benefit from focusing on coeducation schools and vocational high schools.

      Related collections

      Most cited references 56

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      Perceived discrimination and health: a meta-analytic review.

      Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes. Copyright (c) 2009 APA, all rights reserved.
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        Discrimination and racial disparities in health: evidence and needed research.

        This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.
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          Socioeconomic status and health behaviors in adolescence: a review of the literature.

          The goal of this review was to determine the direction of associations between SES and health behaviors during the period of adolescence. We searched the PsychInfo and Pubmed databases for studies that measured the association between SES and cigarette smoking, alcohol consumption, marijuana use, diet, and physical activity in adolescents between 10- and 21-years old. Associations between SES and health behaviors conformed to two patterns. First, low SES was associated with poorer diets, less physical activity, and greater cigarette smoking. Second, there was no clear pattern of associations between SES and alcohol consumption or marijuana use. Results from this review indicate that, although some associations between SES and health behaviors exist during adolescence, the associations are not as robust as those in adulthood. Efforts to curb poor diet, inactivity, and smoking behaviors should target low SES adolescents, whereas efforts to curb teen drinking and marijuana use may be useful across the SES spectrum.

            Author and article information

            [1 ]Public Health Joint Doctoral Program, San Diego State University & University of California San Diego, La Jolla, California, United States of America
            [2 ]JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
            [3 ]Department of Social and Behavioral Science, Harvard School of Public Health, Boston, Massachusetts, United States of America
            University College London, United Kingdom
            Author notes

            Competing Interests: The authors have declared that no competing interests exist.

            Conceived and designed the experiments: JH JO. Performed the experiments: JH. Analyzed the data: JH. Contributed reagents/materials/analysis tools: JH JO SVS. Wrote the paper: JH JO SVS IK.

            Role: Editor
            PLoS One
            PLoS ONE
            PLoS ONE
            Public Library of Science (San Francisco, USA )
            4 June 2014
            : 9
            : 6
            24896251 4045764 PONE-D-12-24975 10.1371/journal.pone.0098683

            This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

            Pages: 8
            These authors have no support or funding to report.
            Research Article
            Medicine and Health Sciences
            Health Care
            Health Care Policy
            Child and Adolescent Health Policy
            Socioeconomic Aspects of Health
            Mental Health and Psychiatry
            Adolescent Psychiatry
            Adolescent Medicine
            Public and Occupational Health
            Tobacco Control
            Science Policy
            Science Policy and Economics



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