A qualitative study on North Korean defectors’ smoking experience in North Korea

Abstract

Significance: The World Health Organization (WHO) reported the prevalence of cigarette smoking in North Korea in 2017 as 19.2% (male 40.3% and female 0%). However, some evidence showed that the actual prevalence would be far higher. While North Korea signed the WHO FCTC in 2003, implementation of tobacco control policy in the country is unknown. This study aimed to explore North Korean defectors’ smoking experience in North Korea so that we can understand their smoking patterns and policy implementation in the country. Methods: Interpretive description approach was used. 13 adult North Korean defectors (mean age: 41.15±13.95 years) who were living in South Korea at the point of data collection and had smoking experience in North Korea were recruited through purposive sampling and snowball sampling methods from April to August 2020. Semi-structured in-depth interviews were conducted with the participants. All interview data were inductively analysed according to the interpretive description guideline using NVivo 12. Results: Three themes with 11 sub-themes were identified: 1. Normalisation of male smoking (High smoking prevalence and cigarette consumption; Smoking as a manly activity; Free distribution of cigarettes in the military; and Tacit social agreement on a ban of female smoking); 2. Cigarettes as bribes (Expensive cigarette smoking as a symbol of wealth; Cigarette as a common problem resolution tool; Hierarchical society); 3. Lack of tobacco control policy implementation (Smoke-friendly contexts; Common indoor smoking; Lack of smoking prevention education; No cigarette taxation). Conclusion: We provided the first findings of the smoking situation in North Korea. Male smoking prevalence presumably exceeds that of the WHO report, and WHO FCTC had not been implemented in North Korea. Moreover, smoking behaviours were highly influenced by socio-cultural norms in North Korea. Further quantitative research is required to confirm our findings.