Smoking in North Korea: a qualitative study.

Background: North Korea has taken steps to reduce smoking prevalence and its associated health risks by implementing the provisions of the WHO Framework Convention on Tobacco Control and enacting the Tobacco Control Regulations. Despite local reports and WHO data suggesting a decline in smoking prevalence, significant discrepancies have been found in existing studies. This study was a qualitative exploration of smoking perceptions and experiences to understand the smoking situation in North Korea.

Methods: This qualitative study used an interpretive description approach. North Korean defectors who had smoked and/or engaged in smoking-related activities such as tobacco cultivation and sales were recruited from a governmental organisation dedicated to assisting North Korean refugees through purposive sampling. Individual semistructured interviews with open-ended questions were conducted between March and November 2020. A thematic analysis was conducted to analyse the interview data.

Findings: 19 North Koreans participated in this study (mean age 41.47 years). Three primary themes were identified: the normalisation of smoking among males, the use of cigarettes as currency and bribes and the inadequate implementation of tobacco control policy. These themes were further broken down into four, three and three subthemes, respectively.

Conclusions: The study findings suggest that the normalisation of smoking among North Korean males, driven by strong sociocultural dynamics, contributes to the perceived high smoking prevalence in North Korea. It is crucial for North Korea to implement stringent monitoring and effective interventions for smoking prevention and cessation. Further large-scale quantitative studies are required to confirm these study findings.