Association between parental country of birth and smoking risk among South Korean adolescents

This study aimed to determine if there is a significant correlation between multicultural families and adolescent smoking. Our results indicate that when adolescent girls have a multicultural background, they have an increased risk of smoking and that adolescent boys have an increased risk of smoking only when both parents are foreigners.

There are many aspects of higher smoking status among multicultural adolescents compared to South Korean adolescents. One of these aspects is the influence of peers on the multicultural smoking status of adolescents. Peer networks and their influence have been identified as important factors, as they may engage in or refrain from risky behaviors23. Friendships are formed based on common behaviors, including smoking, and studies show that teens seek out groups of friends with similar smoking attitudes and behaviors23. In a recent study of eighth-grade students in South Korea, multicultural teens were more likely to commit wrongdoing than monocultural teens, and smoking was no exception.24.

Moreover, depending on the country of birth of the parents, this could have influenced the difference in smoking status among adolescents. Attitude towards smoking may differ, such as whether parents smoke directly depending on nationality25. Additionally, the trend of multicultural families with low socioeconomic status (SES) could be a reason. Especially in South Korea, married multicultural families tend to have a large age gap, low income and low education26. In terms of income, a 2017 study by the Korean Youth Policy Institute showed that the average monthly income of multicultural households was 2.68 million won (equivalent to $2,135), about 1 million won less than most South Korean households.27. As low SES is known to be a proxy measure of family attitudes towards locus of control and general value of health28it could have had a big influence on smoking among multicultural teenagers.

The difference in results by sex could be due to social sanctions. In South Korea, smoking among young people is considered a delinquent behavior, but there is a tendency to see it as a more serious act among girls22. Also, smoking is considered a male characteristic, as it shows masculinity and male bonding29. This could explain why the smoking rate among boys was similar across all domains despite the difference in nationality of their parents.

Children whose parents were born abroad were more likely to suffer from depression and suicidal thoughts. These children tend to face conflict while growing up in different cultures. Their experiences can cause issues with their identity and values.30. Additionally, a lack of Korean language skills can affect multicultural teenagers. Limited Korean language ability can lead to difficulty in understanding the culture, possibly resulting in high cultural adaptation stress31. Similarly, a lack of Korean language skills can lower self-esteem, increasing stress and depression.32. Additionally, limitations in verbal communication can lead to difficulties in school relationships and missed school-presented assignments.31. These factors can affect adolescent mental health, which is closely linked to smoking problems.33.

Multicultural teenagers whose parents were born abroad in a low-income country have a higher risk of smoking than Korean teenagers. This can be due to many reasons. This could be related to the fact that 34% of children aged 13 to 15 who smoke in various forms are from Southeast Asia. In addition, the smoking rate among adolescents aged 15 and over in both sexes is 45%, which is the highest in the world. Additionally, when comparing smoking rates between South Korea (male: 34%, female: 6.7%) and other countries, smoking was higher in low-income countries.34. For example, countries like Russia have the highest smoking rates in Europe among men (over 60%) and women (over 20%)35. In Uzbekistan, although the smoking rate among women was low (1.6%), it was 38.1% among men36. Absence of tobacco-related legal regulations in Southeast Asian countries and awareness of low risk reportedly more influential among adolescents from multicultural families in Korea37. Additionally, discrimination based on skin color or being treated like an outcast is a common experience for multicultural children.38. In addition, people from developing countries face more discrimination than those from more developed countries.39. People with appearances similar to Koreans are less likely to be discriminated against than people with different appearances, study finds40. Experiences of discrimination can cause negative feelings, and to erase these emotions, delinquent behaviors like smoking are more likely41.

Multicultural teenagers whose parents were born overseas in North Korea had a higher risk of smoking than South Korean teenagers. According to the Constitution of South Korea, Article 3 states the following: “The territory of the Republic of Korea includes the Korean Peninsula and its adjacent islands”42, which means that by law, North Korean defectors are considered South Korean. However, while socially and culturally, North Korean defectors are compatriots with the same ethnic roots, they are also cultural minorities who find it difficult to adapt to South Korean society and are sometimes discriminated against.43also due to political issues44; furthermore, many North Korean defectors have to deal with the aftermath of traumatic experiences. Traumatic experiences of fleeing North Korea include starvation, the risk of being discovered, and the stress of the vetting process by North Korean and Chinese border guards, according to research. The more psychological trauma they have suffered, the greater the externalizing and internalizing problems.45. Especially for young male North Korean defectors, difficulty in coping appears as externalizing issues, such as deviance and delinquency46.

This study has certain limitations. First, as this was a cross-sectional survey, causalities could not be confirmed. Second, the data was self-reported by the participants. Answers may not reflect actual smoking status. Third, the KYRBWS only includes Asian countries. According to Statistics Korea47, the top five nationalities in international marriages between South Korean women and foreign men include men from the United States, Australia and Canada. Fourth, factors such as peer influence could not be observed due to data limitations. These limitations should be considered in future studies.

Despite the limitations, this study has its strengths. First, this study used the most recent national stratified data, at several stages. Therefore, the results are representative of adolescents in South Korea. Second, by dividing participants by family type, this study offers new insights into the association between parents’ country of birth and adolescent smoking status.

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