Questions/Answers

Smoking in childhood/adolescence is a major threat that directly influences health inequality throughout all stages of life. To address this issue, all public schools in Korea (including kindergartens) operate programs that explain the dangers of smoking. However, the reality is that, unless smoking is made less socially acceptable, young people will continue smoking. Recently, the sharp increase in the use of e-cigarettes by adolescents around the world has resulted in higher smoking rates among youth. According to the Youth Health Status Survey, 20.8 percent of students (as of 2018) stated that they smell cigarette smoke indoors at school at least once per week. To protect children and teens from tobacco, the best approach is to address supply and demand simultaneously. By establishing a participatory educational system and a local social network/infrastructure to ensure that our youth are aware of the detrimental effects of smoking and grow up in a healthy environment, this project aims to make Seoul a healthy city that alleviates health inequality (caused by unhealthy activities like smoking) and lengthen the healthy lifespan of all citizens. To eliminate both the demand for tobacco among teens and the supply of tobacco available to them, the SMG took a new approach: 1) encouraging youth to play a direct and leading role in establishing anti-smoking policies for children and teens, 2) breaking down barriers between relevant institutions based on a shared goal and mutual understanding for the joint accomplishment of a meaningful goal, and 3) creating a non-smoking environment and self-regulating system that enable local communities to protect their own children and teens.

The SMG’s children/youth-participatory anti-smoking project, which took an integrated public approach, was conducted with the aim of achieving sustainable development. First, the SMG worked with the Seoul Metropolitan Office of Education (SOME) to establish a jointly operated system to assist with project implementation. Second, the project involved the participation of socially vulnerable individuals (children and teens) to encourage them to refrain from smoking. Third, non-smoking areas were designated through agreements with local residents. Fourth, self-regulation systems for cigarette sellers were established. Fifth, an open system was created that prevents overlapping expenditure and collects/utilizes multiple types of data.

This project is aligned with four Sustainable Development Goals. The first is Goal 3 (Good Health and Well-being), which blocks children and adolescents’ access to tobacco, which not only cause diverse cancers and chronic diseases but also decreases healthy life expectancy. The second is Goal 10 (Reduced Inequality). To prevent smoking among teens due to vulnerability caused by weak local social structures and avoid the health inequality caused by smoking, the SMG conducted this project in all districts of Seoul. The third is Goal 11 (Sustainable Cities and Communities). By having this project implemented not unilaterally by a government institution but by local residents and teens with the cooperation of relevant groups, an infrastructure and manpower capability were established that enable the independent maintenance of a healthy, smoking-free environment by local communities without the intervention of administrative offices. The fourth is Goal 16 (Peace, Justice, and Strong Institutions). With the cooperation of local residents and relevant institutions, the number of non-smoking areas was increased. Ultimately, an effective system was put in place through which smokers and non-smokers work together to protect children and teens by designating all paths to school and subway station entrances non-smoking areas.

The project was implemented based on a shared understanding among project participants, institutions, and project beneficiaries. By establishing a shared goal with the SMOE (creation of a tobacco-free generation), the SMG alleviated the conflicts of interest among institutions and established a voluntary system of cooperation in local communities. In addition, the project is implemented and expanded consistently without the need for a large budget. The designation of paths to schools as non-smoking areas was achieved through inter-institutional cooperation and self-funding. By expanding promotional efforts, the project has remained sustainable without injections of large amounts of funding.

This project addressed the lack of an environment in local communities that prevents smoking among children and adolescents. The designation of paths leading to schools as non-smoking areas is participated in by 210 schools (as of 2019), and three districts of Seoul (Guro-gu, Yeongdeungpo-gu, and Seocho-gu) have officially designated all paths near schools as non-smoking. On the other hand, even if the paths children and teens take to school were sites of unrestricted smoking, minors had no way of filing complaints due to their age. So, the SMG inspected such paths and applied for their designation as non-smoking areas. The conflict between smokers and non-smokers was alleviated through the institutional designation of non-smoking areas based on feedback from local residents, making it easier for everyone to understand the purpose and importance of compliance with the project. The SMG also conducted a comprehensive anti-smoking project in cooperation with the SMOE. Previously, anti-smoking campaigns were operated individually by institutions. This time, however, the SMG and SMOE worked together to host student debates on smoking prevention, conduct social campaigns, and establish the GIS, resulting in a cost-effective system with a simplified expenditure process that makes it easier for relevant local institutions to cooperate.

The smoking rate of males aged 15 to 24 is 24.5 percent, while that of women is 4.4 percent. This means that more women than men are exposed to second-hand smoke. Exposure to second-hand smoke among pregnant and nursing women is also a threat to the fetus/infant. To address this, the SMG launched the “Stop Smoking for Your Family” campaign in 2018, with this same message being posted throughout Seoul. The SMG is also conducting a campaign to encourage people to refrain from smoking in public places by communicating that “all places where people gather are non-smoking areas.”

The targets of this project are children and teens, the most vulnerable members of society. If children and adolescents, who are still growing, are consistently exposed to cigarette smoke, the harmful substances in the smoke can cause serious physical damage. Also, such minors become addicted to nicotine more easily than adults and therefore are at high risk of becoming life-long smokers themselves. Constant exposure to second-hand smoke is also detrimental to the lungs and other aspects of physical health and also breeds emotional tolerance of tobacco, increasing the likelihood of those exposed becoming smokers themselves. Therefore, it is important to establish a healthy environment in areas frequented by children and teens and position minors as far from smoking as possible. The participation of teens in making the paths they take to school smoke-free and creating an environment that prevents smoking is even more important, because it is both edifying and beneficial for physical health. By having students participate in the implementation process and planning/implementing of smoking prevention activities (student-led debates, etc.), the project is generally recognized as being doubly effective (physical health and educational) due to the voluntary acquisition of a positive perception of not smoking.

The designation of paths leading to schools as non-smoking areas was carried out in 2017 through the trial designation of one such street per school in each district. Based on feedback from students, teachers, and parents, applications were sent to the relevant community health centers, which then collected feedback from local residents and conducted feasibility reviews before officially designating the given street as a non-smoking area. Afterward, the SMG installed “ground signs” around the designated non-smoking areas, while the SMOE applied wall signs. Non-smoking campaigns were frequently conducted by students with the assistance of parents’ groups and relevant institutions. A total of 77 non-smoking streets were designated as of December 2018, and 210 schools as of October 2019, with an annual inspection conducted of civil complaints to assess the project’s effectiveness. Also, districts and transportation companies worked together to designate the space within a 10-meter radius of every subway station entrance in Seoul (1,673 exits) as a non-smoking area by May 2016. This policy was established based on a proposal by Seoul Metropolitan Council, which secured the cooperation of relevant institutions and stakeholders. Over the course of a year, non-smoking areas were designated in cooperation with the media and civic groups. Later, the effectiveness of this policy was assessed, and subway station entrances continue to be regularly managed by approximately 300 private personnel. In 2015, an annual inspection was conducted of cigarette-selling locations in Seoul to determine whether cigarettes were being sold to minors, and the results were used as the basis for monitoring and subsequent guidance/supervision of teens and crackdowns on complicit sellers. Inspections were conducted by “people’s police forces” and civic groups, while meetings were regularly held with the headquarters of convenience store brands to strengthen store management and encourage voluntary compliance.

This is the first attempt to establish a tripartite system involving health centers, schools, and local education offices. Although there were difficulties initially, the SMG and SMOE stepped in to establish a system in which each institution has its own responsibilities. The SMG conducted information sessions for all municipal districts, while the SMOE did so for all schools, and joint campaigns were conducted to secure the participation of relevant institutions. At first, many people objected to making subway station entrances entirely non-smoking, but the unwavering commitment to protecting children made the project’s successful implementation possible.

This project to designate paths leading to schools as non-smoking areas is the first of its kind in Korea. Previously, the designation of such paths was primarily government-led endeavor, resulting in clashes with citizens. This project, however, went much more smoothly, as it gained the consent of local residents. In terms of securing the cooperation of stakeholders, this project was chosen as the best anti-smoking project of the year in 2019 by the MOHW. In designating subway station entrances as non-smoking areas, the protection of children was emphasized. With such achievements, this project is now frequently benchmarked by other cities.

In Amsterdam, local private sectors conduct anti-smoking campaigns to protect children and teens. After gaining residents’ consent, the competent administrative body designates the areas to be made non-smoking. In 2020, this procedure will be legalized and therefore largely directed by the private sector. The SMG, however, has systematized this project through cooperation among government institutions. With the direct participation of children and teens and support of local residents, the private and public sectors are working to ensure the sustainability of this policy. The SMG’s project can thus be regarded as more advanced than its Amsterdam counterpart.

First, through the trial operation of the project in 2017, the SMG turned it into a social issue by making proposals to the central government and inviting media coverage. In 2018, the number of civil complaints decreased drastically, and the project was expanded based on institutional consent to its premises (creation of a protective environment for children and teens and generation of educational effect to prevent smoking), resulting in its benchmarking by other cities and provinces. Currently, the city of Suwon and several other local governments are implementing their own projects. Moreover, the designation of subway station entrances as non-smoking areas is gradually spreading to other cities. Second, the monitoring of illegal cigarette sales, which has been done since 2015, encourages sellers to not sell cigarettes to minors. The ease with which teens can purchase cigarettes is gradually decreasing, from 79.4 percent in 2015 to 71 percent in 2016 and 67.9 percent in 2017. Central government ministries (Gender Equality and Family, Health and Welfare) are requesting resources/documents on this project, and several districts are conducting their own monitoring of illegal cigarette sales. With this, related voluntary activities in municipal districts are increasing in number.

Being adopted by other cities in Korea (explained in 7-a)

First, KRW 300 million was spent for the installation of signs, and the design budget was minimized through cooperation with the Urban Management and Design Division. Highly visible and easy to understand, the design was created specifically for roads near schools. As of June 2019, 491 signs have been installed at 120 schools. Second, the personnel for this project are from departments of the SMG and SMOE, departments of Seoul’s 25 municipal districts, teachers of 210 schools, and personnel of 11 local education offices. Most important, however, was the participation of all the students, their parents, and local residents.

First, we focused on creating a social consensus. Feedback from teens was collected through student-led debates, and leaflets on the project were distributed. Civic groups, non-profit organizations, and youth organizations helped with promotional activities. Second, a process was developed that allows two or more institutions to jointly carry out necessary tasks, meaning that employee charges do not impede project implementation. Third, in terms of finances, the project was expanded through inter-institutional cooperation, resulting in a budget decrease of 50 percent. Joint media coverage also helped keep the budget at a manageable level.

نعم

The subway station entrance project (2016) and SMG’s youth smoking prevention project (2019) were both selected as the most outstanding anti-smoking projects of the year, with both receiving ministerial citations. Every year, the Youth Health Status Survey is conducted to assess various aspects of teens and smoking, with 8,771 students from 118 schools participating in 2018. The SMG conducts inspections of illegal cigarette sales to minors and other relevant details, while the rate of voluntary non-smoking on school streets is assessed based on the civil complaints filed. Smoking near all 1,673 subway station entrances is assessed by SMG-affiliated employees.

The assessment index for local anti-smoking projects is comprised of: necessity and/or difficulty of project, appropriateness of plan, role of each institution and/or efforts to connect project to other parties, outcomes of interinstitutional communication and cooperation, securing of necessary resources and capability building, tangible outcomes of implementation, and project adaptability. The assessment indices for the project are: teen smoking rate, rate of exposure to second-hand smoke at home and/or school, ease of purchasing cigarettes, rate of illegal cigarette sales, rate of failure to check purchaser’s age, and rate of failure to post warning signs.

After subway station entrances were designated as non-smoking areas, the number of smokers per hour near entrances decreased by 86.1 percent, with 24.4 percent of entrances having no smokers. With these results, this project is spreading to other cities and has served as grounds for the designation of non-smoking streets near schools. The rate of illegal cigarette sales to teens was 48.3 percent in 2015. Through this project, this figure is decreasing every year, from 37.3 percent in 2016 to 32.7 percent in 2017, 24.4 percent in 2018, and 17.8 percent in the first half of 2019. Also, the rate of teenage smoking in Seoul has decreased consistently, from 7 percent in 2015 to 5.8 percent in 2016, 5.7 percent in 2017, and 5.7 percent in 2018. This is in stark contrast to the national average teen smoking rate, which is gradually increasing. In addition, voluntary campaigns and other efforts have resulted in a decrease in teens’ exposure to second-hand smoke at home, from 26.5 percent in 2016 to 19.8 percent in 2018. These figures are significantly lower than the national average (23 percent, as of 2018), showing that a consensus on protecting children and teens is forming in Seoul.

The outcomes of the designation of subway station entrances as non-smoking areas is managed by transportation institutions (KORAIL and Seoul Metro) and competent district governments. The designation of non-smoking streets near schools is regarded as one of the most successful smoking reduction projects, the success of which was made possible by the synergy generation by the cooperation of the SMG, SMOE, and district governments. As this project cannot be handled by only one institution, it is dependent on each stakeholder fulfilling their responsibilities. Therefore, every year, the SMG and SMOE draw up a plan for each activity and host information sessions for local institutions. The SMG will continue working with the SMOE to designate all major streets near elementary, middle, and high schools as non-smoking areas and conduct campaigns targeting students and local residents to create a smoking-preventative environment for all children and teens. The content and outcomes of this project are shared with the Ministry of Health and Welfare and Ministry of Education. With the central government actively encouraging local governments to enact anti-smoking laws and maximize the effects of this project, this project is gradually establishing itself as a future-oriented and sustainable anti-smoking endeavor.

For the non-smoking street designation project, students selected the street, based on which teachers collected feedback from all students, school personnel, and parents. The health center collected feedback from local residents, conducted a feasibility inspection, and announced the designated street. Students and local residents then conducted awareness campaigns, and advisory meetings were held with experts. The central government promoted the project and encouraged its implementation. The designation of subway station entrances as non-smoking areas was assisted by traffic-related institutions and the Korea Land and Geospatial Informatix Corporation, while civic/grassroots groups and local residents also participated. Monitoring illegal sales required the cooperation of all relevant SMG departments/divisions and the combined efforts of stakeholders. Illegal sellers were inspected in cooperation with people’s police forces and civic groups to ensure fairness. Efforts were made to convince convenience store headquarters and retail stores to ensure voluntary adherence to the law and rules. The SMG also cooperated with the Ministry of Health and Welfare, Ministry of Gender Equality and Family, and National Police Agency to design a plan for a retail sales environment that protects children and teens. As such, diverse institutions and personnel from a wide range of social sectors participated in this project.

This project was initially conducted in a fragmented manner due to the desire of relevant institutions to gain credit for its outcomes. This led to significant criticism of the wasted time caused by duplicate budget expenditures and lack of synergy among stakeholders. The most basic problem that must be resolved to achieve two major national initiatives—alleviating health inequality and increasing healthy life expectancy—is to decrease the high smoking rate and prevent the growth of the smoking population. For the health of future generations, all indoor and outdoor spaces frequently were occupied by children and teens must be completely smoke-free. This, however, is impossible to achieve through the efforts of a single public institution. In large cities, there is even greater need for voluntary and sincere cooperation among diverse stakeholders and local residents. The SMG often requested the consent of the SMOE for implementing policies to protect children and teens. A synergy was eventually created by clearly defining and systemizing the roles and responsibilities of each institution. We hope that this system can be utilized for future health-related projects to ensure that young people remain healthy as they grow up.