Epidemiology and Health

Cohort Profile

Study protocol for the Korean Human Exposure Safety Survey (KoHESS): a national biomonitoring program for food and consumer product safety: Hyeon-Jeong Lim, Sang-Yong Eom, Sun-Haeng Choi, Seonmi Hong, Byung-Sun Choi, Young-Seoub Hong, Kwan Lee, Won-Ju Park, Jae-Seok Song, Nam-Jun Kim, Hyo-Jeong Hwang, Rihwa Choi, Hosub Im, Youn-Seok Kang, Hye-Young Lee, Mi-Ran Kim, Hyunjin Son, Yong-Dae Kim; Epidemiol Health. 2025;47:e2025060. Published online October 29, 2025; DOI: https://doi.org/10.4178/epih.e2025060

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Abstract Summary PDF Supplementary Material: Abstract
This protocol paper describes the design and methodology of the Korean Human Exposure Safety Survey (KoHESS), a three-year national biomonitoring program (2023-2025). Korea’s Act on Risk Assessment of Products for Human Use necessitates scientific evidence for aggregate exposure assessment and cumulative risk evaluation of hazardous substances in food and consumer products. Existing biomonitoring programs primarily focus on environmental exposures, limiting comprehensive assessment of products regulated by the Ministry of Food and Drug Safety. KoHESS employs repeated cross-sectional surveys targeting approximately 5,000 Koreans aged 3-79 years per cycle, using complex stratified multistage sampling for national representativeness. Data collection includes standardized anthropometric measurements, biological samples (blood, urine), comprehensive exposure source surveys, and 2-day 24-hour dietary recalls. Chemical analyses using liquid chromatography-tandem mass spectrometry and inductively coupled plasma mass spectrometry measure 24 perfluoroalkyl and polyfluoroalkyl substances compounds, 25 phthalate metabolites, and 7 heavy metals, with quality assurance through certified reference materials. KoHESS will provide scientifically robust data for establishing safety standards, enable advanced exposure modeling, facilitate risk assessments reflecting cumulative exposures, support targeted protection for vulnerable populations, and contribute to international biomonitoring networks while promoting preventive hazardous substance management systems.; Summary

Korean summary
- 식품의약품안전처(MFDS)가 주관하는 KoHESS (2023-2025)는 한국을 대표하는 5,000명의 국민(3~79세)을 대상으로 3년간 반복 수행되는 전국 규모의 인체 모니터링 프로그램이다. - 기존 환경 노출 데이터의 한계를 보완하여 식품 및 소비재 유래 유해 물질(PFAS 24종, 프탈레이트 25종, 중금속 7종)의 인체 노출 수준을 측정한다. - 수집된 과학적 데이터는 유해 물질의 통합 노출 평가, 누적 위해성 평가 및 제품 안전 기준 설정을 위한 핵심 근거 자료로 활용될 것으로 기대된다.

Key Message
- KoHESS (2023-2025) is a national, repeated cross-sectional biomonitoring program led by the Ministry of Food and Drug Safety (MFDS), targeting 5,000 Koreans (3-79 years) per cycle. - It measures 24 PFAS, 25 phthalate metabolites, and 7 heavy metals, specifically focusing on hazardous substances from food and consumer products, filling gaps in existing environmental data. - The data provides robust scientific evidence crucial for aggregate exposure assessment, cumulative risk evaluation, and establishing safety standards for regulated products.

Original Article

Tobacco consumption, sales, and output as monitoring indicators in the era of the tobacco endgame: a Korean example: Hana Kim, Hee-kyoung Nam, Heewon Kang; Epidemiol Health. 2023;45:e2023030. Published online February 27, 2023; DOI: https://doi.org/10.4178/epih.e2023030

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1 Web of Science
2 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The consumption, sales, and output of tobacco products each suggest different areas of intervention for tobacco control. In the era of the tobacco endgame, as increasingly stronger supply-side measures are implemented, multifaceted indicators that assess both supply and/or demand are required. We aimed to estimate the consumption of cigarette and heated tobacco products (HTPs) and sought agreement between the various indicators.

METHODS

The annual cigarette and HTP consumption in 2014-2020 was calculated using the frequency and intensity of cigarette use from representative surveys of adults and adolescents by sex and age. Sales and output data were acquired from governmental sources. Spearman correlation coefficients and Bland–Altman plots were used to compare the indicators.

RESULTS

Tobacco output, cigarette sales, and cigarette consumption were greatest in 2014. The HTP consumption calculated for 2020 was 292.28 million packs. Cigarette consumption and sales correlated significantly, as did tobacco output and tobacco sales. A Bland–Altman plot comparing the difference between cigarette consumption and sales showed that this difference was largest in 2014, immediately before cigarette prices increased. With the exception of a single year, all cigarette consumption values were within the limits of agreement for cigarette sales and tobacco output.

CONCLUSIONS

Our analyses showed agreement between demand-side (tobacco consumption) and supply-side (sales and output) indicators. We recommend using all indicators to monitor the impacts of tobacco control on both demand and supply sides. The systematic use of various indicators is critical to achieve the end of the tobacco epidemic.

Summary

Korean summary
공급 제한 중심의 담배 종결전 정책 채택을 고려하는 국가가 증가하고 있다. 이에 따라, 흡연율과 같은 전통적인 지표 외에 공급 측면의 지표가 필요한 상황이다. 담배 소비량, 판매량 및 반출량을 비교 분석한 결과, 지표 간 일치도가 높았으나 정책이 강화되는 시점에 지표 간 격차가 증가하는 것을 확인할 수 있었다. 담배규제 및 종결전 정책 모니터링을 위해 수요 및 공급 측면 지표 모두를 활용할 필요가 있다.

Key Message
The tobacco endgame, which aims to put an end to the tobacco epidemic once and for all, provides supply-focused measures, in addition to the traditional demand-focused measures based on MPOWER strategies. Thus, new supply-focused indicators are required to supplement the traditional demand-side indicators such as tobacco use prevalence and consumption. Our analysis showed that consumption, sales, and output were generally in good agreement. Yet, substantial gaps were identified when tobacco control measures were strengthened. Each indicator is imperfect in isolation, and we suggest to use all consumption, sales, and output indicators in the national health objectives (e.g. Health Plan 2030).

Citations

Citations to this article as recorded by

Systematic Assessment of Flavor Cues and Additives in Cigarettes and Heated Tobacco Products in Korea: Cross-Sectional Surveillance Study (Preprint)
Geon Heo, Doyoon Kim, Yehyun Kim, Ara Kim, Nagyeong Cho, Naeun Kang, Jungmi Park, Eunsil Cheon, Seulgi Kim, Susan Park, Sungmin Park, Sung-il Cho, Heewon Kang
JMIR Public Health and Surveillance.2025;[Epub] CrossRef
A Scoping Review of Behavioural Studies on Heated Tobacco Products
Ian M Fearon, Sarah F Cordery, Martin Fitzpatrick, Sarah Weaver, Matthew Stevenson, Erika Grandolfo, Layla Malt, Keith Thompson, Thomas Nahde
Cureus.2024;[Epub] CrossRef

Editorial

Monitoring targets and indicators for the prevention and control of non-communicable diseases in Korea: Soon Young Lee; Epidemiol Health. 2015;37:e2015023. Published online May 4, 2015; DOI: https://doi.org/10.4178/epih/e2015023

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Abstract PDF: Abstract
In order to respond to the increasing burden of non-communicable diseases (NCDs) worldwide, the World Health Organization developed the global action plan (GAP), which included nine targets and 25 indicators to monitor the targets. Owing to space constraints, the article reviewed the status of 17 indicators for seven targets out of nine targets in the GAP in Korea. Most of these 17 indicators required additional analysis with existing national data to evaluate the status in Korea. Based on the result from evaluating indicators, the current NCD policy strategy and resources in Korea seemed unlikely to reach the GAP goals, unless innovative policy changes was planned to reduce NCD risk factors particularly focusing on smoking, excessive drinking, and insufficient physical activity.; Summary

An Epidemiologic Study on the Leptospiral Infection in the Period of an Anticipated Epidemic: Bo Youl Choi, Dae Eun Chung, Soo Jin Lee, Hung-Bae Park, Jeoung Bae Park, Kyung Hee Lee, Jeong Soon Kim; Korean J Epidemiol. 1992;14(1):91-101. Published online June 30, 1992

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Abstract PDF: Abstract
A large epidemic of leptospirosis was anticipated in September 1990 because flood has resulted the heavy rain for 4 consecutive days from the 8th of September, 1990, in the Yang-pyeung Gun (Country), a farm area of Central Korea. Actually, patients were already appearing sporadically soon after the flood. Soldiers of ROK Army units stationed in this area were under the higher risk since many of them participated in field works (such as tieing rice plant fallen by the flood) as a part of Civil Aid Plan. The objectives of this study were 1) to detect infected ones at early stage 2) to estimate the attack rates of infection and apparent infection through serologic examinations, 3) to estimate pathogenecity and case-fatality rate and 4) to compare the rates of infection by the type of work and the use of protective devices. All of those with febrile episode were interviewed and the leptospiral antibody was examined during the one month period after the field work. Serologic examinations (including the interview) were done twice with 1 week interval (first on 8th to 10th of October, about 4 weeks following the days of field work) for 446 soldiers belong to three companies stationed in the country area. The serologic test (Microscopic agglutination test) were performed with 4 strains. Icterohemorrhagiae lai and Canicola canicola Hond Utrecht IV as standard strains, and 6P-049-1 and YP-35-1 as strains isolated in Korea in 1986, in accordance with WHO guideline. The results are as follows. 1. Among 57 febrile, suspected cases, 37 had serological tests twice and, 20 of them (54.1%) were serologically confirmed to be infected whereas among other 20 subjects who had single serological test, only 2 persons (10.0%) were serologically positive. 2. The dates of onset of fever in confirmed cases were clustered in 10 to 20 days from late September to early October, which coincided well with the duration of exposure (Sep. 13-18). 3. The attack rate of infection and apparent infection were estimated to be 11.2% (95% C. I. ; 8.3-14.1%), 1.8% (95% C. I. ; 0.7-3.1%). Pathogenecity and case-fatality rate were estimated to be 16.0% (95% C. I. ; 6.0-26.0%) and 0%, respectively. 4. The attack rate of infection of persons who worked in rice paddy for 3-6 days, for 1-2 days and participated in other field work were 3.5, 2.7 and 2.1 time high respectively as high as that of persons who did not join in field work (p<0.05). 5. The effectiveness of protective devices shown in this study was rater poor; perhaps the preparation of the protective devices was not sufficient because the mobilization of army is usually a sudden order. For more satisfactory prevention in the future, a complete clothing (including glove and boots) and chemoprophyaxis (with doxycycline) are recommended.; Summary

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