Cancer Research and Treatment

Original Articles

Lung and Thoracic cancer

Occupational Exposure to Pesticides and Lung Cancer Risk: A Propensity Score Analyses: Byungmi Kim, Eun Young Park, Jinsun Kim, Eunjung Park, Jin-Kyoung Oh, Min Kyung Lim; Cancer Res Treat. 2022;54(1):130-139. Published online March 31, 2021; DOI: https://doi.org/10.4143/crt.2020.1106

Abstract PDF Supplementary Material PubReader ePub

Purpose
Occupational exposure to pesticides is thought to be associated with lung cancer, but studies have yielded conflicting results. We performed a propensity score (PS) based analyses to evaluate the relationship between occupational exposure to pesticides and lung cancer risk in the Korea National Cancer Center community-based cohort study (KNCCCS).
Materials and Methods
During the follow-up period, 123 incidental lung cancer cases were identified, of the 7,471 subjects in the final statistical analysis. Information about occupational exposure to pesticides and other factors was collected at enrollment (2003-2010). Cox proportional hazards regression analyses were conducted. Four PS-based approaches (i.e., matching, stratification, inverse probability-of-treatment weighting, and the use of the PS as a covariate) were adopted, and the results were compared. PS was obtained from the logistic regression model. Absolute standardized differences according to occupational exposure to pesticides were provided to evaluate the balance in baseline characteristics.
Results
In the Cox proportional hazards regression model, the hazard ratio (HR) for lung cancer according to occupational exposure to pesticides was 1.82 (95% confidence interval [CI], 1.11 to 2.98). With all the propensity score matching (PSM) methods, the HRs for lung cancer based on exposure to pesticides ranged from 1.65 (95% CI, 1.04 to 2.64) (continuous term with PSM) to 2.84 (95% CI, 1.81 to 4.46) (stratification by 5 strata of the PS). The results varied slightly based on the method used, but the direction and statistical significance remained the same.
Conclusion
Our results strengthen the evidence for an association between occupational exposure to pesticides and the risk of lung cancer.

Citations

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Lifestyle, Environmental, Occupational, and Dietary Risk Factors in Small-Cell vs. Non-Small-Cell Advanced Lung Cancer Patients: Is There a Connection?
Jelena Jovičić-Bata, Danica Sazdanić-Velikić, Mirjana Ševo, Maja Milanović, Teodora Tubić, Milorad Bijelović, Nataša Milošević, Nataša Milić
Cancers.2025; 17(5): 864. CrossRef
Flavonoids as Insecticides in Crop Protection—A Review of Current Research and Future Prospects
Verónica Pereira, Onofre Figueira, Paula C. Castilho
Plants.2024; 13(6): 776. CrossRef
Comprehensive assessment of pesticide use patterns and increased cancer risk
Jacob Gerken, Gear Thomas Vincent, Demi Zapata, Ileana G. Barron, Isain Zapata
Frontiers in Cancer Control and Society.2024;[Epub] CrossRef
Dietary Exposure to Pesticide and Veterinary Drug Residues and Their Effects on Human Fertility and Embryo Development: A Global Overview
Ambra Colopi, Eugenia Guida, Silvia Cacciotti, Serena Fuda, Matteo Lampitto, Angelo Onorato, Alice Zucchi, Carmela Rita Balistreri, Paola Grimaldi, Marco Barchi
International Journal of Molecular Sciences.2024; 25(16): 9116. CrossRef
Longitudinal study and predictive modelling of urinary pesticide metabolite concentrations in residents of Guangzhou, China
Xiangyu Jia, Xiaotong Li, Fenfang Deng, Jia He, Qin Li, Chongshan Guo, Jun Yuan, Lei Tan
Chemosphere.2024; 365: 143353. CrossRef
Trend Analysis of Lung Cancer Incidence and Mortality in Xiamen (2011-2020)
Jianni Cong, Jiahuang Chi, Junli Zeng, Yilan Lin
Risk Management and Healthcare Policy.2024; Volume 17: 2375. CrossRef
Geographical disparities in cancer and occupational exposure to pesticides in a French-West Indies territory (2006–2019)
Rémi Houpert, Jacqueline Véronique-Baudin, Thierry Almont, Murielle Beaubrun-Renard, Manon Boullard, Aimée Pierre-Louis, Mylène Vestris, Stephen Ulric-Gervaise, Christelle Montabord, Jonathan Macni, Emmanuelle Sylvestre, Clarisse Joachim
BMC Cancer.2024;[Epub] CrossRef
Different types of pesticide exposure and lung cancer incidence in the Agricultural Health Study cohort: A systematic review and meta-analysis
Yu Wang, Jingxuan Yang, Xialian Hu, Jingyi Shi, Jiaxin Deng
Archives of Environmental & Occupational Health.2024; 79(7-8): 263. CrossRef
How Does Environmental and Occupational Exposure Contribute to Carcinogenesis in Genitourinary and Lung Cancers?
Massimiliano Cani, Fabio Turco, Simona Butticè, Ursula Maria Vogl, Consuelo Buttigliero, Silvia Novello, Enrica Capelletto
Cancers.2023; 15(10): 2836. CrossRef
How to promote agricultural enterprises to reduce the use of pesticides and fertilizers? An evolutionary game approach
Qizheng He, Yong Sun, Maoan Yi, Huimin Huang
Frontiers in Sustainable Food Systems.2023;[Epub] CrossRef
Vaping, Environmental Toxicants Exposure, and Lung Cancer Risk
Shaimaa A. Shehata, Eman A. Toraih, Ezzat A. Ismail, Abeer M. Hagras, Ekramy Elmorsy, Manal S. Fawzy
Cancers.2023; 15(18): 4525. CrossRef
Respiratory Tract Cancer Incidences across Industry Groups: A Nationwide Cohort Study with More Than 70 Million Person-Years of Follow-Up
Seong-Uk Baek, Woo-Ri Lee, Ki-Bong Yoo, Jun-Hyeok Choi, Kyung-Eun Lee, Wanhyung Lee, Jin-Ha Yoon
Cancers.2022; 14(21): 5219. CrossRef

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Association between Body Mass Index and Gastric Cancer Risk According to Effect Modification by Helicobacter pylori Infection: Jieun Jang, Eun-Jung Cho, Yunji Hwang, Elisabete Weiderpass, Choonghyun Ahn, Jeoungbin Choi, Soung-Hoon Chang, Hai-Rim Shin, Min Kyung Lim, Keun-Young Yoo, Sue K. Park; Cancer Res Treat. 2019;51(3):1107-1116. Published online November 21, 2018; DOI: https://doi.org/10.4143/crt.2018.182

Abstract PDF Supplementary Material PubReader ePub

Purpose
Few studies investigated roles of body mass index (BMI) on gastric cancer (GC) risk according to Helicobacter pylori infection status. This study was conducted to evaluate associations between BMI and GC risk with consideration of H. pylori infection information.
Materials and Methods
We performed a case-cohort study (n=2,458) that consists of a subcohort, (n=2,193 including 67 GC incident cases) randomly selected from the Korean Multicenter Cancer Cohort (KMCC) and 265 incident GC cases outside of the subcohort. H. pylori infection was assessed using an immunoblot assay. GC risk according to BMI was evaluated by calculating hazard ratios (HRs) and their 95% confidence intervals (95% CIs) using weighted Cox hazard regression model.
Results
Increased GC risk in lower BMI group (< 23 kg/m²) with marginal significance, (HR, 1.32; 95% CI, 0.98 to 1.77) compared to the reference group (BMI of 23-24.9 kg/m²) was observed. In the H. pylori non-infection, both lower (< 23 kg/m²) and higher BMI (≥ 25 kg/m²) showed non-significantly increased GC risk (HR, 10.82; 95% CI, 1.25 to 93.60 and HR, 11.33; 95% CI, 1.13 to 113.66, respectively). However, these U-shaped associations between BMI and GC risk were not observed in the group who had ever been infected by H. pylori.
Conclusion
This study suggests the U-shaped associations between BMI and GC risk, especially in subjects who had never been infected by H. pylori.

Citations

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Ethnic-specific associations between body mass index and gastric cancer: a Mendelian randomization study in European and Korean populations
Sangjun Lee, Sue K. Park
Gastric Cancer.2024; 27(1): 19. CrossRef
Cross-phenotype association analysis of gastric cancer: in-silico functional annotation based on the disease–gene network
Sangjun Lee, Han-Kwang Yang, Hyuk-Joon Lee, Do Joong Park, Seong-Ho Kong, Sue K. Park
Gastric Cancer.2023; 26(4): 517. CrossRef
Association between metabolic syndrome and gastric cancer risk: results from the Health Examinees Study
Dan Huang, Woo-Kyoung Shin, Katherine De la Torre, Hwi-Won Lee, Sukhong Min, Aesun Shin, Jong-Koo Lee, Daehee Kang
Gastric Cancer.2023; 26(4): 481. CrossRef
Cancer Progress and Priorities: Gastric Cancer
Priya Alagesan, Jessica C. Goodwin, Katherine S. Garman, Meira Epplein
Cancer Epidemiology, Biomarkers & Prevention.2023; 32(4): 473. CrossRef
Obesity at early adulthood increases risk of gastric cancer from the Health Examinees-Gem (HEXA-G) study
Hwi-Won Lee, Dan Huang, Woo-Kyoung Shin, Katherine de la Torre, Jae Jeong Yang, Minkyo Song, Aesun Shin, Jong-koo Lee, Daehee Kang, Shengxu Li
PLOS ONE.2022; 17(2): e0260826. CrossRef
Association between Body Mass Index and Risk of Gastric Cancer by Anatomic and Histologic Subtypes in Over 500,000 East and Southeast Asian Cohort Participants
Jieun Jang, Sangjun Lee, Kwang-Pil Ko, Sarah K. Abe, Md. Shafiur Rahman, Eiko Saito, Md. Rashedul Islam, Norie Sawada, Xiao-Ou Shu, Woon-Puay Koh, Atsuko Sadakane, Ichiro Tsuji, Jeongseon Kim, Isao Oze, Chisato Nagata, Shoichiro Tsugane, Hui Cai, Jian-Min
Cancer Epidemiology, Biomarkers & Prevention.2022; 31(9): 1727. CrossRef
Impact of a Fermented High-Fiber Rye Diet on Helicobacter pylori and Cardio-Metabolic Risk Factors: A Randomized Controlled Trial Among Helicobacter pylori-Positive Chinese Adults
Kun Xue, Yuwei Liu, Kia Nøhr Iversen, Mohsen Mazidi, Zheng Qu, Chenglin Dong, Tayi Jin, Göran Hallmans, Per Åman, Anders Johansson, Gengsheng He, Rikard Landberg
Frontiers in Nutrition.2021;[Epub] CrossRef
Current therapeutic options for gastric adenocarcinoma
C.R. Akshatha, Smitha Bhat, R. Sindhu, Dharini Shashank, Sarana Rose Sommano, Wanaporn Tapingkae, Ratchadawan Cheewangkoon, Shashanka K. Prasad
Saudi Journal of Biological Sciences.2021; 28(9): 5371. CrossRef
The U‐shaped association between body mass index and gastric cancer risk in the Helicobacter pylori Biomarker Cohort Consortium: A nested case–control study from eight East Asian cohort studies
Jieun Jang, Tianyi Wang, Hui Cai, Fei Ye, Gwen Murphy, Taichi Shimazu, Philip R Taylor, You‐Lin Qiao, Keun‐Young Yoo, Sun Ha Jee, Jeongseon Kim, Sheau‐Chiann Chen, Christian C Abnet, Shoichiro Tsugane, Wei Zheng, Xiao‐Ou Shu, Michael Pawlita, Sue K. Park,
International Journal of Cancer.2020; 147(3): 777. CrossRef

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Human Papillomavirus Genotype-Specific Persistence and Potential Risk Factors among Korean Women: Results from a 2-Year Follow-up Study: Cecile Ingabire, Min Kyung Lim, Young-Joo Won, Jin-Kyoung Oh; Cancer Res Treat. 2018;50(3):813-822. Published online August 17, 2017; DOI: https://doi.org/10.4143/crt.2017.340

Abstract PDF Supplementary Material PubReader ePub

Purpose
High-risk human papillomavirus (HPV) infection progression should be considered a critical factor for preventing cervical cancer, although most infections are transient and rarely persist. This study aimed to examine the specific types of HPV infections, their change patterns, and the potential risk factors among Korean women.
Materials and Methods
We included 4,588 women who visited hospitals in Busan and Suwon for cervical cancer screening, and 1,224 of thesewomen attended a 2-yearfollow-up. Infection statuswas evaluated using HPV DNA testing (Hybrid Capture 2) and genotyping testing (Linear Array). Data regarding the potential risk factors for HPV infection were collected by trained nurses using structured questionnaires.
Results
Among the 1,224 women (mean age, 47 years), 105 women (8.6%) were HPV-positive at baseline. HPV infections had been cleared among 92 women (87.6%) within 2 years. Only 13 infections (12.4%) were remained, and the 10 cases of them are high-risk HPV types including genotype 33, 45, 16, 35, and 52. Among women who were negative at baseline, the HPV incidence was 4.8%. The HPV incidence was marginally associated with having multiple sexual partners (odds ratio, 2.0; 95% confidence interval, 1.0 to 3.9), although it was not significantly associated with HPV persistence.
Conclusion
Most HPV infections (88%) among Korean women were cleared within 2 years, with only a small number of persistent infections. The persistent HPV genotypes were different in our study, compared to those from previous studies. Having multiple sexual partners was associated with acquiring a HPV infection, but not with persistence.

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Investigation of Human Papillomavirus (HPV) Frequency and Genotype Analysis in Cervical Samples
Yeliz Çetinkol, Selahattin Ünlü, Melahat Gürbüz, Cengiz Demir
Journal of Biotechnology and Strategic Health Research.2024; 8(1): 50. CrossRef
Global pattern of persistent human papillomavirus infection in female genital tract: An update system review and meta-analysis
Ming Zhao, Peipei Kang, Liling Zhu, Dan Zhou, Meimei Cui, Min Zhang, Jingjing Jia, Limei Luo
iScience.2024; 27(10): 110991. CrossRef
Analysis of Human Papilloma Virus Infection and Genotype in 336 Patients
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Hans Journal of Biomedicine.2023; 13(02): 184. CrossRef
Characteristic of persistent human papillomavirus infection in women worldwide: a meta–analysis
Ming Zhao, Dan Zhou, Min Zhang, Peipei Kang, Meimei Cui, Liling Zhu, Limei Luo
PeerJ.2023; 11: e16247. CrossRef
Factors associated with persistence and clearance of HPV16/18 among rural Chinese women: a cohort study in Wufeng, Hubei province
Shuqi Pan, Wenshuang Wei, Xueying Du, Zhi Li, Jiyu Tuo, Min Zhang, Qing Liu
Women & Health.2022; 62(4): 276. CrossRef
Lactobacillus crispatus M247 oral administration: Is it really an effective strategy in the management of papillomavirus-infected women?
Miriam Dellino, Eliano Cascardi, Antonio Simone Laganà, Giovanni Di Vagno, Antonio Malvasi, Rosanna Zaccaro, Katia Maggipinto, Gerardo Cazzato, Salvatore Scacco, Raffaele Tinelli, Alessandro De Luca, Marina Vinciguerra, Vera Loizzi, Antonella Daniele, Ett
Infectious Agents and Cancer.2022;[Epub] CrossRef
Alternative New Mono-scaled Quantitative Benefit–Risk Assessment of Human Papillomavirus Vaccine in Japan
Tomoko Matsumoto, Naoki Matsumaru, Paul Scuffham, Pieter Neels, Katsura Tsukamoto
Therapeutic Innovation & Regulatory Science.2021; 55(1): 48. CrossRef
Next‐generation sequencing for typing human papillomaviruses and predicting multi‐infections and their clinical symptoms
Sang‐Yeon Kim, Kyung‐A Hwang, Ji‐Hoon Ann, Ji‐Hye Kim, Jae‐Hwan Nam
Microbiology and Immunology.2021; 65(7): 273. CrossRef
Association of age and viral factors with high-risk HPV persistence: A retrospective follow-up study
Wending Li, Yifan Meng, Yi Wang, Xiaodong Cheng, Chen Wang, Songshu Xiao, Xiaofei Zhang, Zaixing Deng, Mengjun Hu, Pingrong Shen, Shengfeng Xu, Chenglin Fu, Wen Jiang, Bing Wu, Kezhen Li, Gang Chen, Juncheng Wei, Ling Xi, Junbo Hu, Ding Ma, Min Xue, Xing
Gynecologic Oncology.2019; 154(2): 345. CrossRef
Prevalence of HPV Among HIV-Negative Women of Child-Bearing Age in Lomé, Togo
Yawo Tufa Nyasenu, Fifonsi A Gbeasor-Komlanvi, Sabi Abdul-Raouf Issa, Amivi Ehlan, Martin Kouame Tchankoni, Brice M Yambiyo, Mireille Prince-David, Mounerou Salou, Didier K Ekouevi, Anoumou Dagnra
Future Virology.2019; 14(12): 783. CrossRef

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Awareness of and Attitudes toward Human Papillomavirus Vaccination among Adults in Korea: 9-Year Changes in Nationwide Surveys: Jin-Kyoung Oh, Bo Yoon Jeong, E Hwa Yun, Min Kyung Lim; Cancer Res Treat. 2018;50(2):436-444. Published online May 10, 2017; DOI: https://doi.org/10.4143/crt.2017.174

Abstract PDF PubReader ePub

Purpose
Human papillomavirus (HPV) vaccination has been included in the National Immunization Program in Korea since 2016. We aimed to evaluate changes in the awareness of and attitudes toward HPV vaccination, among adults in Korea since the first introduction of the vaccines in 2007.
Materials and Methods
A nationwide population-based survey was conducted in 2016 for 1,200 nationally representative Korean men and women; the data obtained were compared with the data from the nationwide survey conducted in 2007.
Results
A significant increase in the awareness of HPV infection (35.8%) and vaccination (36.9%) was observed in 2016 from 13.3% and 8.6% in 2007, respectively. Willingness to be vaccinated against HPV decreased from 55.0% in 2007 to 25.8% in 2016, and the proportion of respondents expressing uncertainty increased from 28.3% in 2007 to 43.3% in 2016. Only 12.1% of men and 22.0% of women knew about the free national HPV vaccination program for girls, launched in June 2016. Younger women, with higher income level, awareness of the HPV vaccine, and perception of the seriousness of infections had a higher willingness to be vaccinated. A high education level, awareness of HPV infection and vaccination, and perception of the seriousness of infection were positively associated with the willingness of respondents to vaccinate their daughters.
Conclusion
Raising the awareness of HPV infection and vaccination with appropriate knowledge is necessary for the successful implementation of the national HPV vaccination program.

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Obstetrics & Gynecology International Journal.2024; 15(5): 194. CrossRef
Parental Factors Affecting Decision to Vaccinate Their Daughters against Human Papillomavirus
Yoon Park, Moran Ki, Hyunju Lee, Jae-Kwan Lee, Jin-Kyoung Oh
Cancer Prevention Research.2023; 16(3): 133. CrossRef
Parental intention to vaccinate daughters with the human papillomavirus vaccine in Korea: a nationwide cross-sectional survey
Yejin Ha, Kyeongmin Lee, Bomi Park, Mina Suh, Jae Kwan Jun, Kui Son Choi
Epidemiology and Health.2023; 45: e2023076. CrossRef
ARE WOMEN AWARE OF THE VACCINE AGAINST HUMAN PAPILLOMAVIRUS? A HOSPITAL-FOCUSED CROSS-SECTIONAL STUDY
Ülkü Ayşe TÜRKER, Binali ÇATAK
SDÜ Tıp Fakültesi Dergisi.2022; 29(2): 249. CrossRef
Trends in cervical cancer screening rates among Korean women: results of the Korean National Cancer Screening Survey, 2005–2020
Hye Young Shin, Yun Yeong Lee, Soo Yeon Song, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun
Journal of Gynecologic Oncology.2022;[Epub] CrossRef
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Ye Won Jung, Soo Youn Song, Won Kyo Shin, Su Min Chung, Ji Won Park, Heon Jong Yoo
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Jin-Kyoung Oh, Eunjung Park, Byungmi Kim, Yoon-Jung Choi, E Hwa Yun, Min Kyung Lim, Jeong-Soo Im, Eun Young Park
Epidemiology and Health.2022; 44: e2022068. CrossRef
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Yuh‐Seog Jung, Jungirl Seok, Seri Hong, Chang Hwan Ryu, Junsun Ryu, Kyu‐Won Jung
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Jaehyun Seong, Sangmi Ryou, JeongGyu Lee, Myeongsu Yoo, Sooyoung Hur, Byeong-Sun Choi
Virology Journal.2021;[Epub] CrossRef
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Soojung Jo, Soo-Yeon Han, Connor A. Walters
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Inequalities in Awareness and Attitude towards HPV and Its Vaccine between Local and Migrant Residents Who Participated in Cervical Cancer Screening in Shenzhen, China
Wei Lin, Yueyun Wang, Zhihua Liu, Bin Chen, Shixin Yuan, Bo Wu, Lin Gong
Cancer Research and Treatment.2020; 52(1): 207. CrossRef
Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia
Li Ping Wong, Pooi-Fong Wong, Megat Mohamad Amirul Amzar Megat Hashim, Liyuan Han, Yulan Lin, Zhijian Hu, Qinjian Zhao, Gregory D. Zimet
Human Vaccines & Immunotherapeutics.2020; 16(7): 1611. CrossRef
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Tingting Cui, Guoping Yang, Lili Ji, Lin Zhu, Shiqi Zhen, Naiyang Shi, Yan Xu, Hui Jin
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Tropical Medicine & International Health.2019; 24(9): 1054. CrossRef

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Scientific Evidence Supporting Policy Change: A Study on Secondhand Smoke Exposure in Non-smoking Areas of PC Rooms in Korea: Soon-Yeol Hong, Min Kyung Lim, E Hwa Yun, Eun Young Park, Bo Yoon Jeong, Wonho Yang, Do-Hoon Lee; Cancer Res Treat. 2016;48(2):834-837. Published online August 12, 2015; DOI: https://doi.org/10.4143/crt.2015.151

Abstract PDF PubReader ePub: Purpose
The objective of this study was to measure secondhand smoke (SHS) exposure in personal computer (PC) rooms with the purpose of determining the strength of scientific evidence supporting the legislative ban on smoking in PC rooms located in the Republic of Korea.
Materials and Methods
From June to September 2012, particulate matter (PM_2.5) and air nicotine concentration (ANC) were measured in the smoking and non-smoking areas of PC rooms in Goyang City, Korea. In 28 randomly sampled PC rooms, field investigators completed an observational questionnaire on building characteristics, smoking policies, and evidence of smoking. The geometric means (GM) of PM_2.5 and ANC in smoking and non-smoking areas were compared.
Results
Evidence of smoking was identified in both the smoking and non-smoking areas of all PC rooms. The GMs of PM_2.5 and ANC in both areas were high and did not differ significantly (174.77 μg/m³ and 48.95 μg/m³ in smoking areas; 93.38 μg/m³ and 41.30 μg/m³ in non-smoking areas). Overall PM_2.5 concentrations were 5.5-fold higher than those listed in the World Health Organization guidelines.
Conclusion
This study supported previous reports that a partial smoking ban did not protect individuals from SHS exposure. Furthermore, the results from our study suggest how research can support policy. Countries in which smoke-free policies are not yet comprehensive may find our results useful.

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Consequences of Incomplete Smoke-Free Legislation in the Republic of Korea: Results from Environmental and Biochemical Monitoring: Community Based Study: Eun Young Park, E Hwa Yun, Min Kyung Lim, Do-Hoon Lee, Wonho Yang, Bo Yoon Jeong, Sang-Hyun Hwang; Cancer Res Treat. 2016;48(1):376-383. Published online April 24, 2015; DOI: https://doi.org/10.4143/crt.2014.269

Abstract PDF PubReader ePub

Purpose
In some countries with high smoking prevalence, smoke-free legislation has only been implemented in specific public places, as opposed to a comprehensive ban on smoking in all public places. The purpose of this study was to provide valid data on second-hand smoke (SHS) exposure that reflect the consequences of incomplete smoke-free legislation, and provide a rationale for expanding this legislation.
Materials and Methods
Indoor and outdoor environmental exposure (fine particulate matter [PM2.5], air nicotine, and dust 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone [NNK]) was monitored in 35 public places where smoking is prohibited by law in Goyang, Republic of Korea. Biomarkers of SHS exposure (urinary cotinine, hair nicotine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanol) were measured in 37 non-smoking employees. Geometric means and standard deviations were used in comparison of each measure.
Results
Considerable exposure of SHS was detected at all indoor monitoring sites (PM2.5, 95.5 μg/m3 in private educational institutions; air nicotine, 0.77 μg/m3 in large buildings; and dust NNK, 160.3 pg/mg in large buildings); environmental measures were higher in private or closed locations, such as restrooms. Outdoor measures of SHS exposure were lowest in nurseries and highest in government buildings. Biochemical measures revealed a pattern of SHS exposure by monitoring site, and were highest in private educational institutions.
Conclusion
The evidence of SHS exposure in legislative smoke-free places in Korea suggests that incomplete smoke free legislation and lack of enforcement of it might not protect people from exposure to smoke. Therefore, active steps should be taken toward a comprehensive ban on smoking in all public places and its enforcement.

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Byung Lyul Woo, Min Kyung Lim, Eun Young Park, Jinhyeon Park, Hyeonsu Ryu, Dayoung Jung, Marcus J. Ramirez, Wonho Yang
Sustainability.2020; 12(21): 9099. CrossRef
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Eun Park, Min Lim, Sun Yeol Hong, Jee Oh, Bo Jeong, E Yun, Wonho Yang, Do-Hoon Lee
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International Journal of Environmental Research and Public Health.2018; 15(12): 2693. CrossRef

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