Psychological stress, smoking, and hazardous drinking behaviors in South Korea: findings from the Korea National Health and Nutrition Examination Survey

Introduction: There is growing attention to mental health as a contributor to behavioral health in South Korea. We investigated the prevalence of psychological stress and its associations with cigarette smoking and drinking behaviors among a nationally representative sample of South Korean adults. Methods: Using data from 14,855 adults aged >= 19 years who participated in the 2013-2016 Korea National Health and Nutrition Examination Survey (KNHANES), we performed weighted logistic regression to examine the associations between stress and three binary outcome variables: cigarette smoking, heavy episodic drinking, and frequent drinking. Results: 27.2% of the participants reported high stress. Controlling for sociodemographic covariates, high stress was associated with 1.54 times the odds (p < .001) of being a smoker, 1.25 times the odds (p < .001) of being a heavy episodic drinker, and 1.23 times the odds (p < .001) of being a frequent drinker. There was evidence of effect modification by gender and occupation, such that the effects of stress on these behaviors were particularly stronger among women and pink-collar (service industry) workers (compared to men and white-collar workers). Conclusions: Future policies that aim to address smoking and drinking behaviors in South Korea should consider stress reduction and coping strategies, especially among women and pink-collar workers.