A seven-year health tracking survey of Korean adolescents, following them from the sixth grade of elementary school through the third year of high school, found that smoking and drinking increased as students advanced through school, while dietary habits and exercise levels worsened.
The survey found a high proportion of adolescents using conventional cigarettes, liquid e-cigarettes, and heated tobacco products all at once. The rates of generalized anxiety disorder and smartphone overdependence were markedly higher among female students than male students.
The Korea Disease Control and Prevention Agency (KDCA) released the results of the first through seventh rounds of its "Adolescent Health Panel Survey," conducted from 2019 to 2025, on the 5th. The survey samples 5,051 sixth-grade elementary school students nationwide from 2019 and tracks them annually over 10 years. This round analyzed responses from 3,756 students who participated in every survey from the first through the seventh round.
The rate of those who had used tobacco products at least once jumped by 11.58 percentage points over seven years, from 0.35% among sixth graders to 11.93% among high school seniors. By gender, the rate differed at 16.02% for male students and 7.64% for female students. The current usage rate, defined as having used a tobacco product at least one day within the past month, also rose from 0.01% among sixth graders to 5.30% among high school seniors. Among high school seniors, usage rates by product were 4.41% for conventional cigarettes, 3.61% for liquid e-cigarettes, and 1.59% for heated tobacco products.
Notably, the proportion of those using multiple products together was higher than that of those using a single product only. Among conventional cigarette smokers, only 32.6% smoked conventional cigarettes exclusively, while 32.8% also used liquid e-cigarettes, and 29.3% used all three products.
Drinking experience also increased significantly. Those who reported having taken at least a sip of alcohol rose from 36.4% among sixth graders to 68.4% among high school seniors, while those who had drunk at least one glass rose from 7.5% to 43.2%. The current drinking rate, referring to those who drank alcohol within the past month, increased from 0.7% to 11.2%. The proportion of those newly starting to drink at the point of entering their third year of high school was 18.1%, the highest among all grade transition periods.
Dietary indicators worsened as students advanced through school. The proportion of students skipping breakfast five or more days a week rose by 14.9 percentage points, from 17.9% to 32.8%. The proportion eating fruit at least once a day fell from 35.4% to 16.3%, and the proportion eating vegetables fell from 18.0% to 5.6%.
The intake rate for milk and dairy products also fell by 28.9 percentage points, from 45.7% to 16.8%. Conversely, the intake rates for sugary drinks and fast food rose by 10.0 percentage points and 10.5 percentage points, respectively. The proportion of high school seniors drinking high-caffeine beverages three or more times a week was 29.3%, up 2.4 percentage points from the previous year.
Physical activity levels also declined. The proportion of those who reported exercising for 60 minutes or more a day, five or more days a week, decreased by 18.4 percentage points, from 29.8% among sixth graders to 11.4% among high school seniors, standing at 16.7% for male students and 5.8% for female students.
Gender differences were pronounced in mental health and digital device use. Among high school seniors, the proportion suffering from moderate or higher generalized anxiety disorder was 8.3%, with female students at 11.4%, more than double the 5.3% among male students. The rate of smartphone overdependence among all high school seniors was 31.9%, lower than the 35.1% of the previous year, but female students at 35.2% remained higher than male students at 28.8%.
The KDCA diagnosed that adolescents' health behaviors are worsening overall in an environment of heavy academic pressure. It said smoking- and drinking-cessation programs should be operated at each grade-transition period, while policies should be prepared to address newly emerging risk factors such as e-cigarettes, high-caffeine beverages, and digital overdependence.
