Abstract
Smoking remains the leading preventable cause of death in South Korea, accounting for 58,000-68,000 deaths annually and socioeconomic costs of approximately ₩15 trillion. Despite demonstrated cessation program effectiveness, participation has declined 62% since 2017, and Korea's tobacco landscape is undergoing rapid transformation-including a decade-long cigarette price freeze, one of the world's highest heated tobacco product market shares (18.4%), and the widening gap between total tobacco product use and cigarette-only prevalence. This review applies the World Health Organization Framework Convention on Tobacco Control MPOWER framework to identify policy gaps and strategic priorities for Korean smoking cessation during 2021-2026. We synthesized evidence from PubMed, Cochrane Library, Embase, KoreaMed, and RISS, supplemented by an artificial intelligence-assisted multi-source corroboration protocol using four independent platforms with primary-source verification of all cited claims. Four strategic priorities emerge, ranked by anticipated population-level impact. First, price and packaging policy reform: the 10-year price freeze at ₩4,500 (fifth lowest among Organization for Economic Cooperation and Development countries) represents the most significant modifiable barrier, with expert consensus recommending ₩8,000-10,000 with inflation indexation. Second, evidence-based novel product regulation: marked divergence among international guidelines on e-cigarettes demands a calibrated Korean approach balancing adult cessation benefits against youth initiation risks. Third, product-specific monitoring: total tobacco product use should replace cigarette-only prevalence as the primary national indicator. Fourth, pharmacotherapy optimization and digital integration: combination nicotine replacement therapy showed no clear difference versus varenicline in network meta-analysis (odds ratio, 1.06; 95% credible interval, 0.75-1.48), and digital cessation interventions (relative risk, 1.86) warrant consideration for integration into Korean cessation services. The December 2025 Tobacco Business Act amendment creates a legislative window to address these gaps comprehensively.