use of electronic cigarettes (E-cigars).METHODS: We used data from the Korea National Health and Nutritional Survey 2013 and 2016. A total of 4,744 participants (2,162 men and 2,582 women) were included and were categorized into five groups (Non-smokers, E-cigar non-users in past-smokers, E-cigar users in past-smokers, E-cigar non-users in cigarette-smokers and E-cigar users in cigarette-smokers). Cadmium blood concentration was categorized into tertiles. All sampling and weight variables were stratified, and analysis to account for the complex sampling design was conducted.RESULTS: In both genders, the geometric cadmium concentration was significantly different according to smoking status (both genders, analysis of variance P value < 0.001). In men, E-cigar users were significantly higher than the non-smokers (P value = past-smokers, 0.017; cigarette-smokers, < 0.001) when fully adjusted. Compared with non-smokers, fully-adjusted odds ratios (95% confidence intervals) for the highest cadmium tertiles of E-cigar non-users in cigarette-smokers and E-cigar users in cigarette-smokers were 6.56 (3.55–12.11) and 5.68 (1.96–16.50) in men and 2.74 (1.42–5.29) and 1.29 (0.10–17.44) in women.CONCLUSION: Conventional cigarette smoking in men and women and E-cigar use in men are associated with higher risk of elevated blood cadmium level. Preventive management of cadmium exposure monitoring in conventional cigarette-smokers and E-cigar users may be needed.]]>
Cadmium ; Electronic Cigarettes ; Female ; Humans ; Korea ; Male ; Nutrition Surveys ; Odds Ratio ; Smoke ; Smoking ; Tobacco ; Tobacco Products

This document provides a description of country-level laws that regulate electronic cigarettes and heated tobacco products. The mechanisms used to regulate e-cigarettes were classified as either new/amended laws or existing laws. The policy domains identified include restrictions or prohibitions related to the product (sale, manufacturing, importation, distribution, use, product design including e-liquid ingredients, advertising/ promotion/ sponsorship, and trademarks) and regulatory requirements (taxation, health warning labels, and child-safety standards). A range of regulatory approaches are currently being applied to e-cigarettes globally; however, many countries still regulate e-cigarettes using legislation not tailored specifically for e-cigarettes. Only a handful of countries levy a tax on e-cigarettes. Evidence on the harmful effects and benefits of e-cigarettes usage has not been clearly established yet. The regulatory treatment of heated tobacco products varies from country to country, with some classifying e-cigarettes and cigarettes under the same legislation, other countries treating e-cigarettes more favorably, and some jurisdictions banning them altogether. As the evidence base grows, we expect additional activity in the regulatory arena.
Electronic Cigarettes ; Hand ; Hot Temperature ; Jurisprudence ; Nicotine ; Taxes ; Tobacco Products ; Tobacco

One person dies every six seconds from a smoking-related disease and this problem is likely to worsen. While many people try to quit smoking on their own or with using medicinal products, many of them fail. There is an ongoing debate within the public health community about e-cigarettes on whether they have a potential role in smoking cessation, whether their use can reduce harm for individual users, whether the widespread use of these devices has the potential to reduce or increase population-level harm, and how best to regulate e-cigarette use to minimize both individual and population-level harm. Although the long-term effects of e-cigarette use among smokers and non-smokers are not known, nicotine aerosol produced from a solution, rather than from burning tobacco, releases fewer harmful substances than cigarette smoke does. Some experts advocate wider availability and softer regulations regarding e-cigarette use and perceive them as having the potential to help smokers quit or switch to a harm-reducing means of consuming nicotine. Based on scientific evidence on e-cigarettes, this article explores its pros and cons to public health in order to guide practice, policy, and regulation through reviews of debate articles. ‘Quit or die’ is no longer the only option for those who cannot quit. Safer nicotine products offer another way. There is substantial international and independent evidence that these products are safer than cigarettes.
Burns ; Electronic Cigarettes ; Harm Reduction ; Humans ; Nicotine ; Public Health ; Smoke ; Smoking ; Smoking Cessation ; Social Control, Formal ; Tobacco ; Tobacco Products

E-cigarettes (ECs) and heated tobacco products (HTPs) have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than combustible cigarettes (CCs). In general, the levels of harmful and potentially harmful constituents (HPHCs) are lower in ECs and HTPs than in CCs, although the levels of some heavy metals and HPHCs are higher in ECs and HTPs than in CCs. ECs and HTPs showed possible adverse effects on respiratory and cardiovascular system function, which could result in chronic respiratory and cardiovascular system diseases in animals. An analysis of biomarkers showed that ECs had possible adverse health effects on the respiratory and cardiovascular systems, in addition the effects of HTP on respiratory and cardiovascular systems were not significantly different than those of CC. Epidemiological studies identified positive associations between EC use and asthma, chronic obstructive pulmonary disease, and myocardial infarction. Only one epidemiologic study reported a positive association between ever using HTPs and asthma, allergic rhinitis, and atopic dermatitis among adolescents. Modelling studies of ECs did not show consistent findings regarding the health effects compared with those of CCs. A modeling study of HTPs, performed by tobacco industry, has been criticized for many unfounded assumptions. Lower levels of HPHCs in ECs and HTPs, compared with those in CCs, cannot be directly translated into health benefits because the relationship between exposure and effects is non-linear for cardiovascular diseases and because the duration of exposure is more important than the level of exposure in determining lung cancer mortality. In summary, there is no definite health benefit in using ECs or HTPs instead of CCs, for the individual or the population; hence, tobacco control measures should be the same for ECs, HTPs, and CCs. ECs and HTPs have become popular in Korea; hence, it is important to determine whether ECs and HTPs are less hazardous than CCs.
Adolescent ; Animals ; Asthma ; Biomarkers ; Cardiovascular Diseases ; Cardiovascular System ; Dermatitis, Atopic ; Electronic Cigarettes ; Epidemiologic Studies ; Hot Temperature ; Humans ; Insurance Benefits ; Korea ; Lung Neoplasms ; Metals, Heavy ; Mortality ; Myocardial Infarction ; Pulmonary Disease, Chronic Obstructive ; Rhinitis, Allergic ; Smoking ; Tobacco Industry ; Tobacco Products ; Tobacco

Tobacco products are rapidly evolving. Since the World Health Organization Framework Convention on Tobacco Control came to effect in 2005, the parties of the treaty have been aiming to control tobacco use. Moreover, the social norm of smoking has changed. These changes have prompted the tobacco industry to evolve their products and business model. There have been several evolutions in tobacco products. Firstly, new tobacco products, such as electronic cigarettes and heated tobacco products were introduced into markets that were previously dominated by conventional cigarettes. Thus, smokers are able to select alternative tobacco products. Secondly, new devices for tobacco use, including universal serial bus, smart watch, and car key devices, have been developed and released. These devices are popular among females and youth, who wish to hide their smoking behavior. Thirdly, nicotine, which is used in tobacco products, has also evolved. Typically, ‘free-base nicotine’ has been the main form used in tobacco products, because it helps to deliver nicotine quickly to the smoker's brain. However, a new form of nicotine, ‘nicotine salt’, is used in electronic cigarettes. It can deliver a more highly concentrated dose of nicotine to the smoker’s brain. To regulate these evolving products, laws are required to prevent the easy access of new tobacco products in the Korean market and therefore, a new organization for monitoring the evolution of tobacco products is required. Additionally, we need to encourage young people and scholars to develop interest in tobacco product control, thus ensuring adequate regulation of new tobacco products.
Adolescent ; Brain ; Commerce ; Electronic Cigarettes ; Female ; Hot Temperature ; Humans ; International Cooperation ; Jurisprudence ; Nicotine ; Smoke ; Smoking ; Social Norms ; Tobacco Industry ; Tobacco Products ; Tobacco Use ; Tobacco ; World Health Organization

E-cigarettes, or electronic nicotine delivery systems, are popular among smokers who are looking for a less harmful alternative to conventional tobacco, and the use of e-cigarettes is affected by existing tobacco control policies. E-cigarettes, which are electronic devices designed to allow the user to inhale nicotine as a vapor, are controversial in terms of their harm reduction claims as it can undermine existing tobacco control policies and has the potential to re-normalize smoking behavior. Currently, many of the chemicals used in e-cigarettes have not been comprehensively disclosed, and there is no adequate data on their emissions. Furthermore, the benefits of e-cigarettes have not been adequately shown. To date, a small number of studies have evaluated e-cigarettes as a harm reduction and cessation aid and have found conflicting findings. Meanwhile, e-cigarette or vaping product use associated lung injury has been identified, and an increased use of e-cigarettes in the youth has also been reported recently in the United States. These raise a great social concern around how to regulate e-cigarettes for the protection of public health. A range of current and proposed legislative and regulatory options exists. Some countries have banned e-cigarettes entirely, while others are ready to regulate e-cigarettes as a type of medicine. A lack of consensus on whether e-cigarettes facilitate or threaten existing tobacco control strategies is driving a discussion on how to regulate e-cigarettes in terms of the protection of public health.
Adolescent ; Consensus ; Electronic Cigarettes ; Harm Reduction ; Humans ; Lung Injury ; Nicotine ; Public Health ; Smoke ; Smoking ; Tobacco ; United States

PURPOSE: The purpose of the study was to examine the relationship between smoking attitude and coping skills toward secondhand e-cigarette smoking among nonsmoking college students. METHODS: This study was conducted with 148 students from a University in Seoul, Korea. Participants completed questionnaires and the data were analyzed using a T-test, ANOVA, and Pearson’s correlation coefficients. RESULTS: The mean score of smoking attitude is 51.35±4.73. The mean score of coping skills is 13.89±2.53 in verbal skills, 10.16±2.37 in behavioral skills, and 8.32±2.30 in assertive skills. Coping skills toward secondhand smoking are noted as being different by current cohabitation smoker. A significant relationship between smoking attitude and behavioral coping skills(r=.23, p=.004) was found, which means that a better smoking attitude was correlated with more active behavioral coping skills. CONCLUSION: The results showed that nonsmoking college students with better smoking attitude react to the E-cigarette smoking with more active behaviors. Therefore, interventions are needed to be developed to encourage better smoking attitude and coping skills toward secondhand E-cigarette smoking.
Adaptation, Psychological ; Electronic Cigarettes ; Humans ; Korea ; Seoul ; Smoke ; Smoking ; Tobacco Smoke Pollution

OBJECTIVES: Young adulthood represents a critical developmental period during which the use of tobacco may begin or cease. Furthermore, differences in smoking behaviors between younger (aged 18-24 years) and older (aged 25-34 years) young adults may exist. This study aimed to characterize patterns related to current smoking in younger and older young adults. METHODS: This study used data acquired from the Sixth Korea National Health and Nutrition Examination Survey conducted from 2013 to 2014. A total of 2069 subjects were categorized as younger (712 subjects) and older (1357 subjects) young adults. The chi-square test was used to assess the relationships between smoking status and socio-demographic, health-related, and smoking-related factors. Multivariable logistic regression models were constructed to assess the factors affecting current smoking in these age groups. RESULTS: The current smoking prevalence was 18.3% among the younger young adults and 26.0% among the older young adults. Sex, education level, occupation, perceived health status, alcohol consumption, and electronic cigarette use were related to current smoking in both age groups. Secondhand smoke exposure at home and stress levels showed significant relationships with smoking in younger and older young adults, respectively. CONCLUSIONS: Strong correlations were found between the observed variables and smoking behaviors among young adults. Determining the factors affecting smoking and designing interventions based on these factors are essential for smoking cessation in young adults.
Alcohol Drinking ; Education ; Electronic Cigarettes ; Humans ; Korea ; Logistic Models ; Nutrition Surveys ; Occupations ; Prevalence ; Smoke ; Smoking Cessation ; Smoking ; Tobacco ; Tobacco Smoke Pollution ; Young Adult

Tobacco use is the most important preventable cause of mortality in South Korea and worldwide. This study aimed to evaluate the tobacco control policies of the Moon Jae-in government, which was established in May 10, 2017. Before the Moon Jae-in government, the tobacco tax was raised by the Park Geun-hye government from 2,500 won to 4,500 won (80% increase), but the price of cigarettes was still much lower in Korea than in other high-income countries. Cigarette smoking has been prohibited in all restaurants and bars since 2015; however, smoking rooms are allowed. Only large buildings are smoke-free. Pictorial warnings on cigarette packages were introduced in December 2016; however, they cover only 30% of the main packaging. Smoking cessation services provided by health care facilities have been subsidized by public health insurance since 2015. However, the advertisement, promotion, and sponsorship of tobacco are not further regulated. Since the beginning of the Moon Jae-in government, there has been no further strengthening of major tobacco control policies except for limited expansion of smoke-free public places and introduction of a lung cancer screening program. The first government-level tobacco control policies by the Moon Jae-in government, announced in May 2019, included increasing the size of the pictorial warnings and introducing standardized packaging by 2025, along with incremental expansion of smoke-free public places with prohibition of smoking rooms. These moves are positive; however, they do not include increasing tobacco taxes and regulating advertisement, promotion, and sponsorship of tobacco, which together are the backbone of tobacco control policies. The Moon Jae-in government should strengthen comprehensive tobacco control policies, ncluding tobacco taxes and banning tobacco advertisement, promotion, and sponsorship, to protect public health.
Delivery of Health Care ; Insurance ; Korea ; Lung Neoplasms ; Mass Screening ; Moon ; Mortality ; Product Packaging ; Public Health ; Republic of Korea ; Restaurants ; Smoke ; Smoking ; Smoking Cessation ; Taxes ; Tobacco Products ; Tobacco Use ; Tobacco

BACKGROUND: Electronic cigarette (EC) consumption (‘vaping’) is rapidly increasing, not only in adults but also in adolescents. Little is known about the association between vaping and problem behaviors such as drinking. METHODS: We used data from the 11th Korea Youth Risk Behavior Web-based Survey, which was conducted in 2015 and included 68,043 participants who were Korean middle and high school students. The survey assessed EC, cigarette, and alcohol use. Multiple regression analysis was used to examine risk of current drinking and problem drinking across the following categories of users: never user (never used either product), former user (use of EC or cigarettes in the past, but not currently), vaping only, smoking only, and dual user (current use of both products). RESULTS: EC only users were 1.2% in males, and 0.3% in females. Dual user of both conventional cigarettes and ECs were 5.1% in males, and 1.2% in females. Drinking frequency, drinking quantity per once, and problem drinking were higher among vapers than non-vapers and former-vapers, moreover, were higher among daily vapers than intermittent vapers. Compared to never users, EC only users were higher on risk of current drink and problem drink. The dual users were highest on risk of current drink. CONCLUSION: Vaping is independently associated with alcohol use problems in Korean students, even those not currently smoking. Moreover, dual use of cigarettes and ECs is strongly associated with alcohol use problems. Therefore, vaping students should be concerned about their hidden alcohol use problems.
Adolescent Behavior ; Adolescent ; Adult ; Alcohol Drinking ; Drinking ; Electronic Cigarettes ; Female ; Humans ; Korea ; Male ; Problem Behavior ; Risk-Taking ; Smoke ; Smoking ; Tobacco Products