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

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

PURPOSE: We aimed to identify associations between the frequency of electronic cigarette (e-cigarette) use and smoking-related characteristics among adolescent smokers.METHODS: We used data from the 14th Korea Youth Risk Behavior Survey. The participants were 3,722 smokers who had smoked cigarettes on at least one day during the past 30 days. The frequency of e-cigarette use was defined as the number of days that participants used e-cigarettes during the past 30 days, and was divided into four categories: 0, 1~2, 3~9, and ≥10 days. We used the χ² test and multinomial logistic regression to examine the associations between the frequency of e-cigarette use and smoking-related characteristics.RESULTS: Those who attempted to quit smoking, had used a heated tobacco product (HTP) at least once, or initiated e-cigarette use before middle school were more likely to use e-cigarettes for 3~9 days in the past 30 days. More frequent e-cigarette use (≥10 days) was associated with a higher frequency and greater amount of cigarette use, lifetime HTP use, and earlier initiation of e-cigarette use.CONCLUSION: Smoking-related characteristics differed by the frequency of e-cigarette use. Therefore, intervention programs targeting adolescent smokers should consider differences in smoking-related characteristics based on the frequency of e-cigarette use.
Adolescent ; Electronic Cigarettes ; Hot Temperature ; Humans ; Korea ; Logistic Models ; Risk-Taking ; Smoke ; Smoking ; Tobacco Products

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

BACKGROUND: Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world. METHODS: We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes. RESULTS: There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%. CONCLUSIONS: We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.
Electronic Cigarettes ; Harm Reduction ; Internet ; Korea ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Products

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