J Korean Med Assoc.  2018 Mar;61(3):181-190. 10.5124/jkma.2018.61.3.181.

Issues of new types of tobacco (e-cigarette and heat-not-burn tobacco): from the perspective of ‘tobacco harm reduction’

• Lee C
• Kim S
• Cheong YS

• KMID: 2406972
• DOI: http://doi.org/10.5124/jkma.2018.61.3.181

Abstract

E-cigarettes, heat-not-burn (HNB) tobacco, and other new types of tobacco products are emerging in Korea. These products are particularly popular among smokers who are looking for less harmful means of tobacco consumption, and are highly relevant for 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 safety and effects on smoking cessation, as a variety of harmful substances have been detected in e-cigarette vapor. Due to policy differences in tobacco harm reduction, the regulations on e-cigarettes differ from country to country, and domestic regulations regulate e-cigarettes in a manner similar to conventional cigarettes. In contrast, HNB tobacco was introduced in Korea in June 2017, and is rapidly expanding in the market, as active marketing campaigns seek to communicate to consumers that HNB tobacco use involves no tar and is less harmful to health. However, the World Health Organization and several professional groups have argued that based on independent studies not supported by tobacco companies, HNB tobacco should be regulated in the same way as conventional cigarettes because there is no evidence that HNB tobacco is less harmful. Clinicians need to expand their understanding of new tobacco products so that they can provide appropriate counseling.

Keyword

Tobacco; Smoking cessation; Electronic nicotine delivery systems; Heat-not-burn

MeSH Terms

Counseling
Electronic Cigarettes
Harm Reduction
Korea
Marketing
Nicotine
Smoking Cessation
Social Control, Formal
Tobacco Products
Tobacco Use
Tobacco*
World Health Organization
Nicotine

Reference

1. Chapman S. Should electronic cigarettes be as freely available as tobacco cigarettes? No. BMJ. 2013; 346:f3840.

2. Etter JF. Should electronic cigarettes be as freely available as tobacco? Yes. BMJ. 2013; 346:f3845.

3. Lee C. IQOS and Glo: are these safer cigarettes? Tob Free. 2017; 15:16–27.

4. Scientific Committee on Emerging and Newly Identified Health Risks. Health effects of smokeless tobacco products [Internet]. Brussels: European Commission;2008. cited 2018 Feb 19. Available from: https://ec.europa.eu/health/scientific_committees/consultations/public_consultations/scenihr_cons_06_en.

5. Centers for Disease Control and Prevention. Hookahs [Internet]. Atlanta: Centers for Disease Control and Prevention;2016. cited 2016 May 20. Available from: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/.

6. Kim H. Regulation policies of e-cigarettes and smokeless toba-cco in Japan. Tob Free. 2017; 15:30–51.

7. World Health Organization. Heated tobacco products (HTPs) information sheet [Internet]. Geneva: World Health Organization;2017. cited 2017 Nov 20. Available from: http://www.who.int/tobacco/publications/prod_regulation/heated-tobacco-products/en/.

8. International Union Against Tuberculosis and Lung Disease (The UNION). Union position on heat-not-burn tobacco products [Internet]. Paris: The UNION;2017. cited 2018 Feb 19. Available from: https://www.theunion.org/news-centre/news/union-position-on-heat-not-burn-tobacco-products-published-precautionary-principle-advised.

9. Korean Society for Research on Nicotine and Tobacco. Position statement on HNB (heat-not burn tobacco products) of Korean Society for Research on Nicotine and Tobacco [Internet]. Seoul: Korean Society for Research on Nicotine and Tobacco;2018. cited 2018 Feb 19. Available from: http://www.ksrnt.org/board/view.html?code=notice&num=1032.

10. Westenberger BJ. Evaluation of e-cigarettes. Washington, DC: US Food and Drug Administration;2009.

11. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control. 2014; 23:Suppl 2. ii11–ii17.

12. Dinakar C, O'Connor GT. The health effects of electronic cigarettes. N Engl J Med. 2016; 375:2608–2609.

13. Chatham-Stephens K, Law R, Taylor E, Melstrom P, Bunnell R, Wang B, Apelberg B, Schier JG. Centers for Disease Control and Prevention (CDC). Notes from the field: calls to poison centers for exposures to electronic cigarettes: United States, September 2010-February 2014. MMWR Morb Mortal Wkly Rep. 2014; 63:292–293.

14. Vansickel AR, Eissenberg T. Electronic cigarettes: effective nicotine delivery after acute administration. Nicotine Tob Res. 2013; 15:267–270.

15. McNeill A, Brose LS, Calder R, Hitchman SC, HajeK P, McRobbie H. E-cigarettes: an evidence update [Internet]. [place unknown]: Public Health England;2015. cited 2018 Feb 19. Available from: https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update.

16. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013; 382:1629–1637.

17. Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016; 9:CD010216.

18. Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014; 109:1531–1540.

19. Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016; 4:116–128.

20. World Health Organization Framework Convention on Tobacco Control. Electronic nicotine delivery systems [Internet]. Geneva: World Health Organization Framework Convention on Tobacco Control;2014. cited 2018 Feb 19. Available from: http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf.

21. Lee S. Electronic cigarettes, it should be controlled as cigarettes! J Korean Soc Res Nicotine Tob. 2014; 5:30–33.

22. Cheong Y. Tight regulation over electronic cigarettes: is it really the best way? J Korean Soc Res Nicotine Tob. 2014; 5:26–29.

23. Bekki K, Inaba Y, Uchiyama S, Kunugita N. Comparison of chemicals in mainstream smoke in heat-not-burn tobacco and combustion cigarettes. J UOEH. 2017; 39:201–207.

24. Protano C, Manigrasso M, Avino P, Vitali M. Second-hand smoke generated by combustion and electronic smoking devices used in real scenarios: ultrafine particle pollution and age-related dose assessment. Environ Int. 2017; 107:190–195.

25. Auer R, Concha-Lozano N, Jacot-Sadowski I, Cornuz J, Berthet A. Heat-not-burn tobacco cigarettes: smoke by any other name. JAMA Intern Med. 2017; 177:1050–1052.

26. Farsalinos KE, Yannovits N, Sarri T, Voudris V, Poulas K. Nicotine delivery to the aerosol of a heat-not-burn tobacco product: comparison with a tobacco cigarette and e-cigarettes. Nicotine Tob Res. 2017; 06. 16. [Epub]. DOI: 10.1093/ntr/ntx138.

27. Li X, Luo Y, Jiang X, Zhang H, Zhu F, Hu S, Hou H, Hu Q, Pang Y. Chemical analysis and simulated pyrolysis of tobacco heating system 2.2 compared to conventional cigarettes. Nicotine Tob Res. 2018; 01. 08. [Epub]. DOI: 10.1093/ntr/nty005.

28. Clarke T. US panel deals blow to Philip Morris tobacco device. REUTERS;2018. 01. 26. cited 2018 Feb 19. Available from: https://www.reuters.com/article/us-health-tobacco-pmi/u-s-panel-deals-blow-to-philip-morris-tobacco-device-idUSKBN1FE2IQ.

29. Stratton KR. Clearing the smoke: assessing the science base for tobacco harm reduction. Washington, DC: Institute of Medicine;2001.

30. Lee CM, Joh HK. History and evidence of ‘Tobacco Harm Reduction’. Korean J Fam Med. 2007; 28:575–588.

31. Moon OR, Kim KH. Tobacco harm reduction: its health policy implication. J Korean Public Health Assoc. 2015; 41:1–21.

32. McNeill A. Harm reduction. BMJ. 2004; 328:885–887.

33. National Academies of Sciences Engineering Medicine. Public health consequences of e-cigarettes [Internet]. Washington, DC: National Academies of Sciences Engineering Medicine;2018. cited 2018 Feb 19. Available from: http://nationalacademies.org/hmd/Reports/2018/public-health-consequences-of-e-cigarettes.aspx.

34. Royal College of Physicians. Nicotine without smoke: tobacco harm reduction [Internet]. London: Royal College of Physicians;2016. cited 2018 Feb 19. Available from: https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0.

35. Fairchild AL, Lee JS, Bayer R, Curran J. E-cigarettes and the harm-reduction continuum. N Engl J Med. 2018; 378:216–219.

36. Godtfredsen NS, Holst C, Prescott E, Vestbo J, Osler M. Smoking reduction, smoking cessation, and mortality: a 16-year follow-up of 19,732 men and women from the Copenhagen Centre for Prospective Population Studies. Am J Epidemiol. 2002; 156:994–1001.

37. Centers for Disease Control and Prevention. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. A report of the surgeon general. Atlanta: Centers for Disease Control and Prevention;2010.

38. Hackshaw A, Morris JK, Boniface S, Tang JL, Milenkovic D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018; 360:j5855.

39. World Health Organization Framework Convention on Tobacco Control. Electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) [Internet]. Geneva: World Health Organization Framework Convention on Tobacco Control;2016. cited 2018 Feb 19. Available from: http://www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf?ua=1.

40. Yeh JS, Bullen C, Glantz SA. Clinical decisions: e-cigarettes and smoking cessation. N Engl J Med. 2016; 374:2172–2174.