Is this a cigarette or not··· Blind spots that still remain in tobacco control policy [Medical Magnifier] - 경향신문

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Liquid-type e-cigarette devices made in forms similar to mini game consoles, watches, or wireless earbuds. Provided by the Korea Center for Tobacco Control Research and Education

What is a cigarette? Until just over a decade ago in Korea, when people said cigarette, most imagined only conventional combustible cigarettes, commonly referred to as ‘yeoncho’. Chewing tobacco, waterpipes, and pipe tobacco did exist, although they were rare domestically, and they all shared the common feature of using processed tobacco leaves. In the past, even the Tobacco Business Act defined tobacco as ‘made from tobacco leaves’.

This perception began to change with the emergence of liquid-type electronic cigarettes. Although they merely contain chemically synthesized nicotine, they are unrelated to the process of cultivating the tobacco plant and processing its leaves. This new type of product remained outside the legal framework for a time and only began to be included within the legal scope of ‘tobacco’ in Korea as of April.

However, public health experts point out that there are still products sitting in a blind spot, seeming like cigarettes yet not quite. These products, which can be called ‘look-alike nicotine liquid inhalation products’, use a substance slightly different from nicotine called ‘6-methylnicotine’. It produces effects similar to nicotine, but because it is a different substance, it can slip through legal loopholes.

At a media forum jointly hosted on the 10th by the National Academy of Medicine of Korea and the Korea Medical and Bio Reporters Association under the theme ‘New Tobacco Trends and the Direction of Tobacco Control Policy’, experts exchanged a range of views, including that the emerging look-alike products pose problems and that a turning point is needed in domestic tobacco control policy. There were also calls for tobacco control to evolve so that it can respond to tobacco and look-alike products that are changing rapidly with the times.

The products that are particularly problematic are those that use analog nicotine. A considerable share of items labeled nicotine-free in fact contain such analog nicotine, raising the risk of indiscriminate use. The government announced that, after collecting and analyzing 105 liquid inhalation products marketed online as emphasizing ‘nicotine-free’, nicotine was detected in 13 products and 6-methylnicotine, an analog of nicotine, in 12.

Lee Seong-gyu, head of the Korea Center for Tobacco Control Research and Education, explained, “6-methylnicotine produces similar effects at lower concentrations than nicotine, and products sold as nicotine-free are highly likely to contain this analog nicotine, which may be even more harmful to health than nicotine,” adding, “regardless of whether nicotine is present, the base liquids propylene glycol and vegetable glycerin themselves threaten health.”

In addition, there is a serious problem in that the shapes of liquid inhalation devices containing this analog nicotine are modeled after everyday items such as pencil cases, earbud cases, and cosmetics, encouraging easy access by adolescents. Even among liquid-type e-cigarettes, products have already appeared in forms that look like mini game consoles or watches, making it hard at a glance to recognize them as cigarettes, which raises grave concerns that adolescents can easily conceal their use.

As new forms of nicotine use products distributed overseas are expected to enter the domestic market soon, these concerns are growing. The formats are truly diverse, including nicotine pouches and nicotine toothpicks. The center director said, “In the 2025 U.S. National Youth Tobacco Survey, the share of exclusive liquid-type e-cigarette use among youth users declined, while dual or exclusive use of nicotine pouches increased,” adding, “nicotine pouches are on the verge of entering the domestic market, and on top of that, nicotine toothpicks could also soon become commonplace.”

For this reason, experts stress the need to overhaul the management system so that the scope of tobacco regulated by the Tobacco Business Act is expanded into an integrated framework that also encompasses electronic inhalation products. To reduce accessibility, some also argued that the price of cigarettes, currently 4,500 won, should be raised to at least 8,500 won.

Park Eun-cheol, Deputy Director for Health Policy at the National Academy of Medicine of Korea, suggested that rather than a one-off hike in cigarette prices, there needs to be a legal basis to allow automatic adjustment of cigarette prices in line with inflation. Park explained, “domestic cigarette prices have been frozen at 4,500 won since 2015, and the purchasing-power-parity-adjusted price is 5.51 international dollars, a low level among Organisation for Economic Co-operation and Development (OECD) countries,” adding, “scenario analysis estimated that, when cigarette prices rise, sales of combustible cigarettes would fall by 35.6%, the adult smoking rate would drop from 17.0% to 14.0% by 3.0 percentage points, and annual tobacco-related tax revenue would increase by about 2.76 trillion won.”

There are also calls for broader tobacco control at the public health level, rather than stopping at regulating new types of tobacco and look-alike products and raising prices. According to the World Health Organization (WHO), the score for tobacco control policy in Korea was an average of 3.563 out of 5. It received high scores of 5 for ‘analysis of responses to tobacco use and prevention policies’ and ‘provision of smoking-cessation support services’, but lagged in many areas, including ‘protection from secondhand smoke’ at 2.125, ‘implementation of bans on tobacco advertising, promotion, and sponsorship’ at 2.375, and ‘increases in tobacco taxes’ at 2.5.

Park said, “it is necessary to supplement related policies, including managing secondhand exposure from electronic cigarettes, improving public literacy regarding risks, and managing online and offline sales with geographical accessibility in mind,” and pointed out, “the current ‘Tobacco Business Act’ should be reorganized into the ‘Act on the Management of Tobacco and Electronic Inhalation Products’ to include all tobacco and electronic inhalation products within the regulatory scope, and the industry-centered management system should be shifted toward a focus on public health.”