Are E-Cigarettes Less Harmful? ... Severe Nicotine Addiction Evident as Users Reach for Them Within 5 Minutes of Waking

More Liquid E-Cigarette Users Smoke Within Five Minutes of Waking
Novel Tobacco Products Require Tailored Smoking Cessation Assessment Tools

More smokers are turning to heated tobacco products and liquid-type e-cigarettes, believing they are "less harmful," "produce less odor," and are "more advantageous for quitting smoking." However, new research suggests that these novel tobacco products may actually increase nicotine dependence compared to conventional cigarettes.

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According to the "Development and Application of Standard Evaluation Indicators for Smoking Level Due to the Spread of Novel Tobacco Products" study, conducted by the Korean Association on Smoking and Health at the request of the Ministry of Health and Welfare, some indicators of nicotine dependence showed higher addiction levels among e-cigarette users than among conventional cigarette smokers. The study surveyed 800 smokers aged 20 to 69, including 400 exclusive conventional cigarette users, 100 exclusive heated tobacco product users, 100 exclusive liquid-type e-cigarette users, and 200 dual or multiple product users.

One of the key indicators was "the time taken to smoke the first cigarette after waking up." Among those who reported smoking within five minutes of waking, the proportion was highest among exclusive liquid-type e-cigarette users at 30.0%. Heated tobacco product users followed at 26.0%, while conventional cigarette smokers were at 18.5%. This suggests that e-cigarette users may have a stronger dependence on nicotine, seeking it immediately upon waking.

When comparing daily smoking amounts, 45.8% of conventional cigarette users reported smoking 11 to 20 cigarettes per day, while this figure was higher among heated tobacco product users at 51.0%. For liquid-type e-cigarette users, 63.0% reported using their device 10 times or less per day, but direct comparison is difficult due to differences in usage methods.

The issue is that current standard assessment tools used in smoking cessation clinics, such as the Fagerstrom Test, do not adequately reflect the characteristics of novel tobacco products. For e-cigarettes, variables such as the number of uses, duration, and nicotine liquid concentration are more relevant than the number of cigarettes smoked. The research team emphasized that "it is impossible to provide effective smoking cessation support using only traditional cigarette-focused assessment tools," highlighting the need to develop new standard evaluation indicators tailored to users of novel tobacco products.

Ultimately, contrary to the tobacco industry's image of these products as "less harmful alternatives," this study demonstrates that novel tobacco products are by no means a risk-free option when it comes to nicotine addiction.