Steve Shaowei Xu

Background: China is the global centre for e-cigarette (EC) manufacturing. While regulatory responses have increasingly incorporated supply-side enforcement measures, research examining the supply-side dynamics of the global EC market remains limited. Methods: Using the tobacco industry globalisation framework of Lee and Eckhardt, we examined the globalisation of the Chinese EC industry across three domains: current status, globalisation strategies and structural organisation. Analyses drew on publicly available industry reports, government documents, academic literature, corporate records and media sources in English and Chinese. Results: China dominates the global EC market, producing over 90% of the world’s ECs, including those that are sold by transnational tobacco companies (TTCs) (eg, Vuse, Njoy) and those that are sold by Chinese companies, notably high-volume disposable ECs (eg, Elf Bar, Puff Bar) and exports these products to more than 160 countries. Chinese EC firms operate under a fast-moving consumer goods (FMCG) model characterised by rapid product turnover, extensive flavour and design variation and short innovation cycles, in many respects the inverse of the TTC business model. A vertically integrated manufacturing ecosystem centred in Shenzhen enables low-cost production and rapid regulatory adaptation. Domestic regulations imposed on Chinese ECs in 2022 appear to have further accelerated global expansion, while complex corporate structures obscure accountability. We present examples illustrating how regulations premised on the assumption that ECs behave like cigarettes have failed to keep pace with this industry. Conclusions: The globalisation of Chinese EC companies challenges prevailing tobacco control paradigms. FMCG-style production, rapid product iteration and effective supply chains enable circumvention of regulations. More effective responses require coordinated, supply-side-informed approaches that strengthen oversight of manufacturing, distribution and cross-border trade.

Background: South Korea has progressively strengthened its smoke-free regulations over the past two decades. However, few studies have systematically examined how this expansion has corresponded with changes in observed smoking, support for smoke-free laws, voluntary home smoking bans and motivation to quit smoking. Methods: We analysed nationally representative data from five waves of the International Tobacco Control Korea Surveys (2005: n=991; 2008: n=1733; 2010: n=1552; 2016: n=1989; 2020: n=3763), including 10 028 adults who smoked cigarettes at least weekly. Using a repeated cross-sectional design, we assessed self-reported smoking restrictions in bars/pubs, cafés/restaurants and workplaces, and examined their associations with observed smoking, support for smoking bans, voluntary home smoking bans and motivation to quit smoking. Adjusted associations were estimated using regression models with generalised estimating equations, accounting for survey weights and within-subject correlation. Results: Smoking restrictions expanded substantially across all venues between 2005 and 2020. Over the same period, observed smoking declined markedly (51.4%–97.2% to 5.8%–12.4%), while support for smoking bans (5.3%–17.6% to 78.4%–88.1%), voluntary home smoking bans (29.3% to 60.3%) and motivation to quit smoking (36.3%–38.5% to 57.7%–60.4%) all increased. Both complete and partial bans were inversely associated with observed smoking, with stronger associations for complete bans (adjusted prevalence ratios (aPRs) 0.15–0.44 vs 0.47–0.95). Complete bans were also positively associated with support for smoke-free laws (aPRs 1.82–1.93) and voluntary home smoking bans (aPRs 1.27–1.45), whereas partial bans showed weak or no significant relationships. Only workplace smoking bans were associated with greater motivation to quit smoking (aPRs 1.92). Conclusions: The expansion of smoke-free policies in South Korea has coincided with lower observed smoking, stronger public support and wider adoption of home smoking bans, highlighting that comprehensive bans are more effective than partial bans in strengthening smoke-free norms and advancing tobacco control efforts.

Introduction: This study examined whether Korean adults who smoked cigarettes during the COVID-19 pandemic decreased their smoking because of COVID-19, with a focus on whether perceptions of susceptibility and severity of COVID-19 disease were associated with reduced smoking. Methods: Data...

Introduction Dual use of e-cigarettes and cigarettes is a growing usage pattern in adults, but little is known about the motivations underlying this trend. We investigated the reasons for e-cigarette use among adults who smoke, considering variation in sociodemographic subgroups. Methods This repeated cross-sectional study analysed adults who smoked at least weekly and vaped at any frequency. Data were from the International Tobacco Control Korea Surveys conducted in 2016 (n=164) and 2020 (n=1088). Fourteen reasons for e-cigarette use were assessed in both waves. Subgroup analyses were performed by age, sex and educational level. Results The top reasons for e-cigarette use in 2020 were curiosity (62.8%), less harmful than smoking (45.4%) and taste (43.2%). Curiosity was the most cited across age, sex and education subgroups. Significant differences were observed in 2020 compared with 2016, with lower percentages in goal-oriented reasons: helping quit smoking (36.3% vs 48.9%; p=0.017), helping cut down smoking (35.3% vs 52.7%; p=0.001), less harmful to others (39.0% vs 54.6%; p=0.003) and more acceptable (31.6% vs 61.2%; pConclusions E-cigarette use for curiosity and pleasure predominated among adults who smoked. The reasons for dual use in adults have shifted from goal-oriented to non-goal-oriented.

Introduction: Non-combustible nicotine products (NCNPs), such as heated tobacco products (HTPs) and nicotine vaping products (NVPs) have gained a significant nicotine market share in South Korea. This descriptive study examined patterns of regular cigarette and NCNP use among South Korean...

Background Strong public support can increase the likelihood of adopting tobacco control policies. We assessed support for six commercial tobacco endgame policies in South Korea: limiting the nicotine in cigarettes, banning all additives in cigarettes, restricting the number of places where cigarettes are sold, and banning the manufacture and sales of cigarettes (unconditionally, with the provision of cessation support and with alternative tobacco products available). Methods Data were obtained from 4740 adults who completed the 2020 International Tobacco Control Korea Survey. Participants were categorised based on their nicotine use: (1) did not use any products, (2) vaped and/or used heated tobacco products (HTPs) but did not smoke cigarettes, (3) smoked cigarettes only and (4) smoked cigarettes and vaped and/or used HTPs. Attitudes towards the policies were classified as supportive, undecided or opposed. Weighted multinomial logistic regression models assessed support levels according to nicotine use. Results Support was highest for limiting the nicotine content in cigarettes (68.4%; 95% CI 64.6% to 72.3%) and restricting the number of retailers (68.1%; 95% CI 64.5% to 71.7%), and lowest for banning cigarette sales if alternative products are made available (45.0%; 95% CI 40.9% to 49.1%). People who did not use any products were most likely to support endgame policies, except for banning cigarette sales with alternatives available. The proportion of undecided participants exceeded 10% (range 13%–25%) for all policies. Conclusion There is a strong public support for tobacco endgame policies in South Korea. Further research should prioritise the development of strategies to ensure the effective implementation of highly supported policies.

Background and Aims: Heated tobacco products (HTPs) are electronic devices that heat process tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on world‐wide HTP use prevalence. This meta‐analytic review estimated the prevalence of HTP use by country, World Health Organization (WHO) region, year, sex/gender and age.Methods: Five databases (Web of Science, Scopus, Embase, PubMed and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post‐modern HTP device market entry (2015). A random‐effects meta‐analysis was used to estimate overall prevalence for life‐time, current and daily HTP use.Results: Forty‐five studies (n = 1 096 076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for life‐time, current and daily HTP use was 4.87% [95% confidence interval (CI) = 4.16, 5.63], 1.53% (95% CI = 1.22, 1.87) and 0.79% (95% CI = 0.48, 1.18), respectively, across all years (2015–22). Life‐time HTP use prevalence significantly increased by 3.39% for WPR [0.52% (95% CI = 0.25, 0.88) in 2015 to 3.91% (95% CI = 2.30, 5.92) in 2019] and 5.58% for EUR [1.13% (95% CI = 0.59, 1.97) in 2016 to 6.98% (95% CI = 5.69, 8.39) in 2020]. Current HTP use increased by 10.45% for WPR [0.12% (95% CI = 0, 0.37) in 2015 to 10.57% (95% CI = 5.59, 16.88) in 2020] and 1.15% for EUR [0% (95% CI = 0, 0.35) in 2016 to 1.15% (95% CI = 0.87, 1.47) in 2020]. Meta‐regression revealed higher current HTP use in WPR [3.80% (95% CI = 2.88, 4.98)] compared with EUR [1.40% (95% CI = 1.09, 1.74)] and AMR [0.81% (95% CI = 0.46, 1.26)] and for males [3.45% (95% CI = 2.56, 4.47)] compared with females [1.82% (95% CI = 1.39, 2.29)]. Adolescents had higher life‐time HTP use prevalence [5.25% (95% CI = 4.36, 6.21) than adults [2.45% (95% CI = 0.79, 4.97)]. Most studies scored a low risk of sampling bias due to their nationally representative sampling.Conclusion: The prevalence of HTPs use increased in the EUR and WPR between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period.

South Korea is the world’s second-largest heated tobacco product (HTP) market after Japan. HTP sales in South Korea have increased rapidly since May 2017, accounting for 10.6% of the total tobacco market in 2020. Despite this, little is known as to why HTP consumers who were current and former smokers started using HTPs and used them regularly. We analyzed cross-sectional data for 1815 adults (aged 19+) who participated in the 2020 International Tobacco Control (ITC) Korea Survey, of whom 1650 were HTP-cigarette consumers (those who reported smoking cigarettes and using HTPs ≥ weekly) and 165 were exclusive HTP consumers (using HTPs ≥ weekly) who were former or occasional smokers (smoking cigarette < weekly). Respondents were asked to report the reason(s) they used HTPs, with 25 possible reasons for HTP-cigarette consumers and 22 for exclusive HTP consumers. The most common reasons for initiating HTP use among all HTP consumers were out of curiosity (58.9%), family and friends use HTPs (45.5%), and they like the HTP technology (35.9%). The most common reasons for regularly using HTPs among all HTP consumers were that they were less smelly than cigarettes (71.3%), HTPs are less harmful to own health than cigarettes (48.6%), and stress reduction (47.4%). Overall, 35.4% of HTP-cigarette consumers reported using HTPs to quit smoking, 14.7% to reduce smoking but not to quit, and 49.7% for other reasons besides quitting or reducing smoking. In conclusion, several common reasons for initiating and regularly using HTPs were endorsed by all HTP consumers who were smoking, had quit smoking completely, or occasionally smoked. Notably, only about one-third of HTP-cigarette consumers said they were using HTPs to quit smoking, suggesting that most had no intention of using HTPs as an aid to quit smoking in South Korea.

Background: South Korea has made substantial progress on tobacco control, but cigarette smoking prevalence is still high. Previous studies were conducted before the use of nicotine vaping products (NVPs) or heated tobacco products (HTPs) became popular. Thus, whether the concurrent use of NVPs or HTPs affects quit intentions among Korean smokers remains a question that needs to be explored. This study aims to identify predictors of quit intentions among cigarette-only smokers and concurrent users of cigarettes and NVPs or HTPs. Methods: Data were from the 2020 International Tobacco Control Korea Survey. Included in the analysis were 3778 adult cigarette smokers: 1900 at-least-weekly exclusive smokers and 1878 at-least-weekly concurrent smokers and HTP or NVP users. Bivariate and multivariable logistic regression analyses were conducted. Results: Quit intentions were reported by 66.4% of respondents. Factors significantly associated with quit intentions included younger age, having a spouse/partner, lower nicotine dependence, reporting a past quit attempt, regretting starting smoking, believing that smoking had damaged health, worrying that smoking will damage future health, and perceiving health benefits of quitting. Current use of NVPs or HTPs was not significantly associated with quit intentions. Conclusions: This study contributes the following to current literature: intrinsic health-related beliefs were more important than societal norms in shaping quit intentions. These findings should be considered in shaping future smoking cessation policies, such as reinforcing education programs that emphasize the benefits of quitting for personal health reasons, lowering nicotine dependence, and encouraging multiple quit attempts and successful quitting.