[비즈한국] May 31st is 'World No Tobacco Day.' As a day established to raise awareness about the dangers of smoking and encourage cessation, it is a time when interest in methods to quit smoking heightens. Recently, many people choosing to quit smoking have been selecting e-cigarettes as a substitute. This is due to the perception that they smell less and are relatively less harmful than conventional combustible cigarettes. Can e-cigarettes truly be a viable alternative to traditional cigarettes?
On the afternoon of the 27th, the 'E-cigarette Fact Check and Proper Understanding of Nicotine Substitutes' forum was held at the Seoul National University Cancer Research Institute in Jongno-gu, Seoul. This forum was organized to address the misunderstandings surrounding e-cigarettes. Experts provided their diagnostics regarding the risks of e-cigarettes and the issue of dual use with traditional cigarettes.
E-cigarette Usage Increases by 82% While Traditional Smoking Rates Drop by 12%
According to the industry, the global market for heat-not-burn (HNB) e-cigarettes has been growing annually: $30.3 billion in 2022, $33.7 billion in 2023, $37 billion in 2024, and $43.1 billion (approximately 65 trillion KRW) in 2025. In fact, while the domestic smoking rate for traditional cigarettes decreased by about 12% last year compared to 2019, the usage rate for e-cigarettes increased by about 82%. This indicates that the perception of them being 'less harmful' than traditional cigarettes has acted as a catalyst for their spread.
However, contrary to the perceptions of smokers, e-cigarettes are not free from health risk controversies. The fact that they may emit fewer certain harmful substances than traditional cigarettes does not mean that the health risks are reduced by the same proportion. In particular, because cardiovascular disease risk does not have a linear correlation with the exposure level of harmful substances, the risk may not decrease as much as expected even if one replaces some traditional cigarettes with e-cigarettes or reduces the total amount of smoking.
In the case of liquid-type e-cigarettes, the heating process of the ingredients is also a point of contention. Ingredients like propylene glycol (PG) and vegetable glycerin (VG) used in liquid e-cigarettes are classified as GRAS (Generally Recognized As Safe) substances when used in foods. However, harmful substances like aldehydes can be generated during the heating process, and the effect on the human body can be different when these are directly inhaled into the lungs. Given that the route of administration is different, it is difficult to guarantee inhalation safety simply because the ingredients are food-grade.
Cho Hong-jun, professor emeritus at the University of Ulsan College of Medicine, explained, "Even the US FDA designated some flavorings used in cherry, almond, cinnamon, vanilla, and butter scents as health hazards or potential health hazards this April," adding, "It is difficult to view them as safe substances."
Another limitation is that there is insufficient accumulation of research to judge long-term risks. As the duration of full-scale domestic e-cigarette use is shorter than that of traditional cigarettes, more time is needed to assess risks through long-term epidemiological studies.
"Just Because It Smells Less Doesn't Mean It's Safe"
Another misunderstanding surrounding e-cigarettes is the issue of secondhand exposure. Because they do not leave behind the strong smoke and smell associated with traditional cigarettes, many people believe it is acceptable to use them indoors or in spaces occupied by others. However, experts point out that e-cigarettes can also have negative impacts on non-smokers.
Secondhand smoking is not limited to 2nd-hand exposure—breathing in the smoke or aerosol exhaled by a smoker. There is also the issue of 3rd-hand smoking, where harmful substances remain on walls, furniture, and clothing and are later exposed to others. While the lack of visible smoke from e-cigarettes may lower guard against indoor use, experts emphasized that special caution is needed in spaces where non-smokers, children, and pregnant women are present.
Lee Sung-kyu, head of the Korea Center for Tobacco Control Research and Education, emphasized, "Just because there is no smell or it has a sweet scent, it does not mean it is safe," adding, "Education and promotion are urgently needed to correct the misunderstanding that e-cigarettes cause less secondhand damage. Indoor smoking policies, which have been stagnant since 2017, need to be reactivated."
The perception of using e-cigarettes as an aid for quitting smoking is also considered a problem. Experts advise utilizing verified smoking cessation treatments and nicotine substitutes instead of e-cigarettes. Nicotine substitutes like patches or gum help control withdrawal symptoms while reducing exposure to harmful substances caused by the smoking process. Conversely, it is pointed out that e-cigarettes are difficult to classify as a smoking cessation tool as they can lead to maintaining nicotine dependence or 'dual use' alongside traditional cigarettes.
Overseas Regulations Strengthen While Domestic Perception Remains Stagnant
As the amendment to the Tobacco Business Act, which expanded the definition of tobacco for the first time in 37 years, went into effect on the 24th of last month, liquid e-cigarettes using synthetic nicotine have also come under legal regulation. Previously, as tobacco was defined under the Tobacco Business Act as products made from tobacco leaves, liquid e-cigarettes with synthetic nicotine were in a regulatory blind spot. Although synthetic nicotine products are now classified as tobacco due to the legal revision, experts point out that this is not enough.
Overseas, there is a continuing trend of strengthening e-cigarette regulations. Some countries have set the personal possession and use of e-cigarettes, as well as their manufacturing, sales, and distribution, as punishable offenses. Vietnam, Singapore, Cambodia, Thailand, India, Australia, Mexico, Taiwan, Hong Kong, and Laos are prime examples. Europe is the same. Belgium has banned the sale of disposable e-cigarettes. In the UK, a bill banning the purchase of cigarettes for those born after 2009 has also been finalized.
The background for each country’s moves to regulate e-cigarettes is rooted in concerns over youth uptake and public health. Liquid e-cigarettes have high accessibility and, with various fruit and menthol flavors, are easily perceived as a luxury item rather than tobacco. Additionally, the fact that they smell less than traditional cigarettes and leave no clear traces of use is cited as a factor that makes it difficult to prevent indoor use and exposure to non-smokers.
Even domestically, there are calls for stricter management standards for e-cigarettes following the legal revision. Center Head Lee Sung-kyu stated, "Although the legal framework changed last month, the warning pictures and text are still weaker than those for traditional cigarettes," adding, "Citizens may be misled into thinking e-cigarettes are less dangerous." He emphasized, "We must continuously inform the public that there are harmful elements in liquid e-cigarettes and deliver new research findings in a way that the public can understand."
Kim Yeol, Chairman of the Korean Association on Smoking or Health, also stated, "Amidst indiscriminate marketing and distorted information claiming e-cigarettes are safer than combustible tobacco, they have quickly penetrated the daily lives of teenagers and young people," and added, "Numerous medical studies and clinical results warn that e-cigarettes also carry serious health risks and can never be a safe alternative."