Nicotine Dependence of Electronic Cigarette, Dual Combustible and Electronic Cigarette Users.

Introduction:
This text is a summary of an editorial article by Jungun Lee, an expert in regulatory matters, discussing a study on nicotine dependence among exclusive combustible cigarette (CC) users, electronic cigarette (EC) users, and dual users in South Korea. The study compares the difference between heaviness of Smoking Index with urine cotinine as a biochemical marker.

Key Points:

* The prevalence of male adult tobacco smoking in South Korea has declined, while the prevalence of male adult electronic cigarette users has increased from 2.0% in 2013 to 4.4% in 2017.
* Most EC users begin this habit assuming that it will assist them to cease smoking tobacco, but the main reason for the failure of smoking cessation in this group is associated with the level of nicotine dependence.
* among those who currently smoke any type of cigarette, 89.4% were exclusive CC users, 1.4% were exclusive EC users, and 9.2% were dual users.
* The geometric mean of urine cotinine was highest among dual users (1,356.4 ng/mL), followed sequentially by exclusive CC users (1,270.3 ng/mL), and exclusive EC users (867.7 ng/mL).
* The differences in the average number of cigarettes smoked per day and heaviness of Smoking Index scores were not statistically significant among the three groups.
* The authors rationalized the result due to the lack of a detailed questionnaire on EC use, such as EC use frequency, number of puffs, nicotine concentrations, vaporizing power, flavor, etc.
* Developing new evaluation tools to measure nicotine dependence among dual and poly-users is essential.
* In this study, 64.7% of dual users had tried to quit smoking for more than 24 hours in a day. Smoking cessation consultations for dual users need to be more strategic. New evaluation tools are needed to assess the amount of smoking and nicotine dependence of dual users or poly-users more efficiently.

Main Message:
The study highlights the importance of evaluating nicotine dependence among EC users, CC users, and dual users. as the prevalence of electronic cigarette users increases, it is crucial to develop new evaluation tools to measure nicotine dependence among dual and poly-users more efficiently. The main reason for the failure of smoking cessation among EC users is associated with the level of nicotine dependence. Therefore, smoking cessation consultations for dual users need to be more strategic, and healthcare professionals should consider the different types of cigarettes and their nicotine concentrations when assessing nicotine dependence.

Lee J. Nicotine Dependence of Electronic Cigarette, Dual Combustible and Electronic Cigarette Users. Korean journal of family medicine. 2021;42(3):189-190. doi:10.4082/kjfm.42.3E