Dahae Lim, Jung In Choi, Ryuk Jun Kwon, Sang Yeoup Lee, Young Hye Cho, Eun Ju Park, Youngin Lee, Sae Rom Lee, Soo Min Son, Yun Jin Kim, Jeong Gyu Lee, Yu Hyeon Yi, Young Jin Tak, Seung Hun Lee, Gyu Lee Kim, Young Jin Ra
Received August 21, 2023 Accepted April 22, 2024 Published online August 20, 2024
Background Insulin resistance contributes to the development of cardiovascular disease and type 2 diabetes mellitus. Smoking leads to an increase in triglyceride levels, which, in turn, increases insulin resistance. Although the number of e-cigarette users has increased in recent years, few studies have investigated the association between ecigarette use and insulin resistance. Therefore, this study aimed to determine the association between e-cigarette use and insulin resistance using the triglyceride-glucose (TyG) index in Korean adults.
Methods This study included 4,404 healthy adults aged ≥20 years who participated in the Korea National Health and Nutrition Examination Survey between 2019 and 2020. Participants were categorized as never-smokers or ecigarette users, and the TyG index was categorized into low- and high-TyG index groups according to the median value (9.22). A logistic regression analysis was performed to determine the association between e-cigarette smoking and insulin resistance.
Results E-cigarette users had a higher TyG index than never smokers (e-cigarette: mean=3.95; never: mean=9.18; P<0.001). The e-cigarette users had a higher risk of being in the high TyG index group than never-smokers (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.03–1.84). In the subgroup analysis stratified by sex, age, and body mass index, a higher OR for a high TyG index was observed in men (OR, 1.46; 95% CI, 1.03–2.08) and individuals aged 60 years or older (OR, 3.74; 95% CI, 1.14–12.30).
Conclusion Our findings suggest that e-cigarette use is significantly associated with insulin resistance.
Background Noncombustible nicotine or tobacco product (NNTP) use, and cigarette smoking are associated with a high likelihood of unhealthy weight control behaviors (UWCBs) among adolescents. However, no study has addressed the differences in UWCBs among non-users, single users of combustible cigarettes (CCs) or NNTPs and dual users. This study compared the frequencies of weight control behaviors according to the status of CC and NNTP use among Korean adolescents.
Methods This was a cross-sectional study of 25,094 adolescents who had attempted to reduce or maintain their body weight during the past 30 days, using data from the 15th Korea Youth Risk Behavior Survey, 2019. Data on the status of CC and NNTP use, weight status, and weight control behaviors were obtained using self-report questionnaires. Subjects were categorized into four groups: non-users, cigarette-only users, NNTP-only users, and dual users.
Results Among boys and girls, current smokers and NNTP users were 8.9%±0.3% and 5.5%±0.3%, and 4.2%±0.2% and 1.7%±0.1%, respectively. Among boys, NNTP-only users were more likely to engage in extreme weight control behaviors than non-users. Among girls, users of either CCs or NNTPs were more likely to engage in extreme weight control behaviors and less extreme weight control behaviors than non-users.
Conclusion This study shows that users of either CCs or NNTPs are more likely to engage in UWCBs, and NNTP-only users are the most likely to do so.
Citations
Citations to this article as recorded by
Reflecting on progress and challenges: the Korean Journal of Family Medicine in 2024 Seung-Won Oh Korean Journal of Family Medicine.2025; 46(2): 55. CrossRef
The Interconnected Nature of Smoking, Depression, and Obesity in Behavioral Medicine Joung Sik Son Korean Journal of Family Medicine.2024; 45(4): 181. CrossRef
Heated tobacco products (HTPs), a hybrid between conventional and electronic cigarettes, were first launched in South Korea in June 2017. Owing to advertisements stating that HTPs are odorless, tar-free, and less harmful to health, the sales of HTPs have grown quickly enough to account for about 10% of the total tobacco market in a year. HTP use by young, highly educated, and high-income groups had a significant impact on both the overall tobacco market over the past 3 years and the smoking and quitting behaviors of smokers. Based on national smoking rate statistics, tobacco sales trends, and the number of visitors to smoking cessation clinics, the following changes have been identified: (1) The decline in current smoking rates has slowed or rose in some groups. (2) The decline in total cigarette sales has slowed but rose again in the first quarter of 2020. (3) The number of visitors to smoking cessation clinics decreased just after the advent of HTPs. These results may be due to the insufficient support of tobacco regulation policies but also coincide chronologically with the appearance of HTPs in South Korea. It is necessary to investigate the usage rate of various tobacco products, including HTPs and e-cigarettes, to examine the health risks of novel tobacco products and provide accurate information to users and policymakers. Finally, tobacco companies are continuously developing new product concepts to escape the regulation of existing cigarettes; thus, comprehensive management measures for all nicotine-containing products are needed.
Citations
Citations to this article as recorded by
Maintaining optimal cardiovascular health metrics and carotid intima-media thickness among Korean adolescents Fumie Kaneko, Hokyou Lee, Jee-Seon Shim, Hyeon Chang Kim Clinical Hypertension.2025;[Epub] CrossRef
Assessing use of inhalable nicotine products within complex markets: the dilemma of heated tobacco products Connor Richard Miller, Steve S Xu, Danielle M Smith, Edward Sutanto, Maciej Lukasz Goniewicz, Anne C K Quah, Geoffrey T Fong Tobacco Control.2024; 33(1): 103. CrossRef
The smoking population is not hardening in South Korea: a study using the Korea Community Health Survey from 2010 to 2018 Boyoung Jung, Jung Ah Lee, Ye-Jee Kim, Hong-Jun Cho Tobacco Control.2024; 33(2): 171. CrossRef
Heated Tobacco Product Use and Mental Health: Korean National Health and Nutrition Examination Survey (2018–2020) Young-Gyun Seo, Sungkyu Lee, Min Kyung Lim, Yu-Jin Paek International Journal of Mental Health and Addiction.2024; 22(3): 979. CrossRef
Perception of heated tobacco products and support for regulations: a cross-sectional study in Hong Kong Yongda Socrates Wu, Yee Tak Derek Cheung, Sai Yin Ho, Henry Sau Chai Tong, Vienna Wai Yin Lai, Tai Hing Lam, Man Ping Wang Tobacco Control.2024; 33(e1): e132. CrossRef
Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan Satomi Odani, Kanami Tsuno, Israel T Agaku, Takahiro Tabuchi Tobacco Control.2024; 33(4): 472. CrossRef
A Scoping Review of Behavioural Studies on Heated Tobacco Products Ian M Fearon, Sarah F Cordery, Martin Fitzpatrick, Sarah Weaver, Matthew Stevenson, Erika Grandolfo, Layla Malt, Keith Thompson, Thomas Nahde Cureus.2024;[Epub] CrossRef
Development and validation of a nomogram for predicting COPD: A nationwide population-based study in South Korea Seungeun Oh, Hyungkyun Mok, Kyuhee Jo Medicine.2024; 103(39): e39901. CrossRef
Association between the dual use of electronic and
conventional cigarettes and NAFLD status in Korean men Minjung Han, Seogsong Jeong, Jihun Song, Sun Jae Park, Cheol Min Lee, Kiheon Lee, Sang Min Park Tobacco Induced Diseases.2023; 21(February): 1. CrossRef
JUUL preference among Korean adult tobacco users and its effect on attempts to quit tobacco: A follow- up survey four months post JUUL launch Ju Sam Hwang+, Kiheon Lee+, Choon-Young Kim, Heejin Kim, Sungroul Kim, Cheol Lee Tobacco Induced Diseases.2023; 21(March): 1. CrossRef
Electronic device or regulated tobacco product? Learning from the diffusion of heated tobacco products in Spain J.M. Martín-Álvarez, A. Almeida, A.A. Golpe, E. Asensio Public Health.2023; 219: 61. CrossRef
Is Using Heated Tobacco Products Helpful in Smoking Cessation? Young Gyu Cho Korean Journal of Family Medicine.2023; 44(3): 127. CrossRef
Comparison of the Smoking Cessation of Heated Tobacco Product Users and Conventional Cigarette Smokers in Korea Doyeon Won, Wonyoung Jung, Dongwook Shin Korean Journal of Family Medicine.2023; 44(3): 151. CrossRef
The relationship between heated cigarette smoking and blood white blood cell count: a population-based cross-sectional study D.-H. Koh Public Health.2023; 222: 154. CrossRef
The Need for Policy Changes for Tobacco End Game Cheol Min Lee Journal of the Korean Society for Research on Nicotine and Tobacco.2023; 14(3): 118. CrossRef
Relationship between heated tobacco product use and allergic
rhinitis in Korean adults Young-Gyun Seo, Yu-Jin Paek, Joo-Hee Kim, Jwa-Kyung Kim, Hye-Mi Noh Tobacco Induced Diseases.2023; 21(November): 1. CrossRef
Characterizing Heated Tobacco Product Use Among Adult Cigarette Smokers and Nicotine Vaping Product Users in the 2018 ITC Four Country Smoking & Vaping Survey Connor R Miller, Edward Sutanto, Danielle M Smith, Sara C Hitchman, Shannon Gravely, Hua-Hie Yong, Ron Borland, Richard J O’Connor, K Michael Cummings, Geoffrey T Fong, Andrew Hyland, Anne C K Quah, Maciej L Goniewicz Nicotine & Tobacco Research.2022; 24(4): 493. CrossRef
Heated tobacco products for smoking cessation and reducing smoking prevalence Harry Tattan-Birch, Jamie Hartmann-Boyce, Loren Kock, Erikas Simonavicius, Leonie Brose, Sarah Jackson, Lion Shahab, Jamie Brown Cochrane Database of Systematic Reviews.2022;[Epub] CrossRef
Perceived relative harm of heated tobacco products and
electronic cigarettes and its association with use in smoke-free
places: A cross-sectional analysis of Korean adults Choon-Young Kim*+, Kiheon Lee*+, Cheol Min Lee, Sungroul Kim, Hong-Jun Cho Tobacco Induced Diseases.2022; 20(February): 1. CrossRef
Subjective Changes in Tobacco Product Use among Korean Adults during the COVID-19 Pandemic Jieun Hwang International Journal of Environmental Research and Public Health.2022; 19(6): 3272. CrossRef
Methods of the 2020 (Wave 1) International Tobacco Control (ITC) Korea Survey Anne Quah, Sungkyu Lee, Hong Gwan Seo, Sung-il Cho, Sujin Lim, Yeol Kim, Steve Xu, Matthew Grey, Mi Yan, Christian Boudreau, Mary Thompson, Pete Driezen, Geoffrey Fong Tobacco Prevention & Cessation.2022; 8(March): 1. CrossRef
Evaluation of Japanese university students' perception of smoking, interest in quitting, and smoking behavior: An examination and public health challenges during the COVID-19 pandemic Makoto Aoike, Yukihiro Mori, Kiyoshi Hotta, Yukihiro Shigeno, Yuka Aoyama, Mamoru Tanaka, Hana Kouzai, Hatsumi Kawamura, Masato Tsurudome, Morihiro Ito Drug Discoveries & Therapeutics.2022; 16(3): 118. CrossRef
Factors Associated with Quit Intentions among Adult Smokers in South Korea: Findings from the 2020 ITC Korea Survey Minjung Han, Donghee Seo, Yeol Kim, Hong Gwan Seo, Sung-il Cho, Sungkyu Lee, Sujin Lim, Susan C. Kaai, Anne C. K. Quah, Mi Yan, Steve S. Xu, Geoffrey T. Fong International Journal of Environmental Research and Public Health.2022; 19(17): 10839. CrossRef
Comparison of Tobacco Use and Cessation Behavior between Conventional Cigarette and Heated Tobacco Product Users: Based on the Analyses of the Eighth Korea National Health and Nutrition Examination Survey 2019 Hyeree Yu, Cheol Min Lee Korean Journal of Family Medicine.2022; 43(5): 296. CrossRef
Acute Eosinophilic Pneumonia after Combined Use of Conventional and Heat-Not-Burn Cigarettes: A Case Report Bo Hyoung Kang, Dong Hyun Lee, Mee Sook Roh, Soo-Jung Um, Insu Kim Medicina.2022; 58(11): 1527. CrossRef
Current status of tobacco use, cessation and control policy in Korea Cheol Min Lee Journal of the Korean Medical Association.2022; 65(12): 789. CrossRef
Prevalence and predictors of heated tobacco products use among male ever smokers: results from a Korean longitudinal study Jeeeun Yi, Cheol Min Lee, Seung-sik Hwang, Sung-il Cho BMC Public Health.2021;[Epub] CrossRef
Nicotine Dependence of Electronic Cigarette, Dual Combustible and Electronic Cigarette Users Jungun Lee Korean Journal of Family Medicine.2021; 42(3): 189. CrossRef
Prevalence and reasons for use of Heated Tobacco Products (HTP) in Europe: an analysis of Eurobarometer data in 28 countries Anthony A. Laverty, Constantine I. Vardavas, Filippos T. Filippidis The Lancet Regional Health - Europe.2021; 8: 100159. CrossRef
Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study Seulggie Choi, Kiheon Lee, Sang Min Park Circulation.2021; 144(19): 1528. CrossRef
Bibliometric Analysis of Publications Related to Heated Tobacco Products Reported over the Period 2015-2020 Min Joo Jeon, Su Mi Lee, Kiheon Lee, Eunbyul Cho, Joo Young Kim, Woo Kyung Bae, Jong Soo Han, Hyejin Lee, Se Young Jung Journal of the Korean Society for Research on Nicotine and Tobacco.2021; 12(2): 74. CrossRef
Reasons for Using Heated Tobacco Products among South Korean Adults Ji Min Kim, Hong-Jun Cho Journal of the Korean Society for Research on Nicotine and Tobacco.2021; 12(2): 53. CrossRef
Are Heated Tobacco Product Users Less Likely to Quit than Cigarette Smokers? Findings from THINK (Tobacco and Health IN Korea) Study Cheol Min Lee, Choon-Young Kim, Kiheon Lee, Sungroul Kim International Journal of Environmental Research and Public Health.2020; 17(22): 8622. CrossRef
The Change of Tobacco Use Pattern among Adolescents after the Introduction of Novel Tobacco Products Cheol Min Lee Journal of the Korean Society for Research on Nicotine and Tobacco.2020; 11(2): 84. CrossRef
Background Electronic cigarette (EC) consumption (‘vaping’) is rapidly increasing, not only in adults but also in adolescents. Little is known about the association between vaping and problem behaviors such as drinking.
Methods We used data from the 11th Korea Youth Risk Behavior Web-based Survey, which was conducted in 2015 and included 68,043 participants who were Korean middle and high school students. The survey assessed EC, cigarette, and alcohol use. Multiple regression analysis was used to examine risk of current drinking and problem drinking across the following categories of users: never user (never used either product), former user (use of EC or cigarettes in the past, but not currently), vaping only, smoking only, and dual user (current use of both products).
Results EC only users were 1.2% in males, and 0.3% in females. Dual user of both conventional cigarettes and ECs were 5.1% in males, and 1.2% in females. Drinking frequency, drinking quantity per once, and problem drinking were higher among vapers than non-vapers and former-vapers, moreover, were higher among daily vapers than intermittent vapers. Compared to never users, EC only users were higher on risk of current drink and problem drink. The dual users were highest on risk of current drink.
Conclusion Vaping is independently associated with alcohol use problems in Korean students, even those not currently smoking. Moreover, dual use of cigarettes and ECs is strongly associated with alcohol use problems. Therefore, vaping students should be concerned about their hidden alcohol use problems.
Citations
Citations to this article as recorded by
Changes in health behaviors and obesity of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey Chang-Mo Oh, Yangha Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh Epidemiology and Health.2023; 45: e2023018. CrossRef
Addiction-Related Outcomes of Nicotine and Alcohol Co-use: New Insights Following the Rise in Vaping Jude A Frie, Caitlin J Nolan, Jennifer E Murray, Jibran Y Khokhar Nicotine & Tobacco Research.2022; 24(8): 1141. CrossRef
Vaping Chelsey DeGomez, Jennifer Feirstein JAAPA.2022; 35(9): 25. CrossRef
Comparison of Tobacco Use and Cessation Behavior between Conventional Cigarette and Heated Tobacco Product Users: Based on the Analyses of the Eighth Korea National Health and Nutrition Examination Survey 2019 Hyeree Yu, Cheol Min Lee Korean Journal of Family Medicine.2022; 43(5): 296. CrossRef
Prevalence of Vaping and Behavioral Associations of Vaping Among a Community of College Students in the United States Ogbebor E. Omoike, Kiana R. Johnson Journal of Community Health.2021; 46(1): 190. CrossRef
Use of Single, Dual, and Poly Tobacco Products in Korean Adolescents Min Kwon, Sophia J. Chung, Jinhwa Lee Asia Pacific Journal of Public Health.2021; 33(5): 571. CrossRef
Association between preference for using alcohol beverage-named e-liquids and alcohol use among high school youth Asti Jackson, Ran Wu, Grace Kong, Deepa R. Camenga, Meghan Morean, Patricia Simon, Krysten W. Bold, Angela M. Haeny, Suchitra Krishnan-Sarin Drug and Alcohol Dependence.2020; 209: 107903. CrossRef
Cross-fading: The importance of tissue injury research on dual misuse of alcohol and JUUL Lisa Chudomelka, Todd A. Wyatt Alcohol.2020; 86: 43. CrossRef
Association of E-cigarettes with adolescent alcohol use and binge drinking-drunkenness: A systematic review and meta-analysis Ava N. Rothrock, Halle Andris, Sarah B. Swetland, Valeria Chavez, Shira Isaak, Maria Pagane, Jake Romney, Steven G. Rothrock The American Journal of Drug and Alcohol Abuse.2020; 46(6): 684. CrossRef
Prevalence and Correlates of the Dual Use of Conventional and Electronic Cigarettes among Korean Adolescents: 2016-2018 Korean Youth Risk Behavior Survey Eon Sook Lee, Yu Jin Paek Journal of the Korean Society for Research on Nicotine and Tobacco.2020; 11(2): 64. CrossRef
Electronic and Conventional Cigarette Use and Drinking Behaviors in Korean Adolescents Young Gyu Cho Korean Journal of Family Medicine.2019; 40(4): 201. CrossRef
Background To aim of this study was to examine the association between perceived possibility of purchasing cigarettes and e-cigarette experience among adolescents who currently smoke cigarettes.
Methods Data were derived from the Korea Youth Risk Behavior Web-Based Survey; a total of 29,169 current smokers participated. The dependent variable was e-cigarette experience in the previous month. Analyses included χ2 test and survey logistic regression.
Results A perceived easy possibility of purchasing cigarettes increased the odds of e-cigarette experience (odds ratio, 1.19; 95% confidence interval, 1.07–1.33) compared to when it was perceived as impossible. An easy possibility of purchasing cigarettes increased the odds of e-cigarettes experience among males aged 12–15 or 17 years compared to when it was impossible to purchase cigarettes.
Conclusion A perceived easy possibility of purchasing cigarettes was more likely to increase e-cigarette experience among adolescents. Laws restricting adolescents’ access to e-cigarettes must be strengthened.
Citations
Citations to this article as recorded by
Vaping—An Emerging Threat to Youngsters of Pakistan Nazish Jaffar, Hafiza Tooba Siddiqui, Huda Amin, Md Ariful Haque Addiction Biology.2025;[Epub] CrossRef
Underage E-Cigarette Purchasing and Vaping Progression Among Young Adults Alyssa F. Harlow, Rob S. McConnell, Jessica L. Barrington-Trimis Journal of Adolescent Health.2023; 72(2): 260. CrossRef
The Impact of Heated Tobacco Products on Smoking Cessation, Tobacco Use, and Tobacco Sales in South Korea Cheol Min Lee Korean Journal of Family Medicine.2020; 41(5): 273. CrossRef
First
Prev
