Directions and Challenges in Smoking Cessation Treatment.

Raising the tax on tobacco-related products is the most effective and most sustainable intervention for smoking cessation. The 2015 tobacco tax increase resulted in a decreased smoking rate among Korean adult men. However, the government-sponsored smoking cessation programs, developed after the 2015 tobacco tax increase, have been experiencing a sharp decrease in participation since 2018. The popularity of electronic cigarettes (e-cigarettes) seems to be an important factor in this decline. Indeed, the market share of e-cigarettes has increased steadily since 2007, when the e-cigarette was introduced in Korea as a vaporizer. The introduction of the tobacco-heating device IQOS in 2017 resulted in the skyrocketing popularity of e-cigarettes, especially among the young generation of Koreans. The US Food and Drug Administration (FDA) authorized marketing of IQOS as a "reduced exposure" tobacco product on July 7, 2020, which has complicated smoking cessation efforts further. The agency announced that IQOS produces fewer or lower levels of some toxins compared with combustible cigarettes. However, the US FDA authorization does not mean that these products are safe. There is no evidence that reducing the harmful chemical components leads to health benefits. Clinicians need to maintain the position that those who smoke, regardless of tobacco product type, should be counseled for smoking cessation and prescribed proven pharmacologic agents for smoking cessation.