China’s adult e-cigarette use rate has increased significantly from 2015 to 2019

The Lancet Public Health recently published a joint study from the research team of Zhou Maigeng from the Center for Chronic Noncommunicable Disease Control and Prevention of the Chinese Center for Disease Control and Prevention and Beijing Normal University. The study reports the e-cigarette use rate and related factors in the past 30 days among Chinese adults over 18 years old from 2015-16 to 2018-19.

This study reports for the first time the current status and changing trends of adult e-cigarette use in China in recent years, and provides baseline data for the evaluation of China’s e-cigarette sales restriction policy.

The research results show that between 2015 and 2019, the number of e-cigarette users in China has increased significantly. From 2015-16, the e-cigarette use rate among Chinese adults in the past 30 days is estimated to be 1.3%, of which 2.5% for men and 0.1% for women. From 2015-16 to 2018-19, the adult e-cigarette use rate in China rose from 1.3% to 1.6%, and the number of new adult e-cigarette users was about 3.35 million, of which 3.2 million were men and 150,000 were women.

Figure 1: Prevalence of past 30-day e-cigarette use (A) and e-cigarette awareness (B) in 2015–16 and 2018–19 among Chinese adults, overall and in current smokers
Figure 1: Prevalence of past 30-day e-cigarette use (A) and e-cigarette awareness (B) in 2015–16 and 2018–19 among Chinese adults, overall and in current smokers

Data represent weighted estimates from the China Chronic Disease and Nutrition Survey 2015 (n=189 306) and 2018 (n=184 475). Populations for the years 2015–16 and 2018–19 were standardised with the 2010 population census to gain comparable estimates. Error bars show 95% CIs. The unweighted denominators were much greater than 50 for all subgroups apart from current female smokers aged 18–29 years; in this subgroup, the unweighted denominator was 61 in 2015–16 and 50 in 2018–19, and these results should be interpreted with caution. Among the total population, awareness of e-cigarettes significantly increased in 2018–19 compared with 2015–16 (p<0·0001). p values are shown in appendix 2 (p 12).

Figure 2: Prevalence of past 30-day e-cigarette use in urban and rural areas in China by education level (A) and annual household income (B) in 2015–16 and 2018–19
Figure 2: Prevalence of past 30-day e-cigarette use in urban and rural areas in China by education level (A) and annual household income (B) in 2015–16 and 2018–19

Data represent weighted estimates from the China Chronic Disease and Nutrition Survey 2015 (n=189 306) and 2018 (n=184 475). Populations for the years 2015–16 and 2018–19 were standardised with the 2010 population census to gain comparable estimates. Error bars show 95% CIs. p values are shown in appendix 2 (p 13).

Research shows that China and other countries have similar e-cigarette use patterns. 1. Similar to other countries, e-cigarettes are also popular among Chinese teenagers and young adults. 2. The vast majority of e-cigarette users are smoking traditional cigarettes. In 2018-19, 96.2% of Chinese e-cigarette users are now smoking traditional cigarettes. 3. People who have never smoked traditional cigarettes rarely use electronic cigarettes, but never smokers who are aware of the harm of traditional tobacco are more likely to use electronic cigarettes. Fourth, obese people are more likely to use electronic cigarettes.

Importantly, the study paid special attention to the use of e-cigarettes among young people aged 18 to 29 in China. The use rate of e-cigarettes among young adults aged 18-29 in China has increased significantly from 2.0% in 2015-16 to 2.7% in 2018-19. Due to the harm of nicotine to the brain development of young adults, the US CDC advises young adults not to use e-cigarettes or vaporized products (containing nicotine or THC). However, China’s current regulation on the sales and promotion of e-cigarettes only targets young people under the age of 18. In addition, given that the smoking rate among young Chinese women continues to rise, and the impact of e-cigarettes on fetal brain development is still unclear, the researchers recommend that public health policy makers increase investment in this area and formulate prevention and control plans.

There is still controversy about whether e-cigarettes can be used by smokers to quit smoking. This research shows that the regulatory policies for e-cigarettes may affect the health of up to 16.9 million Chinese. We encourage those who want to quit smoking to the smoking cessation clinic for personalized advice, call on the public health community to pay attention to the short-term and long-term health effects of e-cigarette use, and continue to monitor and regulate it, and develop differentiated e-cigarette policies for different groups of people And public education strategies to deal with the new challenges that e-cigarettes bring to tobacco control.

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