Use of Electronic Nicotine Delivery Systems (ENDS) in China: Evidence from Citywide Representative Surveys from Five Chinese Cities in 2018

Abstract

China is the largest cigarette consuming country in the world. The emergence of electronic nicotine delivery systems (ENDS) in China may have important implications for the Chinese tobacco market. Unfortunately, research on ENDS in China, while growing, is still limited. This study was designed to examine the awareness and use of ENDS among adult urban residents in China. Data from five citywide representative surveys conducted in 2017–2018 were used. Percentages of residents who had ever heard of, ever used, or used ENDS in the past 30 days among all residents and smokers were estimated, in total and by demographic characteristics. Multiple logistic regression models were used to estimate the adjusted associations between awareness and use of ENDS and individual-level demographic characteristics and socioeconomic status (SES). Overall, 51.3% had ever heard, 4.8% ever used, and 0.9% used ENDS in the past 30 days. Men, young adults, those with high levels of education, and current smokers were more likely to be aware of and use ENDS. Among smokers, 67.8% had ever heard, 17.1% ever used, and 3.9% used ENDS in the past 30 days, respectively. Young adult smokers and smokers with high levels of education were more likely to be aware of and use ENDS. Our study results on ENDS awareness and use patterns and associated factors in China provide important evidence to inform research and policies related to ENDS manufacture, marketing, and sales in China.

Smoking, ACE-2 and COVID-19: ongoing controversies

“…For instance, consider the landscape of e-cigarette use in China, the first epicentre of COVID-19. A 2018 survey of 10 233 individuals in five Chinese cities found that only 0.9% had used e-cigarettes within the past 30 days [ 5 ]. Only 0.2% of those 65 years and older reported e-cigarette use within the past 30 days compared to 1.5% of those in the 15–24 year age range.…”

Reasons why Chinese smokers prefer not to use electronic cigarettes

“…Our study results revealed that a significant proportion of Chinese smokers believed e-cigarettes were linked with smoking cessation. Chinese smokers' perception of the potential role of e-cigarettes in aiding cessation was likely the result of exposure to e-cigarette advertising, which often contained unsubstantiated claims about the e-cigarette's effectiveness in helping smokers quit and its role as a better and healthier substitute for cigarettes 17,33,34 . As China increases its effort to promote smoking cessation 35,36 , it is expected that more Chinese smokers will seek to quit smoking, and some of these smokers may start to use e-cigarettes as a result, similar to what has been observed in the US and UK.…”

“…Multi-stage cluster sampling was applied to generate a citywide representative sample for each city following the guidelines of the Sample Design Manual of GATS 25 . Detailed study design and sampling methods can be found in a previously published study using the TQS data 17 . A total of 8043 participants completed the TQS survey in all four cities.…”

“…The 2018 China Global Adult Tobacco Survey (GATS) reported that 48.5% had heard of, 5.0% had ever used, and 0.9% were currently using e-cigarettes among Chinese adults aged ≥15 years 14 . The awareness and use of e-cigarettes varied across regions and population subgroups characterized by sociodemographic factors and smoking status [16][17][18][19][20] . Similar to what has been reported in the US and UK, e-cigarette use was also higher among smokers than among non-smokers in China; however, the prevalence of e-cigarette use among Chinese smokers was much lower 1,3,16,17 .…”

“…The awareness and use of e-cigarettes varied across regions and population subgroups characterized by sociodemographic factors and smoking status [16][17][18][19][20] . Similar to what has been reported in the US and UK, e-cigarette use was also higher among smokers than among non-smokers in China; however, the prevalence of e-cigarette use among Chinese smokers was much lower 1,3,16,17 . While only about one-third to a half of the current smokers had never tried e-cigarettes in the US and UK, more than 80% of current adult smokers had never tried e-cigarettes in China 1,3,16,17 .…”