Electronic cigarette use in China: Awareness, prevalence and regulation

Abstract

INTRODUCTION E-cigarettes were invented in China, and most of the world’s e-cigarettes have been produced in China. However, awareness and use of e-cigarettes in China are lower than in Europe and America. Against the backdrop of the increasing use of e-cigarettes, the supervision of e-cigarettes in China has been almost non-existent. METHODS A literature search was carried out in five popular Chinese and English databases. These databases were PubMed, EMBASE, the Cochrane Library, China national knowledge infrastructure (CNKI), and Wan-fang database. RESULTS Twenty-one studies were identified, and a comprehensive analysis of e-cigarette awareness ratio was conducted for different regions of China and according to gender, age group, and smoking status. We also examined e-cigarette use and associated risk factors, and the relationship between e-cigarette use and smoking cessation. In 2015, the prevalence of ‘ever use’ and ‘current use’ of e-cigarettes in China were 3.1% and 0.5%, respectively. The review indicates that the awareness ratio of e-cigarettes was about 66% in Hong Kong, whereas the ratio for Tianjin was lower (43.6%). Online sales were the main channel for selling e-cigarettes to 80% of the users. Awareness of e-cigarettes has been increasing in China. Awareness was higher in men compared to women in all age groups. Nevertheless, e-cigarette use in China was lower than in developed countries. E-cigarette users were more likely to try to quit smoking, but the relationship between e-cigarette use and smoking cessation is still unclear. Governance is necessary for e-cigarette use and marketing effort. CONCLUSIONS This study investigated the awareness and use of e-cigarettes in China and the existing regulations for e-cigarette use and marketing. The lack of regulations for e-cigarette use and the unrestricted practice encourage the increase in adoption of e-cigarettes and misconceptions of the benefits of using e-cigarettes. Hence, it is crucial that the government of China prioritize the establishment and implementation of regulations for e-cigarette use and marketing.

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

“…However, these numbers were not necessarily comparable since our study included only urban residents. This review also reported that the prevalence of ever ENDS use ranged from 12.8% to 13.3% among adult smokers [31], which was lower compared with our estimate (17.1%, 95% CI = 14.5%-19.7%). In addition, this review identified sex and smoking status as influencing factors of ENDS use [31,39].…”

“…This review also reported that the prevalence of ever ENDS use ranged from 12.8% to 13.3% among adult smokers [31], which was lower compared with our estimate (17.1%, 95% CI = 14.5%-19.7%). In addition, this review identified sex and smoking status as influencing factors of ENDS use [31,39]. Our study results revealed that, in addition to gender and smoking status, age and education were also important factors influencing ENDS awareness and use among urban residents in China.…”

“…The results of our study are consistent with the findings from previous studies. A recent systematic review of ENDS awareness, use, and regulations in China reported that, among adults in the studies identified, the rate of ENDS awareness ranged from 43.6% to 66.0%, the prevalence of ever use was 2.3%, and the prevalence of past 30-day use was 0.5% [31]. Similar to previous reports, our study found that the awareness of ENDS products was high, at 51.3% (95% CI = 48.0%-54.6%) among urban adults in five cities in our study.…”

“…In China, ENDS were largely unregulated until very recently. ENDS are not classified as medical devices or tobacco products, and instead are treated as consumer electronic products [31]. In August 2018, China's State Tobacco Monopoly Administration (STMA) and the State Administration for Market Regulation (SAMR) jointly issued a circular to prohibit selling ENDS to minors (under age 18) [32].…”

“…However, at the local level, a few Chinese cities have adopted measures to regulate ENDS use in public places. For example, the city of Hang Zhou, a large city in the eastern coastal area of China, has implemented policies that prohibit ENDS use in non-smoking areas [31].…”