The Lancet: Adult E-Cigarette Use in China Rose Significantly from 2015 to 2019

The rise in e-cigarette use among smokers, non-smokers, and those with no history of traditional cigarette use has been significant.

Author Introduction

Zhou Maigeng

Deputy Director and Researcher at the Chronic Disease Center of the Chinese Center for Disease Control and Prevention, PhD in Epidemiology and Health Statistics, PhD supervisor, Chairman of the Chronic Disease Prevention and Management Professional Committee of the Chinese Health Information and Big Data Society, and an expert in the National Talent Project. His research areas include chronic disease prevention and control, population health measurement and evaluation, and environmental health.

A joint study by Zhou Maigeng's team at the Chronic Non-Communicable Disease Prevention and Control Center of the Chinese Center for Disease Control and Prevention and Beijing Normal University was recently published in The Lancet Public Health. The study reported the prevalence of e-cigarette use and its related factors among Chinese adults aged 18 and older from 2015-16 to 2018-19. This study is the first to report the current status and trends of e-cigarette use among adults in China, providing baseline data for the assessment of e-cigarette sales restrictions in China.

The results indicate a significant increase in the number of e-cigarette users in China from 2015 to 2019. In 2015-16, the estimated prevalence of e-cigarette use among Chinese adults in the past 30 days was 1.3%, with 2.5% among men and 0.1% among women. From 2015-16 to 2018-19, the prevalence of e-cigarette use among Chinese adults rose from 1.3% to 1.6%, with approximately 3.35 million new adult e-cigarette users, including 3.2 million men and 150,000 women. (Figure 1)
 
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 standardized 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).

The characteristics of e-cigarette users in China differ from those in developed countries. The study shows that e-cigarette use is higher among individuals aged 18-29, urban residents, those with a secondary education or higher, individuals with higher income levels, factory or construction workers, and the obese. In contrast to developed countries like Sweden and the United States, higher education or income levels in the Chinese population are more likely to correlate with e-cigarette use. This indicates a lack of public understanding regarding the health hazards of nicotine or substances that e-cigarettes may contain. Additionally, from 2015 to 2019, e-cigarette use increased among lower-income households, which may exacerbate health inequalities. (Figure 2)
 
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 standardized with the 2010 population census to gain comparable estimates. Error bars show 95% CIs. p values are shown in appendix 2 (p 13). #p#分页标题#e#

The study shows that e-cigarette use patterns in China are similar to those in other countries. First, similar to other countries, e-cigarettes are popular among Chinese adolescents and young adults. Second, the vast majority of e-cigarette users are current smokers, with 96.2% of Chinese e-cigarette users also currently smoking traditional cigarettes in 2018-19. Third, those who have never smoked traditional cigarettes are less likely to use e-cigarettes, but never-smokers who are aware of the harms of traditional tobacco are more likely to use e-cigarettes. Fourth, the obese population is more likely to use e-cigarettes.

Importantly, the study specifically focuses on e-cigarette use among Chinese young adults aged 18 to 29. The prevalence of e-cigarette use among this age group rose significantly from 2.0% in 2015-16 to 2.7% in 2018-19. Due to the harmful effects of nicotine on brain development in young adults, the CDC recommends that young adults should not use e-cigarettes or vaping products (containing nicotine or THC). Currently, regulations on e-cigarette sales and promotion in China only target adolescents under 18. Furthermore, given the rising smoking rates among young women in China, the effects of e-cigarettes on fetal brain development remain unclear. Researchers recommend that public health policymakers increase investment in this area and develop prevention and control programs.

There is ongoing debate globally about whether e-cigarettes can be used for smoking cessation. This study indicates that regulatory policies on e-cigarettes may impact the health of up to 16.9 million people in China. We encourage those who wish to quit smoking to seek personalized advice from smoking cessation clinics and call on the public health community to pay attention to the short- and long-term health impacts of e-cigarette use, and to continue monitoring and regulating it, developing differentiated e-cigarette policies and public education strategies for different populations to address the new challenges posed by e-cigarettes to tobacco control. END