The Lancet: Adult e-cigarette use in China rose sharply from 2015 to 2019

The e-cigarette usage rate has increased among three groups: e-cigarette users who are aware of the harm of smoking but have no history of traditional cigarette use.

Author Introduction

Zhou Maigeng

Deputy Director of the Chronic Disease Center at the Chinese Center for Disease Control and Prevention, researcher, PhD in Epidemiology and Health Statistics, doctoral supervisor, chairman of the Chronic Disease Prevention and Management Professional Committee of the Chinese Health Information and Big Data Society, expert of the National Thousand Talents Program. Research areas include chronic disease prevention and control, population health measurement and evaluation, environment and health, etc.

The Lancet Public Health recently published a joint study by the Chronic Non-Communicable Disease Prevention and Control Center of the Chinese Center for Disease Control and Prevention led by researcher Zhou Maigeng and Beijing Normal University. The study reported the past 30-day e-cigarette usage rates and 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 adult e-cigarette use in China in recent years, providing baseline data for the evaluation of e-cigarette sales restriction policies 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 past 30-day e-cigarette usage rate among Chinese adults was 1.3%, with 2.5% for males and 0.1% for females. From 2015-16 to 2018-19, the e-cigarette usage rate among Chinese adults rose from 1.3% to 1.6%, with approximately 3.35 million new adult e-cigarette users, including 3.2 million males and 150,000 females. (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 usage is higher among individuals aged 18-29, urban residents, those with a secondary education or higher, 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 use e-cigarettes. This indicates a lack of public understanding of the health risks associated with 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 usage patterns in China are similar to those in other countries. First, similar to other countries, e-cigarettes are also popular among Chinese adolescents and young adults. Second, the vast majority of e-cigarette users are currently smoking traditional cigarettes, with 96.2% of Chinese e-cigarette users 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, obese individuals are more likely to use e-cigarettes.

Importantly, the study specifically focused on e-cigarette usage among Chinese young adults aged 18 to 29. The e-cigarette usage rate among this group rose significantly from 2.0% in 2015-16 to 2.7% in 2018-19. Due to the harmful effects of nicotine on the brain development of 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 rate among young women in China, the impact of e-cigarettes on fetal brain development remains unclear. Researchers recommend that public health policymakers increase investment in this area and develop prevention and control programs.

There is still controversy globally about whether e-cigarettes can be used for smoking cessation. This study indicates that e-cigarette regulatory policies may affect the health of up to 16.9 million people in China. We encourage those who want to quit smoking to consult smoking cessation clinics for personalized advice, 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