China CDC Study: Non-Smokers Make Up Less Than 4% of Vape Users

On December 1, the China CDC stated in its latest paper published in the internationally authoritative medical journal The Lancet Public Health that adult vape users in China are primarily traditional cigarette smokers, while non-smokers rarely use vaping devices.

This China CDC study surveyed nearly 400,000 adults and is the first to report the current status and trends of e-cigarette use in China at the national level. In addition, Gao Fu, Director of the China CDC, and Zhou Maigeng, Deputy Director of the National Center for Chronic and Noncommunicable Disease Control and Prevention under the China CDC, are both listed as authors of the paper.
  Paper released by the China CDC: “E-cigarette Use Among Chinese Adults: Findings From Repeated Cross-Sectional Surveys in 2015–2016 and 2018–2019”

The paper points out that in recent years, vape users in China have mainly been men and smokers. Heavy smokers, smokers who want to quit, and people who are aware of the harms of smoking are more likely to choose vaping devices. Industry observers noted that this not only shows that the harm reduction role of vaping devices has been widely recognized by Chinese smokers, but also strongly refutes rumors such as the claim that e-cigarettes are the “first cigarette for non-smokers.”

“China’s regulation of e-cigarettes will affect the health of 16.9 million people. Tailored policies and public education strategies for specific populations are the top priority for the public health community and policymakers,” the authors emphasized in the paper.

About 96.2% of China’s vape users are smokers; e-cigarettes are not the “first cigarette for non-smokers”

This study used data from the China Chronic Disease and Nutrition Surveillance surveys for 2015–2016 (189,306 people) and 2018–2019 (184,475 people), covering nearly 400,000 adults in total. The sample size was large and nationally representative. The results show that from 2015 to 2019, the prevalence of e-cigarette use among Chinese adults rose from 1.3% to 1.6%, with male users accounting for about 97%.

Smokers made up an extremely high proportion of vape users, and the share of smokers among new vape users also continued to rise. In 2015–2016, smokers accounted for about 93% of vape users in China; in 2018–2019, smokers accounted for about 96.2%, meaning non-smokers accounted for less than 4%. Using weighted prevalence estimates, the authors concluded that there were about 16.9 million adult vape users in China in 2018–2019, of whom 16.2 million were smokers.

“Non-smokers rarely use e-cigarettes,” the paper’s authors stressed. This conclusion is also sufficient to show that e-cigarettes are not, as some experts claim, the “first cigarette for non-smokers.”

It is understood that, to cross-validate this conclusion, the research team also conducted a sample survey of 373,781 respondents nationwide. The results showed that among more than 370,000 respondents, only 83 non-smokers became e-cigarette users.

The harm reduction effect of vaping devices is recognized, especially among long-term smokers

The WeChat account E-cigarette News found that, in addition to analyzing the basic proportional characteristics of vape users in China, this study also conducted a detailed assessment of use patterns across dimensions such as gender, age, region (urban or rural), and income. Notably, data across several dimensions show that vaping devices are especially popular among long-term smokers.

The authors stated in the paper that e-cigarettes have greater appeal to smokers who want to quit, smokers who smoke frequently every day, and especially smokers who smoke more than 20 cigarettes per day. This indicates that the harm reduction effect of vaping devices has gained broad recognition among smokers, who hope to make a change by switching to e-cigarettes.

According to the China Survey Report of the International Tobacco Control Policy Evaluation Project (ITC Project), from 2009 to 2014, the proportion of smokers who had heard of e-cigarettes increased from 29% to 60%, and the number of smokers actively learning about and switching to e-cigarettes continued to rise. The data in this study happen to come from 2015 to 2019, allowing the conclusion to some extent that after gaining a real understanding of e-cigarettes, more and more smokers choose to use them.

In addition, unlike survey findings from Sweden and the United States, Chinese smokers with higher education or the highest incomes were more likely to use e-cigarettes.

“Our study shows that after understanding the harms of smoking, smokers are more willing to use e-cigarettes,” the authors added. “Therefore, we call on the public health community to pay attention to the short-term and long-term health effects of e-cigarettes, and to formulate differentiated policies and public education strategies for different groups.”