More Than 96% of E-Cigarette Users Are Smokers

This article is adapted from Blue Hole New Consumption

In recent years, e-cigarettes have increasingly appeared in the public's life. Data from several research companies show that in just a few years, the number of e-cigarette users in China has exceeded ten million. So where do these e-cigarette users come from?

Recently, the Chinese Center for Disease Control and Prevention published a paper in the international authoritative medical journal The Lancet Public Health, which answers this question well: the main adult e-cigarette users in China are traditional smokers, with very few non-smokers using e-cigarettes.

(The paper published by the Chinese CDC titled "E-Cigarette Use Among Chinese Adults: Results from Multiple Cross-Sectional Surveys in 2015-2016 and 2018-2019")

It is reported that the Chinese CDC's research surveyed nearly 400,000 adults, marking the first national-level report on the current status and trends of e-cigarette use in China. The authors noted that both Gao Fu, the director of the Chinese CDC, and Zhou Maigeng, the deputy director of the Chronic Disease Center, are among the authors of the paper.

The paper points out that recent e-cigarette users in China are mainly male and smokers, with those who have a strong addiction to nicotine, want to quit smoking, and understand the harms of smoking being more likely to choose e-cigarettes.

"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 urgent tasks for public health professionals and policymakers," the authors emphasized in the paper.
96.2% of e-cigarette users in China are smokers.

China is a major production base for e-cigarettes and holds an important position in the global e-cigarette market. According to a survey by the Beijing News, in 2019, 218 countries and regions worldwide purchased e-cigarettes from China, with a total export value of 76.885 billion yuan.

The rapidly developing e-cigarette industry has brought e-cigarettes closer to the general public, and the government is actively regulating the e-cigarette industry to promote orderly development. In 2019, the National Tobacco Monopoly Administration and the State Administration for Market Regulation jointly issued a notice on "Further Protecting Minors from the Harm of E-Cigarettes," prohibiting the sale of e-cigarettes on e-commerce platforms, marking the first step in regulation.

This study used data from the Chinese Chronic Disease and Nutrition Monitoring in 2015-2016 (189,306 people) and 2018-2019 (184,475 people), covering nearly 400,000 adults, with a large sample size that is nationally representative. The results show that from 2015 to 2019, the e-cigarette usage rate among Chinese adults increased from 1.3% to 1.6%, with male users accounting for about 97%.

Smokers account for a very high proportion of e-cigarette users, and the proportion of smokers among new e-cigarette users is also continuously rising. In 2015-2016, smokers accounted for about 93% of e-cigarette users in China; in 2018-2019, the proportion of smokers rose to about 96.2%, meaning that non-smokers accounted for less than 4%. The authors estimated using weighted prevalence values that in 2018-2019, there were about 16.9 million adult e-cigarette users in China, of which 16.2 million were smokers.

"Very few non-smokers use e-cigarettes," the authors emphasized. This conclusion can somewhat alleviate public concerns that e-cigarettes will become the "first smoke" for non-smokers.

To cross-validate this conclusion, the research team also conducted a sampling survey of 373,781 respondents nationwide, which showed that among over 370,000 respondents, only 83 non-smokers became e-cigarette users.
Higher-income smokers are more likely to use e-cigarettes.

According to the International Tobacco Control Policy Evaluation Project (ITC Project) China Survey Report, 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 from the Chinese CDC's current study coincidentally comes from 2015-2019, thus reflecting the current psychological state of smokers: after learning about e-cigarettes, more and more smokers are choosing to replace traditional cigarettes with e-cigarettes.

This paper not only analyzes the basic proportional characteristics of Chinese e-cigarette users but also evaluates the usage patterns of Chinese e-cigarette users across dimensions such as gender, age, region (urban or rural), and income. Multiple research dimensions indicate that older smokers are more accepting of e-cigarettes.

The authors pointed out in the paper that e-cigarettes have a higher appeal to smokers who want to quit and those who smoke frequently, especially those who smoke more than 20 cigarettes a day. This indicates that at least this segment of smokers believes that e-cigarettes can replace cigarettes and have a role in quitting smoking, and they hope to achieve change by switching to e-cigarettes.

Additionally, contrary to survey results from Sweden and the United States, higher-educated or higher-income smokers in China are more likely to use e-cigarettes. They are more educated and have a more systematic understanding of e-cigarettes, making them more likely to accept them. #p#分页标题#e#

"Our research shows that after understanding the harms of smoking, non-smokers are more willing to use e-cigarettes," the authors also added related remarks in the paper.

The regulatory storm in 2019 indeed led the e-cigarette industry to experience a winter, with over 90% of small and medium-sized e-cigarette players (including counterfeit and inferior small workshops) being eliminated by mid-2020. This regulatory process has instead allowed the remaining e-brands to emerge as the "survivors of the fittest."

Currently, although the e-cigarette industry has begun to be regulated and more consumers are starting to engage with e-cigarettes, this presents an opportunity for the industry; however, how the e-cigarette market will develop in the future still requires exploration from all sectors of society. Therefore, the authors also call for "public health professionals to pay attention to the short-term and long-term health impacts of e-cigarettes and to develop differentiated policies and public education strategies for different populations."