China releases first public health impact report on vaping; nearly 70% of smokers report health chan

The Regulations on Electronic Cigarettes and the mandatory national standard for electronic cigarettes are about to mark their first anniversary. According to the new policy requirements, only tobacco-flavored electronic cigarette products are allowed for sale in the country, and all stages of production and retail must be licensed, ushering the electronic cigarette industry into a new era of standardized development.

Recently, a research team from the School of Public Health at Shanghai Jiao Tong University released the "Report on the Characteristics of Electronic Cigarette Users in China and Their Public Health Impact (2023)." This study, led by Associate Professor Cai Yuyang, covers 31 provinces, cities, and autonomous regions in the country, with a total sample size of 2,000 people, making it the first research outcome focusing on the public health impact of electronic cigarette users after the new policy.

"There are about 16.9 million electronic cigarette users in China, and their usage behavior may have changed somewhat over the past year," Cai Yuyang stated. "This study profiles the domestic electronic cigarette user group and further investigates their awareness of the health impacts of electronic cigarettes and their views on the new national standards and policies for electronic cigarettes."

Electronic cigarette users are highly educated and mostly former smokers

The survey found that domestic electronic cigarette users are primarily well-educated, middle to high-income, and non-manual laborers, with 89% holding a college degree or higher; 61% of users have a monthly income of over 7,000 yuan.

At the same time, 92% of electronic cigarette users in the country are former smokers, meaning they started with traditional cigarettes before switching to electronic cigarettes, indicating that electronic cigarettes have little appeal to non-smokers, and the "gateway effect" is not significant.

"Previously, public health experts were concerned that electronic cigarettes would become the 'first smoke' for non-smokers," Cai Yuyang noted. "This survey found that the majority of electronic cigarette users are traditional smokers, which is consistent with the findings published by the Chinese Center for Disease Control and Prevention in The Lancet Public Health in 2020."

After switching to electronic cigarettes, nearly 70% of users report health improvements

The survey focused on the impact of electronic cigarette use on smokers' health. Statistical data shows that 68.1% of those who switched from traditional cigarettes to electronic cigarettes reported an improvement in their overall health, with 18.6% of users stating "significant improvement" and 49.5% stating "slight improvement."

The survey found that the use of national standard electronic cigarette products is related to the degree of symptom improvement. Among users of national standard products, 30.3% reported improvement in coughing symptoms, while only 23.9% of non-national standard product users reported improvement in this symptom. Additionally, symptoms such as phlegm, sore throat, yellowing of teeth and fingers, bad breath, dry mouth, and bitter mouth also showed similar proportions.

The report suggests that the national standard for electronic cigarettes, which has been in effect since October 2022, has imposed stricter regulations on potentially harmful substances and additives, thus possibly increasing the safety of national standard products.

It is important to note that about 1% of users reported a decline in their health after using electronic cigarettes, primarily manifesting as dry mouth and bitter mouth. The research team believes that glycerin and propylene glycol in the e-liquid have hygroscopic properties, which may lead to mucosal dryness and oral discomfort. At the same time, 86% of electronic cigarette users also use traditional cigarettes, necessitating further research on the health effects of dual use.

The gray market for electronic cigarettes persists, with only 40% of users using national standard products

The survey found that only 40% of electronic cigarette users primarily use national standard products, while non-national standard products dominate the current electronic cigarette market, indicating a large gray industrial chain for electronic cigarettes.

Among the non-national standard products recently used, 88% were pod-style flavored electronic cigarettes, with the most common flavors being mixed fruit/menthol pods, accounting for as much as 37%.

Additionally, the survey found that users generally have limited knowledge of electronic cigarette regulatory policies. For example, the awareness rate of the ban on selling flavored electronic cigarettes other than tobacco flavor is only 40%; nearly 10% of users are completely unaware of regulatory policies.

Illegal products such as mixed fruit flavor circulate through the black market, posing serious threats to consumer health. Cai Yuyang suggests that regulatory agencies should adhere to the national standards for electronic cigarettes and the Regulations on Electronic Cigarette Management, intensifying efforts to combat the gray industrial chain of electronic cigarettes, curbing the proliferation of illegal products, and preventing public health incidents.

Expert Opinion: The changes in symptoms of "former smokers" after using national standard electronic cigarettes deserve attention #p#分页标题#e#

The report concludes that electronic cigarette users report improved health status compared to when they used traditional cigarettes, while the issuance of national standards for electronic cigarettes has somewhat standardized users' behavior. At the same time, Cai Yuyang also cautions that the survey data is based on users' self-reports and perceptions, and further epidemiological and clinical research is needed for validation.

Based on the findings of this survey, the report presents five expert opinions.

Minimize public health risks by actively addressing smokers' harm reduction demands and exploring the application possibilities of harm reduction strategies.

Electronic cigarettes still carry health risks; minors must be prohibited from accessing and using them, and they should not be used in smoke-free areas.

Follow national regulations, strengthen market supervision, and avoid the proliferation of illegal products with unclear safety.

Emphasize scientific knowledge dissemination to enhance users' awareness of electronic cigarettes and related health literacy.

Conduct precise toxicological, cellular, animal, clinical, and epidemiological studies to clarify the long-term effects of electronic cigarettes.

Cai Yuyang believes that further health economic assessments and analyses should be conducted based on scientific evidence. At the same time, attention should be paid to the health risks of dual users, and more clinical trials and longer-term follow-up studies should be conducted to clarify the public health impact of electronic cigarettes. (Source: Caixin)