Yuchen Zhao, Chenyu Qian, Wenjie Guo, Weiyun Zhu, Siyi Wu, Reziwanguli Yasheng, Qiujia Huang, Pinpin Zheng
The Measures were associated with limited public health benefits, as illicit supply chains and weak risk communication may compromise intended effects. Future e-cigarette governance should prioritise public health leadership over commercial interests and use cross-departmental enforcement to disrupt illicit access.
BACKGROUND: China's E-cigarette Administration Measures, implemented in 2022, restricted non-tobacco flavours and online sales. We examined self-reported perceptual and behavioural changes among young adult current and former e-cigarette users after implementation.
METHODS: From October to December 2024, a convergent mixed-methods design study combined a nationwide cross-sectional survey of 1630 respondents who had regularly used e-cigarettes before implementation (1084 current users; 546 former users, including 274 who quit after and 272 before implementation) with interviews of 25 users. Survey measures compared retrospectively reported pre-implementation flavour diversity, purchasing channel diversity, e-cigarettes and conventional cigarettes use with current reports, and assessed perceived changes in e-cigarette health risks.
RESULTS: Few participants reported reduced flavour diversity (11.6%) or purchasing channels (10.7%). Interviews indicated continued access through illicit or informal sources. Most participants (55.4%) perceived currently marketed e-cigarettes as less harmful than pre-implementation products, partly because the New National Standard label was interpreted as indicating product safety. Reduced flavour options were associated with higher odds of quitting (OR = 1.82), whereas expanded purchasing access was associated with lower odds (OR = 0.54). Overall, 16.8% of all respondents quit after implementation. Among continued users, 31.8% reported increased consumption after imlementation. Residual analysis and interviews suggested opposite-direction changes in e-cigarette and conventional cigarette use among some participants.
CONCLUSIONS: The Measures were associated with limited public health benefits, as illicit supply chains and weak risk communication may compromise intended effects. Future e-cigarette governance should prioritise public health leadership over commercial interests and use cross-departmental enforcement to disrupt illicit access.