Abstract
INTRODUCTIONChina is the world’s largest e-cigarette manufacturer. It also has the world’s largest smoking population. Although smoking is strongly associated with e-cigarette use, the prevalence of e-cigarette use is low among Chinese smokers compared with smokers in countries such as the US and UK. This study aims to explore the reasons why Chinese smokers prefer not to use e-cigarettes.METHODSCross-sectional data from the Tobacco Questions for Surveys (TQS) conducted in four large Chinese cities (Chengdu, Wuhan, Xiamen, and Xi’an) in 2017–2018 were analyzed. A multi-stage cluster sampling approach was applied to select a representative sample of adults for each city. Weighted percentages and 95% confidence intervals (CIs) were estimated for self-reported reasons why smokers in China had never tried e-cigarettes, in total and by demographic characteristics. Multivariate logistic regression models were used to examine the adjusted associations between the top reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics.RESULTSThe top three reasons that Chinese adult smokers reported for never having tried e-cigarettes were: ‘I do not want to quit smoking’ (35.35%), ‘I do not think they would help me quit or cut down’ (24.31%), and ‘I am not addicted to smoking and don't need help to quit’ (14.93%). Other prominent reasons included: ‘I am concerned they are not safe enough’, and ‘I do not want to substitute one addiction for another’. Generally, there were no statistically significant associations between reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics.CONCLUSIONSOur results suggest that many Chinese smokers associate e-cigarette use with smoking cessation. Continued monitoring of smokers’ views, beliefs, and risk perceptions regarding e-cigarettes is warranted. Health education campaigns communicating the risks of e-cigarettes are also needed.
Highlights
China is the world’s largest e-cigarette manufacturer
Demographic characteristics As illustrated in Figure 2, among current smokers residing in the four Chinese cities in our study, the overall prevalence of awareness of any e-cigarette product among adult smokers was 72.3% in 2018, with the highest in Xi’an (78.9%) and lowest in Xiamen (65.2%)
There were some statistically significant bivariate associations between sociodemographic characteristics and selecting ‘I am not addicted to smoking and don't need help to quit’ as a reason for never having tried e-cigarettes
Summary
China is the world’s largest e-cigarette manufacturer. It has the world’s largest smoking population. Smoking is strongly associated with e-cigarette use, the prevalence of e-cigarette use is low among Chinese smokers compared with smokers in countries such as the US and UK. This study aims to explore the reasons why Chinese smokers prefer not to use e-cigarettes. Weighted percentages and 95% confidence intervals (CIs) were estimated for self-reported reasons why smokers in China had never tried e-cigarettes, in total and by demographic characteristics. Previous studies indicated that the prevalence of e-cigarette use was higher among current cigarette smokers than among non-smokers[1,2,3]. The most common reason to use e-cigarettes reported by smokers was to help them quit smoking[9], despite that the scientific evidence on the effectiveness of e-cigarettes as a cessation tool is still equivocal[10,11]
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