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Changes in e-cigarette use and related behaviors following the 2022 e-cigarette tax increase in China: A prospective longitudinal observational study

Year: 2025

Type: article

Abstract: INTRODUCTIONAlthough the relationship between taxation and conventional cigarette use is well established, little is known about the association with electronic cigarette (e-cigarette) use and no study has accounted for the potential delayed effects of e-cigarette policies beyond the observation period.This study aimed to evaluate the impact of China's 2022 e-cigarette tax increase on e-cigarette use.METHODS A prospective longitudinal observational design was utilized by collecting three-waves of online survey data in China.Participants were recruited through social media platforms.Baseline data were collected in October 2022, with followup survey conducted in March and August 2023.Participants were eligible if they were aged ≥18 years, reported using e-cigarettes in the past 30 days at baseline, and provided informed consent to be recontacted for follow-up.The Friedman test and the Cochran's Q test were used to assess differences across the waves.The Wilcoxon signed-rank test and the Tukey test were used to make pairwise comparisons between the groups.RESULTS There were 116 participants recruited at baseline and 91 (78.5%) of them complete all three surveys.E-cigarette use (ECU) decreased by 33.0% (95% CI: 23.7-42.3) in wave 2 after the tax increase was implemented, and by an additional 35.2% (95% CI: 26.8-43.7) in wave 3. The overall quit rate was 68.2% (95% CI: 60.3-75.9).However, 74.2% (95% CI: 65.9-82.5) of e-cigarette users whose quit switched to conventional cigarettes, resulting in an absolute cessation prevalence of only 17.6% (95% CI: 7.8-25.4).While perceived risk for ECU (χ 2 =0.41, p>0.05), perceived severity for ECU (χ 2 =1.02, p>0.05), and behavioral beliefs (χ 2 =2.28, p>0.05) did not change following the e-cigarette tax increase.Friends' attitudes (χ 2 =8.74, p<0.05), coworkers' attitudes (χ 2 =4.71, p<0.05), and exposure to e-cigarette advertising (Q=9.76,p<0.01) showed significant decreases.CONCLUSIONS This study suggests a possible association between the China's 2022 e-cigarette tax increase and changes in e-cigarette use.However, its effectiveness was diminished due to the large number of e-cigarette users who switched to conventional cigarettes.China's 2022 e-cigarette tax increase also affected social norms regarding e-cigarette use and exposure to e-cigarette advertising.The findings may inform future policy considerations for a comprehensive strategy.

Source: Tobacco Induced Diseases

DOI: 10.18332/tid/208848

Authors: Tingzhong Yang, Sihui Peng, Randall R. Cottrell

Institutions: West Virginia University, Zhejiang University, Jinan University, University of North Carolina Wilmington

Language: English

Topic: Smoking Behavior and Cessation

Subfield: Physiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,372