Objective To analyze the effectiveness of school-based tobacco control interventions by comparing students'knowledge,attitudes,and use of e-cigarettes before and after the implementation of interventions,and to provide a basis for further development of school-based tobacco control measures.Methods From October 2022 to May 2023,a six-month tobacco control intervention was conducted among all students in a vocational high school in Qingpu district,Shanghai.Anonymous questionnaires were administered before and after the intervention.Propensity score matching was performed using gender,grade,and smoking/vaping status of family members and friends as matching variables.Data were compared using the χ2 test.Results A total of 981 and 819 valid questionnaires were collected at baseline and post-intervention,respectively.After propensity score matching,baseline and follow-up data from 770 students were obtained.At the end of the intervention,79.5%of the students expressed their hope that the school would continue to promote the construction of a smoke-free environment.After the school-based tobacco control intervention,students'awareness of the harms of e-cigarettes improved.The proportion of students who agreed that"e-cigarettes pose safety hazards"increased significantly from 81.8%to 85.8%(χ2=4.604,P=0.032).Support for e-cigarette control measures increased among adolescents,especially support for banning e-cigarettes in indoor public places,which increased by 4.4%after the intervention.The proportion of students who had ever tried e-cigarettes increased from 4.4%to 5.5%,while the proportions of current e-cigarette users and those intending to use e-cigarettes decreased.Conclusions School-based tobacco control interventions are effective in improving students' knowledge,attitudes,and intentions regarding e-cigarettes,but further efforts are needed to enhance the effectiveness of these interventions.

ObjectiveIn 2018, the Chinese tobacco industry initiated the nationwide ‘civilised smoking environment’ campaign via a 5-year action plan. The goal of this study was to analyse content of reports regarding this topic as evidence to policy-makers to prevent interference from the tobacco industry.MethodsA search of WiseNews, a Chinese media information service provider, for reports regarding the ‘civilised smoking environment’ between January 2018 and December 2022. Reports were coded separately by two trained researchers using a codebook developed by the team, including four sections with 19 items.ResultsA total of 1062 reports were included, of which 66.5% were from general media. Key themes include mention of approaches to promote the civilised smoking environment (59.8%), primarily by establishing civilised smoking areas (86.1%). A majority of reports (72.9%) disclosed key promoters of these initiatives, including the Tobacco Monopoly Administration (69.5%), Tobacco Corporation (52.3%) and other government agencies (20.4%). Funders were mentioned in 252 reports (23.7%), primarily the Tobacco Monopoly Administration (60.3%) and Tobacco Corporation (50.8%). Most reports (92.8%) supported these initiatives, while only 45 (4.2%) opposed it.Conclusions‘Civilised smoking environment’ in China was promoted and financed primarily by tobacco industry and widely supported by media. This undermines smoke-free environments and violates the WHO Framework Convention on Tobacco Control. China’s government should cease its involvement in these initiatives, and government agencies should refrain from agreeing, supporting, cooperating or participating in these activities.

OBJECTIVE:During 2009-2018, the Emory Global Health Institute conducted the Tobacco-Free Cities (TFC) programme in 22 cities in mainland China. This study aims to assess the sustained impact of the TFC programme. DESIGN:A qualitative study using semi-structured interviews was adopted, which focused on the leadership and capacity building, city-level smoke-free policies, tobacco control activities, outcomes of tobacco control, sustainability post TFC programme and the accomplishments of tobacco control. The thematic analysis was employed for qualitative data analysis. SETTING:Online in-depth personal interviews. PARTICIPANTS:This qualitative study recruited 17 participants from 10 cities which participated in the TFC programme (five with comprehensive and five with partial smoke-free policies). Interview participants included TFC programme leaders, TFC staff and current tobacco control staff. RESULTS:First, TFC members reported enhanced competencies in smoke-free policy effort and leadership. Five cities with comprehensive smoke-free policies had a high degree of public support, while cities with partial bans faced barriers such as lack of leadership support and experiencing tobacco industry influence. Tobacco control activities, including media campaigns, policy enforcement, cessation programmes and monitoring activities, were sustained in almost all cities. Enhancement in smoke-free social norms, decrease in smoking rate and second-hand smoking exposure were perceived. Challenges to sustainability included reduced financial and personnel resources and weakened policy enforcement. CONCLUSIONS:The TFC programme was regarded by participants as an effective model that provided the necessary training and technical support to develop and enforce effective and sustainable tobacco control policies and initiatives at the city level in China. Future tobacco control training should focus more on developing concrete solutions for sustainability challenges.

INTRODUCTION:Supervision measures in China have designated offline retail as the only legal channel for the sale and advertising of e-cigarettes. Specialty stores, exclusively selling vaping devices and e-liquids, are professionally designed to showcase company images and provide the best examples of e-cigarette marketing strategies. The goal was to analyze the retail marketing practice of e-cigarette specialty stores and provide a scientific reference for future e-cigarette point-of-sale regulation. METHODS:On-site observations were conducted in specialty stores among the popular business districts of Chengdu and Shanghai, China, from January to May 2021. 'Dianping', known as 'Chinese Yelp', was used to identify 8 business districts in Shanghai and 5 in Chengdu as observation sites. Two trained observers visited each store in the identified business districts. The data were collected with a checklist, which consisted of 5 sections with 37 items, including basic information, marketing practice, age restriction and health warnings. RESULTS:In total, 161 e-cigarette specialty stores, including 82 specialty stores in Shanghai and 79 in Chengdu, were identified. Of these stores, 156 were single-brand retailers and 5 were multi-brand retailers. Each store displayed e-cigarette products, which were visible from outside the store. The most common e-cigarette products were rechargeable kits and nicotine-containing e-liquids, which were available at all specialty stores. Frequent forms of promotion were free e-liquid samples (100%) and slogans (57.8%). Signage stating prohibition of minor use and purchase was presented at 141 (87.6%) specialty stores. Relatively few specialty stores (31.7%) displayed health warnings. CONCLUSIONS:E-cigarette specialty stores featured highly visible product displays, varied product selections, abundant marketing materials, free trial services, absent entry restrictions for minors, and a lack of health warnings. Policymakers should move to reduce youth exposure to e-cigarette products and marketing in the retail environment by strengthening regulations on product display and marketing.

BackgroundE-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. ObjectiveThis study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. MethodsIn phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. ResultsMarketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52%) mentioned product characteristics. In 313 (36.3%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3%) posts, and purchase channels were not mentioned in 790 (98.3%) posts. Social interaction–related posts received attention (n=548, 63.5%), particularly those featuring hashtag content (n=538, 62.3%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6%) or information on health warnings (n=839, 97.2%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. ConclusionsE-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes.

IntroductionYouth e-cigarette (EC) use has rapidly increased in the last few years. It is crucial to identify the susceptible youth and prevent them from EC uptake. This study was conducted to investigate factors that affect youth susceptibility to EC use.MethodsThis study employed a cross-sectional survey design, utilizing multi-center stratified cluster sampling method to select two junior high schools and two senior high schools in Shanghai, Guangzhou, and Chengdu. One-third of classes of each grade in the selected schools were involved in this survey. After obtaining the informed consent of parents, an anonymous and self-administered questionnaire was distributed to students. Questionnaire was designed based on the Ecological Models of Health Behavior. Associations between EC susceptibility and covariates were identified using multivariate logistic regression.ResultsAmong 2,270 students who had never vaped, 38.0% were susceptible to ECs. Logistic regression analysis identified factors on different levels affecting the susceptibility. Individual factors included senior high school students (OR = 1.34, 95% CI: 1.08–1.65), sensation seeker (OR = 1.11, 95%CI: 1.08–1.14), poor academic performance (OR = 1.24, 95% CI: 1.01–1.54), ever cigarette user (OR = 2.27, 95% CI: 1.29–4.01), unaware of the second-hand smoke from vaping (OR = 1.56, 95% CI: 1.25–1.96), agreeable with “I do not want to hang around vapers” (OR = 0.79, 95% CI: 0.64–0.97), agreeable with “ECs are more fashionable than cigarette” (OR = 2.50, 95% CI: 1.72–3.62) and favorable attitudes toward vaping (OR = 5.09, 95% CI: 3.78–6.85) were significantly associated with susceptibility to ECs. At interpersonal level, students who believe they would not be punished by parents for vaping increased susceptibility (OR = 1.27, 95% CI:1.01–1.59). At community level, exposure of EC advertising (OR = 1.81, 95% CI:1.46–2.25), exposure to hazard information (OR = 0.76, 95% CI: 0.59–0.97) and seeing vaping in daily life (OR = 2.11, 95% CI: 1.62–2.74), were statistically significantly associated with youth susceptibility to ECs.ConclusionEC susceptibility was observed in a substantial proportion of adolescents who had never vaped, influenced by factors on different levels. This research underscores the urgent need for comprehensive intervention strategies to prevent the youth susceptibility to ECs.

ObjectiveThe goal was to analyse website content of Chinese electronic (e) cigarette manufacturing enterprises and understand the marketing strategies to provide evidence for decision-makers to regulate manufacturers. MethodsThrough QCC.com, one of the largest enterprise information query platforms in China, we identified 104 official manufacturer websites in 2021. A codebook including 6 sections with 31 items was developed and all webpages were coded separately by two trained researchers. ResultsOver half of the websites (56.7%) did not have age verification for entry. Thirty-two (30.8%) websites had no restriction for minors to use or purchase e-cigarettes, and 79 (76.0%) had no health warning. Overall, 99 websites (95.2%) displayed their products, and 72 (69.2%) displayed e-flavours. The most frequently used descriptions of products included good taste (68.3%), positive mood (62.5%), leakage resistance (56.7%), enjoyment (47.1%), reduced harm (45.2%), alternatives to cigarettes (43.3%) and long battery life (42.3%). Additionally, 75 websites (72.1%) provided contact information on different channels, including WeChat (59.6%), Weibo (41.3%), Facebook (13.5%), Instagram (12.5%) and brand apps (2.9%). Manufacturers provided investment and franchise information (59.6%) and offline store information (17.3%). In addition, 41.3% websites included content regarding corporate social responsibility. ConclusionsChinese e-cigarette manufacturers' official websites have become a platform for presenting product and brand information, establishing online and offline marketing loops, and displaying corporate social responsibility with weak age restrictions on access and a lack of health warnings. The Chinese government should implement strict regulatory measures on e-cigarette enterprises.

目前全球青少年电子烟使用日益普遍,中国中学生的电子烟知晓率和使用率也呈明显上升趋势.电子烟使用不仅会影响青少年自身的健康,还有可能增加其他成瘾物质的使用.青少年电子烟的使用受到个体、产品、环境等多种因素影响.研究旨在了解全球范围内青少年电子烟的使用现状,并对其影响因素进行总结,为预防青少年使用电子烟提供科学建议.