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

Although 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.

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 follow-up 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.

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 (χ²=0.41, p>0.05), perceived severity for ECU (χ²=1.02, p>0.05), and behavioral beliefs (χ²=2.28, p>0.05) did not change following the e-cigarette tax increase. Friends' attitudes (χ²=8.74, p<0.05), coworkers' attitudes (χ²=4.71, p<0.05), and exposure to e-cigarette advertising (Q=9.76, p<0.01) showed significant decreases.

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.