Attractiveness and determinants of different tobacco products among Chinese smokers and non-smokers: a web-based...

Tobacco use remains highly prevalent in China, with the emergence of a growing range of tobacco and nicotine products that vary in design and social presentation, raising questions about how these product characteristics are perceived by consumers. This study assessed the attractiveness of five tobacco products among the general Chinese public, including both non-smokers and smokers, and explored the factors influencing their perceived appeal.

Using a self-designed attractiveness scale, an online survey was administered via smartphone to adults aged 18 years or older across six geographically representative cities in China (Beijing, Shanghai, Guangzhou, Shenzhen, Chengdu, and Zhengzhou). The survey assessed the attractiveness of five tobacco products, including combustible cigarette (CC), e-cigarette (EC), heated tobacco product (HTP), oral nicotine product (ONP) and tobacco-free oral nicotine pouch (TFONP). Attractiveness ratings for different tobacco products were calculated, and mixed linear models were employed to explore associated influencing factors.

A total of 15,601 valid questionnaires were collected, including 9,700 non-smokers and 5,901 smokers. CC had the highest familiarity score (3.97 ± 1.04) and were perceived as having the highest health risks (4.38 ± 0.76) and the highest addictiveness (4.22 ± 0.87). All alternative tobacco products received significantly lower ratings on these measures compared with CC (all p < 0.05). Total attractiveness scores were similar for CC and e-cigarettes (both 3.04) but lower for HTP/ONP/TFONP (range: 2.59-2.63; all p < 0.05). In the multivariable Model 1, which did not include "perceived health risks," smoking status showed no significant association with attractiveness (β = 0.001, p = 0.896). After incorporating this variable in Model 2, the association became modestly negative and statistically significant (β = -0.06, p < 0.001). Relative to CC, e-cigarettes were associated with higher attractiveness ratings (β = 0.14), while HTP, NOP, and TFONP were associated with lower attractiveness ratings (β = -0.09 to -0.14; all p < 0.001). Use history exhibited the strongest association with attractiveness (β = 0.56). In addition, higher "familiarity with tobacco products," "perceived social support" and "perceived addictiveness" were positively associated with product appeal, whereas greater "perceived severity of withdrawal" and "perceived health risks" were negatively associated with appeal. Attractiveness ratings also varied somewhat across cities, and gender, age, and occupation had certain influences on the ratings.

This study identified distinct patterns of perceived appeal across five tobacco/nicotine product types among Chinese adults. E-cigarettes received the highest appeal ratings among non-smokers, whereas combustible cigarettes remained the most appealing among CC users. Prior product use history showed the strongest association with appeal. Perceived health risks were inversely associated with appeal and appeared to partly account for the smoking-appeal association, as the association between smoking status and attractiveness ratings changed after adjustment for perceived health risks. In contrast, greater familiarity and higher perceived social support were positively associated with appeal.