Urgent need for new regulations to stop e-cigarettes from encouraging smoking among Chinese youth

Electronic cigarettes (e-cigarettes) prevalenceE-cigarettes are a growing global health concern, with the number of users nearly doubling from 58 million in 2018 to 114 million in 2023 [1] .By comparison, adult e-cigarette use in the United States increased from 1.2% in 2017 to 4.1% in 2023 [2] , while in England, vaping use grew from 1.3% in 2013 to 10.0% in 2023 [3] , reflecting notable upward trends in both countries, highlighting the cross-national variability in prevalence.Often falsely marketed as 'harmless', 'trendy', and 'fragrant', e-cigarettes are especially appealing to youth and may serve as a trigger to start smoking [4] .Most hardcore smokers start smoking before the age of 20 [5] , and the early onset of tobacco smoking increases the risk of developing tobacco-related diseases [6] .China, as the largest country of tobacco consumption, had a relatively low adult e-cigarette use prevalence of 0.7% in 2022 [7] .However, due to the country's large population base, even a modest prevalence may translate into a significant number of users, with approximately 30% being youth [8] .Notably, attempted use among middle school and university students reached 16.1% and 10.1% in 2021 [9] .Although there was a slight decline to 13.5% among middle school students in 2023 [10] , the rate remains high, reflecting sustained interest and experimentation with e-cigarettes among youth.E-cigarettes remain affordable and accessible, further heightening concern over youth uptake [11] .The escalating experimentation among youth, and limited regulatory controls, make the case for urgent action to prevent e-cigarettes from encouraging early smoking.