Effects of China’s E-cigarette administration measures on users: a mixed-methods study of perceptual and behavioural changes among Chinese e-cigarette users

BACKGROUND: China's E-cigarette Administration Measures, implemented in 2022, restricted non-tobacco flavours and online sales. We examined self-reported perceptual and behavioural changes among young adult current and former e-cigarette users after implementation. METHODS: From October to December 2024, a convergent mixed-methods design study combined a nationwide cross-sectional survey of 1630 respondents who had regularly used e-cigarettes before implementation (1084 current users; 546 former users, including 274 who quit after and 272 before implementation) with interviews of 25 users. Survey measures compared retrospectively reported pre-implementation flavour diversity, purchasing channel diversity, e-cigarettes and conventional cigarettes use with current reports, and assessed perceived changes in e-cigarette health risks. RESULTS: Few participants reported reduced flavour diversity (11.6%) or purchasing channels (10.7%). Interviews indicated continued access through illicit or informal sources. Most participants (55.4%) perceived currently marketed e-cigarettes as less harmful than pre-implementation products, partly because the New National Standard label was interpreted as indicating product safety. Reduced flavour options were associated with higher odds of quitting (OR = 1.82), whereas expanded purchasing access was associated with lower odds (OR = 0.54). Overall, 16.8% of all respondents quit after implementation. Among continued users, 31.8% reported increased consumption after imlementation. Residual analysis and interviews suggested opposite-direction changes in e-cigarette and conventional cigarette use among some participants. CONCLUSIONS: The Measures were associated with limited public health benefits, as illicit supply chains and weak risk communication may compromise intended effects. Future e-cigarette governance should prioritise public health leadership over commercial interests and use cross-departmental enforcement to disrupt illicit access.