Nearly 5 percent of middle school students in three major Chinese cities admitted that they had used e-cigarettes, and 1.6 percent had done so within the past 30 days, according to a report released late last month.
The students polled hailed from Shanghai, Guangdong's provincial capital Guangzhou and Sichuan's provincial capital Chengdu.
Almost all the young smokers said they had also used traditional cigarettes, and more than one in four smoked them after using e-cigarettes first, according to the report conducted and published by the Health Communication Institute of Fudan University in Shanghai.
"Teenagers' curiosity about e-cigarettes creates a risk that they will use the product, and that curiosity is closely related to online and offline marketing," said Zheng Pinpin, head of the tobacco control center of the institute.
"On the other hand, we found that youth had insufficient knowledge of health threats from e-cigarettes," she concluded in the report, which was based on a survey conducted in June of more than 2,400 junior and senior school students in the three cities.
The report said that among the 104 official websites of e-cigarette producers and sellers, only 43 percent had set age restrictions, and most of those did not require any identification authentication. More than 75 percent of these websites had not displayed health warnings.
Promotions of e-cigarettes on popular social media platforms have also increased, according to the report. Although online sales of e-cigarettes are banned, experts said that sellers of e-cigarettes are better at internet promotion than those who sell traditional cigarettes.
Analyzing more than 870 posts on Weibo accounts run by e-cigarette brands published between October and December 2020, the report said such posts mainly consisted of pictures and video clips to show to potential consumers that e-cigarettes are fashionable among youth.
"Images of women and young people were common in such posts," Zheng said.
Moreover, nearly two-thirds of the posts attempted to engage potential consumers by generating topics about e-cigarette products and encouraged people to interact, she said.
The report also found that all 201 e-cigarette stores in downtown areas of Shanghai, Guangzhou and Chengdu provided free trials for customers. More than one-third of those physical stores offered express delivery service.
E-cigarette use in China is rising sharply. The Chinese Center for Disease Control and Prevention's latest data showed that only 0.5 percent of individuals aged 15 and above used e-cigarettes in 2015.That figure had nearly doubled by 2018.
Notably, 1.5 percent of youths aged between 15 and 24 used e-cigarettes, the highest among all age groups included in the 2018 China CDC data.
"There has been research showing that e-cigarettes affect teenagers' brains and physical development, as well as their moods and ability to focus," said Kan Haidong, vice-dean of the School of Public Health at Fudan University.
Aerosols produced by e-cigarettes contain nicotine and toxic chemicals harmful to both users and secondhand smokers, and they have been proven to increase the risks of cardiovascular and pulmonary diseases, according to the World Health Organization.
"So far, e-cigarettes offer more than 15,000 flavors globally. This can attract young people, cause them to be exposed to nicotine and become addicted eventually," said Sun Jiani, a technical officer with the tobacco-free initiative at WHO China Office.