What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Tobacco and e-cigarette use (n=16365). Primary outcome: Prevalence of overall tobacco use (95% CI 25.0, 29.5).

What does this research mean for the field?

Among Chinese high-school students in 2021, the prevalence of overall tobacco use was 27.2%, with 24.6% using cigarettes, 9.5% using e-cigarettes, and 6.9% engaging in dual use, while school-based tobacco education showed no associated reduction in use. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to examine cigarette and e-cigarette use among adolescents across China, distinguishing between dual and exclusive users.

April 12, 2026Open Access

Cigarette and E-Cigarette Use Among Adolescents Based on a Nationwide Survey — China, 2021

MKMin KaiyuanChinese Academy of Medical Sciences & Peking Union Medical College MZMeng ZiyanChinese Academy of Medical Sciences & Peking Union Medical College MRMa RunpingChinese Academy of Medical Sciences & Peking Union Medical College

Key Result

Among Chinese high-school students in 2021, the prevalence of overall tobacco use was 27.2%, with 24.6% using cigarettes, 9.5% using e-cigarettes, and 6.9% engaging in dual use.

Key Points

This research aims to examine cigarette and e-cigarette use among adolescents across China, distinguishing between dual and exclusive users.
Conducted a nationwide survey among high-school students in China in 2021.
Collected data from 31 provincial-level administrative divisions.
Analyzed sociodemographic variables and tobacco use patterns.
24.6% of adolescents reported exclusive cigarette use.
9.5% identified as exclusive e-cigarette users.
6.9% were found to be dual users of both cigarettes and e-cigarettes.
Preventive measures, like school-based education, did not significantly reduce tobacco use.

Study Design

Type

Cross-Sectional (n=16,365)

Multicenter

Yes

Structured PICO

Population

High-school students in 31 provincial-level administrative divisions in China

Outcome

Prevalence of dual, exclusive cigarette, and exclusive e-cigarette use

A 2021 nationwide survey in China reveals significant rates of adolescent tobacco use, highlighting the need for differentiated control strategies and improved school-based education.

Limitations

Online survey excluded adolescents without internet access or who had dropped out of school
Voluntary participation may have led to overrepresentation of students more interested in tobacco use
Self-report may have introduced bias due to inaccurate recall, underreporting, or overreporting
Cross-sectional design limits findings to associations rather than causal relationships

Abstract

What is already known about this topic? Adolescent cigarette and e-cigarette use remains common in China. Previous studies identified multiple individual-, family-, and school-related risk factors. However, national-level evidence distinguishing dual use from exclusive cigarette or e-cigarette use is limited. What is added by this report? A nationally representative survey of high-school students in 31 provincial-level administrative divisions in China produced updated estimates of tobacco use in 2021: dual (6.9%), cigarette (24.6%), e-cigarette (9.5%). Socio-ecological factors differed across statuses, and some preventive measures, including school-based tobacco education, had no associated use reduction. What are the implications for public health practice? Adolescent tobacco control should adopt differentiated strategies for dual/exclusive tobacco use, strengthen family/peer involvement, and improve school-based education program effectiveness.

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