The scene is becoming increasingly common on university campuses: a few puffs to ease pre-exam anxiety, a drag while pulling an all-nighter to finish assignments, or passing a device around during social gatherings. Compact, portable, and leaving almost no lingering smell, e-cigarettes have shed the negative stereotypes of traditional tobacco. Many young people label them as "trendy, stress-relieving, and harmless," turning them into a popular social accessory.
In China, e-cigarettes are classified as novel tobacco products and fall under the regulatory oversight of the tobacco monopoly administration. The "E-Cigarette Management Measures" issued by the State Tobacco Monopoly Administration on March 11, 2022, emphasize that the state and society should strengthen education on the health hazards of e-cigarette use, discourage adolescents from using them, and prohibit primary and secondary school students from using e-cigarettes.
May 31st of this year marks the 39th World No Tobacco Day, with the theme "Youth Free from Tobacco for a Limitless Future." Data from the China CDC's "2024 China Adult Tobacco Survey Key Findings" shows that the current smoking rate among people aged 15 and above in China is 23.2%. Public awareness of the harms of tobacco has improved, but there remains a gap from the goal of "below 20%" set in the "Healthy China 2030" plan. The prevalence of e-cigarettes on campuses is also an issue requiring attention.
Many young people believe that e-cigarettes, producing only a light vapor, do not constitute real smoking and that occasional use is harmless. However, e-cigarettes are far from a "stress-relief tool"; they are a "health trap" laden with hidden risks.
Behind "Harmless Experimentation": From Following Trends to Addiction Luo Yu, a 22-year-old junior, took her first puff of an e-cigarette during a dormitory gathering in her sophomore year. "My roommates and classmates were all using them. They'd pass them around during parties or while pulling all-nighters for gaming; the atmosphere was intense," she explained. At the time, it was pure curiosity. Seeing everyone else doing it, she felt out of place not trying. Why not choose traditional cigarettes? Luo Yu's reason was simple: traditional cigarettes have a strong, harsh smell, leave an odor on clothes (making it easy for parents and teachers to notice), and seem outdated. In contrast, some e-cigarettes have fruit flavors, aren't pungent to smell, and have a sleek, minimalist design like an electronic gadget. "At the time, it seemed perfect for young people," she recalled. Hearing others claim e-cigarettes were "harmless," "tar-free," and "healthier than cigarettes," Luo Yu tried her first one with a mindset of "harmless experimentation," gradually developing a habit. Whether stressed, pulling an all-nighter for assignments, anxious about exams, or during social dinners and late-night entertainment, Luo Yu would take a few puffs. "Taking a drag instantly felt soothing, it calmed my mood a bit." In her view, e-cigarettes became a convenient way to relieve stress. Zhang Rui, 24, started using e-cigarettes after entering the workforce. Facing high workplace pressure and frequent overtime, seeing colleagues use e-cigarettes to decompress, he began trying them too. "When working late into the night, a puff can quickly refresh you and ease fatigue," he said. Businesses have precisely captured the psychological needs of young people. Luo Yu noticed that in advertisements on social platforms, e-cigarettes are packaged as "stress-relief tools" and "trendy items," with their harms deliberately downplayed and their "fashionable" and "social" attributes amplified. "Many short videos on social platforms used to heavily promote e-cigarette reviews and flavor recommendations, misleading young people into thinking vaping is trendy and normal," Zhang Rui said. "Businesses and advertisements tout 'zero tar, low harm, healthy cigarette replacement,' emphasizing mildness and non-injury. I believed it at the time." However, this "disguise" cannot conceal the real harms of e-cigarettes. After two years of use, Luo Yu found her throat often felt dry after vaping, she coughed frequently, and experienced dizziness and heart palpitations after late-night sessions. "Honestly, even though I knew there were harms, I still had a sense of侥幸心理, thinking my usage wasn't particularly heavy and wouldn't lead to serious problems," Luo Yu admitted. Li Mu, a 20-year-old university student, has never tried e-cigarettes, but she observed that in her dorm of four, three people vape. "My roommate has vaped daily since freshman year, often coughing while doing it. I reminded her to vape less, that it hurts the lungs, but she just waved it off saying it's fine, it's not paper cigarettes, it's pure fruit flavor, completely harmless," Li Mu said. Simultaneously, lax age verification at offline stores and the proliferation of online private/underground transactions make it easy for young people to obtain e-cigarettes, further exacerbating misuse. "During finals week, there are many people vaping in the dormitory hallways, treating e-cigarettes as a 'study aid and energy booster.' My roommates always vape when they study," Li Mu said. "Walking by, a sickly sweet smell hits you, making your throat tight and dizzy. You're forced to inhale secondhand vapor, which is very unpleasant, but the users don't seem to care at all."
Beware the Risks of E-Cigarettes "Young people using e-cigarettes, seemingly engaging in 'harmless experimentation,' are actually stepping into a trap," said Li Min, Deputy Chief Physician of the Respiratory and Critical Care Medicine Department and Smoking Cessation Clinic at Beijing Chest Hospital, Capital Medical University. Statements like "e-cigarettes have no tar, they're healthier than cigarettes" are akin to saying "jumping from a building is less harmful than jumping off a cliff." Vaping is fundamentally still a smoking behavior that affects physical health. "While e-cigarettes may lack tar, the aerosol produced contains known carcinogens like formaldehyde, acetaldehyde, and heavy metals (nickel, lead)," Li Min cautioned. Some e-cigarettes have fruit and sweet flavors achieved through chemical additives (like diacetyl), which when heated can form highly toxic substances like diacetyl. Inhaling these into the lungs can potentially cause "popcorn lung" (bronchiolitis obliterans). "The trendy appearance of e-cigarettes only leads people to underestimate their harm," Li Min added. "E-cigarette liquid is highly hygroscopic, causing persistent dry mouth, throat discomfort, and chronic cough in users, and inducing airway inflammation, which is particularly impactful for asthma patients," Li Min explained. "Nicotine causes increased heart rate and elevated blood pressure, and has long-term effects on adolescent brain development." Li Min observes a common phenomenon in the clinic: regardless of the amount, as long as one vapes, damage accumulates. There is no "safe threshold" for lung damage; often, by the time one "feels fine," function has already been quietly impaired. Some young people start vaping "to quit smoking," with counterproductive results. Li Min said, "The vast majority not only fail to quit but become 'dual addicts,' using both cigarettes and e-cigarettes. Their risk of cardiovascular disease and COPD is several times higher than those who use only one type." In December 2023, the World Health Organization stated that e-cigarettes generate harmful substances, some of which are carcinogenic and pose risks to heart and lung health. They can also harm young people's brain development and may lead to nicotine addiction in children and youth. More alarmingly, the full spectrum of health risks潜藏 by e-cigarettes remains incompletely understood. Zhi Xiuyi, Vice President of the Chinese Association on Tobacco Control and Health and Chief Expert of Thoracic Surgery at Xuanwu Hospital, Capital Medical University, noted that research on the health hazards of traditional cigarettes has been ongoing for over 50 years, yielding extensive findings and data. Heavy smokers with a smoking index greater than 400 (smoking 20 cigarettes daily for over 20 years) have a lung cancer incidence 5-10 times higher than non-smokers. Major chronic diseases in China, such as cancer (especially lung cancer), cardiovascular and cerebrovascular diseases, respiratory diseases like chronic obstructive pulmonary disease (COPD), stroke, and metabolic diseases (diabetes), are closely linked to long-term smoking. However, e-cigarettes have a shorter history, and their health risks are more隐蔽. Zhi Xiuyi特别强调 that e-cigarettes also produce secondhand aerosol, affecting non-users. "If individuals with respiratory diseases, or the elderly, children, or pregnant women are exposed to secondhand aerosol from e-cigarettes, it is同样不利于健康." For young people wanting to quit scientifically, Li Min建议 first recognizing it as nicotine addiction, not simply attributing it to lack of willpower. Those with the intention to quit can visit smoking cessation clinics or call the national quitline (400-808-5531) for professional help. Behavioral替代 is also important. Li Min建议 that when feeling the urge to vape, try taking several deep breaths, drinking water, or squeezing a stress ball. The peak physical craving during a nicotine craving lasts 5-10 minutes; "getting through it is a victory."
Shattering the "Fashionable" Facade for a Truly "Smoke-Free" Youth China's Law on the Protection of Minors and the "E-Cigarette Management Measures" explicitly prohibit the sale of tobacco products, including e-cigarettes, to minors. Since the formal implementation of the "E-Cigarette Management Measures" in May 2022, flavored e-cigarettes have been completely banned from sale. However, e-cigarettes' small size and极强隐蔽性 mean covert use and private transactions still exist. On short video social platforms, they are often referred to using code words like "atomizer" or "herbal atomization." There are even instances where primary and secondary school students use fruit emojis as code, with reports of "being able to buy e-cigarettes if not wearing a school uniform," making管控难度较大. Zhi Xiuyi emphasized that youth tobacco control and e-cigarette regulation are long-term endeavors crucial to国民健康与国家人才建设. If adolescents start using e-cigarettes and are exposed to nicotine between ages 12-16, they are highly likely to become traditional cigarette consumers as adults, becoming a高危人群 for smoking-related diseases by age 40. Role model leadership is a vital force in protecting youth from tobacco. Zhi Xiuyi pointed out that teachers and doctors should lead by example in staying away from tobacco. Public figures with large youth followings need to率先摒弃 smoking and vaping, setting a positive example. Parents, as the first责任人 for family health, even if they are smokers themselves, should not use cigarettes or e-cigarettes in front of minors, and certainly should not smoke at home, forcing youth to be exposed to secondhand and thirdhand smoke. Simultaneously, university students should also abandon the misconception of e-cigarettes as trendy, lead by example, set a榜样 for primary and secondary school students,杜绝 smoking on campus, and participate in building smoke-free campuses. This year marks the 20th anniversary of the WHO Framework Convention on Tobacco Control taking effect in China. Over these 20 years, China's tobacco control system has continuously improved, successively推进 the construction of smoke-free campuses, hospitals, office buildings, communities, and families. Zhi Xiuyi stated that regarding smoke-free environment construction, the Chinese Association on Tobacco Control and Health will accelerate the formulation and release of standards for smoke-free campus construction, standards for brief smoking cessation interventions in medical institution outpatient clinics, and other norms. After the standards are issued, the association will guide units nationwide in implementation,全方位推动 smoke-free campus construction and规范戒烟门诊 through pilot demonstrations, training and empowerment, and supervision and evaluation from three dimensions. "We will select some vocational colleges nationwide to participate in pilot work for 'tobacco control entering campuses,' creating replicable, scalable benchmarks to subsequently promote更广泛的 hospital smoking cessation services," Zhi Xiuyi表示. Strengthening law enforcement supervision and public舆论监督 is key to治理. Zhi Xiuyi建议 that law enforcement departments need to加大排查力度 on offline tobacco stalls and实体店, increasing penalties for merchants illegally selling cigarettes and e-cigarettes to minors. Li Min也建议 that platforms and logistics companies must be held accountable to intercept coded marketing and private transactions of e-cigarettes on social platforms, and strictly investigate disguised or variant e-cigarette products. Currently, many provinces and cities nationwide have issued tobacco control-related regulations. "We have noticed that some provinces and cities have enacted控烟立法, but there are still many hospitals, especially in prefecture-level cities and county-level hospitals, that have not included indoor public workplaces and e-cigarettes in their管理范围," Zhi Xiuyi呼吁. Cities with existing控烟立法 need to尽快增补 e-cigarette control clauses, and cities newly enacting such legislation should directly include e-cigarettes in their管控体系. In Li Min's view, the大量电子烟信息 on social media is essentially marketing promotion. Tobacco control宣传 should真正进入 university dormitories,融入 short video platforms, and redefine the "trendy" label as "damaging to health." "We hope young people strengthen the观念 that 'e-cigarettes are also tobacco products' and 'using e-cigarettes is also a smoking behavior,'" Zhi Xiuyi said. "The Chinese Association on Tobacco Control and Health will尽快出台相关规范 for 'tobacco control entering campuses.' Let us work together for a 'Youth Free from Tobacco, Future Limitless.'" (At the request of the interviewees, Luo Yu, Zhang Rui, and Li Mu are pseudonyms.)
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