Dear Editor,
Tobacco use has imposed a substantial disease burden on China1,2. Adolescents, undergoing critical physical and mental development, are particularly susceptible to the harms of tobacco use. According to the 2023 China National Youth Tobacco Survey, 4.2% of middle-school students were current cigarette smokers and 2.4% were current electronic cigarette users3. These figures highlight the serious threat of tobacco use among adolescents in China, driven by the increasing popularity of flavored e-cigarettes and emerging trends like ‘smoking cards’ that normalize smoking behavior. Flavored e-cigarettes, often marketed with appealing flavors and designs, are particularly attractive to young people. In some regions of China, adolescents can easily purchase e-cigarettes, including flavored ones, as long as they are not wearing school uniforms4. The normalization of smoking through games like ‘smoking cards’ further exacerbates the problem, introducing children to smoking culture at an early age.
A survey conducted at a university in Guangzhou, China, found that college students hold a ‘permissive’ attitude toward e-cigarette use: more than 70% reported they would be willing to try an e-cigarette if a friend offered them one5. Early exposure to tobacco, whether through traditional cigarettes or e-cigarettes, poses significant health risks. E-cigarettes, despite being marketed as a safer alternative, still contain harmful substances, including nicotine, which can lead to addiction6. The normalization of smoking through games and advertisements claiming health benefits misleads adolescents into believing that smoking is socially acceptable. This not only increases the likelihood of smoking initiation but also undermines public health efforts to reduce tobacco use.
To address this issue, comprehensive measures are needed. Strengthening the enforcement of regulations on e-cigarette sales and advertising, increasing public awareness of the health risks of e-cigarettes, and developing targeted interventions to counteract the normalization of smoking are essential7. Educational programs that emphasize the dangers of smoking and promote healthy lifestyles can play a vital role in preventing adolescents from starting to smoke8,9. The health of future generations depends on our ability to effectively counter these emerging threats and protect young people from the dangers of tobacco use10.
Funding Statement
FUNDING There was no source of funding for this research.
Conflicts of interest
The authors have completed and submitted the ICMJE Form for disclosure of Potential Conflicts of Interest and none was reported.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval and informed consent were not required for this study.
Data availability
Data sharing is not applicable to this article as no new data were created.
PROVENANCE AND PEER REVIEW
Not commissioned; internally peer reviewed.
DISCLAIMER
The views and opinions expressed in this article are those of the authors.
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Data Availability Statement
Data sharing is not applicable to this article as no new data were created.