• Electronic nicotine delivery devices
• Advertising and Promotion
• Global health
• Social marketing
• Priority/special populations

China produces 41% and consumes >38% of the world's cigarettes.1 It is also a global production and export centre of the electronic cigarette (e-cigarette) industry. Around 95% of the world's e-cigarettes are manufactured in China, mainly in the southeastern metropolis of Shenzhen,2 but the market share of e-cigarettes is tiny within the country.2 According to the most recent data of the International Tobacco Control Survey, only 2% of adult current or former smokers in China had ever used e-cigarettes in 2009.3 However, e-cigarette use has become increasingly popular, particularly among young people.4 The large smoker population and the hardening tobacco control measures (many cities have enacted local smoke-free laws,5 and a nationwide smoke-free law has been drafted6) create a huge potential for the e-cigarette market in the country.7

China has no regulations on e-cigarettes, including on their manufacture, distribution, sales, health warnings, packaging and advertising.8 The devices are mainly sold online, at sites such as taobao.com and jd.com—large online shopping destinations in China. In recent years, physical stores that sell e-cigarettes have increased rapidly.9 Chinese e-cigarette manufacturers used to focus on the export market (eg, the USA and Europe), but have now started to exploit the vast domestic e-cigarette market.9 Foreign e-cigarette companies have also made attempts to enter China's market. Since the first e-cigarette forum in Shenzhen in September 2014,10 at least three e-cigarette forums and nine expos have been held in major cities (eg, Shenzhen, Beijing, Shanghai and Guangzhou) up to December 2015.11–21 E-cigarette manufacturers, industry associations and related organisations (eg, e-cigarette online bulletin board systems and industry' magazines) were involved in most (10 of 12) of these as organisers, sponsors, or supporters (table 1). At these events, domestic and international e-cigarette manufacturers and companies built connections with potential franchisees, distributors, retailers, wholesalers and individual consumers. The suddenly increased frequency of these events reflects the e-cigarette industry's explosive efforts to expand the market in China.

Similar to Western countries,22 China's e-cigarette market targets the younger generation. E-cigarette companies at the expos often promoted their products as fashion accessories, emphasised the modern stylish design (see online supplementary figure S1) and highlighted the devices' temperature control function, and wide range of voltage and wattage adjustment, features meant for producing massive vapour clouds. The product appearance often featured icons popular among youth (eg, movie stars and cartoon characters). Manufacturers encouraged people to take free trials of their e-liquids with a variety of flavours. Vapour cloud competitions and vaping trick shows (usually sponsored by e-cigarette manufacturers or industry associations) were often included in the expos (figure 1). The competitions offered tens of thousands of Renminbi in prizes (equal to thousands of US$).23 The shows gave away thousands of free e-cigarettes, e-liquid samples, hats and T-shirts bearing product brand names. The contests and the shows always attracted big crowds, predominantly young people, around the stages. Moreover, manufacturers hired young attractive women to promote their products (see online supplementary figure S2).

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Figure 1

Vapour cloud competitions attracted big crowds, predominantly young people. Photo credit: Nan Jiang.

All these e-cigarette marketing tactics copied the old playbooks of cigarette promotions long used in Western countries, and may lead to favourable perceptions about the devices and fast-growing e-cigarette use among youth, as documented in Western studies.24–26 It is not known how e-cigarette promotion would change China's social norms around tobacco use or how it would affect Chinese people's smoking behaviour, especially among young people. E-cigarette regulations are urgently needed before the device gains more popularity among youth in China. E-cigarette marketing must be closely monitored. E-cigarette use should be included in the nation's surveillance efforts.