A Cross-Sectional Survey on Prevalence and Behaviour of Smokeless Tobacco Use Among Tobacco Users in China

Increasing tobacco control and public health awareness have increased smokers’ attempts to quit smoking. However, some smokers also seek alternative products claimed to pose less risks. The use of smokeless tobacco (ST) products may thus increase in some countries which are not traditionally ST markets. To provide a cross-sectional picture on ST usage in China, a survey was conducted from December 2019 to March 2020 in representative metropolitan cities (divided into three tiers by their populations and gross domestic product (GDP) sizes), from which 3,000 tobacco users and 801 ST users were randomly recruited to provide a snapshot of ST usage behaviour and other pertinent factors for Chinese tobacco users. The study included questionnaires designed to probe potential reasons behind ST use, usage habits, and nicotine dependence attributes. These questions were devised to cover the type of tobacco products used, users’ age, gender, city of residence, residence time, household monthly income, etc., and was supported by some verification questions. Mann-Whitney-analysis was used for significance analysis between different groups. The results showed that ST prevalence for Chinese tobacco users was around 2.1%. The proportion of exclusively ST use was about 8.99%, and the mean conversion time to habitual ST use was about three months. Demographic information such as the city tiers where ST users lived, their age, gender, educational and income levels appeared to correlate with ST use habits although more studies are needed to verify the observations. The fact that a small but measurable population of Chinese ST users exists has important implications for tobacco control. This study provides the first large-scale, single-time-point survey on Chinese ST user profiles, which may help the future research on tobacco control policy regarding ST products in China.