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Introduction: The long-term health effects of e-cigarettes are uncertain, and data on e-cigarette use among Chinese adults are limited. This study examined the prevalence and correlates of e-cigarette awareness and use among urban residents in China. Data came from the China City Adult Tobacco Survey (CCATS), a city-representative household survey conducted using electronic tablets during 2013-2014 in 14 major Chinese cities., Methods: CCATS used multistage geographically clustered samples with standardized survey protocols and questionnaire to ensure data comparability. Overall, 31151 adults completed the survey, with sample size varying from 1977 to 3838 across cities, and survey response rates ranging from 79.8% to 97.5%. Respondents were considered current e-cigarette users if they self-reported using e-cigarettes 'daily' or 'less than daily' at the time of the survey. Descriptive statistics and multivariate logistic regression were conducted. Assessed correlates included: age, education, quit attempts in past 12 months, cigarettes smoked per day, and monthly expenditures on cigarettes., Results: Overall, 46.7% of respondents were aware of e-cigarettes, 2.9% ever used, and 0.8% currently used. Most current e-cigarette users (93.0%) also currently smoked tobacco. Among male current tobacco smokers, adjusted odds ratio (AOR) of current e-cigarette use was higher among those aged 15-29 (AOR=2.5; 95% CI: 1.5-4.3) or 30-49 (AOR=1.9; 95% CI: 1.0-3.4) than those ≥50 years; those who attempted to quit in the past 12 months than those who did not (AOR=4.7; 95% CI: 2.2-10.1); those with a college degree (AOR=3.4; 95% CI: 1.9-6.2) or just finished high school (AOR=2.2; 95% CI: 1.2-4.2) than those who did not finish high school; and those who smoked ≥15 cigarettes per day (AOR=2.8; 95% CI: 1.4-5.6) than those who smoked fewer., Conclusions: These findings reveal that during 2013-2014, many urban Chinese adults were aware of e-cigarettes, while use was relatively low and most current users also smoked tobacco. Continued monitoring of e-cigarettes could help inform public health policy, planning, and practice., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2019 Zhao L.)

Introduction: Hardened smokers are those who do not want to quit, or find it very difficult to quit. This study assessed the prevalence and predictors of hardened smokers in 19 low- and middle-income countries (LMICs)., Methods: We used nationally representative data from 19 LMICs that conducted the Global Adult Tobacco Survey during 2009-2013. Our analysis is restricted to adults aged ≥25 years. Hardened smokers were defined as daily smokers who smoked for 5 or more years, and who reported the following: no quit attempt in the past year that lasted 24 or more hours; no interest in quitting, or not planning to quit in the next year; and currently smoked within 30 minutes after waking. For each country, the prevalence of hardened smokers was analyzed by sex, age, residence (urban or rural), educational attainment, wealth index, and knowledge of the danger of smoking. Multivariable logistic regression was used to assess predictors of hardened smoking., Results: Prevalence of hardened smokers among adults (aged ≥25 years) ranged from 1.1% (Panama) to 14.3% (Russia). Among current smokers (aged ≥25 years), the proportion of hardened smokers ranged from 7.5% (Mexico) to 38.4% (Romania). Adjusted odds of hardened smokers were significantly higher for males (9 of 19 countries), smokers aged 65 years or older (12 of 19 countries), adults with lower educational attainment (9 of 19 countries), and no knowledge of the danger of smoking (8 of 19 countries)., Conclusions: The spectrum of smokers in the LMICs includes hardened smokers and prevalence varies across population groups. Full implementation of proven tobacco control strategies could reduce hardened smoking in LMICs., Competing Interests: Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2019 Yin S.)