Young people at universities in Yunnan are taking up vaping years before they reach the legal tobacco age of 18, often drawn by sweet flavours and the belief that the habit looks modern. The early start and the high rate of dual use with ordinary cigarettes raise fresh concerns for the long term health of students who will soon enter working life.

Researchers questioned 2,259 undergraduates and postgraduates at eight universities and colleges in Kunming in late 2023. Ever use of e-cigarettes stood at 8.8%, current use at 1.9% and past use at 6.9%. Smoking rates were higher still, with 20% having ever smoked and 8% smoking at the time of the survey. The findings appear in BMC Public Health.

Most current vapers had begun at an average age of 15.5 years and more than half used the devices every day. Nearly four-fifths had continued for more than a year. Fruity flavours were chosen by just over half of users, with tobacco and menthol or mint each preferred by about a third.

Students said they vaped because the flavours appealed to them, because they hoped to avoid slipping back into cigarette smoking, and because they found the experience pleasurable. Many also believed vaping was less harmful than smoking. They most often used the devices in bars and pubs, on campus and at home. Almost half bought supplies from online shops even though internet sales were banned in 2019.

The great majority of current vapers also smoked combustible cigarettes. They showed markedly higher nicotine dependence than exclusive smokers and were less likely to intend to quit smoking. Male students faced a far greater risk of current vaping than female students.

Positive attitudes towards vaping and the presence of other vapers among friends, classmates or family members both increased the likelihood of use. Knowledge of health risks such as cancer, heart disease and stroke, and of the rules that now treat e-cigarettes as tobacco products, was generally weak across the whole sample.

China placed e-cigarettes under state tobacco controls in 2022 and limited flavours, while most universities already prohibit smoking and vaping in classrooms and dormitories. The survey shows that these measures have not fully prevented underage access or campus use.

Health staff at universities are being urged to add clear information on vaping harms and regulations to existing tobacco education. Tighter age checks on sales and a complete ban on vaping in public campus spaces could also reduce both use and the social visibility that encourages imitation.