In 2019, China CDC conducted the National Youth Tobacco Survey among secondary school students, and the prevalence rates of ever, current, and frequent smoking were 17.9%, 5.9%, and 1.8%, respectively.

The prevalence rate of cigarette use in males decreased largely from 2019 to 2021 in China, while it increased in 18 provincial-level administrative divisions (PLADs) for females. The tobacco control situation remains challenging among vocational senior high school (VSHS) students. Significant geographical disparities existed in cigarette use.

Targeted tobacco control policies aimed at VSHS students are needed, specifically those PLADs with higher smoking rates. Additionally, close attention should be paid to female smokers.

Previous studies about tobacco use among college students in China were conducted at the school level or city level, with fewer than 5,000 students participating.

In 2021, China CDC conducted a national tobacco survey targeting students enrolled in the public higher education system. Overall, 124,119 students from 220 colleges and universities in 31 provincial-level administrative divisions participated in this survey. Current cigarette smoking, current daily smoking, willingness to quit, and smoking cessation among college students were explored.

The current daily cigarette smoking rate of college students was significantly higher than that of senior high school students, especially higher vocational college students. Tobacco control interventions, such as a smoke-free school policy and smoking cessation services, need to be reinforced on college campuses.

Branding of cigarettes may play a role in shaping the smoking behaviors of Chinese smokers, and local brand (LB) cigarettes may reflect this influence because of greater tax and non-tax incentives compared to non-LB. Some of these brands are regional flagships that market to smokers using local landmarks or icons.

LB brands were significantly more likely to be the usual brand of smokers residing in provincial-level administrative divisions (PLADs) that produced their own LB cigarettes [adjusted odds ratio (AOR): 30.95; 95% confidence interval (CI): 26.36–36.49] compared to those residing in PLADs that had non-local ventures with non-LB cigarettes. Further, smokers residing in urban areas were found to be less likely to smoke LB cigarettes (AOR: 0.79; 95% CI: 0.67–0.93) compared to those in rural areas.

These findings suggest that LB smoking may be a result of industry-driven incentives to boost LB sales, fueled by such as supply-side strategies to boost LB sales or targeted cultural/social marketing that appeals to certain demographic groups. Although addressing these incentives to support LBs would be challenging given the nature of China’s tobacco industry, doing so would have potential to reduce cigarette smoking and ultimately the health burden of smoking in China.