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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (3): 575-583. doi: 10.19723/j.issn.1671-167X.2026.03.018

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Cessation intention and behavior of e-cigarettes and associated factors among 18-44 Chinese adults: Based on protection motivation theory

Xiaoyue ZHANG1, Xiaochen YANG1, Haoxiang LIN2, Ying JI1, Wangnan CAO1, Chun CHANG1,*()   

  1. 1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
    2. Institute for Global Health and Development, Peking University, Beijing 100871, China
  • Received:2026-02-25 Online:2026-06-18 Published:2026-04-15
  • Contact: Chun CHANG
  • Supported by:
    the National Natural Science Foundation of China(82173637)

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Abstract:

Objective: Based on protection motivation theory (PMT), this study aimed to examine the current status of e-cigarette cessation intention and cessation behavior, as well as their associated factors, among adult e-cigarette users in China. Methods: This was a cross-sectional study. The data were derived from a nationwide "E-cigarette Use Survey" conducted in 2023, covering 31 provinces (municipality, autonomous region) in China. A total of 550 current e-cigarette users aged 18-44 years were selected as the study population. After adjusting for sociodemographic variables, multiple linear regression models were used to identify factors associated with e-cigarette cessation intention, while binary Logistic regression models were applied to examine factors associated with e-cigarette cessation behavior. In addition, subgroup analyses were conducted according to smoking status to explore potential differences among exclusive e-cigarette users and dual users of e-cigarettes and combustible cigarettes. Results: The mean score of e-cigarette cessation intention was 3.52±0.96, and 31.64% of participants reported having attempted to quit e-cigarettes. After adjustment for covariates, cessation intention was associated with both the threat appraisal and coping appraisal pathways within the PMT framework. Specifically, in the threat appraisal pathway, severity (β=0.14) and vulnerability (β=0.12) were positively associated with cessation intention, whereas perceived extrinsic rewards (β=-0.12) were negatively associated. In the coping appraisal pathway, both response efficacy (β=0.26) and self-efficacy (β=0.28) were positively associated with cessation intention. Regarding cessation behavior, only severity (OR=1.58) in the threat appraisal pathway was positively associated, and cessation intention was also positively associated with cessation behavior. Subgroup analyses further showed that, regardless of smoking status, cessation intention was positively associated with both the threat appraisal pathway (β=0.20, β=0.31) and the coping appraisal pathway (β=0.23, β=0.21). Conclusion: PMT provides a valuable theoretical framework for understanding e-cigarette cessation among adults. Factors related to the threat appraisal pathway are associated not only with cessation intention but also with actual cessation behavior. More-over, the associations of PMT-related factors vary across different smoking status subgroups. These findings suggest that future e-cigarette control policies and interventions could focus on enhancing risk perception and cognitive awareness, and develop more targeted cessation strategies for specific subgroups.

Key words: E-cigarettes, Tobacco use cessation, Intention, Behavior and behavior mechanisms, Protection motivation theory, Adult

CLC Number: 

  • R163.2

Figure 1

The framework of protection motivation theory in this study"

Table 1

Basic characteristics of the participants and their e-cigarette cessation intention and behavior (n=550)"

Characteristics Whole participants, n (%) E-cigarette cessation intention E-cigarette cessation behavior
$\bar x \pm s$ t P Yes, n (%) No, n (%) χ2 P
Age/years 0.176 0.839 1.214 0.545
  18-24 56 (10.18) 3.59±0.95 20 (11.49) 36 (9.57)
  25-34 307 (55.82) 3.52±0.93 100 (57.47) 207 (55.05)
  35-44 187 (34.00) 3.50±1.01 54 (31.03) 133 (35.37)
Gender -0.909 0.364 0.252 0.616
  Male 395 (71.82) 3.50±0.96 122 (70.11) 273 (72.61)
  Female 155 (28.18) 3.58±0.95 52 (29.89) 103 (27.39)
Marital status 0.012 0.990 2.429 0.119
  Married 418 (76.00) 3.52±0.96 140 (80.46) 278 (73.94)
  Widowed/Divorced or separated/ Never married 132 (24.00) 3.52±0.96 34 (19.54) 98 (26.06)
Education level 1.082 0.339 1.528 0.466
  High school and below 27 (4.91) 3.26±1.02 9 (5.17) 18 (4.79)
  College or undergraduate 480 (87.27) 3.54±0.95 155 (89.08) 325 (86.44)
  Master and above 43 (7.82) 3.51±0.96 10 (5.75) 33 (8.78)
Region -0.172 0.864 0.501 0.479
  Rural 118 (21.45) 3.51±0.95 41 (23.56) 77 (20.48)
  Urban 432 (78.55) 3.53±0.96 133 (76.44) 299 (79.52)
Smoke cigarettes -0.405 0.686 1.164 0.281
  Yes 373 (67.82) 3.53±0.93 124 (71.26) 249 (66.22)
  No 177 (32.18) 3.50±1.01 50 (28.74) 127 (33.78)
Cessation behavior -8.002 < 0.001
  Yes 174 (31.64) 3.95±0.79
  No 376 (68.36) 3.32±0.96
Total 550 (100.00) 3.52±0.96 174 (31.64) 376 (68.36)

Table 2

Descriptive statistics of PMT-related factors"

PMT variables Total, $\bar x \pm s$ Cessation intentiona(r) Cessation behavior, $\bar x \pm s$
Yes No P
Threat appraisal -3.75±6.49 0.32*** -1.55±6.62 -4.77±6.18 < 0.001
  Perceived threat 17.39±4.58 0.33*** 19.05±4.68 16.63±4.33 < 0.001
    Severity 8.87±2.46 0.32*** 9.78±2.52 8.46±2.31 < 0.001
    Vulnerability 8.52±2.60 0.28*** 9.28±2.57 8.17±2.54 < 0.001
  Perceived reward 21.15±3.84 -0.14** 20.60±4.12 21.40±3.68 0.029
    Intrinsic reward 11.19±2.09 -0.07 11.01±2.26 11.27±2.00 0.194
    Extrinsic reward 9.96±2.40 -0.16*** 9.59±2.58 10.13±2.29 0.018
Coping appraisal 11.75±4.50 0.34*** 11.89±4.56 11.69±4.47 0.633
  Perceived efficacy 20.21±3.80 0.40*** 20.68±3.77 19.99±3.79 0.045
    Response efficacy 9.55±2.53 0.30*** 9.58±2.61 9.53±2.49 0.837
    Self-efficacy 10.66±2.54 0.30*** 11.10±2.51 10.45±2.53 0.005
  Perceived cost 8.46±2.36 0.003 8.80±2.52 8.30±2.27 0.027
    Response cost 8.46±2.36 0.003 8.80±2.52 8.30±2.27 0.027

Table 3

Multiple linear regression analysis of e-cigarette cessation intention based on the PMT"

Variables E-cigarette cessation intention
Seven primary PMT sub-elements [Model 1, β (95%CI)]
  Severity 0.14 (0.02, 0.26)**
  Vulnerability 0.12 (0.01, 0.23)**
  Intrinsic rewards -0.07 (-0.19, 0.05)
  Extrinsic rewards -0.12 (-0.22, -0.01)**
  Response efficacy 0.26 (0.16, 0.35)***
  Response cost -0.01 (-0.10, 0.09)
  Self-efficacy 0.28 (0.20, 0.37)***
Four perceptions [Model 2, β (95%CI)]
  Perceived threat 0.26 (0.16, 0.36)***
  Perceived rewards -0.19 (-0.31, -0.08)***
  Perceived efficacy 0.54 (0.42, 0.66)***
  Perceived cost -0.01 (-0.11, 0.08)
Two pathways [Model 3, β (95%CI)]
  Threat appraisal 0.27 (0.20, 0.34)***
  Coping appraisal 0.22 (0.14, 0.29)***

Table 4

Binary Logistic regression analysis of e-cigarette cessation behavior based on the PMT"

Variables E-cigarette cessation behavior
Seven primary PMT sub-elements [Model 1, OR (95%CI)]
  Severity 1.58 (1.12, 2.23)***
  Vulnerability 1.03 (0.76, 1.39)
  Intrinsic rewards 0.97 (0.70, 1.35)
  Extrinsic rewards 0.85 (0.63, 1.15)
  Response efficacy 1.00 (0.77, 1.31)
  Response cost 1.27 (0.96, 1.68)
  Self-efficacy 0.77 (0.59, 1.00)
  Quitting intention 2.16 (1.66, 2.81)***
Four perceptions [Model 2, OR (95%CI)]
  Perceived threat 1.60 (1.20, 2.14)***
  Perceived rewards 0.84 (0.60, 1.16)
  Perceived efficacy 0.80 (0.56, 1.13)
  Perceived cost 1.32 (1.01, 1.73)**
  Quitting intention 2.13 (1.64, 2.77)***
Two pathways[Model 3, OR (95%CI)]
  Threat appraisal 1.41 (1.15, 1.72)***
  Coping appraisal 0.76 (0.62, 0.94)**
  Quitting intention 2.21 (1.71, 2.84)***

Table 5

Subgroup analysis of e-cigarette cessation intentions stratified by smoking cigarette"

Variables Exclusive e-cigarette users Dual users
Seven primary PMT sub-elements (Model 1，β)
  Severity 0.03 0.21***
  Vulnerability 0.14 0.10
  Intrinsic rewards -0.11 -0.05
  Extrinsic rewards -0.06 -0.13**
  Response efficacy 0.17** 0.31***
  Response cost 0.00 -0.02
  Self-efficacy 0.37*** 0.23***
Four perceptions (Model 2，β)
  Perceived threat 0.17* 0.31***
  Perceived rewards -0.19 -0.19***
  Perceived efficacy 0.53*** 0.55***
  Perceived cost -0.03 -0.01
Two pathways (Model 3，β)
  Threat appraisal 0.20*** 0.31***
  Coping appraisal 0.23*** 0.21***

Table 6

Subgroup analysis of e-cigarette cessation behaviour stratified by smoking cigarette"

Variables Exclusive e-cigarette users Dual users
Seven primary PMT sub-elements (Model 1, OR)
  Severity 2.18** 1.40
  Vulnerability 0.77 1.21
  Intrinsic rewards 0.86 1.09
  Extrinsic rewards 0.54 0.93
  Response efficacy 1.30 0.90
  Response cost 1.58 1.13
  Self-efficacy 0.66 0.82
  Quitting intention 2.10*** 2.30***
Four perceptions (Model 2, OR)
  Perceived threat 1.60 1.69***
  Perceived rewards 0.52 1.01
  Perceived efficacy 0.96 0.74
  Perceived cost 1.70** 1.14
  Quitting intention 1.87*** 2.30***
Two pathways (Model 3, OR)
  Threat appraisal 1.72*** 1.33**
  Coping appraisal 0.71 0.81
  Quitting intention 1.96*** 2.35***
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