Combustible cigarettes remain the dominant tobacco product in China, although use of emerging tobacco/nicotine products such as electronic cigarettes (ECs), heated tobacco products (HTPs), smokeless tobacco and nicotine pouches (NPs) is increasing. However, their addictive potential is not well understood. We conducted an online survey (June-September 2025) among 5,901 adult tobacco/nicotine users in China, assessing dependence using the Autonomy Over Tobacco Scale (AUTOS) and the Fagerström Test for Nicotine Dependence (FTND). General linear regression indicated that EC-only users had the lower AUTOS scores (18.32 ± 6.84), while poly-users, especially cigarette + EC users, showed the higher AUTOS (21.61 ± 6.46) and FTND scores (4.06 ± 2.10), compared with cigarette-only users (AUTOS: 20.41 ± 7.02, FTND: 3.63 ± 2.26). Similarly, individuals using ECs plus HTPs (4.79 ± 2.39), cigarettes plus ECs plus HTPs (4.77 ± 1.70), or other combinations (4.76 ± 2.02) exhibited higher FTND scores than cigarette-only users. Familiarity with tobacco/nicotine products and perceived social facilitation were positively associated with both AUTOS and FTND, while perceptions of addictiveness, quitting difficulty, and health risk were positively related to AUTOS. These findings highlight multidimensional dependence, encompassing psychological and physiological dimensions, and reflect influences of diverse product use and cognitive perceptions.
Yan et al. (2026) studied this question.