# Cognitive confusion: A cross-sectional study on the cognitive differences between traditional tobacco and e-cigarettes among college students in Zhejiang Province, China

## TL;DR

College students in Zhejiang Province, China, have lower awareness and inconsistent understanding of e-cigarettes compared to traditional tobacco, highlighting a need for better education.

## Contribution

This study reveals significant cognitive gaps and misinformation about e-cigarettes among Chinese college students, emphasizing the need for targeted public health strategies.

## Key findings

- Only 42.72% of students had high knowledge of e-cigarettes, compared to 80.36% for traditional tobacco.
- Students showed poor consistency in knowledge and risk perception between e-cigarettes and traditional tobacco (κ<0.6).
- 75.19% of students learned about e-cigarettes via the internet, and only 20.37% correctly identified e-cigarette packaging.

## Abstract

This study aimed to explore the differences in knowledge and cognitive perceptions of traditional tobacco and e-cigarettes among college students in Zhejiang Province, China, and to provide evidence-based insights for future prevention and control strategies.

A cross-sectional survey was conducted in September 2020 among students from nine undergraduate institutions in Zhejiang Province, selected through a combination of typical and convenience sampling. An anonymous online questionnaire was used to collect data on tobacco-related knowledge, usage behavior, and cognitive perceptions. Statistical analyses included chi-squared tests, rank-sum tests, logistic regression, McNemar's tests, and Cohen's kappa (κ) to assess differences and consistency in knowledge regarding traditional tobacco and e-cigarettes.

A total of 728 valid responses were obtained. Among the respondents, 9.20% were current smokers and 6.73% were current e-cigarette users, of whom 1.37 % used e-cigarettes exclusively. Only 42.72% of respondents showed high knowledge of e-cigarettes, significantly lower than the 80.36% for traditional tobacco (χ2=128.410, p<0.001). Consistency in knowledge and risk perception between the two product types was also poor (κ<0.6). Among college students, 75.19% learned about e-cigarettes through the internet, and only 20.37% of those who had never used e-cigarettes correctly identified e-cigarette packaging.

College students demonstrated significantly lower awareness of e-cigarettes compared to traditional tobacco, with notable cognitive inconsistency regarding health risks. The prevalence of misinformation, especially from online sources, underscores the urgent need for targeted education and control measures to address cognitive confusion and improve awareness of e-cigarette risks.