Recent decades have witnessed a continued decline in overall tobacco use worldwide, yet the rapid proliferation of novel nicotine and tobacco products, such as electronic cigarettes (ENDS), heated tobacco products (HTPs), and other emerging products (1). China is the world’s largest tobacco-consuming nation (2). In 2024, China’s smoking prevalence among adults aged ≥15 years was 23.2% (current) and 20.3% (daily), with current smokers averaging 15.8 cigarettes/day and daily smokers initiating daily smoking at 22.4 years, and slim cigarette use accounted for 32.9% of current smokers (3). Although only 2% of women in China now smoke, half of all adult men smoke cigarettes (4). While combustible cigarette smoking continues to account for the majority of tobacco use, Chinese consumers are also exposed to a growing diversity of nicotine and tobacco products and related marketing narratives (5, 6). In recent years, China’s regulatory landscape for novel tobacco products has evolved substantially. The mandatory national e-cigarette standard took effect in October 2022 (7), alongside strengthened licensing, transactional regulations, and a market restriction to tobacco-only flavors, significantly reshaping product availability and marketing (8). Within this context, “product appeal”—encompassing sensory experience, perceived benefits or risk, marketing cues, and psychosocial meanings—has emerged as a key construct for understanding experimentation and continued use across product categories (9).

Studies suggest that e-cigarettes may be perceived as appealing due to novelty flavors, convenience, and ease of use, which may contribute to experimentation (10), and HTPs highlight appeal dimensions such as innovation, substitutability for cigarettes, and youth appeal, although use intention may remain low in some samples (11). In China, university students—particularly males—appear more likely to endorse social or psychological advantages of alternative nicotine/tobacco products (12). Overall, appeal is product-specific and context-dependent, underscoring the need to compare perceived attractiveness across multiple products within China. To move from description to explanation, determinants of appeal can be organized into three interrelated domains: (i) Product Appeal and Perceived Vulnerability, capturing how attractiveness interacts with perceived susceptibility to shape awareness and behavioral vulnerability (13–16); (ii) Psychosocial Appeal, including motivations related to social belonging, group identity, and psychological needs (17, 18); and (iii) External and Contextual Influences, such as the policy/regulatory environment (7, 8) and marketing-related factors (17, 19). These domains are linked through individuals’ risk appraisal and health beliefs: higher appeal may attenuate perceived threat or weaken protective responses. Rooted in Protection Motivation Theory (PMT) and the Health Belief Model (HBM), this pathway encompasses perceived severity, susceptibility, response efficacy, and self-efficacy (20, 21).

Evidence regarding perceived attractiveness of different tobacco/nicotine products among the Chinese public, and the factors shaping such attractiveness, is limited (12, 15). To address this gap, we adopt an integrated perspective that combines multi-dimensional appeal (product-related, marketing-related, and psychosocial appeal) with risk appraisal (22). Specifically, PMT and HBM are used to structure the risk appraisal pathway, capturing how perceived severity, susceptibility, and efficacy beliefs relate to perceptions of tobacco-related threats (20, 21). Appeal is conceptualized as a parallel pathway that may directly influence interest and trial and may also interact with risk appraisal (6, 9). Higher appeal is expected to be associated with lower perceived threat (e.g., reduced perceived severity/susceptibility) or to attenuate the translation of threat appraisal into avoidance intentions (20, 21). Accordingly, this study aims to (i) compare perceived attractiveness across five tobacco/nicotine product types between smokers and non-smokers and (ii) identify key correlates of attractiveness.

This study examined perceived attractiveness of five tobacco/nicotine product types (combustible cigarettes, e-cigarettes, heated tobacco products, oral nicotine products, and tobacco-free oral nicotine pouches) among a large sample of smartphone-using adults. Our findings show clear product- and user-group differences in perceived appeal: e-cigarettes were rated as most appealing among non-smokers and among smokers without prior e-cigarette experience, whereas combustible cigarettes remained most appealing among combustible-cigarette smokers. These patterns are broadly consistent with prior research showing that e-cigarettes may be perceived as appealing due to features such as flavors, accessibility/convenience, and the social media environment (32, 33). While e-cigarette appeal has been widely discussed in the literature, our contribution lies in providing a within-respondent, multi-product comparison using a designed attractiveness scale across five product categories. In particular, we extend the comparative evidence base by including oral nicotine products and tobacco-free oral nicotine pouches alongside cigarettes, e-cigarettes, and HTPs, and by examining appeal patterns and correlates across smoking/use-history subgroups. This multi-product perspective helps clarify where novel products may rank in perceived attractiveness relative to cigarettes and e-cigarettes, which is directly relevant to anticipating substitution versus uptake among nicotine-naïve individuals.

The prior use of tobacco/nicotine products was strongly associated with higher attractiveness ratings in our study, and e-cigarette use—particularly current use—was positively associated with susceptibility to tobacco product use (34). We also observed that higher perceived health risk was associated with lower attractiveness, whereas greater familiarity with tobacco products, perceived addictiveness, perceived severity of withdrawal, and perceived social support were associated with higher attractiveness. These findings suggest that attractiveness is not driven solely by sensory or marketing cues, but also reflects cognitive appraisals (e.g., risk and dependence perceptions) and social-context factors that may shape perceived desirability and intentions. Prior studies have similarly shown that communication environments can shift perceived appeal and risk—for example, pictorial warnings reducing attractiveness and increasing perceived risks, and modified-risk claims reducing perceived risk without necessarily increasing appeal (14, 19). However, given the cross-sectional design, these associations should not be interpreted causally (i.e., use history causing higher attractiveness). A more plausible interpretation is that higher perceived attractiveness increases the likelihood of trial and continued use; following experimentation, direct experience with the product (e.g., sensory satisfaction or perceived benefits) may further reinforce perceived appeal. This potential feedback process is consistent with prior literature linking product appeal, perceived benefits/risk, and marketing receptivity to susceptibility and use behaviors (19, 35). Longitudinal or experimental research is needed to determine temporal ordering and causal mechanisms.

Furthermore, our analysis indicated that perceived health risks influenced the observed association between smoking status and attractiveness. To better characterize the difference between smokers and non-smokers, we fitted two models. In Model 1, which adjusted for sociodemographic and product-related covariates but not for perceived health risks, smoking status showed no meaningful association with attractiveness. In contrast, Model 2 additionally adjusted for perceived health risks, which was strongly and inversely associated with attractiveness; after this adjustment, smoking status became modestly but statistically significant. The divergence between the two models indicated that perceived health risk was an important correlate of both smoking status and product appeal (36). This pattern suggested that risk perceptions were closely intertwined with the smoking–appeal association and meaningfully altered the estimated effect of smoking, consistent with evidence that perceived risks are closely linked to product appeal and consumer responses (19, 22). Our univariate analysis revealed that Smokers scored low on health risk perception but high on attractiveness, and stratified analyses further revealed a stronger negative association between risk perception and attractiveness among non-smokers than among smokers. Future longitudinal research should examine how risk perceptions and appeal co-vary over time and evaluate their relative contributions to smoking-related differences in perceived attractiveness (37).

Because attractiveness is closely tied to experimentation and potential uptake, our findings have several practical implications for public communication and health education. First, the consistently high appeal of e-cigarettes among non-smokers highlights the importance of providing clear and comprehensive information about product characteristics, including novelty, perceived social benefits, and risk-related attributes, particularly for youth and other nicotine-naïve groups (33, 35, 38). Second, the relatively high appeal of tobacco-free oral nicotine pouches among non-smokers without prior use history suggests that descriptors such as “tobacco-free” may shape perceptions of product acceptability and risk, underscoring the need for transparent communication that enables consumers to better understand what such descriptors do and do not imply (34, 39). Communication materials should therefore present balanced, evidence-based information on nicotine dependence and potential health risks, allowing individuals to interpret these attributes in an informed manner. Third, given the observed association between perceived risk and attractiveness, providing accessible and accurate information on health risks may support consumers in making more informed and reasoned decisions regarding the use of different tobacco and nicotine products (40, 41).

A key strength of this study is its within-respondent, multi-product design, which allowed for standardized comparisons of five tobacco/nicotine products in a large sample of smartphone-using adults. However, several limitations should be noted. First, this was an online, non-probability survey that skewed toward younger and more highly educated respondents with greater internet access (42) so findings should not be interpreted as nationally representative prevalence estimates and may not generalize to adults with limited internet access. Second, the cross-sectional design precludes causal inference, and reverse causation is possible (e.g., higher perceived attractiveness may precede trial and continued use). Third, measures were self-reported and may be subject to recall and social-desirability biases. Future studies using probability-based sampling, longitudinal follow-up, and experimental designs would strengthen external validity and causal interpretation.

This multicenter study of a large sample of smartphone-using adults in China revealed distinct patterns in perceived appeal across five tobacco/nicotine product types. Among smokers with a history of CC use, combustible cigarettes remained the most appealing, whereas e-cigarettes received the highest appeal ratings among non-smokers. Prior product use history showed the strongest association with attractiveness. Notably, adjustment for perceived health risks changed the association between smoking status and attractiveness ratings, strengthening the observed negative relationship. Perceived health risks were inversely associated with appeal, while greater familiarity and higher perceived social support were positively associated with appeal.