To understand different ways of obtaining and unrestricted access to purchase cigarettes and e-cigarettes among Chinese secondary school students to provide evidence to evaluate the effectiveness of tobacco control laws and regulations.

Study participants were 273 154 students recruited using a multistage stratified cluster random sample from 912 junior high schools, 590 regular high schools, and 274 vocational high schools in 31 provincial-level administrative divisions of China. On-site, anonymous, self- administered surveys were conducted from September to December 2023 using the questionnaire developed by the Tobacco Control Office, Chinese Center for Disease Control and Prevention.

Of the 261 454 participants who provided valid responses, 14 199 (corresponding to a national estimate of 4 678 233 students) and 4 643 (corresponding to a national estimate of 1 483 681 students), based on sampling, non-response, and post-stratification weighting, self-reported having purchased cigarettes and e-cigarettes, respectively, in the past 30 days. Among cigarette purchasers, 75.8% obtained cigarettes through a single channel, while 24.2% used two or more channels. The top three access channels were retail outlets (58.7%), sharing from others (42.3%), and obtaining them at home (13.4%). Similarly, among e-cigarette purchasers, 84.4% accessed e-cigarettes through one channel, and 15.6% used two or more channels. The main access channels for e-cigarettes were online shopping (44.2%), experience shops or retail outlets (33.1%), and shopping malls, supermarkets, convenience stores, or grocery stores (28.3%). Among current school smokers surveyed, 71.7% (4 738 corresponding to a national estimate of 1 585 135 students) and 66.7% (2 333, corresponding to a national estimate of 791 337 students) reported unrestricted access to purchase cigarettes and e-cigarettes, respectively, in the past 30 days. Higher rates of unrestricted access to cigarettes were observed among female smokers compared with male smokers (76.0% vs. 70.7%, P<0.05) and among high school smokers compared with middle school smokers (75.2% vs. 66.8%, P<0.05). Similarly, unrestricted access to e-cigarettes was higher among high school smokers than among middle school smokers (69.7% vs. 64.9%, χ²=3.900; P=0.048).

In 2023, a significant proportion of secondary school student smokers in China reported easy access to purchasing both traditional cigarettes and e-cigarettes, primarily through retail stores and online platforms. This concerning trend highlights the urgent need to strengthen regulatory measures and enforcement in tobacco retail operations and e-commerce channels to effectively prevent underage tobacco use among secondary school students.