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Online information on electronic cigarettes (e-cigarettes) may influence people’s perception and use of e-cigarettes. Websites with information on e-cigarettes in the Chinese language have not been systematically assessed.
The aim of this study was to assess and compare the types and credibility of Web-based information on e-cigarettes identified from Google (in English) and Baidu (in Chinese) search engines.
We used the keywords
Compared with websites on Google, more websites on Baidu were owned by manufacturers or retailers (15/50, 30% vs 33/50, 66%;
Although conflicting or unclear claims on e-cigarettes were common on websites from both Baidu and Google search engines, there was a lack of online information from public health authorities in China. Unbiased information and evidence-based recommendations on e-cigarettes should be provided by public health authorities to help the public make informed decisions regarding the use of e-cigarettes.
Electronic cigarettes (e-cigarettes) are also called electronic nicotine delivery systems or nicotine vaping products, although nicotine-free e-cigarettes exist. Users of e-cigarettes inhale a vapor that may contain nicotine by heating a solution with battery power. Since the first patent of e-cigarettes in 2003 in China, different types of e-cigarettes have been developed [
Along with dramatically increased popularity, the potential impact of e-cigarettes on public health remains controversial [
There are very different prevalence rates of use of e-cigarettes across countries [
Online advertising is an important approach for manufacturers and retailers to marketing e-cigarettes and accessories. A systematic review found an association between exposure to online marketing and intention to use or trial use of e-cigarettes [
A study evaluated websites of e-cigarette manufacturers in China and concluded that e-cigarette marketing should be better regulated [
We found no studies on keywords used by ordinary users to search for online information on e-cigarettes. The term
We developed a data extraction form, which was tested and revised using the first 4 included websites from each of the 2 search engines (
We extracted the following data from the relevant websites: characteristics of the website, main messages regarding the use of e-cigarettes, and website credibility (
Quality of included websites was assessed using the Quality Evaluation Scoring Tool (QUEST) [
We summarized data extracted from included websites in tables and reported percentages of the main website characteristics. Differences in the proportion of websites with certain characteristics between Google and Baidu search engines were tested using Pearson chi-square test or Fisher exact test if any of the expected cell sizes were less than 5. Two-sample Wilcoxon rank-sum method was used to test the difference in the total QUEST score between websites from Google and Baidu search engines. Statistical significance was defined as 2-sided
The main characteristics of included websites are shown in
Compared with websites from Google search engine, those from Baidu search engine were more likely to contain e-cigarette advertising (37/50, 74% vs 15/50, 30%;
The main characteristics of included websites.
Characteristics | Baidu (N=50), n (%) | Google (N=50), n (%) | ||
|
—a | |||
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China | 50 (100) | 0 (0) |
|
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United States | 0 (0) | 24 (48) |
|
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United Kingdom | 0 (0) | 20 (40) |
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Other | 0 (0) | 6 (12) |
|
|
<.001 | |||
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Public or health professional institutions | 0 (0) | 12 (24) |
|
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Manufacturer/retailer | 33 (66) | 15 (30) |
|
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Media/information technology services | 15 (30) | 12 (24) |
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Charity/not-for-profit nongovernment organization/other | 2 (4) | 11 (22) |
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|
|
|||
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Health education | 3 (6) | 30 (60) | <.001 |
|
News | 21 (42) | 14 (28) | .14 |
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Advertisement | 37 (74) | 15 (30) | <.001 |
|
Blogs/user feedback | 21 (42) | 11 (22) | .03 |
|
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|||
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What are e-cigarettesd | 31 (62) | 35 (70) | .40 |
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E-cigarettes’ harm | 32 (64) | 40 (80) | .08 |
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E-cigarettes for quitting | 35 (70) | 31 (62) | .40 |
|
E-cigarette regulation | 23 (46) | 33 (66) | .04 |
aNot applicable.
b
cAs individual items were not mutually exclusive for type of information and content coverage,
de-cigarettes: electronic cigarettes.
The included websites from Baidu search engine had lower modified QUEST scores than those from Google search engine. The median QUEST score was 5 (range: 0-16) for the Baidu websites and 15 (range: 0-27) for the Google websites (
Modified Quality Evaluation Scoring Tool website quality criteria and scores. For categorical variables with items that were mutually exclusive, a single
Criteria | All included websites | Nonmanufacturers or nonretailers | |||||
Baidu (N=50), n (%) | Google (N=50), n (%) | Baidu (N=17), n (%) | Google (N=35), n (%) | ||||
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|
|
.008 |
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|
.13 | |
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No indication of authorship | 44 (88) | 33 (66) |
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12 (71) | 18 (51) |
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All other indications of authorship | 6 (12) | 10 (20) |
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5 (29) | 10 (29) |
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Author/qualification clearly stated | 0 (0) | 7 (14) |
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0 (0%) | 7 (20) |
|
|
|
|
<.001 |
|
|
<.001 | |
|
No sources | 28 (56) | 9 (18) |
|
10 (59) | 0 (0) |
|
|
Mention of expert source and research findings, but insufficiently | 20 (40) | 14 (28) |
|
7 (41) | 12 (34) |
|
|
Reference to at least one identifiable scientific study | 2 (4) | 10 (20) |
|
0 (0) | 6 (17) |
|
|
Reference to mainly identifiable scientific studies | 0 (0) | 17 (34) |
|
0 (0) | 17 (49) |
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|
|
|
<.001 |
|
|
.001 | |
|
Not available; in vitro, animal, and editorials | 46 (92) | 23 (46) |
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15 (88) | 14 (40) |
|
|
Single journal article | 3 (6) | 2 (4) |
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2 (12) | 1 (3) |
|
|
Multiple journal articles | 1 (2) | 15 (30) |
|
0 (0) | 13 (37) |
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|
Systematic reviews of studies | 0 (0) | 10 (20) |
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0 (0) | 7 (20) |
|
|
|
|
<.001 |
|
|
<.001 | |
|
High risk of conflict of interest | 27 (54) | 15 (30) |
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5 (29) | 1 (3) |
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|
Unclear risk of conflict of interest | 23 (46) | 15 (30) |
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12 (71) | 14 (40) |
|
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Unbiased information | 0 (0) | 20 (40) |
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0 (0) | 20 (57) |
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|
|
|
.001 |
|
|
.006 | |
|
No date present | 7 (14) | 25 (50) |
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0 (0) | 12 (34) |
|
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Dated but 1 year old or older | 7 (14) | 3 (6) |
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0 (0) | 3 (9) |
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Dated within the last 1 year | 36 (72) | 22 (44) |
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17 (100) | 20 (57) |
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|
|
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<.001 |
|
|
<.001 | |
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Fully supported | 36 (72) | 12 (24) |
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14 (82) | 3 (9) |
|
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Mainly supported | 13 (26) | 17 (34) |
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3 (18) | 12 (34) |
|
|
Balanced/cautious support | 1 (2) | 21 (42) |
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0 (0) | 20 (57) |
|
After excluding websites owned by manufacturers or retailers, the differences in quitting, health claims, and social claims between Baidu and Google websites were statistically nonsignificant (
Claims or messages from the included websites.
Claims | Manufacturer/retailer websites | Nonmanufacturer or nonretailers | ||||||
Baidu (N=33), n (%) | Google (N=15), n (%) | Baidu (N=17), n (%) | Google (N=35), n (%) | |||||
|
||||||||
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Help quit | 22 (67) | 5 (33) | .053 | 8 (47) | 14 (40) | .86 | |
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Not help quit | 1 (3) | 0 (0) | —b | 2 (12) | 7 (20) | — | |
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Unclear/other | 10 (30) | 10 (67) | — | 7 (41) | 14 (40) | — | |
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||||||||
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Healthier than cigarettes | 20 (61) | 7 (47) | .53 | 7 (41) | 16 (46) | .21 | |
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More harmful than cigarettes | 0 (0) | 0 (0) | — | 3 (18) | 1 (3) | — | |
|
Unclear/other | 13 (39) | 8 (53) | — | 7 (41) | 18 (51) | — | |
|
||||||||
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Less expensive than cigarettes | 3 (9) | 7 (47) | .006 | 0 (0) | 2 (6) | >.99 | |
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Cleaner than cigarettes | 14 (42) | 4 (27) | .35 | 4 (24) | 4 (11) | .41 | |
|
More socially acceptable | 5 (15) | 3 (20) | .69 | 1 (6) | 6 (17) | .40 | |
|
||||||||
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Yes | 10 (30) | 15 (100) | <.001 | 2 (12) | 29 (83) | <.001 | |
|
No | 23 (70) | 0 (0) | — | 15 (88) | 6 (17) | — |
aWhen items belonging to a variable were mutually exclusive, a single
bNot applicable.
cIf items for a variable were not mutually exclusive (ie, social claims), a
Types of electronic cigarettes on advertising websites.
Types of electronic cigarettes | Baidu (N=37), n (%) | Google (N=15), n (%) | |
Cigalike | 14 (38) | 10 (67) | .07 |
Advanced personal vaporizers or eGo | 27 (73) | 14 (93) | .15 |
Mods | 30 (81) | 13 (87) | .63 |
24 (65) | 1 (7) | <.001 |
Findings of this study revealed that the overall credibility and quality of the included Baidu websites were much lower than those of the included Google websites. Compared with Google websites, the included Baidu websites were more likely to be owned by manufacturers or retailers, more likely to advertise HNBT products, less likely to focus on health education, and less likely to have an age restriction warning. The included websites from the 2 search engines similarly provided conflicting or unclear claims regarding whether the use of e-cigarettes helped smoking cessation and whether the use of e-cigarettes was more or less harmful and more or less socially acceptable compared with the use of conventional cigarettes.
Claims made on the marketing websites included in this study were similar to those identified by previous studies, including claims that e-cigarettes could help smoking cessation and that e-cigarettes are safer, cheaper, cleaner, and more socially acceptable than combustible cigarettes [
To avoid
A public health challenge in China is the very high prevalence of cigarette smoking among men (52.1% in 2015 and 50.5% in 2018) [
This is the first study to compare information on e-cigarettes between Baidu (in Chinese language) and Google (in English language) search engines. The credibility of and claims on the included websites were systematically assessed. Although the existing study had focused on advertising or marketing websites [
We included only the first 50 websites from each of the 2 search engines, assuming that ordinary internet users tend to look at the first few search pages. This study considered only websites in Chinese and English language. We used simple terms (
The overall quality of the included Baidu websites was much lower than that of the included Google websites, although conflicting or unclear claims on e-cigarettes were common on websites from both Baidu and Google search engines. Compared with websites from Google search engine, relatively more websites from Baidu search engine were e-cigarette advertising. Particularly, there was no credible information on e-cigarettes from public health authorities in China. Unbiased information and evidence-based recommendations on e-cigarettes should be provided by public health authorities to help the public make informed decisions regarding the use of e-cigarettes.
Data extraction form: assessment of Web-based information on electronic cigarettes.
electronic cigarette
heat-not-burn tobacco
information technology
Quality Evaluation Scoring Tool
FS designed the study. FS, SG, TC, and CN contributed to the development of data extraction form. FS conducted Google search, and TC conducted Baidu search. FS, TC, SG, DQ, CN, GC, and FS collected data from the included websites. FS analyzed data and drafted the manuscript. All authors commented on the manuscript.
None declared.