Background:
Tobacco is the leading cause of preventable death in China. Any comprehensive strategies to reduce tobacco use in China need to increase smoking cessation among current smokers. While the evidence is limited, ENDS may reduce the health risks for current smokers if they switch completely to ENDS. ENDS have the potential of reducing harms of tobacco smoking if Chinese smokers who do not intent to quit can switch completely to ENDS. To systematically assess the awareness and use of ENDS among Chinese adults, Tobacco Questions for Surveys (TQS) was conducted in twelve Chinese cities from 2014 to 2016.

Methods:
Citywide representative surveys were conducted in 12 Chinese cities between 2014 and 2016. The target population was non­institutionalized urban adults age 15 and above. Multi­stage cluster sampling was applied to select 2,500 individuals from each city. SAS and R were used to obtain point estimates and adjusted associations accounting for the complex sample design features.

Results:
Awareness of ENDS was above 40% in all 12 cities, the percent of respondents who have heard about ENDS ranging from 41.3% (Qingdao) to 63.2% (Xi'an). The overall rate of ever use ENDS was 2.9%, and the overall rate of current use was 0.9%. In addition, across most cities, awareness of ENDS were statistically significantly associated with current smoking, being male, aging 25-34, and having higher education.

Conclusions:
Significant variations existed in awareness and use of ENDS among urban Chinese adults. Tailored interventions, as part of a comprehensive tobacco control and cessation strategy, which may include ENDS in assisting smokers in achieving complete cessation, may have a positive public health impact in China. In addition, nation-wide surveillance is needed to monitor the use of ENDS among both adult smokers and among adolescents and young adults, with an emphasis on the complete abstinence from any nicotine product among adolescents.