MORE and more people are trying e-cigarettes at least once, but the number of people going on to use them regularly is declining, according to American research published in JAMA last week.

The study by researchers from the University of Iowa, in the US, and Guangzhou Medical University, in China, analysed data from 101 175 participants aged 18 years and over in the National Health Interview Survey 2014–2016. They were asked about their lifetime use of e-cigarettes: “Have you ever used an e-cigarette, even one time?”

“Adults who had ever used an e-cigarette were then asked, ‘Do you now use e-cigarettes every day, some days, or not at all?’” the authors explained. “Current use of e-cigarettes was defined as using e-cigarettes every day or some days. Participants were also asked about their ever and current use of conventional cigarettes (not including e-cigarettes).”

“The weighted prevalence of ever use of e-cigarettes increased significantly from 2014 (12.6%) to 2016 (15.3%; P < 0.001),” the authors wrote.

“In contrast, the weighted prevalence of current use of e-cigarettes decreased significantly from 2014 (3.7%) to 2016 (3.2%). The decrease was significant in subgroups including individuals [aged] 65 years or older, women, non-Hispanic white participants, low-income participants, and current cigarette smokers. However, the prevalence increased significantly among former smokers and never smokers.”

The researchers concluded that “these trends may suggest that some individuals are trying but not continuing use of e-cigarettes, but further investigation with individual longitudinal data on use of both e-cigarettes and other nicotine products is needed”.

“Current use of e-cigarettes declined among current smokers but increased among former smokers. This pattern may reflect e-cigarette use as adults are transitioning from current to former smokers, but further investigation is warranted.

“The observed increase in both ever and current e-cigarette use among never smokers is concerning, because these never smokers were being exposed to nicotine and other harmful ingredients.”

Professor Mike Daube, professor of Public Health at Curtin University and a long-time antismoking advocate, told MJA InSight that the JAMA research made it clear that “the National Health and Medical Research Council, the Therapeutic Goods Administration, the World Health Organization, all Australian governments and innumerable other health authorities are right to be cautious [about e-cigarettes]”.

“The evidence for cessation benefits is at best limited; the evidence for concern about use by non-smokers (including children and young people) is now very substantial; and there are also increasing concerns about a range of health harms,” Professor Daube said.

He also flagged the rise of novel vaping products such as Juul, a vaping product that looks like a flash drive, with assorted flavours such as cool mint and fruit medley. The Juul website includes a warning about its products dangers: “This product contains chemicals known to the state of California to cause cancer and birth defects or other reproductive harm”.

Despite being restricted as a product for those aged 21 years and over, according to a report in The New Yorker, “kids can buy Juuls in bulk on eBay and Alibaba with prepaid debit cards and a little creativity”.

“[These products are] now so widely used by children and young people that it has been described by a leading American paediatrician, Dr Jonathan Winickoff, former chair of the American Academy of Paediatrics Tobacco Consortium as ‘already a massive public-health disaster — and without dramatic action it’s going to get much, much, much worse’,” Professor Daube said. “Eleven US senators have written that this is ‘putting an entire new generation of children at risk of nicotine addiction and other health consequences’.”

Reuters reports that tobacco company Philip Morris is promoting iQOS, a vaping product that collects data on its user.

“The tobacco giant is already building a database of iQOS customers who register with the company. And it has developed a software application that could take things a step further,” the report writes.

“The initiative, if allowed by regulators, could extract information about a user’s smoking routine from the device and use it for marketing purposes, said a former project manager at the company who tested the software in Japan. That data would include the number of puffs and average consumption per day.”

Professor Daube told MJA InSight that products such as these were “a distraction from the evidence-based action that we know will reduce smoking – which is one of the reasons they are being so massively promoted by tobacco companies”.

“So, the conclusion for Australia is clear: we should avoid these distractions and get on with leading the world in evidence-based action.”


To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.

2 thoughts on “More trying vaping, but fewer making it a habit

  1. Dr Craig Morris says:

    Australia is procrastinating in respect to the legal sale of Nicotine vapes and it is certainly creating a certain “void”, which is being filled by a poorly regulated internet vape market.

    I personally believe that the tax on cigarettes significantly impacts cigarette consumption. I don’t see as many chain smokers though I worry about the hardcore nicotine addict , who can’t help but smoke despite not being able to afford the habit. Our current taxation certainly makes a black market and illegal market attractive .

    The AMA I believe apposes legal over the counter nicotine vape sale in Australia.

    I believe that the current marketing push from Tobacco companies entering the vape market is to position Vapes as a “safe product “, and so it is not surprising that the former smoker might give it a go.

    Vapes are here. I personally think we need to legalise over the counter sales but then decide on whether a tax should be imposed to put vapes on par with the smoked product.

    Currently nicotine vape can be bought cheaply through an unregulated internet and I think this is a less than ideal situation.

  2. Anonymous says:

    This article is totally irrelevant to Australia, which has the most expensive tobacco products in the world. I was paying $27 per packet, costing $260 per week. I switched to vaping 3 years ago and still vape, costing $4 to $5 per month. I tried some cigarettes on a trip to Vietnam in 2017 costing $2.80 per packet or $12 per carton. I preferred the vape and resumed it. Many patients have switched to vaping and continue to do so. The Commonwealth Government draws $10 billion per year from excise and GST and has no interest in any research, honest or dishonest.

Leave a Reply

Your email address will not be published. Required fields are marked *