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THE debate about electronic cigarettes has spawned a number of factoids: “facts” that become accepted as true because of their frequent repetition. “Vaping is 95% less risky than smoking” is one that has been recently eviscerated and shown to have a highly questionable provenance. Last year, I critically reviewed (here) another claim that smoking was increasing in Australia.
In recent weeks, it has been stated that there are 250 000 people using e-cigarettes in Australia, although the details on how that figure was calculated were not published (see “Vaping may have its drawbacks but it’s a lifesaver for many smokers”). Associate Professor Colin Mendelsohn also wrote in MJA Insight last month, based on overseas data, that “regular vaping by young people is rare and is almost exclusively confined to current or past smokers”.
Let’s take a look at this big, memorable number and the statement on young people and never-smokers.
Australian data on e-cigarette use
There are two main recent sources of data on e-cigarette use in Australia: the 2016 national data on e-cigarette use obtained by the Australian Institute of Health and Welfare (AIHW) from its National Drug Strategy Household Survey, and the Australian Secondary School Smoking, Alcohol and Drug Use Survey conducted in 2014.
If we apply the 2016 AIHW e-cigarette prevalence estimates to 2016 Australian census data, the table below shows there may be some 239 000 people currently vaping in Australia. Note, however, that this figure includes a large number of people who use e-cigarettes less frequently than once a month. If these are excluded, then the number comes down to fewer than 178 000.
As with the results of any survey, the estimates for population use of e-cigarettes are subject to sampling error, which means that the real percentages (and consequently the real numbers) might be considerably greater or fewer than that number. So, the number of people using e-cigarettes at least once in the previous month was somewhere between approximately 149 000 and 207 000. Whatever the true figure, and whether or not one excludes less-than-monthly trivial use, 250 000 looks like a considerable overestimate — almost 30% higher than the mid-point of 178 000.
Estimated percentage and numbers of resident population aged 14 years and over using e-cigarettes, Australia, 2016
| Smokers
(14.9%) 2967837 |
Ex-smokers
(22.8%) 4541389 |
Never-smokers
(62.3%) 12409145 |
Total
(100%) 19918371 |
|
| Vaping daily | 1.5% ± 0.5% | 0.8% ± 0.3% | 0.2%‡ ± 0.2% | 0.5% ± 0.1% |
| Vaping at least weekly | 1.2% ± 0.4% | 0.1%† ± 0.1% | <0.1%† ± 0.1% | 0.3% ± 0.1% |
| Vaping at least monthly | 0.7% ± 0.3% | <0.1%‡ ± 0% | <0.1%† ± 0% | 0.1% ± 0.1% |
| Use less than monthly | 1.0% ± 0.4% | 0.2%† ± 0.2% | 0.2%† ± 0.1% | 0.3% ± 0.1% |
| Calculated total vapers | 4.3% ± 0.81%
127717 ± 23994 |
1.2% ± 0.35%
54497 ± 15953 |
0.4% ± 0.12%
49637 ± 15310 |
1.2% ± 0.17%
239020 ± 33434 |
| Calculated total vapers excluding those who vape less than monthly | 99854 ± 21328 | 42663 ± 14143 | 34060 ± 12690 | 177874 ± 28887 |
| Ex-vaping, trivial use or never vaping | ||||
| Used to use, but no longer use | 6.8% ± 1.1% | 1.7% ± 0.4% | 0.3% ± 0.1% | 1.6% ± 0.2% |
| Only tried once or twice | 19.9% ± 1.7% | 4.7% ± 0.7% | 3.2% ± 0.4% | 6.0% ± 0.4% |
| Never used | 69.0% ± 1.9% | 92.5% ± 0.9% | 96.1% ± 0.5% | 91.2% ± 0.5% |
| Total ex-, trivial and never use | 95.7% | 98.8% | 99.6% | 98.8% |
| Estimated numbers and % of current vapers by smoking status | ||||
| Minimum | 103623 | 38544 | 34327 | 205586 |
| Mid-point | 127617 | 54497 | 49637 | 239020 |
| Maximum | 151611 | 70450 | 64947 | 272455 |
| % that this group makes up of total current vapers (using mid-point) | 53% | 23% | 21% | 100% |
* 2016 National census data. † Estimate has a relative standard error of 25–50% and should be used with caution. ‡ Estimate has a high level of sampling error (relative standard error of 51–90%), meaning that it is unsuitable for most uses.
How many non-smokers are vaping?
Apart from the likely overestimate of the total number of vapers, there is concern about the potential extent of vaping among non-smokers, particularly among teenagers and others who have never smoked regularly. In the UK, 90% of vaping retailers are known to break the UK industry voluntary code by selling to non-smokers and to children.
As can be seen from the footnotes to the table above, the AIHW cautions that for five out of the six data cells for ex-smokers and never-smokers currently using e-cigarettes, the standard errors are large to very large, so that we cannot have confidence in the percentages provided. However, one cannot conclude from this that the total number of non-smokers who vape is therefore negligible. Looking down the columns one can see that, while a total of 98.8% of ex-smokers and 99.6% of never-smokers have never vaped, no longer vape or have only vaped a couple of times, this leaves 1.2% of ex-smokers and about 0.4% of never-smokers who currently vape at least to some degree.
While the percentages of ex-smokers and never-smokers vaping are much lower than the percentages of smokers who are currently vaping, the far greater numbers of ex-smokers and never-smokers compared to smokers in the Australian population means that the aggregated small percentages translate to larger, commercially beguiling numbers. Based on these figures, about 50 000 people (21% of current vapers) could be never-smokers. Applying confidence intervals, the number of never-smokers currently vaping could be anywhere between about 34 000 and 65 000.
Of even greater concern, it appears that a high percentage of these never-smokers who use e-cigarettes are young people, including teenagers.
So how many children?
In the 2016 National Drug Strategy Household Survey, 7.1% of respondents in the 12–17-year age range (including 6.2% of non-smokers) reported having ever used an e-cigarette. It is instructive to note that in the 18–24-year old age group, ever use (at 19.2%), ever use among non-smokers (at 13.6%) and current use among smokers (at 6.8%) were the highest levels of use of any age group.
Corroborating evidence about the extent of use of e-cigarettes among teenagers comes from the Australian secondary school survey of smoking, alcohol and drug use which provides much more reliable estimates of drug use among teenagers of school age. In this very large survey of more than 23 000 students, we see in 2014 that 13.2% of 12–17-year old students (~ 229 000 Australia-wide, if equivalent rates were reflected in the whole population) had ever tried an e-cigarette, and that 3.3% ± 0.3% had vaped at least once in the last month (~ 56 850 Australia-wide); that is, again not a trivial number. No information is available about the proportion of student e-cigarette users who used more frequently than monthly, and this survey was conducted prior to the implementation of laws restricting sales of e-cigarettes to teenagers in several states. So, it is important to be careful in interpreting these figures and the risks they might point to. The 2017 Australian Secondary School Alcohol and Drug survey (results currently under analysis) should reveal whether use of e-cigarettes was a passing fad for Australian teenagers or has persisted as a serious concern.
Overall public health effects of vaping
Ex-smokers in the AIHW national survey can mean smokers who quit at any time, and thus include those who have not smoked for many years as well as those who quit in the days, weeks or few months prior to answering survey questions such as those asked by the AIHW. We do not know what proportion of ex-smokers who are vaping are those who quit with the help of their e-cigarette use and what proportion are long term ex-smokers who took up vaping after not smoking for many months or years. Neither do we know what proportion of the 1.7% who are both ex-smokers and ex-vapers quit because of their vaping, versus those who tried and failed to quit via vaping and later quit either unaided or using another method.
Importantly, a large proportion of people who describe themselves as ex-smokers when they answer a survey question will relapse back to smoking at a later date. The same is true for those ex-smokers who are currently vaping. So, triumphalism about large numbers of ex-smokers obtained from cross-sectional, snapshot surveys needs to be tempered.
The likely scale and consequences of each of various forms of “on-target” versus “off-target’’ use can only be assessed by surveying a very large cohort of smokers, ex-smokers and never-smokers and following them over a sufficient number of years. This will enable critical information to be gathered on vaping uptake by smokers, ex-smokers and non-smokers (especially children), duration of use, concomitant dual use of cigarettes and e-cigarettes, and smoking cessation and relapse rates comparing vaping with other approaches to quitting tobacco products.
Until this happens, e-cigarette advocates should be cautious about overhyping potential cessation benefits and dismissing potential risks.
Simon Chapman, AO, is Emeritus Professor of Public Health at the University of Sydney. He can be found on Twitter @simonchapman6
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Meanwhile in the UK , real world experience shows e-cigs reduces harm and helps smokers.
https://publichealthmatters.blog.gov.uk/2018/02/06/key-questions-and-findings-from-our-e-cigarette-evidence-update/
And from the BMJ
Doctors should state clearly that vaping is much lower risk than smoking, says report
http://www.bmj.com/content/360/bmj.k575
It’s great to see Dave B join the conversation.
Thought it would be amiss not to have the new refreshed PHE report on these comments. Highlights are worth a read.
https://phe-newsroom.prgloo.com/news/phe-publishes-independent-expert-e-cigarettes-evidence-review
https://pubs.acs.org/doi/10.1021/acs.est.6b01741
Emissions from Electronic Cigarettes: Key Parameters Affecting the Release of Harmful Chemicals
“Six principal constituents in three different refill “e-liquids” were propylene glycol (PG), glycerin, nicotine,
ethanol, acetol, and propylene oxide. The latter, with mass concentrations of 0.4-0.6%, is a possible carcinogen and
respiratory irritant. Aerosols generated with vaporizers contained up to 31 compounds, including nicotine, nicotyrine, formaldehyde, acetaldehyde, glycidol, acrolein, acetol, and diacetyl. Glycidol is a probable carcinogen not previously identified in the vapor, and acrolein is a powerful irritant.
Emission rates ranged from tens to thousands of nanograms of toxicants per milligram of e-liquid vaporized, and they were
significantly higher for a single-coil vs a double-coil vaporizer (by up to an order of magnitude for aldehydes).
PO will likely be present in most e-liquids on the market. This possibility is of particular concern because PO is
listed by the WHO/IARC as a group 2B possible carcinogen, by the U.S. EPA as a group B2 probable carcinogen,
and as a known carcinogen under California Proposition 65. In addition, PO is considered a respiratory and eye irritant.
Several harmful and potentially harmful compounds were detected, including glycidol, a compound that has not been previously reported in the vapor of e-cigarettes. Glycidol is listed by WHO/IARC as a group 2A probable carcinogen, by the U.S. EPA as a group A anticipated carcinogen, and by the State of California Proposition 65 as a compound known to cause cancer. Other compounds of concern detected at significant levels include acrolein (a severe respiratory and eye irritant, with a very low reference exposure level) and formaldehyde and acetaldehyde (both of which are listed by WHO/IARC as group 2B possibly carcinogens, by the U.S. EPA as group B2 probable carcinogens, and by the State of California Proposition 65). These aldehydes also have low reference exposure levels for respiratory and eye irritation. Emission rates of these aldehydes largely exceeding 3 orders of magnitude those corresponding to evaporation of trace levels present in the e-liquid, suggesting that emissions are the consequence of thermal decomposition of other constituents taking place during the vaping process. In addition to these compounds, diacetyl (2,3butanedione) has been associated with lung disease.
Overall, only small variations in emission factors were observed across the three e-liquids, suggesting that the main source of these chemicals was the thermal decomposition of the solvents. Emissions of formaldehyde and acetaldehyde were of the same order of magnitude as those of nicotine. These were the three most prevalent species in the vapor.”
https://www.ncbi.nlm.nih.gov/pubmed/28167683
“Among never-smokers at baseline, recent vapers were more than 4 times (RR=4.73) more likely to move away from the perception of cigarettes as posing a ‘great risk’ of harm, a finding consistent with a desensitisation process.”
CONCLUSIONS: These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth. Vaping as a risk factor for future smoking is a strong, scientifically-based rationale for restricting youth access to e-cigarettes.”
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61842-5/fulltext
The MOH NZ currently has an industry stacked advisory panel on ENDS (members are from NZ Vape companies and they even have one guy from Nerudia-Fontem Ventures-Imperial Brands!)
The chairman of the panel is Dr Hayden McRobbie
See what McRobbie’s own report says about the efficacy of e-cigs vs patches as quitting aids
“Achievement of abstinence was substantially lower than we anticipated for the power calculation, thus we had insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches or to placebo e-cigarettes. We identified no significant differences in adverse events, with 137 events in the nicotine e-cigarettes group, 119 events in the patches group, and 36 events in the placebo e-cigarettes group. We noted no evidence of an association between adverse events and study product. Interpretation E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events.
Uncertainty exists about the place of e-cigarettes in tobacco control,”
Simon,
re: your reply to Geoff, no you wouldn’t want those cancer meds or AIDS treatments mixed in someone’s basement, but the clear difference here is that vaping products aren’t medicine’s and shouldn’t be treated as if are. They are an alternate to smoking that greatly deuces the harm to the user compared to smoking.
Does the industry need some regulation? Absolutely! There isn’t an industry that doesn’t need at least some regulation, but let’s focus on a framework that ensures production standards and minimum safety standards so consumers have confidence in what their using. What TGA is doing right now is putting roadblocks between smokers and products that could save their lives. The de facto ban (yes it’s a ban) will cost lives and those that support the current regulatory requirements will have blood on their hands.
Most smokers now realise they are hitting themselves in the head with a 2 kg hammer daily
The promoters of e-cigs are telling them to use a 1kg hammer instead – the end result will be the same
Cigarettes, e-cigs, HNB gizmos are all nicotine addiction delivery systems for profit and trials on human lab rats
Recent evidence shows that certain ecig flavors cause more DNA strand and cell damage than nicotine ejuice,if the exploding battery does not maim you first
https://www.frontiersin.org/articles/10.3389/fphys.2017.01130/full
http://journals.sagepub.com/doi/10.1177/0033354917723597
http://discovermagazine.com/2017/dec/the-problem-with-ecigarettes
http://www.annualreviews.org/doi/10.1146/annurev-publhealth-040617-013757
http://www.leedsbeckett.ac.uk/news/1217-e-cigarettes-lancet-letter/
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30467-8/fulltext
https://www.sciencedaily.com/releases/2016/11/161110085644.htm
https://www.ncbi.nlm.nih.gov/pubmed/29323232
http://tobaccocontrol.bmj.com/content/early/2018/01/31/tobaccocontrol-2017-054070
http://www.ingentaconnect.com/contentone/stl/sciprg/2016/00000099/00000004/art00001#
https://theconversation.com/want-to-quit-smoking-switching-to-e-cigarettes-no-advantage-40499
https://pubs.acs.org/doi/10.1021/acs.est.7b00710
http://www.health.gov.au/internet/main/publishing.nsf/Content/principles-underpin-current-policy-regulatory-approach-electroniccigarettes-eeCigarettes-australia
https://www.medicalnewstoday.com/articles/320778.php
https://www.medicalnewstoday.com/articles/320818.php
https://www.medicalnewstoday.com/articles/315596.php
https://www.medicalnewstoday.com/articles/320040.php
https://tobacco.ucsf.edu/blogs/sglantz
https://tobacco.ucsf.edu/blogs/sglantz?page=1
https://tobacco.ucsf.edu/youth-using-alternative-tobacco-products-are-more-likely-smoke-1-year-later-including-e-cigarettes-and-smokeless-tobacco
https://www.ucsf.edu/news/2017/12/409501/youth-using-alternative-tobacco-products-are-more-likely-smoke-1-year-later
FROM THE EDITOR: Thanks Meg, you beat me to it. Folks, please stick to the issues — let’s not do the ad hominem thing. If you disagree with someone’s facts, make your argument. Otherwise I will close this discussion down. CS
Disappointing to see the discussion here playing the man, not the ball.
Please play nicely, people.
Hi Geoff, so you’d be perfectly happy if some backyard chemist mixing up something said to cure cancer, or AIDS or asthma ran the same argument that they should be exempt from TGA scrutiny because they couldn’t afford it, they had testimonies from people who swore it worked, and they were doing God’s work? And please tell me about my “industry mates”. Which industry is that. I’m really keen to know.
Come on Simon. The whole TGA thing is like saying “You can come post a letter in my letterbox, but just hand over 100’s of thousands of dollars and get past the ravenous dogs on your way through”.
I guess you’ve heard the news https://uk.reuters.com/article/us-mars-science-candy/mms-maker-publishes-science-policy-in-bid-to-boost-transparency-idUKKBN1FP2AO
Here’s how tobacco harm reduction strategies work in the real world https://nnalliance.org/blog/227-smoking-plunges-to-1-among-young-women-in-norway-media-release
Don’t you think its time for you and your industry mates to let go of an ideology that is costing lives.
“simon” as a simple ex smoker, now vaper to be described as “inveterate” is perfectly fine by me. I believe in the ethos of NOTHING ABOUT ME WITHOUT ME. I’d suggest you should listen to those of us that are afterall, the people you are trying to help!
Why don’t you answer the questions I posited to you?
You and I both know your way of legalising vaping is prohibition just by another name. You just need to look at the UK where vaping is encouraged to know that the medically approved product has not made it to market and never will. http://www.dailymail.co.uk/health/article-5351331/NHS-plan-prescribe-e-cigarettes-goes-smoke.html
We both know the TGA have even refused to assess the voke. The TGA have also refused an application to have low strength liquid nicotine be excluded from the poisons standard. Thus providing the most harmful method of using it a market advantage ie. smoking.
I’m sure many of the readers don’t realise that smokes are exempt by the TGA but the far less harmful eliquid for vaping is by virtue of the scheduling illegal.
Current scheduling status and relevant scheduling history
Nicotine is currently listed in the Poisons Standard in Schedules 7, 6 and 4, Appendix F (Part 3), and Appendix J (Part 2) as follows:
Schedule 7
NICOTINE except:
when included in Schedule 6;
in preparations for human therapeutic use; or
in tobacco prepared and packed for smoking.
https://www.tga.gov.au/book-page/21-nicotine
If you didn’t want to keep the incumbent, tobacco smoking and nrt the only way to consume nicotine legally for smokers, why did you oppose this application?
Thank you for the kind words Simon. It was remiss of me to have forgotten that no edict from public health can ever be questioned or challenged by anyone under any circumstances. Everything is well done and every approach to every health problem is perfect. Thus no new ideas or approaches to any issue are to be considered. Those who dare suggest othewise are , (quite rightly) to be personally attacked.
“Donna” is an inveterate ecig advocate who likes to misrepresent my position as “prohibitionist”. She is unable to point to any instance of me ever caling for ecigarettes to be banned. My position has always been that I support strong regulation of ecigarettes via the TGA. The fullest expression of the reasons for my position can be found here https://t.co/KnuxV6Y5EQ
Joe Kosterich says that an “ideological war [to tobacco] ended for everyone else in the early 1980’s”. Oh, really? Let’s remind ourselves about what has happened to smoking and tobacco control in Australia since the 1980s: we’ve seen adult and teenage smoking fall to all-time lows; male lung cancer incidence stopped rising and has been falling continuously since 1982; female lung cancer incidence is plateauing at a level that is way below that experienced by males; a total ban on tobacco advertising and promotion; smoke free laws in all indoor areas; tobacco taxation reform from weight-based to stick-based (look it up Joe if you don’t understand the massive implications); graphic health warnings; reduced ignition propensity cigarettes; plain packaging; duty free limits of 1 pack; retail display bans; and national public awareness campaigns that are the envy of the world and have been used in many other nations. So Joe wants the baton passed to the likes of him. Here’s Joe speaking at a conference about “health nazis” last year. I think we get the picture about the relay race Joe is running in. https://www.youtube.com/watch?v=Yoh8CuynOs4
Readers unfamiliar with the most authoritative evidence about ecigs would do well to check this summary of the conclusions about the levels of evidence that the 650p door stopper report released last month by the American National Academies of Sciences, Engineering and Medicine (NASEM) here http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24952
Three years ago my daughter aged 16 at the time visited her best friend for a sleepover. The two girls decided to get a nicotine free tobacco flavoured e cigarette to see what smoking was like. The girls puffed away on it for the evening trying to blow smoke rings and taking photos as teenage girls are apt to do.
When my daughter told me she had tried it I was unimpressed to put it mildly but she said she has wanted to see what smoking was like but didn’t want to get addicted. When I calmed down I realised that had ecigs not been around it could well have been a cigarette they experimented with. Three years later neither of them smoke or vape.
Whilst this is only one experience it shows the difference between smoking and vaping. Kids can experiment nicotine free and not risk getting addicted. This doesn’t happen with cigarettes.
The recent American report found that “Across a range of studies and outcomes, e-cigarettes appear to pose less risk to an individual than combustible tobacco cigarettes”. That a less harmful product is harder to obtain legally than a more harmful makes no sense. The UK, USA,Europe and new Zealand get this. Somewhere we have lost sight that our aim is to help smokers reduce harm, not continue to wage some ideological war which ended for everyone else in the early 1980’s. The baton needs to pass to those who apply a 21st century approach to problems.
The two questions for Simon Chapman and his prohibition buddies should be….
1. If my child, brother, sister, parent or neighbour is an committed smoker and wouldn’t or couldn’t stop, would he prefer they illegally vape instead of smoke?
2. If my teen or young adult child was prone to try stuff, would he prefer they try illegal vaping rather than legal smoking?
Essentially, Simon promotes evidence based policy. So do I. The evidence is that smoking is much more harmful than nicotine vaping and yet the latter is illegal to do in Australia. The former available to buy on every street corner.
Simon would like us to prove that vaping stops people smoking. It’s the wrong question. A terribly harmful consumer product is legal and the much less harmful product is illegal. Vaping leads to smoking abstinence and it’s harms are much less than smoking. This is a fact and no matter how many times Simon says ‘unassisted’ is the best method doesn’t change the fact that for many like me, vaping is the best method.
Vaping works because it is enjoyable and can be customised to suit the user. Maybe I should just go back to smoking because I quit the wrong way and to please those that want me to feel pain and anguish. Let’s make sure those vaper numbers don’t increase hey!
Why not allow vaping to compete fairly and squarely with the deadly competitor product, combustible tobacco?
For those of us who believe vaping is a safer alternative to smoking and are frustrated by the governments position, take heart. In my experience the more the government opposes vaping – the greater the uptake rate by smokers!
Vaping becomes infinitely more appealing if the government opposes it – especially in a mild way whereby it is still legal to get from New Zealand. I am beginning to think that there is an absolute public health genius behind the position to make it illegal to sell. Circa the Captain Cook mythology and Lime Juice.
Colin Mendelsohn seems to want to walk on both sides of the street. On the one hand he says that his 250,000 vapers figure is reasonable because it includes those who vape very occasionally (“some vapers use their vapes less than daily. No one is claiming otherwise.’) So he’s happy to count them in his estimate which is 30% over the figure (~178,000) which excludes those who vape less than once a month. But then argues that kids who only vape occasionally are really of no consequence and that “Only regular vaping is of real public health significance”. So we shouldn’t really worry about them?
Surely if Mendelsohn is keen to count less than monthly adult vapers as vapers, he should also count the very large number of children doing the same.
Leading vaping advocate Peter Hajek recently reported that over two thirds of smokers who tried as little as a single puff of a cigarette became, for a time, regular smokers (Nicotine Tob Res. 2017 Nov 4. doi: 10.1093/ntr/ntx243). Vaping advocates’ efforts to minimise the same possibilities occurring with experimental vaping are noteworthy.
Three “factoids” Mr. Chapman left out:
1) We have yet to find a single disease or condition to be caused by vaping in direct users or bystanders. Should this be monitored? Absolutely, but the evidence so far is vaping is far less harmful than smoking (whether it’s 95% or 75% or 99% safer isn’t the question that needs answering right now) and that encouraging and smokers looking to reduce harm to convert to vaping will undoubtedly save lives.
2) Never smokers of any demographic do not use e-cigarettes regularly. If vaping was as addictive as some fear, this would not be the case. Vaping does not appear to have the strong reinforcing properties that we see with smoking.
3) The gateway hypothesis that Mr. Chapman and his like minded colleagues have a penchant to hyperbolize as “bullet proof” or a “one way bridge” is still more hype than harm. Yes we do know that experimentation with e-cigarettes among youth is high, but in any area where e-cigarettes are available every metric for youth smoking (ever tried, past 30 day use, established smoker, daily smoking) is decreasing and in many instances outpacing gains in the years before e-cigarettes were available. This leads to a few possible conclusions: a) the gateway is weak and is sufficiently combatted by traditional tobacco control tactics, b) the gateway doesn’t exist at all or c) vaping isn’t creating any new smokers and is in fact diverting youth who would’ve smoked from ever trying a cigarette. No one is advocating that youth should use e-cigarettes, but the heavy hand approach and hype surrounding this hypothesis is doing harm.
There is still no study that shows a trajectory to regular smoking from vaping. All that has ever been shown is vaping is associated with experimenting with cigarettes and none can claim that those that did end up trying a cigarette wouldn’t have tried one anyway had vaping never existed.
Simon should be cautious hyperbolizing theoretical harms, and not to dismiss the appeal vaping has to committed smokers who are unlikely to quit smoking without a substitute.
Harm reduction has a place in tobacco control. Quit, or die smoking, isn’t a viable solution.
Could we speculate that the headline of this article is intended to sway politicians from thinking that there could be a large number of voters supporting parties that endorse legalising nicotine vaping and harm reduction for smokers.
Whether that number be 250,000 or 150,000, smokers and vapers have family and friends and when combined, they make up a large block of the voting public. What parent, brother, sister or child would not want their loved one to take the far less harmful road when it comes to consuming nicotine. They know that for some, quit or die is not the preferred option.
Will be interesting to see if Labor, Liberal or the Greens come out in support before the next federal election. If they don’t, the LibDem’s, Australian Conservatives and the Reason Parties might just get a heap more votes than any of the major parties expected. It will only take Nick X to get on board and every smoker/vaper will find someone to vote for other than the majors.
Thank you ‘Anonymous’. I totally agree. Vaping has the potential improve public health by helping smokers who are otherwise unable to quit.
There is a risk of uptake by young non-smokers, but it is very small. Modelling studies show that the overall net benefit is positive, even with very pessimistic assumptions about youth uptake.
We need a regulatory framework which allows legal access by adult smokers who are unable to quit while restricting access to young people. It is not rocket science.
Unfortunately, as with any survey, the data can be interpreted to support ones own specific agenda. What concerns me most however is the current stalemate between the opposing camps on this issue in Australia, with the current 3 million smokers paying the ultimate price. Whilst i agree in principal with the concerns of both Colin Mendelsohn and Simon Chapman, it frustrates me (and i’m sure the rest of all Australians who are either directly or indirectly affected by this stalemate) that the two camps have not yet been willing to accept that they both ultimately share the same goal, the health of the greater public, and be willing to put their differences aside and cooperatively develop a solution which both provides legal access to safe, certified, and controlled nicotine inclusive offerings for the 3 million addicted smokers who may wish to quit using an e-cigarette product, whilst also developing strict safeguards against the uptake of these products from youth and non-smokers alike. Surely Simon, all other issues aside would agree in principal that if in a perfect world where there was no risk of youth uptake, he would prefer to see every current smoker using an e-cigarette instead of smoking if all other quit methods had failed them, and Colin would prefer to see a restricted allowance of these products for those who need them as opposed to the current complete restriction we’re faced with now.
The author is making an assumption that e-cigarette usage has remained static since 2016. Like any novel technology, uptake is likely to grow significantly every year. I would not be surprised if e-cigarette usage was greater than 250,000.
I have several comments to make about this article
Current vapers in Australia
Simon Chapman argues that the claim that 250,000 people in Australia are currently vaping is a gross exaggeration, then confirms that 239,000 were vaping in 2016. At the rate of increase of vaping in Australia, the 250,000 estimate seems quite reasonable. Of course, some vapers use their vapes less than daily. No one is claiming otherwise. The figure is likely to be higher as many vapers are not willing to disclose their illegal behaviour.
Non-smokers vaping
Overseas data is very clear that regular vaping by adult never smokers is rare. Most vape only occasionally and do not use nicotine. In a major European study, only 0.09% of never smokers vaped nicotine daily (Farsalinos 2016). In the US, 0.1%-0.3% of never smokers vape daily (Delnevo 2015; Zhu 2017). In Germany, only 0.1% of never smokers vaped (Eichler 2016). In the UK only 0.7% of never smokers use e-cigarettes (ONS, 2017).
Vaping by children
Chapman’s concerns about vaping by children do not take into account the important different between experimentation and regular use. Only regular vaping is of real public health significance.
Solid data from overseas confirms that regular vaping is rare and confined almost exclusively to kids who already smoke. In the UK, Bauld found in a study of 60,000 teenagers that only 0.1-0.5% of never smokers were regular vapers (at least weekly) (Bauld 2017). In the US, <0.1% of never smokers vaped regularly (Villanti 2016). Moreover, progression of use beyond experimentation has not been established (Abrams 2018).
“Importantly, a large proportion of people who describe themselves as ex-smokers when they answer a survey question will relapse back to smoking at a later date. The same is true for those ex-smokers who are currently vaping”
Evidence for this?
How hard is it to get reliable stats in Australia with de-facto vaping illegality?
I am struggling for public health consistency here:
*we don’t ban cigarettes or alcohol
*we do ban vaping
*we liberalize drug laws with injecting rooms etc.
*we want to de-criminalise marijuana use and possession
Some drugs good/some drugs bad?
Dr. Miachael Gannon, the President of the Australian Medical Association (AMA) on 29 January 2018 on MJA Insight advised that the AMA took the position that the evidence on e-cigarettes, and their role in cessation and the risk they pose to young people, is not conclusive.
It is clear that the evidence on e-cigarettes is not yet compelling, and there is a very real potential that e-cigarettes can have unintended health consequences.
He also advised that the NHMRC, has funded research into e-cigarettes, which will begin to become available over the next 12–24 months.
A News Release from The National Academies of Sciences Engineering Medicine News release, one of the most comprehensive studies on health effects of E-Cigs, finds that using E-Cigs may lead youth to start smoking, and adults to stop smoking. A range of health impacts also shown on the release can be found here: http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24952&_ga=2.227315540.810940964.1516640363-1933305849.1453397105 . I totally agree with what Tahir says above.
Yes let’s wait for the evidence to come in before letting the marketing hype and novelty of ecigs lead us toward another major health problem and a windfall for the industry that created the carnage in the first place!