more_vert
The latest data from the Cancer Institute NSW Tobacco Tracking Survey (CITTS) show a sharp rise in the use of e-cigarettes in younger adult consumers, raising concerns over youth-focused marketing …
A RECENTLY published article in the Medical Journal of Australia by Associate Professor Becky Freeman and colleagues has reported notable increases in New South Wales e-cigarette consumers between 2016 and 2020.
Overall, e-cigarette use increased from 6.6% of survey respondents to 13% in 2020. The proportion of 18–24-year-old respondents using e-cigarettes tripled to 27.2%, and the proportion of 25–39-year-old respondents using e-cigarettes doubled to 16.1%. For smokers and recent quitters aged 40 years and over, there was no substantial change in the use of e-cigarettes.
The rise of vaping among young people contrasts with the claims of tobacco companies that e-cigarettes are designed to help older smokers quit. Notably, only one-third of survey respondents using vape products claimed they were using them to help them quit smoking.
Anita Dessaix, one of the co-authors of the MJA article and Director of Cancer Prevention and Advocacy for the Cancer Council NSW, explained, “[e-cigarettes] were only meant to be used by smokers who, in consultation with their doctor and under [Therapeutic Goods Administration] laws, had obtained a valid doctor’s prescription. This study provides up-to-date data that the users of these products are up the younger end of the spectrum as opposed to the older end of the spectrum. So that doesn’t really stack up as far as the original intended purpose of these products”.
The article found that the marketing of vaping products was largely targeted towards young people. Notable marketing tactics included:
- using social media “influencers” to advertise products (here);
- sponsoring music festivals (here);
- using fashion and style trends in their promotions (here);
- maintaining commercial relationships with international motor sport, including Formula One (here); and
- designing their products to appeal to younger people via visual appearance, the wide variety of flavours, and the low price point (here).
Lead author, Associate Professor Freeman commented on the context of these tactics, saying, “you have these companies who want to claim that the reason we need vaping products so readily available in Australia … is because they help people to quit. But actually the reason they want them available is so that they become normalised and that they’re used by young people”.
Measures are being implemented in NSW to limit e-cigarette use, including banning retail displays of products and banning the use of e-cigarettes in smoke-free enclosed public places (here and here).
As of October 2021, a prescription is required in order to purchase nicotine-containing vape products in Australia. However, many over-the-counter nicotine-free products are actually found to contain nicotine when tested, and are being sold illegally.
Freeman commented, “With a non-nicotine containing e-cigarette, you can just pop down to your local convenience store and pick one up. When NSW Health sees these products at convenience stores or tobacconists and tests them, invariably they have nicotine in them, so they’re being sold illegally”.
Despite 22% of survey respondents saying they used vape products because they believed they were better for them than regular cigarettes, the flavours and chemicals used in vape products are often toxic, cancer-causing, and not safe for inhalation (here).
“We actually don’t know conclusively what the long term health effects of nicotine vaping products are,” Dessaix commented. “So caution is still warranted.”
The Therapeutic Goods Administration has just closed calls for consultation around changes to the regulation of nicotine vaping products given that, according to its November 2022 consultation paper, “there is evidence that many adults are accessing [nicotine vaping products] without a prescription, rather than through lawful supply channels with a prescription from an Australian doctor”.
The Heart Foundation has already welcomed the move with a statement on 17 January 2023. “With increasing evidence that e-cigarette use by young people can be a gateway to smoking and nicotine addiction, the Heart Foundation supports the commitment of all Australian governments to maintaining a precautionary approach to e-cigarettes.”
Alecia Brooks, Tobacco Control Unit Manager with Cancer Council NSW and co-author of the MJA article, believes policies around restricting access to vape products are essential in turning the tide of the youth vaping uptake, commenting, “If you have access to a product, it speaks volumes to young people around what is acceptable and what is safe as well. So young people think, if I can buy this from the corner shop, then surely it’s not that harmful. And so that’s first line of defence for us”.
Removing e-cigarettes products from general retail sale could help limit the supply of illegal vape products, while also strengthening the prescription model for smokers using e-cigarettes to help quit smoking.
“If you’re a smoker who’s tried absolutely everything you can to quit,” Freeman said, “and you and your health professional decide that vaping might help you stop smoking, then that’s who this product is for. No one else should be vaping.”
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners
The provision of e cigarette cessation services for adolescents in clinical settings is a fundamental clinical responsibility and permits the opportunity to assist with cessation more effectively. Moreover, systematic integration of evidence-based e cigarette cessation has yet to be broadly viewed as a standard-of-care. The role of clinicians in prioritizing adolescents e cigarette cessation is essential in all settings.
Adolescents have the right to tobacco free lifestyles. The health care community, parents and caregivers all have a huge responsibility to protect our next generations’ health and wellbeing. Therefore, policymakers in the health regulation agencies should ensure that all social media content associated with e-cigarettes is consistent with official health guidance and ensure that only accurate information is being posted on these platforms- popular among our vulnerable children.
Adolescents have the right to tobacco free lifestyles. The health care community, parents and caregivers all have a huge responsibility to protect our next generations’ health and wellbeing. Therefore, policymakers in the health regulation agencies should ensure that all social media content associated with e-cigarettes is consistent with official health guidance and ensure that only accurate information is being posted on these platforms- popular among our vulnerable children.
A couple of qualifications:
1) The percent of youth regular vapers is far lower than the reported percent of “users” (e.g., 27.2% 18-24yo in NSW) above.
Defining percent of people who have ever tried vaping as “users” is not particularly meaningful when trying to assess health burden or risk of it being a gateway drug (or even consistent with the connotations of the word “user” — the referenced paper would have been better avoiding the term and reporting what they found: percent who “have ever used…”.
Your reference “Electronic cigarettes and health outcomes: systematic review of global evidence”, gives a more meaningful stat, the percent by age of those who have vaped in the past week (daily, weekly, or less than weekly), which for 18-24yo is only 5%, with percent decreasing with increasing age bracket. Far less sensationalistic.
2) I do not believe that the systematic review referenced supports the claim “the flavours and chemicals used in vape products are often toxic, cancer-causing, and not safe for inhalation”. For example, the review reports that there is no evidence of cancer risk with vaping due to lack of studies (and limited time period to examine since vaping has been available). OTOH using terms like “toxic” or “not safe” isn’t particularly helpful since not terribly meaningful in toxicology — e.g., toxicity is dependent on dose, time frame, and route, and applies to all chemicals, even H2O, and even colloquially anything not considered benign, including nicotine itself which in high acute doses can kill but at low doses is not very dangerous, though as a stimulant has some obvious short-term side effects like ‘increased heart rate” as ‘found’ and reported in the review.
The risks of vape flavourings are chiefly unknown and therefore theoretical, with the two known dangerous additives no longer used by commercial producers — one of which was used by some early producers as a flavour enhancer, the culprit behind ‘popcorn’ lung (a form of reversible chronic bronchitis) because of its discovery in factory workers exposed to aerosolized artificial popcorn butter (which finding caused vape scare campaign #1), and the other being fat-soluble vitamin E found in some previous underground vape liquids used primarily in THC delivery and which caused ~20 deaths in the US (vape scare #3). Formaldehyde, not an additive, was behind vape scare #2 in response to a study showing that if one were to burn their vape liquid (rather than aerosolizing it) using unrealistically high temps that caused it to be intolerable to the user, formaldehyde was formed.