Facts about vaping (e-cigarettes)

Vaping (e-cigarettes) in Australia

The use of vapes (e-cigarettes) to quit tobacco smoking is a controversial topic which continues to be debated internationally. In Australia, the sale and use of non-nicotine vapes by adults is controlled by state and territory laws. This means restrictions vary across the country. Nicotine vapes are covered by federal law, because nicotine is regulated as a poison by the Therapeutic Goods Administration (TGA). Australia has taken strong action to address recreational vaping by introducing reforms restricting the importation, manufacture and supply of vapes. For the latest information on vaping reforms, visit the TGA’s Vaping hub. The sale and use of nicotine vapes is illegal without a valid prescription as described below.

According to the National Drug Strategy Household Survey (NDSHS) 2022-2023, vaping increased across Australia between 2019 and 2022–‍2023 for most population groups, including Aboriginal and Torres Strait Islander people. The NDSHS found that for Aboriginal and Torres Strait Islander people aged over 14 years who were livening in non-remote areas:

• almost 1 in 3 had ever tried a vape (31%)
• around 7% reported using vapes regularly (e.g., daily weekly, monthly)
• 1 in 20 both smoked and used vapes (5.1%).

Analysis of the 2018-19 National Aboriginal and Torres Strait Islander Health Survey by the Australian National University found Aboriginal and Torres Strait Islander people who had tried vaping were more likely to be:

• male
• younger (under 45 years of age)
• living in urban and regional areas.

Vaping is increasingly popular in Australian youth who prefer vapes that are:

• cheap
• easy to conceal
• contain nicotine and flavourings.

Many youth who vape have never smoked conventional cigarettes. This suggests that many people in Australia who vape are not using vapes to help them quit. Staying up-to-date with the evidence about vaping is important as it is an evolving area of study. The Lung Foundation Australia, in partnership with La Perouse Local Aboriginal Land Council’s TIS team Na Joomelah, and the NBPU TIS created a resource package, consisting of three short animations and accompanying factsheets, to help young First Nations people better understand how vaping can affect them, the people around them and the environment. You can access the resource package here.

The NBPU TIS has also created a series of factsheets to keep you up to date, they cover vaping as a smoking cessation aid, health outcomes and other risks of vaping, and vaping in Australia. You can find the latest evidence updates on vaping on the Tobacco Control News page.

 

At the National TIS Workers Workshop held in Darwin on 7-8 March 2023, a Nation to Nation café session took place. In the session, TIS teams discussed vaping and what activities they were doing to change youth attitudes and behaviour about vaping. You can read the report summarising the key findings of the café here.

What are the risks of vaping?

Vaping may be less harmful than smoking conventional cigarettes. However, this does not mean that using them is harm-free. At the moment we don’t really know how harmful vaping might be because:

• vapes have not been around long enough for all the effects to show
• not enough research looking at the health effects has been completed
• most people who vape used to smoke, so it can be difficult to separate the effects of vaping from long-term tobacco use.

In 2022, a review of global evidence on the health effects of vaping was commissioned by the Australian Department of Health and conducted by the National Centre for Epidemiology and Population Health. You can read a summary of the findings here. Although we still need more and better research into the outcomes of vaping, the emerging evidence suggests that vaping:

• changes lung functioning suggesting a potential link to respiratory health problems
• may be associated with an increased risk of heart attack
• may affect fertility
• lowers immunity, meaning people who vape have a higher risk of catching colds, flu or other infections
• is highly addictive and exposure during adolescence can change the structure and function of the brain
• can cause injury, including poisoning, seizures and burns.

Some of these harms are actually caused by the flavours that are added to vapes. Studies have shown that people who vape are exposed to heavy metals such as chromium, nickel and lead in greater quantities than in conventional cigarettes. High concentrations of these heavy metals have been linked to health problems such as cardiovascular disease, brain damage, and cancer. A 2021 study from Curtin University identified a number of chemicals in vapes that are known carcinogens. You can find out more about this study and the range of chemicals they found and their health risks by listening to this short podcast.

The emerging evidence also suggests that using vapes containing nicotine during pregnancy is at least as harmful for the baby as smoking conventional cigarettes. Animal studies have also shown that flavourings in non-nicotine vapes can affect the developing heart and lungs.

Vapes, particularly disposable devices which are popular among young people, here. 

For more information on the safety challenges associated with vaping and implications for Aboriginal and Torres Strait Islander tobacco control, you can watch this webinar, hosted by the Aboriginal Health and Medical Research Council of NSW (AH&MRC).

What are the risks to passive bystanders?

The vapour produced by vaping does contain toxins, although many of these are at lower levels than the smoke produced by conventional cigarettes. However, exposure to some toxins (such as heavy metals) may be greater than in conventional cigarettes. The World Health Organization states than any level of exposure to these substances may be harmful and should be avoided. We also know that passive exposure to e-cigarette vapour can aggravate existing chronic health conditions such as asthma or COPD. So those clouds of vapour are probably less harmful to bystanders than cigarette smoke, but they are not completely harm-free. A summary of recent research papers about passive vaping can be found here. One of the key messages from this summary is that homes and cars should be vape-free, as well as smoke-free, to protect children and adults from exposure to harmful second- and third-hand aerosol.

Can vaping help someone to quit?

The evidence is mixed around the effectiveness of vaping for quitting the smokes. International studies have found that many people who vape carry on smoking tobacco, although this may be at reduced levels. A trial carried out in the UK in 2019 compared NRT with vaping, and found that people given vapes were more likely to stop using conventional cigarettes than those given NRT. The people who vaped were also more likely to report maintaining this tobacco-free status at one year follow-up. However, this study does not provide enough evidence to support the use of vaping as a quit method since:

• the majority (80%) were still vaping at one year follow-up, suggesting most people who smoke had simply replaced conventional cigarettes with vaping
• the better quit rate for vaping might reflect the incorrect use of NRT, rather than any advantage for vapes.

More recently, a trial in Australia found no advantage for vaping over standard NRT use for quitting smoking.

Access to nicotine vapes in Australia

General Practitioners (GPs) have been able to prescribe nicotine vapes under a special access scheme since 2020. However, nicotine vapes are a last resort rather than a first line treatment. With a prescription, nicotine vapes are available in some pharmacies. They are not available in other retail stores. To make sure all Australians were aware of this change in the law, the TGA ran a communication and education campaign. As a part of this campaign, NBPU TIS worked with TIS funded teams to co-redesign some of the TGA resources to ensure messaging was tailored to Aboriginal and Torres Strait Islander people. These resources are available to download here. You can read more about vaping regulations here.

In the video below, National Coordinator for TIS, Professor Tom Calma AO answers questions about what vaping is, the laws around nicotine vaping, and the effectiveness of vaping as a method to quit smoking.

Is vaping a gateway to tobacco use?

There is a lot of debate about whether access to vapes creates a new pathway into harmful behaviours for the next generation. A recent review of the international evidence from ANU found that vaping was strongly associated with becoming a regular tobacco user. The study authors conclude that a gateway effect for vaping is supported by this evidence.

It is important to remember that because the evidence we have is only observational, it is not possible to be 100% certain that vaping causes conventional cigarette use. Some experts argue that vaping and conventional cigarette use are both explained by a third factor – for example young people who are drawn to try new experiences or to take risks, will try both vaping and conventional cigarettes. This is known as the common liability theory. However, support for the gateway effect is strengthen by evidence from the USA that:

• around three-quarters of young people who begin their use of conventional cigarettes by trying vaping do not show the characteristics usually associated with tobacco use 
• young people use vapes differently to adults. While adults usually reduce their tobacco smoking when they increase vaping; when young people increase their vaping, they increase their tobacco smoking as well.

This is not the only concern with the popularity of vaping with young people. Vaping by young people is a problem because:

• nicotine in vapes can negatively affect adolescent brain development
• non-nicotine vapes still contain toxic chemicals and so pose a potential harm to health.

Even if vaping does not lead to conventional cigarette use, vaping can be addictive and harmful, so this is a concern. At a time when we know that fewer Aboriginal and Torres Strait Islander young people are taking up tobacco smoking than ever before, introducing a new pathway to harmful addictive behaviour is very worrying.