E-cigarettes

E-cigarettes in Australia

The use of e-cigarettes (vaping) to quit is a controversial topic which continues to be debated internationally. In Australia, we have a tightly regulated environment where the sale and use of e-cigarettes containing nicotine is illegal. Despite this, around 30% of all Australian smokers have tried e-cigarettes. According to the Talking About the Smokes survey, 21% of Aboriginal and Torres Strait Islander smokers have tried e-cigarettes. Of those Aboriginal and Torres Strait Islander people who had tried e-cigarettes, they were:

  • younger
  • living in non-remote areas or more advantaged areas
  • daily smokers
  • wanting to quit, having made a quit attempt/used NRT in the past year.

We also know from a recent survey that e-cigarettes are increasingly popular in Australia, with those containing nicotine and flavourings preferred by young people, many of whom have never smoked conventional cigarettes. This suggests that many Australian vapers are not using e-cigarettes to help them quit. It is therefore important to stay up-to-date with the evidence in the area. Much of this evidence comes from studies and surveys carried out in the USA and UK, where e-cigarettes are more readily available.

What are the risks of vaping?

Using e-cigarettes 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:

  • e-cigarettes have not been around long enough for all the effects to show
  • not enough research looking at the health effects has been completed
  • most vapers are former smokers, so it can be difficult to separate the effects of e-cigarette use from long-term tobacco use.

Although we still need more and better research into the outcomes of e-cigarette use, the emerging evidence suggests that using e-cigarettes:

  • changes lung functioning suggesting a potential link to respiratory health problems
  • may be associated with an increased risk of heart attack
  • could lead to ‘popcorn lung’ (bronchiolitis obliterans), an irreversible lung disease
  • may affect fertility
  • lowers immunity, meaning vapers have a higher risk of catching colds, flu or other infections.

Some of these harms are actually caused by the flavours that are added to e-cigarettes. Studies have shown that vapers 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.

The emerging evidence also suggests that using e-cigarettes containing nicotine during pregnancy is at least as harmful for the baby as smoking conventional cigarettes.

What are the risks to passive bystanders?

The vapour produced by e-cigarettes 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 Organisation 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 produced by e-cigarettes are probably less harmful to bystanders than cigarette smoke, but they are not completely harm-free.

Can vaping help someone to quit?

The evidence is mixed around the effectiveness of e-cigarettes for quitting the smokes. International studies have found that many vapers carry on smoking tobacco, although this may be at reduced levels. A recent trial carried out in the UK compared NRT with vaping, and found that people given e-cigarettes were more likely to stop using conventional cigarettes than those given NRT. E-cigarette users 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 e-cigarettes as a quit method since:

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

Is vaping a gateway to tobacco use?

There is a lot of debate about whether access to e-cigarettes creates a new pathway into harmful behaviours for the next generation. The most recent evidence to emerge from the USA suggests that:

  • over half of all e-cigarette users are under 35 years of age
  • just over 9% of 18-24 year olds are regular e-cigarette users
  • adolescent e-cigarette users experience symptoms of dependence which may be barriers to e-cigarette cessation
  • more teens in the USA smoke e-cigarettes than conventional cigarettes
  • use of e-cigarettes by adolescents may lead to an increase in the use of conventional cigarettes over time.

So, we know that e-cigarettes are popular with young people, and there is a strong like between vaping and smoking. However, it is not possible to tell from the evidence we have, if e-cigarette use leads to conventional cigarette smoking or vice versa. What the latest data from the USA does suggest is that young people use e-cigarettes 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. E-cigarette use in young people is a problem because:

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

Even if vaping does not lead to conventional cigarette use, using e-cigarettes 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 smoking then ever before, introducing a new pathway to harmful addictive behaviour would be very worrying.

Further reading