Electronic cigarettes
Electronic cigarettes (also known as e‑cigarettes, e‑cigs, electronic nicotine delivery systems, electronic non‑nicotine delivery systems, alternative nicotine delivery systems, personal vaporisers, e‑hookahs, vape pens or vapes) are devices designed to deliver nicotine and/or other chemicals via an aerosol vapour that the user inhales (Greenhalgh & Scollo 2018). Most e‑cigarettes contain a battery, a liquid cartridge and a vaporisation system and are used in a manner that simulates smoking (ACT Health 2019). The liquid solution used in e‑cigarettes can contain nicotine, but also flavourings and other chemicals. In Australia, it is illegal to sell e‑cigarettes and e‑liquids that contain nicotine in any form (Cancer Council 2017), however, it may be lawful for people to import up to 3 months’ personal supply of nicotine for personal therapeutic use in e‑cigarettes with a written authorisation from a doctor, subject to state and territory laws (TGA 2019).
Australian governments have taken a precautionary approach to the marketing and use of e‑cigarettes in view of the risks these products pose to tobacco control and population health. This approach is underpinned by the current state of evidence regarding: the direct harms e‑cigarettes pose to human health, their impacts on smoking initiation and cessation, uptake among youth and dual use with conventional tobacco products (Byrne et al 2018; Gotts et al 2019; Kennedy et al 2019).
New questions about the frequency and duration of e‑cigarette use were added to the NDSHS in 2016. According to the NDSHS in 2019:
- current use of e‑cigarettes reported by people aged 18 and over increased from 1.2% in 2016 to 2.6% in 2019
- among current smokers aged 18 and over, almost 2 in 5 (38%) had tried e‑cigarettes in their lifetime (an increase from 31% in 2016) and 9.6% currently use them (an increase from 4.4% in 2016)
- among non‑smokers aged 18 and over, 6.8% had tried e‑cigarettes in their lifetime (an increase from 4.7% in 2016) and 1.4% currently use them (an increase from 0.6% in 2016)
- e‑cigarette use was higher among younger age groups with 64% of smokers aged 18–24 trying an e‑cigarette in their lifetime, compared with 26% of smokers aged 60–69 (AIHW 2020a).
In 2017, 1 in 5 (21%) secondary school students aged 16–17 had tried e‑cigarettes (Guerin & White 2018).
The most common reason for trying e‑cigarettes for people aged 18 and over was curiosity (53%), but people’s reasons varied by age (AIHW 2020a).
Smoking was responsible for 9.3% of the total burden of disease in Australia in 2015, making it the leading risk factor contributing to disease burden. Almost three-quarters (73%) of the burden due to smoking was fatal—that is, due to premature death. In 2015, smoking was responsible for more than 1 in every 8 (21,000) deaths.
Cancers accounted for 43% of the burden of disease from smoking, and almost two-thirds of this was from lung cancer (28% of total burden). Chronic obstructive pulmonary disease (COPD) accounted for 30% of the burden, followed by cardiovascular diseases (17%) primarily related to coronary heart disease (10%) and stroke (3.1%) (AIHW 2019).
Tobacco use has remained the leading risk factor, but the disease burden from smoking fell from 10.5% of total burden to 9.3% between 2003 and 2015. After adjusting for age, the rate of disease burden from smoking showed a decrease of 24% between 2003 and 2015, with a greater decrease in males than females. The burden also fell for all 6 of the leading diseases that are linked to smoking (COPD, lung cancer, coronary heart disease, stroke, oesophageal cancer and asthma). However, while the burden linked to current smoking decreased, the burden linked to past smoking (ex-smokers) rose. This is likely to be because some diseases associated with smoking, such as lung cancer and COPD, can take many years to develop. As a result, the effects of past smoking are expected to continue to have an impact on disease burden in the near future, even if smoking rates continue to decrease (AIHW 2019). See Burden of disease.
A major Australian study estimated that mortality from cardiovascular disease (CVD) is almost 3 times higher in current smokers than never smokers (Banks et al. 2019). Quitting smoking at any age substantially reduces a person’s risk of CVD, with those quitting by age 45 avoiding almost all of the excess risk (Banks et al. 2019).
Remoteness area
The burden of disease attributable to tobacco use is unequally distributed across Australia. In remote and very remote areas tobacco use was responsible for 10.7% of the total burden of disease, compared with 8.5% in major cities in 2015. After adjusting for age, rates similarly showed that burden of disease attributable to tobacco use increases as remoteness increases, with Remote and very remote areas experiencing 1.8 times the burden of Major cities (AIHW 2019).
Socioeconomic area
There was a clear gradient of decreasing burden as socioeconomic position increased. In the lowest socioeconomic areas (those experiencing the highest socioeconomic disadvantage), tobacco use was responsible for 11.7% of the total burden of disease, compared with 6.5% in the highest socioeconomic areas (those experiencing the least disadvantage). After adjusting for age, rates similarly showed that burden of disease attributable to tobacco use was 2.6 times higher in the lowest socioeconomic area than in the highest socioeconomic area (AIHW 2019).
Exposure to second-hand smoke affects people of all ages and can cause cardiovascular and respiratory diseases in adults, and in infants and children can cause low birthweight and sudden infant death syndrome, and induce and exacerbate a range of mild to severe respiratory effects (WHO 2018).
Results from the 2019 NDSHS show that parents and guardians are choosing to reduce their children’s exposure to smoke inside the home. The proportion of households with dependent children where someone smoked inside the home fell from 19.7% in 2001 to 2.8% in 2016 and to 2.1% in 2019 (AIHW 2020a).
Between 2016 and 2019, the proportion of adult non-smokers exposed to tobacco smoke inside the home decreased from 2.9% to 2.4%, this was lower than in 2001 (10.6%) (AIHW 2020a).
Proportions of smoking during pregnancy in Australia have fallen over time, with fewer than 1 in 10 (9.6%, or 28,219) mothers who gave birth smoking at some time during their pregnancy in 2018, a decrease from 15% in 2009 (AIHW 2020b).
Despite the decline in smoking proportions in Australia over recent decades, a significant health and economic burden is experienced by individuals and society. The total net cost of smoking in Australia in 2015–16 has been estimated at $136.9 billion, comprising $19.2 billion in tangible costs and $117.7 billion in intangible costs. The largest of these tangible costs was spending on tobacco by dependent smokers ($5.5 billion), followed by workplace costs ($5.0 billion) and the reduction in economic output due to premature mortality ($3.4 billion). Intangible costs were estimated using the value of life lost and pain and suffering caused by smoking-attributable ill health ($25.6 billion), and premature mortality ($92.1 billion) (Whetton et al. 2019).
For more information on tobacco smoking, see:
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References
ABS (Australian Bureau of Statistics) 2019a. National health survey, first results, 2017–18. Cat. no. 4364.0.55.001. Canberra: ABS.
ABS 2019b. National Health Survey, 2017–18. Customised report. Canberra: ABS.
ACT Health 2019. Electronic cigarettes. Viewed 21 January 2020.
AIHW (Australian Institute of Health & Welfare) 2019. Burden of Tobacco Use in Australia: Australian Burden of Disease Study 2015. Cat. no. BOD 20. Canberra: AIHW.
AIHW 2020a. National Drug Strategy Household Survey 2019. Drug statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW.
AIHW 2020b. Australia’s mothers and babies 2018 — in brief. Perinatal statistics series no. 35. Cat. No. PER 100. Canberra: AIHW.
Banks E, Joshy G, Korda RJ, Stavreski B, Soga K, Egger S et al. 2019. Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study. BMC Medicine 28(128):1–18.
Byrne S, Brindal E, Williams G, Anastasiou KM, Tonkin A, Battams S and Riley MD (2018). E-cigarettes, smoking and health. A Literature Review Update. CSIRO, Australia.
Cancer Council 2017. National Cancer Control Policy: position statement—electronic cigarettes. Viewed 13 June 2018.
Gotts et al 2019. What are the respiratory effects of e-cigarettes? BMJ.
Greenhalgh EM & Scollo MM 2018. In Depth 18B: electronic cigarettes (e-cigarettes). In: Scollo MM and Winstanley MH (eds). Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria. Viewed 12 June 2019.
Guerin N & White V 2018. Australian secondary students’ use of tobacco, alcohol, over-the-counter drugs, and illicit substances in 2017. Victoria: Centre for Behavioural Research in Cancer. Viewed 5 November 2019.
Kennedy et al 2019. The cardiovascular effects of electronic cigarettes: A systematic review of experimental studies. Preventive Medicine.
TGA (Therapeutic Goods Administration) 2019. Electronic cigarettes. Viewed 4 May 2020.
WHO (World Health Organization) 2018. Tobacco fact sheet.
Whetton S, Tait R, Scollo M, Banks E, Chapman J, Dey T et al. 2019. Identifying the social costs of tobacco use to Australia in 2015/16. Perth: National Drug Research Institute, Curtin University.