Tobacco and e-cigarettes/vapes
Background
Tobacco use is responsible for more deaths in Australia than alcohol and illicit drugs combined and causes more deaths than any other behavioural risk factor (AIHW 2021). Use of electronic cigarettes and vapes (e‑cigarettes) has increased markedly in the last 10 years, and while the long-term harms are not fully known, the National Health and Medical Research Council has advised that “all e‑cigarette users are exposed to chemicals and toxins that have the potential to cause adverse health effects”.
It is important to monitor the use of tobacco and e‑cigarettes in Australia, in order to measure progress, determine populations that are most at risk, and identify any potential areas for intervention.
The average age of people who smoke tobacco is increasing
Between 2019 and 2022–2023, among people aged 14 and over, daily tobacco smoking dropped from 11.0% to 8.3%.
This drop occurred for most age groups, with the smoking rates for people aged 25–29 and 30–39 dropping below 10% for the first time. However, the daily smoking rate for people aged 60–69 and 70 and over did not change between 2019 and 2022–2023 (Figure 11).
Figure 11: Daily smoking by age, 2010 to 2022–2023
Source: NDSHS 2022–2023, Table 2.4.
As a result, the average age of people who smoke tobacco now is much older than in previous years. Around 1 in 4 (25%) people who smoked daily were aged 60 or older in 2022–2023, compared to around 1 in 7 (13.6%) in 2010.
And while fewer young people are taking up smoking in the first place, the proportion of older people quitting smoking has not shifted substantially and may require additional support to see declines in future years.
Vaping and e‑cigarette use increased, especially among young people
E‑cigarette policy in Australia
From early 2024, new regulations on vapes and electronic cigarettes (‘e‑cigarettes’) come into effect. These include restrictions on the importation of vapes (including those that do not contain nicotine), except for therapeutic purposes, such as tobacco smoking cessation and nicotine dependence (TGA 2023).
The 2022–2023 NDSHS was conducted before these restrictions were put into place. At the time, in most jurisdictions, it was legal for adults to purchase e‑cigarettes that did not contain nicotine without restrictions. Adults could also import nicotine e‑cigarettes with a prescription.
These results reflect the prevalence of electronic cigarette and vape (‘e-cigarette’) use among young people in Australia prior to the new restrictions coming into effect in 2024. Between 2019 and 2022–2023, the use of ‘e‑cigarettes’ in Australia rose substantially, particularly among young people.
While current use of e‑cigarettes among people aged 14 and over nearly tripled between 2019 (2.5%) and 2022–2023 (7.0%), it quadrupled among people aged 18–24 (from 5.3% to 21%) and increased more than five-fold among people aged 14–17 (from 1.8% to 9.7%). In contrast, only 1.6% of people aged 60–69 currently used e‑cigarettes in 2022–2023, and just 0.4% of people 70 and over were using them. This is the opposite pattern to tobacco smoking, which was more common among older people.
As shown in Figure 12, younger people and older people who did use e‑cigarettes had very different reasons for doing so. Young people were most likely to use them out of curiosity, or because they thought that e‑cigarettes taste better than regular cigarettes, while older people were most likely to use them to help them quit smoking.
Figure 12: Main reasons for using e‑cigarettes by selected age groups, 2022–2023
Note: People could select more than one response.
Source: NDSHS 2022–2023, Table 3.34.
This means that use of e‑cigarettes to quit smoking is much less common than use of e‑cigarettes out of curiosity, due to the fact that younger people were the most likely to use e‑cigarettes and the least likely to smoke tobacco in 2022–2023.
Results from the National Drug Strategy Household Survey do not provide evidence for or against the use of e-cigarettes as a smoking cessation tool, or as a gateway to tobacco smoking. The age groups most likely to smoke tobacco in 2019 and 2022–2023 were the least likely to use e-cigarettes, and the age groups most likely to use e-cigarettes had low tobacco smoking rates in 2019 and 2022–2023.
The impact of socioeconomic area on smoking and e‑cigarette use
Use of e‑cigarettes, as with use of tobacco cigarettes, is not the same among everyone in Australia. In previous years, people living in the most disadvantaged socioeconomic areas were consistently the most likely to smoke tobacco daily. This was also the case in 2022–2023, as higher levels of socioeconomic disadvantage were associated with higher rates of tobacco smoking (Figure 13).
Figure 13: Current use of tobacco, e‑cigarettes, or both, by socioeconomic area, 2022–2023
Source: NDSHS 2022–2023, Table 3.43.
However, the opposite was true for the use of e‑cigarettes. Current use of e‑cigarettes was more likely in areas of more socioeconomic advantage. In the most advantaged socioeconomic areas, people were more likely to use e‑cigarettes than to smoke in 2022–2023.
The proportion of people who reported both smoking and using e‑cigarettes was similar across all socioeconomic areas.
Taken together, the results show that e‑cigarettes as a smoking cessation aid are not reaching key demographic groups that have high levels of smoking (older people and those living in areas of high socioeconomic disadvantage), and that vaping is higher among groups with pre-existing lower levels of smoking (younger people and those living in areas of high socioeconomic advantage).