Croakey is closed for summer holidays and will resume publishing in the week of 15 January 2024. In the meantime, we are re-publishing some of our top articles from 2023.
This article was first published on Wednesday, May 3, 2023
Alison Barrett writes:
In the most significant tobacco and vaping control reforms in years, the Albanese Government has announced a range of measures aimed at reducing the prevalence of tobacco use, its associated harms and reducing the risk of a new generation of people becoming addicted to nicotine.
The Government will work with state and territory governments to restrict the import and sale of vaping products, increase minimum quality standards for e-cigarettes to make them less appealing, reduce allowed nicotine concentrations and ban all single use, disposable e-cigarettes.
Many public health leaders welcomed the news, including the World Health Organization’s Director-General Dr Tedros Adhanom Ghebreyesus.
Emeritus Professor Simon Chapman, a longstanding advocate for tobacco control, said in a statement:
Like plain packaging, countries around the world will be lining up to copy Australia. The Government has again stared down Big Tobacco. All companies wanted to be able to sell these products through cooperative retail outlets with years of form in selling tobacco and illegal vapes to kids.”
Dr Raglan Maddox, program lead of the Tobacco Free Program at the Australia National University, said: “We know that people who don’t smoke but use e-cigarettes are around three times as likely to take up smoking as those who don’t use e-cigarettes…these measures are a much welcome step toward accelerating reductions in tobacco use”.
Speaking ahead of his Douglas Gordon Oration at the Preventive Health Conference on Kaurna Country on Thursday, Emeritus Professor Mike Daube AO said the Government’s announcement on tobacco and vaping “is the best news the public health community has had in years”.
VicHealth CEO Dr Sandro Demaio also welcomed the announcement:
With these ground-breaking reforms, the Australian Government has demonstrated its commitment to prioritising the health and wellbeing of its citizens above the profits of the tobacco and e-cigarette industry.”
While welcoming the vaping reforms, the Alcohol and Drug Foundation said that it is important for adequate support to be in place for people who developed a nicotine dependence through vaping.
“The long-term health effects of e-cigarettes are unknown, so it’s important to take a precautionary approach,” ADF CEO Dr Erin Lalor AM said.
“It’s important that before the vaping changes come into effect, people who vape are aware of nicotine withdrawal signs, and where they can get help and support, should they want it.”
Knocking out the market
Speaking at the National Press Club on Tuesday, Butler outlined details of the vaping reforms, which are primarily targeted at the availability of non-prescription e-cigarettes.
“We want to knock out the market. We are not blaming the customers,” Butler said.
“Vaping was sold to governments and communities around the world as a therapeutic product to help long-term smokers quit.
“It was not sold as a recreational product – especially not one for our kids. But that is what it has become: the biggest loophole in Australian history.”
Highlighting the significance of the issue, recently published evidence found that 14 percent of young Australians (15-30 year old) currently use e-cigarettes and that e-cigarette use increases uptake of tobacco smoking.
In next week’s Budget, $737 million is allocated to measures to support these reforms, including public health information campaigns to prevent the uptake of vaping and smoking and education around nicotine cessation.
At the NPC, Butler said that the successful Tackling Indigenous Smoking (TIS) program, which currently has a focus on cigarette smoking cessation, will be extended and broadened to reduce vaping among Aboriginal and Torres Strait Islander people.
He also announced there will be an increase on tobacco tax from 1 September that will raise an additional $3.3 billion over the next four years, most of which will be allocated to health.
More than $260 million of the $3.3 billion will be invested in a new national lung cancer screening program.
In response, Cancer Council Australia CEO Professor Tanya Buchanan said this is a “timely addition to Australia’s successful national screening programs, with the potential to save 12,000 lives in the first ten years of the program”.
Writing for Croakey this week, Charles Maskell-Knight suggested the extra tobacco tax revenue could be invested in Closing the Gap,preventive health, assisting states with costs of public dental services, and action on the Aged Care Royal Commission recommendations.
National Tobacco Strategy
The Albanese Government also released the long-awaited National Tobacco Strategy 2023-2030, five years after the previous strategy expired.
While progress was made under the previous Tobacco Strategy (2012-2018) – including strengthened smoke-free laws and increased accessibility to nicotine-replacement therapies – challenges remain.
Even though smoking prevalence decreased across population groups and the proportion of people who never smoked has risen, tobacco use is the leading cause of preventable health burden and leading cause of cancer in Australia.
The prevalence of tobacco use among some population groups, including people who live in outer regional and remote areas and Aboriginal and Torres Strait Islander people, remains “very high”, according to the Strategy.
In 2018-19, 37 percent of Aboriginal and Torres Strait Islander people 15 years and older smoked. While this is less than the 41 percent who smoked in 2012-13, it is far more than the prevalence of smokers in overall Australian adult population, of 13.8 percent in 2017-18.
Priority Area 4 of the Strategy is to ‘strengthen and expand efforts and partnerships to prevent and reduce tobacco use among First Nations people’.
In addition to expanding the TIS program, as Butler announced at NPC, other actions outlined under this priority include monitoring and evaluating effects of programs and policies implemented to increase tobacco cessation, and ensuring First Nations people have access to culturally safe cessation supports.
“The guiding principles and actions outlined in this strategy aim to align with the spirit and the priority reform areas of the National Agreement on Closing the Gap,” the Strategy states.
Another challenge is the significant influence and power of the tobacco industry, which continues efforts to promote tobacco use to “children as new consumers of tobacco products” and invest in and promote vaping products.
Digital media is being increasingly used to promote tobacco products by the tobacco industry, an approach which “evades legislation and controls that apply to traditional forms of marketing”, according to the Strategy.
A new focus, under Priority Area 6 in the Strategy, will be needed to “monitor, identify and eliminate these forms of promotion”.
It is unclear whether this applies to the digital promotion of vape products, which as discussed below is of huge concern with promotion of vaping on social media and easy access to purchasing.
As with the vaping reforms, the updated Strategy has been welcomed (see tweets at end of article).
Quit Director Matthew Scanlon “praised the breadth and depth of the Strategy, congratulating Health Minister Mark Butler and his State and Territory counterparts for their commitment to strong regulation in the face of a resurgent tobacco industry; an industry attempting to maintain its profitability through aggressive marketing and interference in government policies aiming to end the tobacco epidemic”.
“This National Tobacco Strategy provides us with a very comprehensive road map for action to accelerate the decline in smoking rates and to address nicotine addiction. This includes policies to both discourage people from starting smoking whilst best supporting individuals to successfully quit for good”, Cancer Council’s Buchanan said.
Culturally safe support
In an interview prior to this week’s announcements, Associate Professor Michelle Kennedy, proud Wiradjuri women and researcher in smoking cessation, emphasised the key role of Aboriginal Community Controlled Health Services (ACCHS) in vaping control, as they have done in the past with tobacco.
Education about the harms of vaping delivered by people in community, including by the Aboriginal health sector, is well accepted as it is delivered in a way that’s culturally appropriate and from trusted and respected members of the community, Kennedy told Croakey.
“Our community partners have been talking about how they can be strong role models so that we’re not coming in hard and fast, like police force, but talking about our rights to be healthy and strong and safe,” Kennedy said.
She expressed concern about the harmful social, financial and health impacts of vaping in Aboriginal and Torres Strait Islander communities.
“Vaping is coming into our communities in ways that we would never allow a tobacco company to come into our communities. It’s quite alarming, and extremely dangerous and worrisome,” Kennedy told Croakey.
While vaping use appears higher in urban settings, Kennedy told Croakey she has noticed it “expanding and growing quite quickly in areas that we had not anticipated”.
“Some of our communities are trying to play catch up…and some are saying we want to get on the front foot before it is really bad here,” Kennedy said. “Our communities are talking about it with our teens as an urgent priority for us to address.”
Easy access
The new measures announced by Butler aim to restrict access to e-cigarettes, except for people with a prescription to use e-cigarettes to stop smoking.
At present, people can purchase e-cigarettes online and have them delivered to their homes without having their age checked, according to Kennedy. In addition, she has heard stories about young people buying e-cigarettes online and then selling them at school.
Also concerned about how easy it is for young people to access e-cigarettes is Sally Smith*, whose teenage son became addicted to them after the Melbourne lockdowns. (*pseudonym used for privacy)
Her son was in grade seven during the lockdowns and Smith said he missed critical social interactions with friends, as well as important education about drug and alcohol safety due to the lockdowns, which may have influenced his use of e-cigarettes.
She told Croakey she noticed an alarming increase of e-cigarettes in the community after the long lockdowns, with vape shops popping up “everywhere” including at train stations.
“It is so insidious,” she said. “Why are the vape shops still open?”
She added that most shops don’t ID buyers, and that she would like to see stronger regulations on vape shops, which are “really crucial” for controlling the epidemic.
In addition, echoing Kennedy’s comments, Smith told Croakey that social media plays a large role influencing the use of e-cigarette use in adolescents and young adults.
New generations
Unlike earlier generations, Smith said her son hasn’t grown up with tobacco control and lung cancer campaigns. She told Croakey it’s likely he and his friends weren’t aware of the potential harms of vapes.
As a caution to other parents, Smith told Croakey she guessed what her son and friends were up to as his behaviour changed, wanting to go out after school every day and also using more cologne and deodorant to mask the smell of the vapes.
However, it wasn’t until her son started vomiting uncontrollably after being with friends that she realised how bad the vaping was.
After that, Smith and her husband tried to help their son stop vaping, with the help of his GP, paediatrician and counsellor. Smith told Croakey that her son has significantly cut back on using e-cigarettes in the past six months.
“He really did want to stop properly…he knew it was bad for him because he was coughing so much,” Smith said.
Speaking to Croakey after the announcement, Smith told Croakey she welcomed the reforms, but echoing concerns raised by the ADF, said young people will need access to appropriate support to get help quit vaping.
Smith suggested the numbers for helplines be promoted strongly on social media channels Snapchat and TikTok where adolescents tend to spend their time.
Calls for support
Lindsay Whelan, Quitline’s Manager, told Croakey via email they’ve had clients as young as 12 -years-old looking for support to quit vaping, and others up to 79-years-old.
Echoing both Kennedy and Smith, Whelan said Quitline have heard of children seeing e-cigarettes being sold at school or train stations.
“Some young adults have told us they keep their vaping devices in their beds or under their pillows to conceal them from parents – they wake up during the night to vape,” Whelan said.
Quitline counsellors have reported an increasing number of calls from parents and teachers who want more information, concerned about people as young as 12, 13 and 14 years vaping.
Whelan told Croakey it has been challenging for Quitline counsellors to establish therapeutic one-on-one relationships with young people in some situations. It is important for people to want information or advice, rather than being pushed towards it.
As an ex-smoker and parent of a 17-year-old, Whelan said the level of vaping in community was very concerning, “especially as it is so accessible and so prevalent amongst his peers and can act as a gateway to smoking cigarettes”.
Note, Croakey asked Health Minister Mark Butler to comment on concerns about regulations on digital platforms and e-cigarette marketing. At time of publishing, no response had been received.
This article was funded as part of VicHeath’s ‘Health Equity Champion’ membership of the Croakey Health Media funding consortium. VicHealth had input into the selection of the topic of the article (vaping); Croakey maintained editorial control over the research, writing and publication of the article.
Vaping and smoking cessation support
Call Quitline 13 78 48; or online: https://www.quit.org.au/
How can I help my teen quit vaping? by Associate Professor Michelle Jongenelis in The Conversation
My teen’s vaping. What should I say? 3 expert tips on how to approach the ‘talk’ by Dr Joshua Trigg and Professor Billie Bonevski in The Conversation
Additional reading
Transcript of Health Minister Mark Butler’s presentation at National Press Club, 2 May 2023
National Tobacco Strategy 2023-2030, by Department of Health and Aged Care
As Queensland Government launches inquiry, public health leaders call for stronger regulations on vaping by Alison Barrett in Croakey Health Media
Will vaping reforms go up in smoke? by Jennifer Doggett in Inside Story
Why is the tobacco industry continuing to call the shots? by PhD candidate Andrew Perusco, Associate Professor Raglan Maddox and Professor Coral Gartner in Croakey Health Media
Vaping and behaviour in schools: what does the research tell us? By Associate Professor Becky Freeman, in The Conversation
Why tobacco companies’ warnings about a black market are inflated – and misleading by Professor Janet Hoek and Anna DeMello, in The Conversation
Albanese government launches war on vaping, declaring it the ‘number one behavioural issue in high schools, by Professorial Fellow Michelle Grattan in The Conversation
From Twitter
Read last year’s Croakey article on tobacco control and reform plans here
