Introduction by Croakey: Adding to the growing body of evidence about the influence of vaping on young Australians, new research has found that nearly one-third of people between 14 and 17 years have reported vaping.
In addition, the research – a collaboration between Cancer Council NSW and the University of Sydney, with funding support from the Minderoo Foundation and the NSW and Australian governments – has found that most young Australians find it easy to access nicotine vaping products.
Below, researchers on the GenVape Project Paul Grogan, Associate Professor Becky Freeman and Anita Dessaix, discuss their findings, calling for Australian governments to “to restrict all e-cigarette access, both nicotine and non-nicotine, that falls outside of TGA prescription pathway”.
Follow @WePublicHealth on Twitter next week as VicHealth take over to discuss vaping and other #unhealthyindustries.
Paul Grogan, Becky Freeman and Anita Dessaix write:
Almost one-third of young people between 14 and 17 years old have reported vaping nicotine products, of which about half had never smoked cigarettes prior.
In addition, most young people find it easy to access nicotine vaping products, according to new research from the GenVape project.
The GenVape project is the first study on the experiences of e-cigarettes among young people, parents and teachers before and after Australia’s independent Therapeutic Goods Administration (TGA) introduced streamlined nicotine prescribing rules from 1 October 2021 to protect young people from the harms of vaping.
The first report from the GenVape study – a collaboration between Cancer Council NSW and the University of Sydney, with funding support from the Minderoo Foundation and the NSW and Australian governments – was published in September.
While the TGA rules were designed to facilitate access only to individuals who think e-cigarettes might assist them to quit smoking, most vape users are young adults and teenagers not using vapes for smoking cessation.
Restricting e-cigarette access to smokers is complicated by the proliferation of vapes claiming to be nicotine-free yet when lab-tested, many are found to contain nicotine (and other highly dangerous substances).
Our first report focuses on teenagers through a cross-sectional survey of 721 people aged 14 to 17 years recruited through online panels. It provides new evidence, emphasising the growing concerns about e-cigarette use in young people and related health harms.
Growing evidence
Growing evidence and media reporting over the past two years has shown that teenagers are easily accessing vapes, despite the TGA prescribing rules and the sale of all vaping products to minors being illegal.
One-third of teenagers who took part in our survey have vaped. Of them, four out of five described that getting hold of vapes as “easy”, through a mix of multiple interrelated channels.
Of those who vaped but didn’t purchase their last vape, most obtained the product from a friend or other social contact.
Of the 30 percent who purchased vapes, 49 percent bought them from a friend or other individual and almost one third (31%) from a petrol station, tobacconist, or convenience store. Teens also purchased vapes through social media, at vape shops or from websites.
Teenagers reported that “flavour” was the main driver of product preference. Among the most popular varieties are teen-friendly flavours such as bubble gum, dessert, fruit and energy drinks.
Teens reported a preference (80%) for disposable vapes, favoured for ease of use and low cost (a single disposable vape can deliver hundreds of “puffs” for as little as $5.00).
Respondents observed that disposable products were marketed as “good for beginners”. More than half said they knew the vape contained nicotine while a quarter did not know if nicotine was in the product.
Vaping and smoking
A systematic review by the Australian National University this year found that vaping increases the risk of smoking uptake three-fold in non-smokers.
Our study showed vaping was the strongest risk factor for smoking uptake, and vice versa.
Young people who identified as ever-vapers were 18 times more likely to be ever-smokers than those who had never vaped. Among ever-vapers, more than half had never smoked before vaping.
This suggests there is not a unidirectional relationship between vaping and smoking in young people and that vaping may not preclude subsequent smoking initiation and that dual use of cigarettes and vaping products is common.
A public health crisis
Use of other harmful substances, legal and illegal, in young Australians is steadily declining.
So why is e-cigarette use going the other way?
There are four things that set vaping apart:
- the products are manufactured for and pitched at young people
- despite policies designed to protect young people from e-cigarettes, commercial entities and entrepreneurs are breaking the rules in plain sight
- it can be impossible to tell which vapes contain nicotine and which do not without laboratory testing, complicating enforcement (a prescription is not legally required for non-nicotine vapes) and
- e-cigarettes are the only harmful product promoted as a solution to the problem they are creating.
These four things did not occur through happenstance. They are all the result of ruthless exploitation by commercial interests, which recognise that mass-produced, addictive over-the-counter products are lucrative like no other business.
The market opportunity and the crisis in youth vaping which it is creating are enabled by government inaction on enforcing and tightening existing rules designed to protect young people from the short- and long-term harms of vaping.
The laws are clear. Nicotine e-cigarettes can only be legally accessed by an individual with a doctor’s prescription, like other controlled substances (nicotine for vaporising is a schedule 4 controlled substance due to its high toxicity and addictiveness).
Any vaporising nicotine products which are imported without medical authority should be confiscated at the border, just as the authorities do to other schedule 4 substances.
It is federal law, yet it is not being enforced. Any retailers other than pharmacies selling nicotine vaporising products are breaking state and territory laws, yet these laws are also poorly enforced.
Online and social media sales are also illegal, because at some point a controlled substance is being transported, stored or sold in breach of laws across jurisdictions.
Our research and other studies show that mislabelling of vapes is rife. The need to lab-test products before seizing them complicates enforcement.
Simple solution
The solution is simple. Remove e-cigarettes that claim to be nicotine-free or are not labelled as containing nicotine from the market. They are marketed under the shadow of misinformation about e-cigarettes being a safer alternative to smoking – when they have no place in smoking cessation – are full of harmful toxins and pitched at children.
Removing them would make it easier to capture nicotine vapes under the established rules and help ensure that only individuals with a prescription access them.
Adolescent vapers in our study are accessing vapes through organised commercial interests, no matter the primary source. Key access points (importer, wholesaler, online, social media, over-the-counter sales) are in plain view and facilitating – on a commercial scale – the illegal sale to children of harmful, addictive products.
A new generation of young Australians is being exposed to lung damage and nicotine addiction. We also risk undoing decades of success in youth and young adult tobacco control.
Australian governments must act now to restrict all e-cigarette access, both nicotine and non-nicotine, that falls outside of TGA prescription pathway. This will not only prevent easy access to harmful products by children, young people and non-smokers, but will also enhance the prescription-only policy.
About the authors
Paul Grogan is senior adviser to The Daffodil Centre, a joint cancer research venture between Cancer Council NSW and the University of Sydney. He is a former chair of Cancer Council Australia’s national Tobacco Issues Committee.
Becky Freeman is an Associate Professor in the School of Public Health, at the University of Sydney.
Anita Dessaix is Director, Cancer Prevention and Advocacy at Cancer Council NSW and Chair of Cancer Council’s Public Health Committee.
See Croakey’s extensive archive of articles on the commercial determinants of health.
