Australia: Teens who have vaped are 5 times more likely to smoke

A new study led by the Daffodil Centre, Cancer Council NSW and the University of Sydney, and published in the Australian and New Zealand Journal of Public Health[1], says Australian teenagers aged 12 to 17 are five times more likely to try smoking tobacco after vaping.

The authors used data from the Generation Vape survey of over 5,100 adolescents aged 12 to 17 years in a retrospective cohort analysis. The data were collected in 2023, before new Australian legislation that allows vaping products to be purchased only in pharmacies comes into effect on 1 July 2024.[2].

A gateway effect even more pronounced among young adolescents

Even after accounting for other factors that may influence a youth’s likelihood of trying vapes or tobacco, the estimated rate of smoking initiation was nearly 5 times higher among teens who had ever vaped than among those who had never vaped. The age-specific results show that the younger a person started vaping, the higher the rate of smoking initiation. Twelve-year-olds who had ever vaped were 29 times more likely to later smoke than those who had never vaped. The risk was 11.5 times higher for 13-year-olds, 6.3 times higher for 14-year-olds, and 2.4 times higher for 17-year-olds.

The association between vaping and later smoking initiation also varies across population groups. For example, among adolescents who had ever vaped and identified as non-binary, smoking initiation was 8.4 times higher (4 times higher among boys and 5.4 times higher among girls). Adolescents living in urban areas who had ever vaped were more likely to later initiate smoking: 5.3 times more likely v/ 3.7 times more likely among adolescents living in more rural areas. Finally, adolescents who had ever vaped and who were from the most affluent social groups were more likely to later smoke than those from the least advantaged social groups (6.2 times more likely vs. 2.2).

The importance of implementing strong measures to regulate vaping

Becky Freeman, an associate professor at the University of Sydney who oversaw the study, said the latest study supports the relevance of national vaping laws passed this year and stresses the need for them to be strictly enforced going forward.

Australia has observed a general downward trend in smoking among adolescents aged 12–17 years since the mid-1990s, but recent analysis of six-monthly monitoring data from 2018 to 2022 suggests a possible increase in current smoking among 14–17 year olds, from 2.1 % to 6.7 %, and a sharp increase in vaping, from 0.8 % to 11.8 %.[3].

For the authors, although e-cigarettes were initially presented as an aid to smoking cessation for adult smokers, "The weight of vaping and its diverse consequences among young adolescents underline the consequences for public health of a market whose marketing and access to products have not been controlled."

The influence of digital advertising on youth consumption

Another Australian study published this week showed the influence of social media messages on how young people perceive smoking and vaping. The University of Queensland study, published in the American Journal of Preventive Medicine[4], assessed responses from more than 5,600 young people who did not smoke or vape and who had used social media in the previous month.

61% of them reported being exposed to tobacco or vaping content on social media, and about 28 % reported being curious about trying a nicotine product according to the study results. For the study's lead author, Dr. Carmen Lim, “The promotion of tobacco products through paid influencers, often without a declared financial interest, has played a significant role in the normalization and progression of smoking and nicotine use.”

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[1] Sam Egger, Michael David, Christina Watts, Anita Dssaisx, Alecia Brooks, Emily Jenkinson, Paul Grogan, Marianne Weber, Qingwei Luo, Becky Freeman, The association between vaping and subsequent initiation of cigarette smoking in young Australians from age 12 to 17 years: a retrospective cohort analysis using cross-sectional recall data from 5114 adolescents, Australian and New Zealand Journal of Public Health, 2024, 100173, ISSN 1326-0200, https://doi.org/10.1016/j.anzjph.2024.100173.

[2] Generation without tobacco, Australia reconsiders its bill banning vapes without a prescription, published June 28, 2024, accessed September 11, 2024

[3] M. Wakefield, A. Haynes, T. Tabbakh, M. Scollo, S. Durkin, Current vaping and current smoking in the Australian population aged 14+ years: February 2018–March 2023, Center for Behavioral Research in Cancer, Cancer Council Victoria , Melbourne (2023)

[4] Carmen CW Lim, Tianze Sun, Wayne Hall, Coral Gartner, Jason P. Connor, Swipe to Inhale: Tobacco-Related Content on Social Media and Susceptibility to Tobacco Use, American Journal of Preventive Medicine, 2024,ISSN 0749-3797,https: //doi.org/10.1016/j.amepre.202