Clarifying Australia’s youth vaping figures

Over the past fortnight Australian media outlets have been awash with alarmist claims about a large increase in youth vaping. The problem was reported as being so dire that it prompted several Sydney private school principals to send letters to parents. These media reports provided no data on the size of the problem.

The National Drug Strategy Household Survey data released a week after those media reports should have clarified the true extent of Australia’s youth vaping problem. However, reporting and interpretation of those results by some media outlets was inaccurate and confusing.

For example, one news story claimed the survey data found “65% of adolescents and 39% of young adults report using e-cigarettes despite having never smoked.” This is incorrect.

Even when using the broad definition of ‘ever use’, instead of the more meaningful ‘current use’, the correct figure is 6.1%, that is, less than tenth of the reported figure.

Current use (daily, weekly, monthly and less than monthly) of e-cigarettes among 14-17 year olds is actually 1.8%, and more than 90% of adolescents have never tried an e-cigarette.

The survey data also shows most of the 6.1% of adolescents who said they tried an e-cigarette before trying a tobacco cigarette didn’t progress to regular use of e-cigarettes.

The figure for young adults was also reported incorrectly: only 10.2% of 18-24 year olds had ever tried an e-cigarette, and considered themselves to be a never-smoker at the time. The figure reported (39%) was nearly fourfold higher than this. Furthermore, current use of e-cigarettes by non-smokers (ex-smokers + never smokers) aged 18-24 is actually only 2.9%.

Media reports that “use of e-cigarettes among non-smokers aged 18 to 24 years had quadrupled in just 6 years: from 5% in 2013 to 20% in 2019” is true for ‘lifetime use’, but also includes one-off use and past use to quit smoking. The general public could erroneously assume the figures relate to the percentage of 18 to 24 year old smokers using e-cigarettes now.

Most (85%) of the 19.6% of young adult non-smokers who had ever used an e-cigarette didn’t continue with it. Of non-smokers who currently use e-cigarettes at least once a month, the vast majority (85%) are ex-smokers.

Other Australian media outlets also incorrectly reported the percentage of current smokers who vaped as if it was the percentage of the whole population.

We were told by media “In 2016, fewer than 7 per cent of people aged 18-24 were vaping. In 2019, that figure jumped to almost 19 per cent.” These figures are inflated 3.5 times, and should actually show a change from 2.8% to 5.3%.

While a pessimistic picture of Australian youth and young adult vaping rates has been reported, smoking rates (which are far higher) have been given an optimistic treatment.

The prevalence of smoking in Australia was reported as a daily smoking rate (11%) when 14% of the population aged 14 and over currently smoke, if we include non-daily smokers. Only people who smoked 100 or more cigarettes were classified as having ever smoked.

By contrast, the prevalence of “e-cigarette use” has often been reported as lifetime use. So, anyone who had tried an e-cigarette once or twice was counted as an e-cigarette user, but only current daily smokers were counted as smokers. If we used lifetime use to measure smoking then 37% of Australians are smokers (and that figure doesn’t include those who smoked less than 100 cigarettes in their lifetime).

‘Current use’ of e-cigarettes in the AIHW report was also very broadly defined to include daily, weekly, monthly, and less than monthly use. This includes someone who used an e-cigarette at a party once or twice a year.

The prevalence of daily use of e-cigarettes in 2019 was only 1.1% (9.4% of 11.3% of ever users). This is a tenth of our daily smoking prevalence.

Most e-cigarette use occurred among current or former smokers. Only 0.2% of never smokers currently vaped daily, and a further 0.3% did so weekly or monthly. Of ‘never smokers’, 95% have never tried e-cigarettes and an additional 4.2% only tried them ‘once or twice’.

How does Australia’s smoking prevalence compare internationally? Other countries report their smoking prevalence as current smoking (both daily and non-daily smoking) for people aged 18 years and over. If we used the same definition, Australia’s rate would be 14.7%, marginally behind England (13.9%) and the United States (13.7%).

The incorrect reporting of Australia’s purported ‘youth vaping epidemic’ has been used to argue for even tougher restrictions on access to nicotine vaping products. We should be restricting access to the nicotine product that causes the greatest harm in Australia, tobacco cigarettes. Cigarettes are still used by 2.9 million Australians who easily access them at retail outlets, despite being the leading preventable cause of disease burden.

Associate Professor Coral Gartner’s main research interest is evaluating strategies to reduce the harm from tobacco use. She leads the Nicotine and Tobacco Regulatory Science Research Group, and is also the program convenor for the Master of Environmental Health Sciences program in the School of Public Health.