Correlates of electronic cigarette use in the general population and among smokers in Australia – Findings from a nationally representative survey
Introduction
The prevalence of electronic cigarette (e-cigarette) use, known as vaping, has increased dramatically in many developed countries while the prevalence of tobacco smoking has steadily decreased (Farsalinos, Poulas, Voudris, & Le Houezec, 2016; Johnston et al., 2018). Proponents support e-cigarettes as a promising cessation aid or a less harmful substitute for combustible tobacco. Opponents argue that e-cigarettes may renormalize smoking among young people and hinder quit attempts in smokers by encouraging dual use of e-cigarette with cigarettes (Green, Fielding, & Brownson, 2018). A consensus report by the US National Academies of Science, Engineering and Medicine concluded that there was observational evidence that smokers who switch to e-cigarettes will reduce their exposure to harmful chemicals and that they may be an effective cessation aid, but youth who vape are at greater likelihood of also experimenting with smoking (National Academies of Sciences E, 2018).
In most developed countries, such as the UK and USA, e-cigarettes can be sold and used as consumer products (European Commission, 2018; Kennedy, Awopegba, De León, & Cohen, 2017; UK Government Digital Service, 2018). Australia has taken a more restrictive approach to e-cigarettes and remains the only Westernized democracy that prohibits the sale, and possession or use of non-therapeutic nicotine containing e-cigarettes (Gartner & Bromberg, 2019). E-cigarettes that don't contain nicotine can be sold in most states and territories as consumer products, however one state has also banned the sale of nicotine-free e-cigarettes.
The distinctive regulatory environment in Australia reduces the generalizability of studies done in other countries to the Australian context. Yet, few empirical e-cigarette studies have been conducted in Australia, and most were not based on population samples (Adkison et al., 2013; Sutherland et al., 2016; Yong et al., 2017). The aim of this study is to:
- 1.
estimate the prevalence of vaping based on data from the latest and largest nationally representative survey on substance use in Australia and identify correlates of use;
- 2.
examine the association between vaping, intention to quit smoking, and reduction in smoking among smokers and recent quitters (participants who reported past year smoking but no current smoking).
Section snippets
Sample
The data were drawn from the 2016 National Drug Strategy Household Survey (NDSHS) dataset. Households were randomly selected using a multistage stratified design based on statistical local areas in every State and Territory. Detailed information on methods of the NDSHS can be found elsewhere (AIHW, 2017). The response rate was 51.1% and this was comparable to past NDSHS and other international surveys of alcohol and drug use (AIHW, 2014; Kraus, Baumeister, Pabst, & Orth, 2009). Sample weights
Results
Among the 22,354 participants, 269 reported current vaping and 117 reported daily vaping. It was estimated that 227,000 Australians (1.2% of the population 18 years old or above; 95% confidence interval [1.03%–1.40%]) were current e-cigarette users and 97,000 (0.5%; 95% CI [0.4%–0.7%]) vaped daily. Among daily users, 18% were non-smokers, 32% were daily smokers, 11% were non-daily smokers, and 38% were ex-smokers. Table 1 shows the results from logistic regression analyses predicting current
Discussion
The prevalence of vaping was substantially lower than in other countries such as the US (Mirbolouk et al., 2016) and UK (Office for National Statistics, 2018), possibly because of a more restrictive e-cigarette regulations in Australia. Males and younger people were more likely to use e-cigarettes and these findings are consistent with existing literature from other countries (Levy, Yuan, & Li, 2017). Indigenous Australians in this study were also more likely to use e-cigarettes daily compared
Conclusion
The prevalence of vaping was low in 2016 in Australia, likely reflecting the ban on sales of nicotine-containing e-cigarettes. Being male, young, being either a current or ex-smoker, and having a higher level of psychological distress were associated with increased odds of current vaping. Among smokers, patterns of vaping were differentially associated with an intention to quit, reduction in smoking and recent quitting.
The following are the supplementary data related to this article.
Role of funding sources
This research was supported by a research fellowship from the University of Queensland and funding from the Department of Health, Australia. The funding body has no role in the study design, analysis or interpretation, writing the manuscript, or the decision to submit the paper for publication.
Contributors
GC and JL performed the analyses and drafted up the manuscript. CG, HHY, RB and WH provided guidance on the research direction, and commented and revised on all drafts of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
There is no conflict of interest.
Acknowledgement
We would like to acknowledge the Australian Institute of Health and Welfare for the provision of the National Drug Strategy Household Survey data (NDSHS). We would also like to acknowledge the Australian Data Archive for access to the NDSHS.
References (31)
- et al.
Electronic nicotine delivery systems: International tobacco control four-country survey
American Journal of Preventive Medicine
(2013) - et al.
Interpreting scores on the Kessler psychological distress scale (K10)
Australian and New Zealand Journal of Public Health
(2001) A typology of vaping: Identifying differing beliefs, motivations for use, identity and political interest amongst e-cigarette users
International Journal of Drug Policy
(2017)- et al.
The challenge of reducing smoking in people with serious mental illness
The Lancet Respiratory Medicine
(2016) - et al.
Tobacco and e-cigarette use amongst illicit drug users in Australia
Drug and Alcohol Dependence
(2016) 2013 National Drug Strategy Household Survey report. Drug statistics series no 28
(2014)2016 National Drug Strategy Household Survey: Detailed findings
(2017)SEIFA
(2013)Remoteness structure
(2014)- et al.
Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012–2015
PLoS One
(2017)