Key messages
- Results from the 2022–2023 National Drug Strategy Household Survey showed that the proportion of people using e-cigarettes daily in Australia has increased substantially, from 0.5% (an estimated 100,000 people) in 2016 to 3.5% (an estimated 700,000 people) in 2022–2023.
- The proportion of people smoking tobacco daily has fallen from 12% (an estimated 2.4 million people) in 2016 to 8.3% (an estimated 1.8 million people) in 2022–2023.
- The population groups most likely to be using e-cigarettes were different to those most likely to smoke tobacco between 2016 and 2022–2023:
- Use of e-cigarettes is particularly high among younger people, with 9.3% of people aged 18–24 and 6.5% of people aged 25–29 using them daily in 2022–2023. Conversely, daily tobacco smoking is highest among people aged 40–49 (11%) and 50–59 (12%) in 2022–2023.
- People living in the most disadvantaged socioeconomic areas are most likely to smoke tobacco, while people in the most advantaged areas are most likely to use e-cigarettes.
Introduction
Electronic cigarettes or vapes (referred to collectively as ‘e‑cigarettes’) are personal vaping devices where people inhale aerosol rather than smoke. The inhaled aerosol usually contains flavourings and a range of hazardous chemicals; it may also contain nicotine, even if labelled ‘nicotine free’ (Department of Health and Aged Care 2023).
While the adverse effects of long-term e-cigarette use are currently unknown, there are well-documented short-term effects, including e-cigarette associated lung injury, cough, throat irritation and nausea. The adverse effects of using e-cigarettes that contain nicotine can also include inhalation toxicity (including seizures), nicotine dependence and increased heart rate and blood pressure (Banks et al. 2023).
The use of e-cigarettes (commonly referred to as vaping) was first identified in Australia around 2007, with evidence of use increasing since 2016 (AIHW 2024b; Wilkins et al. 2024).
This increasing use of e-cigarettes has occurred in an environment of steadily declining levels of tobacco smoking in Australia, a trend seen since the early 1990s (AIHW 2023).
Tobacco and e-cigarette control in Australia
The tobacco control measures of all Australian governments and public health organisations have been key to Australia’s success in tobacco control. In recent decades, Australia has progressively implemented a comprehensive suite of tobacco control measures, including:
- increasing excise
- running social marketing campaigns
- introducing plain packaging
- issuing graphic health warnings
- prohibiting tobacco advertising and promotion
- providing support for people who smoke to quit (Department of Health and Aged Care 2024).
Work is ongoing, with new regulatory measures, public health campaigns and expansion of smoking cessation services being introduced in 2024 (The Hon. Mark Butler MP 7 December 2023).
In partnership with state and territory governments, the Australian Government is taking action to reduce e-cigarette use through stronger legislation, enforcement, education and support. These changes are being implemented over the course of 2024, with the intention of prohibiting non-therapeutic e-cigarettes in Australia. This effort has included:
- banning the importation of disposable single use e-cigarettes
- stopping the personal importation of e-cigarettes
- banning the importation of non-therapeutic e-cigarettes (that is, e-cigarettes not intended to help with quitting or reducing the use of regular cigarettes)
- imposing requirements on therapeutic e-cigarette importers and manufacturers, including compliance with minimum product standards.
A prescription is required to access e-cigarettes containing nicotine to help in stopping tobacco smoking. Further reforms are likely to be introduced later in 2024, including the introduction of pharmaceutical style packaging and quality and safety standards for all therapeutic e-cigarettes. See Vaping hub | Therapeutic Goods Administration (TGA) for more information.
Findings presented in this article
This article summarises select findings from the National Drug Strategy Household Survey (NDSHS) 2022–2023 on:
- use of e-cigarettes in Australia among people aged 14 and over
- comparisons between trends in e-cigarette use and recent trends in tobacco smoking.
It also compares e-cigarette use by older and younger age groups, and across socioeconomic areas.
The long-term impacts of e-cigarettes on the health of people who use them, and the impacts of policy measures aimed at reducing the use of e-cigarettes, require more data before both of these impacts can be fully understood.
Data on e-cigarette use were collected in late 2022 and early 2023, prior to the new restrictions coming into effect in 2024. At the time, in most jurisdictions, it was legal to sell and purchase e-cigarettes that did not contain nicotine, and to import and use e-cigarettes containing nicotine with a prescription.
E-cigarette use in Australia
How many people are using e-cigarettes in Australia?
E-cigarette use has increased substantially in recent years. In 2016, an estimated 100,000 (0.5%) people in Australia were using e-cigarettes daily (AIHW 2024a). By 2019, this number had doubled to an estimated 200,000 (1.1%) and, by 2022–2023, had increased to an estimated 700,000 (3.5%). In 2022–2023, almost half of people currently using e-cigarettes (49%) used them every day, and 68% at least weekly.
How many people are smoking tobacco in Australia?
Over the same period, consistent with the steady declines in smoking seen since 1991, the number of people smoking tobacco fell. An estimated 2.4 million (12%) people were smoking tobacco daily in 2016, but, by 2022–2023, that number had fallen to an estimated 1.8 million (8.3%). In 2022–2023, most of those people currently smoking tobacco did so every day (79%), and 90% smoked at least weekly.
Relationships between tobacco smoking and using e-cigarettes
Tobacco smoking and use of e-cigarettes have often been considered in the same context, either with use of e-cigarettes being an introduction to smoking, or by people using e-cigarettes to help them quit smoking. According to Australian guidance on the use of e-cigarettes to manage nicotine dependence (RACGP 2024), e-cigarette products that contain nicotine may improve quit rates for smoking cigarettes; however, there is currently not enough evidence for it to be prescribed as a first-line treatment. In contrast, evidence suggests that people who have never smoked tobacco who use e-cigarettes are around 3 times as likely to start smoking cigarettes as people who have not used e-cigarettes (Banks et al. 2022).
Point-in-time survey data such as from the NDSHS cannot be used to provide strong evidence on the use of e-cigarettes to help in stopping tobacco smoking or as a gateway to smoking. The NDSHS did show, however, that regardless of the potential relationships between tobacco smoking and use of e-cigarettes, the population groups most likely to be using e-cigarettes were different to those most likely to smoke tobacco.
E-cigarette use and tobacco smoking – by age group
Among people aged 14 and over in 2022–2023, older people were much more likely to smoke tobacco than younger people, but younger people were the most likely to use e-cigarettes. Figure V.1 shows smoking and e-cigarette use among 2 different age groups: people aged 18 to 24 (the most likely to use e-cigarettes) and people aged 50 to 59 (the most likely to smoke).
