E-cigarette use is the single strongest risk factor for adolescents taking up tobacco smoking, outranking social norms, poor mental health and misperceptions about smoking harms, research published on Wednesday has found.
The findings come from 4,266 Victorian students aged 12 to 17 who anonymously took part in the 2017 Australian Secondary School Students Alcohol and Drug Survey (Assad), with researchers then focusing on 3,410 students who reported never having smoked even part of a cigarette.
The students were asked questions about their use of substances, mental health, social groups, school absenteeism and e-cigarette use. They were also asked how likely they believed they were to be smoking cigarettes in the next year.
More than one in 10 of the students who said they had never smoked were nonetheless susceptible to tobacco smoking, the study, led by Cancer Council Victoria and the University of Melbourne, found.
Published in the Australian and New Zealand Journal of Public Health, it found the strongest factor for susceptibility to future smoking was having ever smoked e-cigarettes. Four other factors – perceiving smokers to be more popular than non-smokers, having at least one close friend that smokes, perceiving smoking one or two cigarettes occasionally as not dangerous, and having symptoms of depression – were also independently associated with vulnerability to smoking.
Prof Sarah Durkin, a co-author of the study and principal research fellow at the Centre for Behavioural Research at Cancer Council Victoria, said the findings were consistent with data released in May which found an increase in tobacco smoking among 14- to 17-year-olds for the first time in about two decades. It is also consistent with other international studies that have found young people who vape are three times as likely to take up smoking, Durkin said.
Prof Emily Banks, an epidemiologist with the Australian National University and a leading tobacco control expert, said the Assad study contained the highest-quality data available about smoking in the teenage age group because it was collected at school and not in the presence of parents.
But because Covid-19 lockdowns delayed the 2020 Assad survey, which is only now being conducted, Banks said the data predated the “huge” increase in e-cigarette use in Australia.
People who use e-cigarettes were more likely to go on to smoke, Banks said, because “it softens them up, it gets them used to the hand-mouth motion, gets them addicted to nicotine, gets them exposed to some of the advertising, makes them think more positively about inhaling something to get that hit”.
Terry Slevin, the chief executive of the Public Health Association of Australia, said the recent increase in cigarette smoking rates in young people was due to the “huge incursion” of vaping. Slevin said the tobacco and vaping industries want to “claw back” the numbers of people who are addicted to nicotine so they can sell more of their products.
Following the announcement in May that Australia would ban non-prescription vapes, the government is currently in negotiations with the states and territories about how to implement tough new laws aimed at protecting children.
Prof Becky Freeman, a leading tobacco control expert with the University of Sydney’s School of Public Health, said the research added weight to “why we need to act on e-cigarettes”.
“Not only because e-cigarettes [in] and of themselves are dangerous for young people, but that they also potentially can lead to smoking uptake, which we have decades and decades of evidence knowing just how harmful that is,” Freeman said.
