The World Health Organization (WHO) has reportedly warned about the negative health effects of e-cigarettes and the potential for tobacco consumption to be re-normalized due to public exposure to e-cigarettes. As a result, Australia has taken precautionary measures to regulate e-cigarettes.

A new study, to be published in the Australian and New Zealand Journal of Public Health, looked at e-cigarette use and attitudes towards e-cigarettes in a sample of Australians aged 15 to 30. The main goal of the study was to provide novel insights into how to minimize the harm of e-cigarettes to young people.

In Australia, nicotine-free e-cigarettes can be sold to people aged 18 and over in most states. Nicotine-free and nicotine-containing e-cigarettes are banned from most types of media, with the exception of online marketing. Despite a restrictive regulatory environment, e-cigarette use among 18- to 24-year-olds nearly doubled, from 2.8% in 2016 to 5.3% in 2019.

E-cigarettes are known to contain a range of toxins that are often mislabeled. While combining tobacco and e-cigarettes can help some people quit smoking, this can be problematic due to multiple factors, such as higher overall nicotine intake, greater sensitivity to smoking cues, and a greater risk of respiratory and cardiovascular adverse outcomes.

The current study explored a variety of behaviours and attitudes associated with vaping among Australian youth and young adults. The main interests are young people's motivations for vaping, use/intention to use other tobacco products, location of use, exposure to advertising and awareness of the associated hazards. Cannabis e-cigarette use, tobacco use and dual use were also assessed, taking into account the interrelationships that exist between the use of these substances.

A nationally representative sample of 1,006 Australians completed an online survey. The participants were between 15 and 30 years old. The key areas of interest mentioned above were included in the questionnaire. Descriptive and chi-square analyses were performed to detect significant differences between groups, and multivariate logistic regression was estimated to identify factors associated with previous or current e-cigarette use.

The results provide important information about how young people access and use e-cigarettes. In the current sample, current usage is estimated at 14%, significantly higher than 4.8% for 25-29 year olds and 4.5% for 15-24 year olds. Results that have been used (current or past) are more comparable. It has previously been documented that 41% of people aged 18-39 have tried or used e-cigarettes. The current study reported that 47 percent had used e-cigarettes, a slightly higher number likely due to the cohort being younger in this case.

Most current users reported smoking nicotine e-cigarettes, and most participants under the age of 18 found it relatively easy to buy e-cigarettes in stores. This suggests that young people using e-cigarettes in Australia are doing so via banned devices and are circumventing regulations.

Current smoking status was found to be the strongest correlation factor for e-cigarette use. In addition, the number of friends who use e-cigarettes is another key factor associated with e-cigarette use. This was striking because most participants reported having at least one close friend who used an e-cigarette. It is therefore vital to manage the environment to minimise e-cigarette use among young people.

Respondents expressed a preference for fruit-flavored products and disposable e-cigarettes. About 25 percent of non-e-cigarette users show curiosity about e-cigarettes. It is illegal to promote e-cigarettes in Australia, so it is surprising that about 25 per cent of people reported seeing adverts at petrol stations and supermarkets.

A key limitation of the study is that participants were recruited online and could not be as representative of the general population as thought. The findings should not be generalized and more research is needed to confirm the results documented here. Furthermore, due to the use of cross-sectional data, only correlation, not causation, can be determined. Third, other survey items (e.g., source and place of use) do not distinguish between nicotine and non-nicotine e-cigarettes. This is due to inconsistent labelling of vape products in Australia. The uncertainty caused by labels was evident in the survey sample, as about 25 percent of users were unable to correctly specify the strength of the e-liquid they were using.

All in all, the results have implications for Australia's approach to e-cigarette regulation. Despite bans and restrictions, young people seem to be exposed to vaping-related stimuli in their physical and social environments and seem to have easy access to e-cigarettes. More regulation and enforcement are needed to minimize the harm e-cigarettes cause to young people.