Tobacco smoking down, vaping on the rise

Anastasia Tsirtsakis

16/07/2020 4:19:56 PM

The National Drug Strategy Household Survey has noted a concerning uptake of e-cigarettes, particularly among young people.

Using an e-cigarette
Though smoking is on the decline, the survey revealed a concerning uptake of vaping and use of e-cigarettes.

The survey results, released on Thursday 16 July by the Australian Institute of Health and Welfare (AIHW), involved a sample of 22,271 people aged 14 and over from across Australia to assess drug use, attitudes and behaviours.
It was found that fewer Australians are smoking daily than ever before – 11% in 2019, down from 12.2% in 2016. This equates to a reduction of about 100,000 people who smoke daily.
Two in five people who smoke reduced the amount of tobacco smoked per day in the previous 12 months, with the average number of cigarettes smoked at 13 in 2019, compared to 16 in 2001. More people who smoke (58%) cited cost as the motivator for cutting back or quitting.
As a result, exposure to tobacco smoke is households with dependent children has significantly dropped to about one in 50 (2.1%) in 2019, compared to one in five (19.7%) in 2001.
Professor Nick Zwar, Chair of the Expert Advisory Group for the RACGP’s Smoking cessation clinical practice guidelines, told newsGP that while he is pleased to see a decline in smoking, there is still a way to go.
‘Australia had a target to get to less than 10% daily smokers by 2018, and we still haven’t made that. But we’re closer now to that target than we were,’ he said.
‘Having said that, there are still quite high rates of smoking among people with mental health conditions, [and] still high rates of smoking among Aboriginal and Torres Strait Islander people. It has dropped further, which is great, but it’s still a lot higher than the general community.
‘There’s definitely a socioeconomic gradient.’
The survey found those most likely to smoke daily are aged in their 40s and 50s, compared to 2001, when it was young people in their 20s.
While Professor Zwar said it is ‘fantastic’ to see the proportion of young people who smoke daily has more than halved since 2001, he believes older people who smoke are indicative of a generation that has not had the supports in place to quit.
‘It’d be fair to say that quite a lot of focus of tobacco control in Australia has been around bans on advertising, cost, restriction of smoking in public places, etcetera. But there hasn’t been as much attention on supporting people to quit,’ he said.
‘Article 14 of the Tobacco Framework Convention talks about the need to support cessation. But when you look at what we do … we don’t have any funded face-to-face dedicated cessation services.
‘Obviously GPs do a lot of work in this space, but if we look at the UK, for example, they have funded smoking cessation services. That’s their job, to help people quit. We’ve never invested in that.’
Concern has also been raised over the uptake of vaping and use of e-cigarettes, up from 4.4% in 2016 to 9.7% among people who smoke in 2019. That upward trend has also been noted among non-smokers, from 0.6% to 1.4%.
The rise is particularly notable among young adults, with nearly two out of three people who currently smoke and one in five non-smokers aged 18–24 reporting having tried e-cigarettes.
Professor Zwar said while the increase is comparatively lower to other countries like the US, it is still concerning.
‘This increase is not a surprise,’ he said.
‘It’s interesting that there’s a reasonable amount of dual use of people who smoke and use e-cigarettes as well, and you can look at that in a range of ways; you can say well maybe they’re smoking less because they’re using e-cigarettes too, or … they’re just doing both.
‘e-Cigarettes may well have a useful role in helping people to quit. But while they’re a consumer product, there will be a whole lot of use that isn’t around quitting or reducing tobacco use, and there will be, and is, use amongst young people who may otherwise not have exposed themselves to nicotine.
‘Though some people hotly dispute this, there may also be the risk that those people who experiment with e-cigarettes then go on to experiment with smoking tobacco.’
A 12-month ban on the importation of all e-cigarettes containing vaporiser nicotine and nicotine-containing refills, announced by the Federal Government in June, has since been delayed until 2021.
Under the prohibition, those using e-cigarettes as a means to end their smoking would only be given access with a prescription from their GP.

A 12-month ban on the importation of all e-cigarettes containing vaporiser nicotine and nicotine-containing refills, announced by the Federal Government in June, has since been delayed until 2021.

The survey found support for measures related to the use of e-cigarettes has grown, with two-thirds of the population supporting restrictions on where e-cigarettes can be advertised (67%) and used in public (69%). 
While alcohol remains the most used drug in Australia, the survey found more are giving up drinking (8.9% in 2019 compared to 7.6% in 2016). However, the proportion of people drinking quantities that exceed the single-occasion risk (25%) and lifetime risk guidelines (16.8%) remained stable over the three-year period.
Non-medical use of pharmaceuticals fell in the last 12 months from one million (4.8%) to 900,000 (4.2%).
The decrease is thought to be driven by a drop in the non‑medical use of painkillers and opioids (from 3.6% to 2.7% in 2019), likely due to a reclassification of medications containing codeine implemented in 2018.
Though illicit drug use remained relatively stable from 2016 to 2019, there was a notable increase from 13.4% in 2007 to 16.4% in 2019, with levels of use similar in the highest and lowest socioeconomic areas with a variation on the drug used.
Cocaine use is at an all-time high, with use in the previous 12 months at 4.2% in 2019 compared to 1% in 2004. Methamphetamine use, which has been declining since its 2001 peak of 3.4%, stabilised at 1.3% in 2019. 
Across the board, the further Australians live from major cities, the more likely they are to partake in substance abuse at risky levels:

  • smoking daily: 19.6% in remote and very remote areas compared to 9.7% in major cities
  • drink in excess of alcohol lifetime risk guidelines: 25% in remote and very remote areas compared to 15.6% in major cities
  • recent illicit drug use: 18.8% in remote and very remote areas compared to 16.7% in major cities 
Despite tobacco smoking being the leading cause of preventable disease and death in Australia, the survey revealed most participants think alcohol (34%) was a greater burden, followed by methamphetamines (20%), compared to 18.7% for tobacco.
Professor Zwar says that perception comes as no surprise to the control community.
‘The public attention has drifted away from smoking as a key public health issue, and there’s a tendency [to think] that the problem is solved and that other things are our problem now, whether it’s alcohol or methamphetamine or obesity,’ he said.
‘Yet the data has never really supported that.
‘We don’t really have much social marketing about tobacco use anymore on radio and television, and there isn’t as much funding as there used to be for tobacco awareness and quit campaigns. That’s part of that picture of focus moving off to other things and sort of associated with slightly wishful thinking that the tobacco problem is not the problem it once was.
‘Well, it’s not – but it’s still a problem.’
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