In spite of a substantial fall in the smoking rate over several decades, nearly three million or 15.2% of Australian adults still smoke tobacco. 1 Smoking remains the leading preventable cause of death and illness in Australia. 2 Smoking is especially prevalent in disadvantaged populations such as Indigenous people, low-income groups and those with mental illness or substance use and is a major contributor to health and financial inequalities.
The long-term decline in smoking rates in Australia has slowed considerably since 2013. 1,3 Many Australian smokers are unable to quit in spite of Australia having the highest cigarette prices in the world, plain packaging and strict tobacco control laws. Ever-increasing tobacco prices place a huge financial burden on low-income smokers and are almost certainly contributing to a growing illicit tobacco industry. New and effective strategies are needed.
One option being widely used overseas is vaping (using an e-cigarette). Vaping is a reduced-risk alternative to smoking for adult smokers who are unwilling or unable to quit. 4 Vaping delivers the nicotine smokers are addicted to along with the hand-to-mouth ritual smokers enjoy, but without most of the harmful toxins present in smoke.4 Australia imposes a de facto ban on vaping and is increasingly out of step with other similar countries, such as New Zealand, the United Kingdom, the European Union, Canada and the United States. Smoking rates are declining faster in many countries where vaping and other reduced-risk nicotine products are legal and readily available. Ironically, it is illegal to possess nicotine liquid for vaping in Australia without a prescription from a doctor although smokers can readily purchase higher-risk cigarettes from supermarkets and most corner shops.
Legalising vaping has enormous potential to improve public health, particularly for disadvantaged smokers who are disproportionately affected by smoking-related diseases.
The authors recommend that vaping products should be primarily regulated as consumer goods rather than as a therapeutic, medicinal or tobacco product. Regulation should aim to maximise the benefit for adult smokers while reducing any potential risks to users and harm to the wider population, especially young people who have never smoked. Regulation should be proportionate to the risk of vaping.
The authors strongly recommend that Australia’s successful tobacco control policy continues and is supplemented by two changes: first, ending the de facto ban on vaping; and second, re-introducing appropriately funded mass media campaigns and supporting counselling to increase quitting rates.