Impact: The George Institute’s research informs Australian govt advice on e-cigarettes

NHMRC health advice

After reviewing the current available evidence, the National Health and Medical Research Council (NHMRC) has issued new public health advice on the use of e-cigarettes in Australia. The NHMRC is Australia’s peak government medical body that funds research and helps translate research into better health outcomes.

The NHMRC’s health advice states that:

  • All e-cigarette users are exposed to chemicals and toxins that have the potential to cause harm. In addition to nicotine, more than 200 chemicals have been associated with e-liquids.
  • E-cigarettes containing nicotine are addictive; people who have never smoked and use e-cigarettes are more likely to take up tobacco smoking.
  • E-cigarettes are not proven safe and effective smoking cessation aids. There are other proven safe and effective options to help smokers quit.
  • Teenagers are more likely to try e-cigarettes if they are exposed to e-cigarettes on social media

Research impact

The George Institute is proud to have contributed to the body of evidence analysed by the NHMRC to develop this health assessment. A systematic review conducted by the Institute looked at the effect of exposure to e-cigarette advertising on people’s e-cigarette-related perceptions, attitudes, intentions, and behaviours. Commissioned by the NHMRC, this review harnessed evidence from 76 studies conducted globally and published between January 2015 and June 2021.  

The review found that exposure to e-cigarette advertising across a wide range of media was positively associated with e-cigarette use among young people. The strongest available evidence was found for adolescents exposed to advertising on social media being more likely to try e-cigarettes.

“Digital marketing, particularly through social media, is the new challenge for public health – effective regulation is complex to implement, but possible. Social media companies also need to take responsibility for harms occurring through their platforms and take appropriate action”, said Soumyadeep Bhaumik, Co-Head of the Meta-research and Evidence Synthesis Unit of the George Institute, an author who contributed to the study.

Worrying uptick in e-cigarette use in Australia

Prof Simone Pettigrew, Director of Health Promotion and Behaviour Change at The George Institute and a co-author, says the findings mirror those of the effects of exposure to tobacco and alcohol advertising.  

“Our findings are consistent with outcomes in related substance use areas and support the implementation of appropriate restrictions on e-cigarette marketing to reduce harms among young people,” she warns.

Tobacco smoking in Australia is at its lowest for decades, thanks to effective policy measures and public health messaging on its harm. But the uptake of e-cigarettes by young adults is a worrying trend. According to the 2019 National Drug Strategy Household Survey, between 2016 and 2019, the proportion of people who had ever used e-cigarettes rose from 8.8% to 11.3%, with a notable increase among youth and young adults. Nearly 64% of current smokers and 20% of people who had never smoked aged 18–24 reported having tried e-cigarettes. When first using e-cigarettes, 64.5% of youth aged 14–17 and 39% of young adults aged 18–24 were never smokers. This data strengthens health experts’ argument that people who have never smoked are more likely to take up tobacco smoking, especially young adults.

One of the strongest marketing messages for e-cigarettes has been that they help tobacco smokers quit. But the NHMRC cautions against this assumption.

“There is limited evidence on the efficacy of e-cigarettes as successful cessation tools. Research studies have found that it was more common for smokers to become dual users (using both e-cigarettes and tobacco products at the same time) than quit if they used nicotine e-cigarettes. So, if you’re looking to kick the habit, seek help and find a proven, safe aid to help you quit,” advises Prof Pettigrew.

Regulatory framework in Australia

E-cigarettes that contain nicotine currently cannot be sold freely in Australia and are regulated as prescription medicines. Those without nicotine can be sold freely to adults in Australia, except in the state of Western Australia.

There are also regulations that prohibit the advertising and sponsorship of both nicotine and non-nicotine e-cigarettes. While these laws cover most types of advertising, including print, TV, and radio, online promotion has proven harder to regulate. This is a substantial problem because 70% of e-cigarettes are bought online.

With the government taking an unequivocal stand on the potential harm posed by e-cigarettes, especially to younger populations, it is time for tighter regulation of Internet advertising and higher levels of monitoring and enforcement to address e-cigarette availability.