Using a vaporiser is known as ‘vaping’. Vaporisers (vapes or e-cigarettes) are battery-powered devices that heat a liquid (usually containing nicotine) into an aerosol for inhalation. Vaping is used as a safer substitute by smokers who are unable or unwilling to quit smoking or nicotine with approved therapies. It is not recommended for non-smokers or young people under 18 years of age.
Vaping is popular because it:
- Delivers nicotine and relieves the urge to smoke, and
- Provides a ‘smoking-like experience’ – it addresses the behavioural (hand-to-mouth action), sensory (‘throat hit’, taste, inhaling and exhaling a visible ‘smoke’) and social aspects of the smoking ritual – but without most of the harmful toxins in smoke.
There is growing evidence that vaping has helped many smokers to quit. Millions of smokers have quit overseas with vaping and personal vaporisers are the most popular quitting aid in the UK, US and EU.
Complete cessation of all tobacco and nicotine is always the preferred goal. Where this is not possible, vaping is a form of tobacco harm reduction (THR) which aims to prevent the harm from smoke without necessarily ceasing nicotine.
In Australia in 2016, 1.2% of adults or 240,000 Australians were using a vaporiser, according to the 2017 National Drug Strategy Household Survey. It is legal to use nicotine in a vaporiser in Australia if you have a prescription from a registered Australian doctor.
Who is it for?
Vaping is for adult smokers who are unable or unwilling to quit smoking or nicotine with the currently available treatments. It can be especially useful for smokers who miss the hand-to-mouth ritual of smoking and a ‘smoking-like experience’.
Some former smokers continue to vape long-term to avoid relapsing to smoking. Others use vaping devices briefly as a quitting aid, switching to vaping for a time, then ceasing vaping altogether.
Other common reasons for vaping are to reduce cigarette intake, to avoid harm to others from second hand smoke and to save money.
ATHRA strongly discourages the use of vaporisers by non-smokers. Although much less harmful than smoking they are not risk-free. The vapour contains some chemicals which could cause unwanted health effects.
Vaping should also not be used under the age of 18 years or in pregnancy. However, in all situations, it is likely to be much safer than smoking.
Vaporisers consist essentially of three components: a battery, a tank that holds the e-liquid and the coil (heating element).
A wick (usually cotton) draws e-liquid onto the coil (a coiled metal wire). When the user breathes in or presses a button, the battery turns on and heats the coil, vapourising the e-liquid into an aerosol which is inhaled and exhaled as a visible mist.
The e-liquid consists of nicotine (usually) and flavourings dissolved in propylene glycol and vegetable glycerine.
There is a staggering array of vaporisers. The most suitable devices for tobacco smokers who are new to vaping (‘beginners’) are:
- Pod models
- Intermediate models with refillable tanks
More advanced models are generally not recommended for beginners.
‘Cigalikes’ are designed to look and feel like a cigarette.
They consist of a battery and a prefilled cartridge of e-liquid. They have no buttons, do not require coil replacement and are very easy to use. Some models are disposable. Others use a rechargeable battery and replaceable cartridges.
Cigalikes do not deliver as much nicotine as more advanced models and may be sufficiently strong for some users.
Pod models are simple to operate and are also a good choice for beginners. These devices consist of a rechargeable battery with sealed pods prefilled with nicotine e-liquid.
These models replicate the smoking experience more closely. They have no buttons and are activated by breathing in. When the pod is empty, simply remove it and replace with another. There is no filling from a bottle, no coil replacement and no need to open the devices.
These basic tank models are more complex to use than cigalike and pod models but deliver higher nicotine doses. They have a single or no-button operation
These devices have tanks which are refilled by the user with e-liquid which is purchased separately. The coil needs to be replaced at regular intervals.
More advanced models or box mods are larger and more complex to use. They have larger batteries with LED screens and adjustable settings.
Advanced models are not generally recommended for new vapers. It is best to first become familiar with one of the intermediate models, learning the basics of how to vape, including refilling, recharging and changing coils.
What is e-liquid?
E-liquid or e-juice is the liquid solution used in vaping devices. E-liquid generally consists of nicotine and flavourings dissolved in propylene glycol (PG) and vegetable glycerine (VG).
Most beginners use about 2-5 ml daily, so a 30ml bottle lasts 1-2 weeks on average.
Propylene glycol (PG)
Propylene glycol (propane-1,2 diol) is a clear, tasteless liquid found in almost all e-liquids. It is also used in a wide range of products such as foods, asthma inhalers, air disinfectants and food flavorings. Another common use is for making theatre fog in stage productions.
Along with nicotine, PG helps to create the familiar ‘throat hit’ that smokers are used to, which can help make the transition from smoking to vaping easier. PG also helps to carry the flavouring in the e-liquid.
PG is generally regarded as safe but there is limited experience with long term inhalation. Some people can find it irritating in the mouth or lungs and may need to choose e-liquids with lower PG levels. On the other hand, PG has antibacterial properties and may help to reduce infections.
PG is a ‘thin’ liquid and is drawn into the wick more efficiently when you take a puff.
Vegetable glycerine (VG)
The other ingredient in almost all e-liquids is vegetable glycerine (VG), a clear, sweet tasting liquid. VG is also widely used in pharmaceuticals (such as cough syrups, creams), toothpaste and foods. It is generally regarded as very safe although there is limited information on long-term inhalation.
The main function of VG is to produce a thicker, denser vapour with a smoother feel. The greater the percentage of VG in the liquid, the more vapour is produced.
VG is quite viscous liquid though and does not soak quickly into the wick.
Most e-liquids are based on a combination of PG and VG, expressed as a PG:VG ratio, such as 50:50, 60:40 or 70:30, depending on the percentages of each in the mix.
A good starting ratio is 50:50. People who want big clouds choose more VG. Higher levels of PG give a stronger ‘throat hit’. People who are sensitive to PG, may reduce their PG levels and increase the VG component. The ratio you choose is very much a matter of personal preference.
Nicotine is the main addictive chemical in tobacco smoke and most vapers use nicotine in their e-liquid to avoid smoking urges and withdrawal symptoms. It also contributes to the familiar ‘throat hit’ from vaping. Some users find nicotine-free e-liquid is effective as they are not nicotine-dependent but enjoy the hand-to-mouth vaping experience.
Nicotine in e-liquid is extracted from the tobacco leaf, just like the nicotine used in nicotine patches and gums etc. Although many companies now use pharmaceutical grade nicotine (medicine quality) it still may contain small amounts of contaminants from the tobacco plant. Some companies are now making synthetic non-tobacco nicotine, although it is expensive and not widely available.
Nicotine in liquid form is classified as a ‘dangerous poison’ in Australia, however, the low concentrations used in vaping have relatively minor health effects. As nicotine can be absorbed through the skin, it is best to avoid excessive contact with the skin and to wash your hands after handling. However, the concentrations found in ready-to-vape e-liquid are very unlikely to cause harm even after significant skin exposure.
Popular nicotine concentrations range from 3-24mg/ml. Most people start in the 6-18mg/ml range. It is best to try different strengths first wherever possible to find what suits you best.
Many users start with tobacco flavoured e-liquid which more closely resembles a smoking experience. However, over time, most progress to other flavorings such as mint, fruit, sweet, food and beverage flavors. Flavours are usually included in pre-mixed solutions.
Most of the flavouring chemicals are food flavourings and are safe to ingest, but less is known about their safety for inhalation. Some flavors could potentially cause harm from long-term vaping. However, any risk from flavoring chemicals is likely to be much less than from smoking. If you are concerned about the potential risks from flavourings you could consider unflavoured e-liquid.
Certain chemicals are known to have potential risks and are best avoided. These include
- Diacetyl and acetyl diproprionyl. Used to give a buttery flavour. Many sites will indicate that their products are diacetyl- and acetyl proprionyl-free.
- Cinnamaldehyde. Cinnamon flavouring.
- Benzaldehyde. Used in some cherry flavouring.
Small amounts of chemicals and some toxins are produced by the thermal breakdown of PG, VG and flavourings when e-liquid is heated. These chemicals are present in the inhaled vapour in low quantities. Although some of these chemicals are potentially harmful, they are generally less than 1% of the concentrations in smoke.
So far there has been no sign of any serious health effects from vaping. The long-term health effects of the inhalation of these low levels of chemicals is unknown. However, based on what we currently know about the nature of these chemicals they are certain to be much less harmful in the long-term than smoking.
What does vaping cost?
Vaping is substantially cheaper than smoking. Australia has the highest cigarette prices in the world and the tobacco tax is set to rise 12.5% every year on September 2018, 2019 and 2020. A pack-a-day smoker (20 cigarettes) spends $9,125 per year on smoking.
The cost of vaping depends on the vaping device used and the level of vaping. Here are some average costs for the purchase of devices and nicotine e-liquid.
- Vaping devices. Many people start with a simple pod device or a refillable tank. Typical cost is about $35-$50.
- Nicotine e-liquid. E-liquid for refillable devices can be purchased for $20 per 30ml bottle in Australia. A typical vaper uses 4ml e-liquid per day or 1,460 ml per year, which is 50 bottles. Replaceable pods cost $3-6 and and deliver 200-300 puffs on average.
Total cost of vaping (refillable tank): $1,150 per year.
The comparative cost saving for a 20 cigarette-a-day smoker using a refillable device is nearly $8,000 per year. So vaping can be about 85% less expensive than smoking.
The cost of using a pod device is a little more than using refillables.
Vapers who mix their own e-liquid and/or build their own coils save a lot more, but there are risks in that and we do not recommend this for new vapers.
Calculate your cost of smoking here.
Is vaping safer than smoking?
Vaping is not risk-free, but scientists agree that it is far safer than smoking. According to the UK Royal College of Physicians report in 2016:
‘the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco’
There is still some uncertainty about long-term safety as vaping has only been around about 10 years but the evidence so far is pointing towards it being much safer than smoking.
This is not surprising as most of the harm from smoking is due to the tar, carbon monoxide and 7,000 other toxic chemicals produced by burning tobacco. Vaporisers do not contain tobacco and there is no combustion or smoke. According to Public Health England
‘the constituents of cigarette smoke that harm health – including carcinogens – are either absent in e-cigarette vapour or, if present, they are mostly at levels much below 5% of smoking doses (mostly below 1% and far below safety limits for occupational exposure)’
Vapour contains small amounts of toxins such as formaldehyde, acetaldehyde, cadmium and nitrosamines which are associated with cancer. However, these toxins are found at much lower levels than in tobacco smoke. The overall cancer risk from long-term vaping has been estimated at less than 0.5% of the risk from smoking.
The small health risks from vaping should be compared to the substantial risks from smoking. Two out of three long-term smokers will die from a smoking-related disease.
Although nicotine is the main addictive chemical in tobacco, it has relatively minor health effects except in pregnancy, where it can harm fetal development. The UK Royal Society for Public Health says nicotine is ‘no more harmful to health than caffeine’ and by itself is fairly harmless.
According to the UK Royal College of Physicians report
‘The long-term adverse effects of nicotine are likely to be minimal’
Nicotine does have some relatively minor effects on the cardiovascular system. It causes a temporary increase in the heart rate and blood pressure and may induce an irregular heartbeat (arrhythmia). Nicotine also increases the body’s resistance to the hormone insulin, leading to increased blood sugar (glucose) levels. However, these effects from nicotine are much less from vaping than they are from smoking tobacco.
In animal studies, there is some evidence that nicotine may be harmful to the developing adolescent brain. However, it is unclear how this research in animals translates to humans. There is no evidence of harm to the adolescent brain in humans so far. It is important to note that nicotine replacement therapy products (patches, gum, lozenges etc) are approved for use in adolescence from the age of 12 and appear to be well tolerated.
Nicotine also has positive effects as well. It can improve concentration, fine motor coordination, memory and cognition (brain function). It also helps with weight control and is a mental stimulant. There are a number of diseases known to be improved by nicotine, including ADHD, schizophrenia, Parkinson’s disease and ulcerative colitis.
For more about the health effects of nicotine, click here.
Small amounts of potentially toxic chemicals and some carcinogens are present in vapour. These chemicals include:
- Carbonyls such as formaldehyde, acetaldehyde and acrolein
- Nitrosamines such as NNN and NNK
- Toxic metals, such as cadmium, nickel and lead
- Volatile organic compounds such as toluene, benzene
These chemicals are from
- The breakdown of chemicals in the e-liquid (PG and VG) when it is heated
- Trace amounts of metals leached from the vaping device itself
- Contaminants in the nicotine liquid
Although some of these chemicals are potentially harmful, they are generally less than 1% of the concentrations in smoke. In larger doses, they are known causes of cancer, heart and lung disease.
A leading analysis confirmed the presence of potentially toxic compounds in vapour, although at very low doses:
‘The levels of potentially toxic compounds in e-cigarette vapour are 9–450-fold lower than those in the smoke from conventional cigarettes, and in many cases comparable with the trace amounts present in pharmaceutical preparations’.
Because the doses of these toxins are so small in vaping, the risk of harmful effects is substantially less than smoking. So far there has been no sign of any serious health effects from vaping.
The effects of long-term inhalation of these low levels of chemicals is unknown. However, based on what we currently know about the nature of these chemicals they are likely to be far safer in the long-term than smoking.
Risk to bystanders
The risk to bystanders from ‘passive vaping’ appears to be minimal. Negligible amounts of nicotine and other chemicals are released into the air when the user exhales. Furthermore, the vapour consists of liquid droplets which evaporates almost immediately (within 10-15 seconds) after exhalation, unlike cigarette smoke which persists in the air for 30-45 minutes.
The report by Public Health England in 2018 concluded:
‘electronic cigarette use releases negligible levels of nicotine into ambient air with no identified health risks to bystanders’
Another comprehensive review by leading researcher Konstantinos Farsalinos concluded:
‘the potential of any significant adverse effects on bystanders is minimal’
Nevertheless, indoor vaping is best avoided around children, pregnant women and people with heart or lung disease.
Health benefits of switching
Based on reports from research studies so far, smokers can expect significant health improvements after switching to vaping, such as:
- Improved lung function, reduced asthma symptoms and less need for asthma medication
- Chronic obstructive pulmonary disease (‘emphysema’). Significant reduction in flare-ups, improved symptoms and exercise ability
- Reduced pneumonia risk
- Blood pressure. Reduction in blood pressure in smokers with hypertension
- Cardiovascular health improved
Is vaping effective?
There is growing scientific evidence that vaping helps some people quit smoking and personal vaporisers are now the most popular quitting aid in the United Kingdom, the United States and the European Union.
Modern devices can provide the same levels of nicotine as tobacco cigarettes and can relieve urges to smoke and nicotine withdrawal symptoms such as irritability and loss of concentration. They also address the sensations and hand-to-mouth action of smoking.
According the Royal College of Physicians review
‘E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking’
Public Health England concluded
‘Recent studies support the Cochrane Review findings that e-cigarettes can help people to quit smoking and reduce their cigarette consumption’
Vaping is mostly used as a long-term safer substitute for smoking (tobacco harm reduction). It can help prevent relapse by acting as a smoking substitute to relieve urges to smoke after quitting. Vaping is also used as a short-term quitting aid.
Millions of smokers have reported quitting using a personal vaporiser in the UK, US and EU. For example, over 6 million people reported quitting smoking with a vaporiser in the European Union in a study in 2014. In the US there were 2.6 million former smokers who had switched completely to vaping in 2016, and 1.5 million in the UK in 2017.
Much of the research so far has used now-obsolete first generation ‘cigalikes’ with low nicotine delivery. These devices were found to be at least as effective as nicotine replacement therapy, such as the nicotine patch. However, newer devices deliver nicotine more effectively and have higher quit rates.
Vaping is most effective when used daily. Recent studies in the US here and here found that daily users were 3-8 times more likely to quit than non-users. Longer use is also associated with increased quitting. A study from the US reported that those who used the devices for at least 2 years were 4 times more likely than non-users to quit.
Some published research studies did not find that vapers were more likely to quit. However, many of these studies were not well conducted and some made important scientific errors, so their conclusions are not considered reliable.
More evidence of the effectiveness of vaping is that smoking rates are falling in countries where vaping is widely available, in some cases such as the US, faster than ever. Many experts feel it is likely that vaping is contributing to the rapid decline. However, in Australia where vaping is heavily restricted, the smoking rate has stalled for the last 3 years (2013-2016).
Data: UK. Annual Population Survey, Office of National Statistics; US. National Health Interview Survey, CDC National Centre for Statistics; Australia. National Drug Strategy Household Survey, Australian Institute of Health and Welfare
There are many thousands of personal stories online of individuals who have quit smoking with a personal vaporiser, such as here, here and here. These testimonials are not strong scientific evidence, but are important when added to the above evidence from properly conducted research studies.
Under Australian law, it is illegal to buy, possess or use liquid nicotine for vaping without a prescription from a registered Australian medical practitioner.
In Australia, medicines and poisons are listed in the Poisons Standard and are classified into categories called Schedules, which determine how they are regulated. Nicotine is classified as a Schedule 7 ’dangerous poison’, along with arsenic and strychnine. The exceptions to this classification are nicotine in tobacco for smoking and medicinal nicotine replacement products.
However, use and possession of liquid nicotine for a ‘therapeutic use’ (eg to quit or reduce smoking or to prevent relapse) are legal if the user has a prescription. It is then classified as a Schedule 4 product (prescription only) and it is permissible to possess or use it for personal use.
Legal access to nicotine
It is legal to import and use nicotine e-liquid legally to help you quit or reduce smoking (ie for a ‘therapeutic purpose’) if you have a prescription from a registered Australian medical practitioner.
1. TGA Personal Importation Scheme
You can legally import nicotine from overseas to help you quit or reduce smoking under the Therapeutic Goods Administration (TGA) Personal Importation Scheme. You may import 3 months’ supply at a time for personal use, up to a total of 15 months’ supply per year. The law requires you to have a prescription from a registered Australian doctor. Keep the script at home, or as a photo on your phone in case it is required. However, the TGA warns that there may be risks in importing nicotine from overseas suppliers as quality cannot be guaranteed.
2. Australian compounding pharmacies
Authorised Australian compounding pharmacies can legally prepare nicotine e-liquid if provided with a doctor’s prescription for a therapeutic purpose.
Preparation and supply of liquid nicotine for a particular person is legal under the ‘Compounding exemption’ in item 6 of Schedule 5 to the Therapeutic Goods Regulations 1990.
It is ILLEGAL to source liquid nicotine in Australia without a prescription. Purchase of illegal nicotine ‘under the counter’ is STRONGLY DISCOURAGED. There are no guarantees of product quality or safety or that the liquid is what it claims to be. It is also an offence under state laws.
State laws regulate issues such as sale, use in public places, age limits on sale, display and promotion of vaporizers. Regulations are different between states and may change from time to time.
- Sale to minors (<18y) is an offence
- No purchase by adults of vaporisers for a minor
- NSW Police have the power to seize a vaporiser that is in the possession of a person under the age of 18.
- Sale to minors (<18y) is an offence
- Sale to minors (<18 years) is an offence
- No free samples, sponsorship or shopper loyalty programs
- No purchase by adults of a vaporiser for a minor
- Under the act, authorised persons have the power to seize a vaporiser that is in the possession of a person under the age of 18 years
- Sale to minors (< 18 years) is an offence
- No purchase by adults of vaporiser for a minor
- An enforcement officer has the power to seize a vaporiser that is in the possession of a person under the age of 18 years
Note: The SA Parliament passed the Tobacco Products Regulation (E-Cigarettes and Review) Amendment Bill on 16 November 2018 to apply harsh restrictions on vaping use and sales in SA. The Bill will apply from mid-May 2019. For more information click here.
The Tobacco Control Amendment Bill 2018 is currently before the Northern Territory Parliament. If passed, it will regulate vaping products in the same way as tobacco products.
- Sale to minors (<18 years) is an offence
- No purchase by adults of vaporisers for a minor
- Under the act, authorised persons have the power to seize a vaporiser that is in the possession of a person under the age of 18 years
There are serious penalties for acquiring, using and/or possessing liquid nicotine unless it is prescribed by a doctor to help you quit or cut down smoking. Fines are based on ‘penalty units’, which can be located here.
|ACT||$30,000 max Or prison or both||2 years||Medicines, Poisons and Therapeutic Goods Act 2008|
|Western Australia||$45,000||Medicines and Poisons Act 2014|
|Victoria||$15,546 max||Drugs, Poisons and Controlled Substances Regulations 2017|
|South Australia||$10,000 max||Controlled Substances Act 1984|
|Northern Territory||$15,400 max Or prison||12 months||Medicines, Poisons and Therapeutic Goods Act|
|Queensland||$9752 max||Health (Drugs and Poisons) Regulation 1996|
|New South Wales||$1,100 max||Poisons and Therapeutic Goods Regulation 2008|
|Tasmania||$7,850 Or prison||Up to 2 years||Poisons Act 1971|
It is not an offence to import nicotine e-liquid into Australia under the Customs (Prohibited Imports) Regulations 1956 and an import permit is not required.
However, you may be committing an offence when you take possession of imported nicotine if you do not possess a prescription and do not meet the requirements of the TGA Personal Importation Scheme (above).
Imported vaping devices with nicotine which make a health claim (eg they are to help you stop or cut down smoking) may be referred to the TGA for a decision on whether to confiscate them, even if you have a prescription.
It is not illegal to possess or use a vaporiser (without nicotine) in all states and territories of Australia.
However, it is illegal to sell a vaporiser in Western Australia. In some other states, there are restrictions on the sale of vaporisers that resemble cigarettes.
Most other developed countries support vaping. In the UK, vaping is supported by the UK government (Public Health England), the Royal College of Physicians, the British Medical Association and most other, but not all, public health organisations and medical associations.
Public Health Concerns
Vaping is a controversial topic in public health in Australia. Some experts feel that vaping has the potential to save the lives of hundreds of thousands of smokers who are unable to quit smoking with conventional treatments. By switching to vaping, smokers are dramatically reducing their exposure to harmful chemicals for themselves and the people around them. This is known as tobacco harm reduction.
However, some public health experts are concerned that vaping may have unwanted effects. For example, there is concern that vaping devices may entice young people to start smoking and they may ‘renormalise smoking’ (make smoking look more socially acceptable again). There is also concern about possible unknown long-term risks.
Vaping for harm reduction is supported by the Royal Australasian and New Zealand College of Psychiatrists and Drug and Alcohol Nurses of Australasia.
However, most of Australia’s public health and medical organisations are taking a precautionary approach until more is known about vaping. This includes the federal and state health departments, the National Health and Medical Research Council, the Therapeutic Goods Administration, the Cancer Council, the Heart Foundation, the Australian Medical Association and the Thoracic Society of Australia and New Zealand.
Gateway to smoking for youth
It would be a serious concern if vaping was leading more young people to smoke (the ‘gateway theory’). In fact, the opposite may be true, ie that vaping is a gateway out of smoking. According to a comprehensive report of the University of Victoria, Canada in 2017:
‘There is no evidence of any gateway effect whereby youth who experiment with vapour devices are, as a result, more likely to take up tobacco use. The available evidence is that tobacco use by youth has been declining while use of vapour devices has been increasing’
Other evidence that suggests that vaping is not leading to smoking in young people:
- As vaping rates have been increasing in countries where nicotine vaporisers are readily available like the UK and US, smoking rates are declining rapidly in young people and are at record low levels. The evidence suggests that vaping may be reducing smoking uptake.
- Although about one in five teens try vaping, regular vaping (at least weekly) is almost exclusively confined to those who already smoke. Of young people who have never smoked, less than 5 in one thousand are regular vapers. Teens are curious and some may try it for a while and then most stop.
- One theory is that adolescents who would never have smoked, will become addicted to nicotine from vaping and then progress to tobacco cigarettes. However, the majority of adolescent who vape do not use nicotine.
- Some young people are using vaping devices to quit smoking or reduce cigarette use.
- ‘Common causality’. Many young people who try vaping will go on to become smokers later. However, there is no evidence that vaping causes smoking. It is more likely that ‘kids who try stuff, try stuff’ ie young people who are more likely to experiment with vaping are more likely to also try smoking. In fact, the vast majority of regular vapers started smoking first.
Uptake by adult non-smokers
Another concern is that non-smoking adults may try vaping and become regular users or ultimately smokers. However, according to the UK Royal College of Physicians:
‘e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely’.
Numerous studies have found that the use of vaping devices by adults who have never smoked is rare. In surveys in the UK, US, European Union, Greece and Germany, only between 1 and 5 in a thousand adults who had never smoked were currently using a vaporiser.
Renormalisation of smoking
Another legitimate concern about vaping is that increased visibility of an activity that resembles smoking may make smoking appear more socially acceptable again. Some fear that this may undermine many years of tobacco control which has ‘denormalised’ smoking.
However, there is no evidence that e-cigarettes are undermining tobacco control or leading to the renormalisation of smoking. In fact, the very opposite is occurring. Smoking rates in many countries where vaping products are widely available are falling faster than in Australia. It is very likely that e-cigarettes are a contributing factor to this rapid decline although it is not possible to prove cause and effect. Some research suggests that observers typically interpret vaping as indicating that the individual was seeking to reduce or cease his or her smoking and is more likely to denormalise smoking.
According to Public Health England:
‘There is no evidence that e-cigarettes are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it’.
Personal vaporisers were invented in 2003 by Hon Lik, a Chinese smoker who was looking for a less harmful alternative to smoking. The rise of vaping has been a grassroots consumer movement, taken up by smokers wanting to improve their health and save money.
The tobacco industry became involved much later to avoid becoming redundant from this new technology. They have been playing catch-up ever since in this rapidly evolving field. Most vaping devices internationally are not made by the tobacco industry – for example 15% of vaporisers in the US are made by Big Tobacco. Currently, no vaping devices sold in Australia, New Zealand or Canada are made by a tobacco company.
Some commentators want to ban vaping because they do not trust Big Tobacco and speculate that their agenda is to get people to smoke and vape. The past behaviour of Big Tobacco has been appalling and their behaviour needs to be closely monitored. However, it is wrong to automatically assume anything they do is bad. Vaping has the potential to dramatically reduce death and illness from smoking and this should be our priority.
Some commentators have expressed concern that many vapers are continuing to smoke (dual use). The concern is that being able to vape at times and places where smoking is not allowed may delay attempts to quit smoking.
However, there is no evidence that dual use delays or prevents quitting. Research shows that dual users are more likely to quit smoking than people who just smoke.
Many smokers go through a transition stage of smoking and vaping together before finally quitting smoking permanently. This transition stage can take weeks or years. The same process occurs with nicotine replacement products, ie that many smokers do both for a while before quitting.
In any case, evidence suggests that even long-term dual use is less harmful than smoking alone because most dual users significantly reduce the number of cigarettes they smoke thereby lowering their exposure to toxins. Consequently, health conditions such as emphysema, asthma and high blood pressure improve after switching to dual use.
However, quitting smoking completely should always be the preferred goal for smokers.
Forums are a valuable online resource for new vapers. They provide a wealth of information and an opportunity to ask questions from experienced vapers who are very willing to share their knowledge.
Vaping Australia Forum
Australian forum for vapers for information sharing and queries.
The world’s largest e-cigarette website (US based)
Vape Fam Facebook Group
A good Australian facebook page, very friendly and helpful for new users
UK National Centre for Smoking Cessation and Training (NCSCT)
Here is a list of scientific reports by independent expert organisations that have reviewed the science on vaping.
- Royal College of Physicians, UK. Nicotine without smoke. Tobacco Harm Reduction. 2016
- Public Health England.E-cigarettes and heated tobacco products: evidence review. 2018
- Clearing the Air Evidence Review Monograph, University of Victoria, Canadian Institute for Substance Use Research – Jan 2017
- United Kingdom Centre for Tobacco and Alcohol Studies report on electronic cigarettes. October 2016
- National Academies of Sciences Engineering and Medicine, US. Public Health Consequences of E-Cigarettes. 2018
New Nicotine Alliance
A national, independent not-for-profit consumer organisation representing Australian vapers.
For practical advice on all vaping matters.
Clive Bates: The counterfactual
Insightful analysis by the world’s leading campaigner on tobacco harm reduction and former head of Action on Smoking and Health UK.
Professor Michael Siegel: The Rest of the Story
Analysis and commentary by leading US academic.
Dr Konstantinos Farsalinos: E-cigarette Research
Scientific blog by one of the world’s leading e-cigarette researchers.
Professor Brad Rodu: Tobacco Truth
Professor of Medicine with special expertise in tobacco harm reduction.
Blog by Harry Shapiro on the Nicotine Science and Policy website.
FAQs about vaping
What is a personal vaporiser (e-cigarette)?
Personal vaporisers are battery-powered devices that heat a liquid nicotine solution (‘e-liquid’) into an aerosol which is inhaled and exhaled as a visible mist (known as ‘vaping’). Vaping delivers nicotine and replicates smoking behaviour, with the familiar hand-to-mouth action, ‘throat hit’ and the physical sensation of ‘smoke’ going into the lungs.
Vaporisers consist essentially of three components: a rechargeable battery, a tank, ‘pod’ or cartridge that holds the e-liquid and a coil (heating element).
What is vaping for?
Vaping is mainly used as a short-term aid to quitting smoking, or as a long-term substitute for smoking by smokers who are otherwise unable or unwilling to quit smoking or nicotine on their own or with the available treatments. Switching to a less harmful alternative such as vaping (known as ‘tobacco harm reduction’) reduces the health risks without quitting the ‘smoking’ behaviour
Is it safer than smoking?
Vaping is not harmless, but there is overwhelming scientific agreement that it is far less harmful than smoking. The UK Royal College of Physicians and Public Health England concluded that the long-term health risk from vaping is unlikely to exceed 5% of the harm from smoking tobacco. This is not surprising as most of the harm from smoking is due to the tar, carbon monoxide and 7,000 other toxic chemicals produced by burning tobacco leaf. Vaporisers do not contain tobacco and there is no combustion or smoke.
Some potentially harmful toxins are present in vapour, but at much lower levels than in cigarette smoke and in most cases below the level known to cause harm. Furthermore, there is a substantial reduction in toxins measured in the blood and saliva of vapers compared to tobacco smokers. A recent study calculated that the overall cancer risk from long-term vaping is <1% of the risk from smoking.
Significant health improvement after switching from smoking to vaping include improved asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and reduced pneumonia risk.
The small health risks from vaping should be compared to the substantial risks from smoking. Up to two out of three long-term smokers will die prematurely from a smoking-related disease.
What are the long-term risks?
Like all new products, the long-term health effects of vaping have yet to be established. However, based on current knowledge of the ingredients of vapour, the risk is certain to be much less than smoking. Studies of up to three and a half years and ten years of real-world experience have not identified any significant risks to health.
Is nicotine dangerous?
Although nicotine is the main addictive chemical in tobacco, it has relatively minor health effects, except in pregnancy and possibly in adolescence. The UK Royal Society for Public Health says it is ‘no more harmful to health than caffeine’. It does not cause cancer or lung disease and plays only a minor role in heart disease.
Can vaping help you quit smoking?
There is growing scientific evidence that vaping helps some people quit smoking. Personal vaporisers are now the most popular quitting aid in many countries including the United Kingdom and the United States.
Modern devices can provide the same levels of nicotine as tobacco cigarettes and can relieve urges to smoke and nicotine withdrawal symptoms such as irritability and loss of concentration. They also replicate the psychological and hand-to-mouth aspects of smoking.
Millions of smokers have reported quitting using a personal vaporiser in the UK, US and EU – over 6 million people reported quitting smoking with a vaporiser in the EU alone in 2014. Older devices are at least as effective as the nicotine patch. Newer devices deliver nicotine more effectively and have higher quit rates.
Is vaping legal?
It is legal to vape in Australia to quit smoking if you have a prescription from a registered Australian medical practitioner. Nicotine can be imported from overseas under the TGA Personal Importation Scheme or accessed legally from an accredited online Australian compoundingpharmacy.
State laws regulate issues such as sale of nicotine, use in public places, age limits on sale, display and promotion of vaporisers. Regulations are different between jurisdictions and may change from time to time.
Is secondhand vapour harmful?
The risk to bystanders from ‘passive vaping’ appears to be minimal. Negligible amounts of nicotine and other chemicals are released into the air when the vaper exhales, and this dissipates quickly. Nevertheless, indoor vaping is best avoided around children, pregnant women and people with heart or lung disease.
How much does it cost?
Vaping is substantially cheaper than smoking. A simple starter device can be purchased for about $30. Depending on which products you buy and how heavily you vape, vaping is 80-90% less costly than smoking. Most smokers will save thousands of dollars each year by switching to vaping.
Is vaping a gateway to smoking for young people?
Contrary to alarming claims, regular vaping by young people is rare and is almost exclusively confined to current or past smokers. Most teen vaping is experimental and short-lived. Also, the great majority do not use nicotine and there is little or no evidence of progression to smoking.
Overseas experience suggests that vaping is replacing—rather than encouraging—smoking of tobacco cigarettes among young people. Smoking rates in young people are continuing to fall in countries where vaporisers are readily available, in some cases such as the US, more rapidly than ever before.
ATHRA strongly discourages the use of vaping devices by non-smokers and minors.
Does vaping renormalise smoking?
There is no evidence that the increased visibility of vaping makes smoking appear more socially acceptable (renormalising smoking). In fact, in countries where vaporisers are freely available, smoking rates are continuing to fall, in some countries faster than ever. On the other hand, in Australia where vaping is restricted, smoking rates have stagnated over the 3-year period 2013-2016, for the first time ever.
Most vaping devices now look nothing like cigarettes and don’t smell of smoke. Vaping normalises ‘not smoking’, and its visibility may encourage smokers to switch and quit smoking
What about Big Tobacco?
Vaping is a grass-roots consumer movement by smokers wanting to improve their health and save money. The tobacco industry became involved much later to avoid becoming redundant as a result of this new technology and they have been playing catch-up ever since in this rapidly evolving field. Most vaporisers are made by small to medium businesses, not by Big Tobacco. In fact, the tobacco industry may be part of the solution if it is encouraged to move out of selling tobacco cigarettes and into less harmful alternatives. Currently, no vaping devices sold in Australia are made by a tobacco company.