Opinion: Youth vaping is a problem, let’s look at the evidence – Sam Egger

As vaping rates climb, New Zealand's youth smoking gains begin to falter. Photo / Getty Images

THE FACTS

• Smoking rates in New Zealand have declined to 7%, but vaping’s role is overstated.
• Studies show youth vaping may slow the decline in adolescent smoking rates.
• Vaping might slightly accelerate adult smoking decline, but strong tobacco policies are key.

In many countries, smoking rates have been declining for decades. New Zealand is no exception.

As Professor Robert Beaglehole correctly noted in his recent New Zealand Herald opinion piece, the adult daily smoking rate in New Zealand has now declined to an impressively low 7%.

But his assertion that “vaping has significantly contributed to the decline” is not just an overstatement of the evidence.

It risks reinforcing a narrative implied by e-cigarette companies, including some owned by Big Tobacco: that New Zealand should never clamp down on e-cigarettes or smoking rates may rise again.

Let’s re-examine the evidence.

Beaglehole claims: “So far, there is no evidence that teen vaping leads to smoking.”

This is incorrect. I was an investigator on the only New Zealand study to date to directly compare adolescent smoking trends before and after e-cigarettes became available. We found that the decline in 14– and 15-year-olds initiating smoking – and smoking regularly – significantly slowed after the emergence and rise of vaping in New Zealand.

Had pre-vaping trends in adolescent smoking continued, the smoking initiation rate in 2023 would have been around 6.6%, rather than the 12.6% it ultimately reached.

Also, our new study – published today in The Medical Journal of Australia – adds to the evidence, albeit from the other side of the Tasman. As in New Zealand, we found that Australia’s progress in reducing adolescent smoking significantly slowed after the emergence and rise of vaping.

In both countries, the pattern is similar in a manner that seems unlikely to be a coincidence. While youth vaping may be less of a problem in Australia than in New Zealand, it is still a serious problem.

But it’s not just our New Zealand and Australian studies. There is also a large body of evidence from international cohort studies – the strongest type of observational study for understanding cause-and-effect relationships.

These studies track individuals over time and have consistently found that adolescents who vape are more likely to go on to smoke. None have yet been conducted in New Zealand, but their findings are so consistent across countries and cultures that it seems likely a New Zealand cohort study would show the same.

To suggest all of these studies provide “no evidence that teen vaping leads to smoking” is simply inaccurate.

What about adult smoking?

Beaglehole’s claim that vaping has significantly contributed to its decline in New Zealand also deserves a closer look.

It is true that adult daily smoking in New Zealand declined more sharply than expected between 2020 and 2023 – from 11.9% to 6.8%, a period when daily vaping rose rapidly from 3.5% to 9.7%.

This four-year window is what many e-cigarette advocates rely heavily on when declaring victory on behalf of e-cigarettes.

But the most recent New Zealand data diverge from that narrative. Despite daily vaping continuing to increase from 9.7% in 2023 to 11.1% in 2024, the rate of daily smoking failed to decrease for the first time in a decade.

Other countries offer further reason for caution. In England, although smoking rates declined between 2016 and 2023, there was no acceleration in that decline among adults aged 18-24 and 25-44, despite a sharp rise in e-cigarette use from 2021. Among those aged 45 and over, the decline in smoking not only failed to accelerate – it actually slowed.

Smoking rates in New Zealand were already falling before e-cigarettes emerged – and they continued to fall afterwards. This progress is at least partly due to the impact of strong tobacco control policies accumulating over many years – policies that continue to influence smoking patterns today.

These include smokefree bars and restaurants, regular increases in tobacco excise taxes, graphic health warnings on packaging, point-of-sale display bans, plain packaging and legislation prohibiting smoking in cars carrying children.

At best, vaping may have slightly sped up the decline in adult smoking. At worst, it may have made no difference – or even slowed progress – while embedding a commercial nicotine industry that will be hard to wind back.

The risk of overstating the evidence is that it fuels the idea that New Zealand now needs a thriving vaping industry. That if it’s reined in, smoking will inevitably rise.

It’s a convenient narrative. Especially for companies that profit from it.

Vaping may have a role to play in quitting smoking. But that doesn’t mean efforts to limit access to young people who have never smoked should be dismissed.

Now more than ever, New Zealand should double down on a progressive, evidence-based approach to tobacco control. Decades of hard-won progress shouldn’t now be handed to an industry eager to claim the credit.