E-cigarette use among young Australians has increased “alarmingly” in recent years, as a major peer-reviewed study led by The Australian National University (ANU) confirms the health risks vaping poses.

Published in the Medical Journal of Australia, the study builds on a 2022 ANU report on e-cigarettes, with additional peer-review and evidence from more than 400 studies and reports. The study is the most comprehensive review of the health impacts of e-cigarettes of its kind to date.

Lead author Professor Emily Banks, from the ANU National Centre for Epidemiology and Population Health, said the review confirms multiple risks of e-cigarettes, particularly for non-smokers, children, adolescents and young adults.

“Recent evidence shows vaping is becoming more popular, especially among children and adolescents, even though it is illegal except on prescription,” Professor Banks said.

“Almost all e-cigarettes deliver nicotine, which is extremely addictive. Addiction is common in people using vapes and young people are especially vulnerable to addiction as their brains are still developing.

“We tend to trivialise addiction, saying things like ‘I’m addicted to chocolate’. Addiction is a serious health issue and people addicted to vapes are going through repeated cycles of withdrawal, irritability, feeling bad and craving until they vape to feel normal again.

“For children and adolescents that can mean having difficulty sitting through a lesson or a meal with family.”

Other risks identified in the review included poisoning, especially in small children, seizures and loss of consciousness caused by nicotine overdose, headache, cough, throat irritation, and burns and injuries, largely caused by exploding batteries.

There was also indirect evidence of adverse effects on blood pressure, heart rate and lung functioning.

Another major risk identified by the study was that young non-smokers who use e-cigarettes are about three times as likely to go on to smoke regular cigarettes compared with young people who did not use e-cigarettes.

The review found that most use of e-cigarettes is not for smoking cessation, since most smokers who vape continue to smoke and most use in young people isn’t about quitting smoking. While most people who quit smoking successfully do not use any specific products, the review found that e-cigarettes can help some smokers to quit.

“Our lungs are designed to breathe fresh air,” Professor Banks said.

“People using vapes are inhaling a complex cocktail of chemicals. While we know about some of the risks of vaping, the review found that the effects of e-cigarettes on major health conditions like cancer and cardiovascular disease are unknown.

“The evidence supports Australia’s prescription-only model for e-cigarettes, which aims to avoid use in non-smokers and young people while targeting use for smokers seeking to quit.”

Australian Medical Association President Professor Steve Robson said the study was further evidence of the need for strong action by the federal government on nicotine vaping products and non-nicotine products, with vaping now presenting one of the biggest public health issues since tobacco.

“There is now more than enough evidence for strong action to enforce Australia’s prescription-only model for vaping products, which we know are harmful and can be a gateway to smoking for young people,” Professor Robson said.

“Australian governments need to act now to enforce existing laws and clamp down on the illegal non-prescription sale of e-cigarettes, as well as strengthen controls on the importation of both nicotine and non-nicotine vaping products. This will help us start to tackle the issue of vapes being marketed and sold to children.”

Ms Anita Dessaix, Chair of Cancer Council’s Public Health Committee, said: “This comprehensive review recognises that for the overwhelming majority of Australians, 89 per cent, who do not smoke, e-cigarettes are not safe and threaten Australia’s hard-fought tobacco control successes.

“It again confirms what the public health community has been repeatedly calling for. Strengthening and enforcing the Therapeutic Goods Administration’s existing legal prescription pathway is the only acceptable way to protect Australians from nicotine addiction and the numerous health harms, whilst supporting those smokers who want to try these products to quit.

“Every state, territory and the federal government now has more than enough evidence to act immediately to reduce illegal supply and access to e-cigarettes.

“The Australian Government must stop illegal imports of vaping products destined for illegal sale, whilst every state and territory government must crack down on the hundreds of retailers illegally selling e-cigarette products outside of pharmacies, under the noses of authorities.” 

Read the full study in the Medical Journal of Australia.