Professors Janet Hoek and Richard Edwards, Emeritus Professor Phil Gendall, Jude Ball, Dr Judith McCool, Anaru Waa, Dr Becky Freeman
Recent media reports have presented conflicting evidence on youth vaping in NZ. While some NZ school principals report concerns about increasing vaping on school grounds and confiscating vapes, ASH Year 10 survey data have been interpreted as suggesting few young people who are non-smokers are vaping. How can these apparently contradictory perceptions co-exist? In this blog, we begin by outlining recent findings on electronic nicotine delivery systems (ENDS) and their potential contribution to public health. We then explore possible explanations for why reports and perceptions about youth vaping sometimes differ and offer suggestions about how this behaviour needs to be more effectively monitored.
ENDS’ impact on population health
Electronic nicotine delivery systems (ENDS) deliver nicotine to smokers using a hand-to-mouth process that parallels smoking. Because ENDS mimic smoking behaviour and can deliver nicotine more rapidly than traditional nicotine replacement therapy (NRT), they have generated considerable enthusiasm among some health workers who view them as a potential means to achieve rapid reductions in smoking.1 Despite uncertainty about ENDS’ immediate and long-term health effects, there is general agreement that vaping is likely to be less harmful than smoking, so long as smokers transition fully from smoking to vaping or use them to quit their nicotine addiction completely.
However, opinions on ENDS’ likely contribution to ending the smoking epidemic vary in at least two ways. First, debate over vaping’s effectiveness as a smoking substitute or cessation aid continues and, second, evidence regarding vaping uptake among adolescents and young adults is interpreted in different ways. With respect to the former, a recent randomised trial found vaping accompanied by behavioural support was about twice as effective at supporting smokers to quit as NRT (e.g. nicotine patches) combined with behavioural support.2 Another trial from New Zealand reported modest increases in cessation when nicotine patches were supplemented with vapes containing nicotine relative to when they were used with vapes containing no nicotine or nicotine patches alone.3 However, evidence from observational population-based studies is more mixed.4 While some studies suggest ENDS could help reduce smoking prevalence at the population level, their introduction about a decade ago has not resulted in big declines in the proportion of people who smoke, or had more than a modest impact on quit rates.5 Therefore vaping’s a potential contribution to achieving the Smokefree Aotearoa 2025 goal through acting as a substitute for smoking and supporting cessation remains unclear.
Gaps in the NZ data?
Data on youth vaping and smoking is primarily reported from the ASH Year 10 Snapshot survey (commonly known as the ASH Y10 survey). Other sources of data include the Youth Insights survey and the Youth19 survey. The Snapshot survey is a short cross-sectional survey administered to between 20,000 and 30,000 14 and 15 year olds annually since 1999. The survey data have documented changing tobacco use patterns and informed policies, including youth access to tobacco,9 smoking in cars,10 11 removal of tobacco point of sale displays,12 and tobacco endgame goals.13 The ASH Y10 survey continues to offer important data on youth smoking in Aotearoa and rangatahi contributing to the survey have provided key insights over two decades.
In contrast to the extensive annual data available on 14-15 year olds, monitoring of young people aged 16-24 years is limited in scope, partly as it is very difficult to cost-effectively survey this age group. Hence available data are largely restricted to those collected as part of broader adult surveys such as the NZ Health Survey, and Health and Lifestyle Survey. As a result, estimates of smoking and vaping behaviour among young adults have limited precision due to the small numbers of participants from these age groups in these surveys. Limited numbers also means that exploring how use varies by ethnicity and socio-economic factors is not very informative.
Differences in perceptions about youth vaping prevalence
The ASH Y10 survey reported overall daily e-cigarette use of 1.8% and daily or weekly of 4%. Reports of ENDS use based on the ASH Y10 surveys have also described prevalence of use in relation to smoking status (daily e-cigarette use was 0.4% among never smokers and 14.4% among regular smokers). For example, the 2018 survey briefing released by ASH NZ (in April 2019) noted “Fewer than 1% of Year 10 students who reported never smoking reported using e-cigarettes daily” and concluded that “….daily use of e-cigarettes is rare and is largely confined to those who have smoked.”14 This finding has been cited by Associate Minister Salesa to support the conclusion that youth vaping was at minimal levels, particularly among never smokers, and that the risk of vaping functioning as a gateway to smoking was thus low.
However, in the last few months some school principals have made media statements indicating their concern at the rapid growth in vaping they had observed among their students.15 For example, the President of the Auckland Secondary School Principals’ Association commented: “At some schools we are starting to see over 30 per cent of students have tried it. The percentages of people who are using it regularly are pushing up towards five, six-plus per cent and the interesting thing about that statistic, that might seem low, but that’s in schools where smoking has hit basically zero per cent.”15
Sourced from: blogs.otago.ac.nz
Youth Vaping in New Zealand can be contained if done properly