How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales

Dunlop and colleagues1 provide valuable insights into the use of e-cigarettes and their potential for improving public health.

First, e-cigarettes are popular with Australian smokers. Despite legal barriers and restricted availability, 9% of smokers and 7% of recent quitters are currently using e-cigarettes.

The appeal of e-cigarettes to young smokers is important as they have the most to gain from quitting. The study reported that 16% of 18–29 year olds were current e-cigarette users. It also noted the interest from smokers in lower socio-economic groups, who have lower quit rates with conventional therapies.

Second, the study found that smokers are using e-cigarettes principally to quit and to reduce the harm from tobacco and this should be encouraged. Standard smoking cessation therapies have relatively low compliance and success rates and many smokers remain unable to quit smoking in spite of repeated attempts. Evidence from England shows that the availability of e-cigarettes has led to a substantial increase in the number of long term quitters who otherwise would not have quit.2

Third, prohibition is not working. The use of e-cigarettes has risen considerably since the New South Wales Population Health Survey in 2014.3 Some smokers are purchasing nicotine liquid online or “under the counter” and are being criminalised for “quitting the wrong way”. Many others are forced to use nicotine-free solutions, which are significantly less effective.

According to a recent landmark report by the Royal College of Physicians in the United Kingdom, the widespread uptake of e-cigarettes has huge potential to prevent death and disability from tobacco.4 Current laws allow the widespread sale of deadly tobacco products while perversely banning a safer alternative. Australian smokers have embraced e-cigarettes to reduce the harm from smoking and it is now up to the regulators and health professionals to provide their support.