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

In his letter about our article,1 Mendelsohn states that e-cigarettes are popular with Australian smokers. While some groups of smokers in our sample were more likely to be using e-cigarettes, the overall use was relatively low at 9%. Mendelsohn also suggests that the rates of e-cigarette use are increasing, using 2014 data from the New South Wales Population Health Survey as a comparison. However, the samples of our survey and the NSW Population Health Survey are not comparable, with ours being a sample of current smokers and recent quitters and the other being a general population survey.

The United Kingdom report from the Royal College of Physicians referenced by Mendelsohn2 also recognises that there are public health concerns over e-cigarette use because it may be seen as renormalising the act of smoking, acting as a gateway to smoking in young people, and being used for temporary, not permanent, abstinence from smoking. While the UK reports no evidence that these processes are occurring to any significant degree, our research provides the first evidence that Australian adults aged 18–29 years old are in fact dual using tobacco cigarettes and e-cigarettes, and that quitting is not the primary intent of their use. Moreover, emerging research continues to question whether e-cigarettes act as a gateway to tobacco smoking among young people.3

The same UK report also recognises that, internationally, the tobacco industry has become involved in the e-cigarette market — which may undermine the tobacco control efforts — and that existing alternative nicotine replacement therapies could be promoted.

Caution and further investigation is warranted, particularly in the Australian context, before lauding e-cigarettes as a potential solution for smoking cessation, particularly among young people.