The NHMRC makes vaping position heard
December 21, 2023
Vaping increases as regulations tighten
Electronic cigarettes (e-cigarettes) have dramatically altered the landscape of smoking and nicotine use in Australia over the last 24 months. In NSW alone, daily or occasional e‐cigarette use by 16–24‐year‐olds has now increased from 11.1% to 16.5% in the last 3 years. Since the National Health and Medical Research Council’s (NHMRC) 2017 statement, there’s been a noticeable shift in e-cigarette usage and demographic patterns, but with the boom of vaping products targeting young adults and adolescents since 2021, the e-cigarette industry sees greater challenges for the future.
In recent years, e-cigarette technology and user demographics have undergone significant changes. The rise in popularity of disposable e-cigarettes, especially among younger non-smokers, is a concerning trend. These devices, often high in nicotine content and appealingly flavoured, pose a risk of initiating nicotine addiction in a new, younger demographic.
Research continues to confirm health risks
The 2022 NHMRC statement highlights the potential harms of e-cigarettes. All users, irrespective of their smoking history, are exposed to an array of chemicals and toxins. This exposure carries a risk of adverse health effects, a fact often overshadowed by the misconception of e-cigarettes as a safer alternative to traditional tobacco products.
In reality, what is often perceived as harmless vapour in e-cigarettes is, in fact, an aerosol consisting of hazardous particles. This aerosol includes harmful compounds like formaldehyde and acrolein, which can cause irreversible lung damage. It also contains propylene glycol, known for its toxicity to human cells. Additionally, nicotine, a highly addictive substance, is present and particularly dangerous for the still-developing adolescent brain. It adversely affects areas that control attention, learning, mood, and behavioural control.
Clinical practice implications
As medical professionals, the NHMRC’s findings prompt us to re-evaluate our approach to discussing e-cigarettes with patients. This involves understanding the individual’s smoking history, potential susceptibility to nicotine addiction, and considering the full range of cessation tools available. It’s a call to tailor advice and support based on a comprehensive understanding of both the risks and potential benefits of e-cigarette use.
Medical professionals will increasingly need to adopt a comprehensive and nuanced approach when discussing vaping with patients and the community in the future. This approach will centre around education, harm reduction, and patient-centred counselling.
Educationally, healthcare providers should begin to focus on informing both patients and the broader community about the potential risks and evolving knowledge associated with vaping. They hold a unique position to dispel common myths, such as the belief that vaping is entirely safe or a completely harmless alternative to smoking. This will involve providing up-to-date information about the chemicals in e-cigarettes and their potential health impacts, including lung damage, nicotine addiction, and the risks posed to adolescent brain development.
In cases where patients turn to vaping as a method to quit smoking, medical professionals should look to adopt a harm reduction perspective, in line with the most recent regulations and guidelines. For those using vaping as a smoking cessation aid, the conversation will include discussions about the efficacy and safety of various cessation methods, including FDA-approved options. For adolescents and young adults, the focus will be more on the risks of nicotine addiction and its impact on brain development. However, it should be emphasised that the long-term goal should be total cessation of all tobacco and nicotine products.
In addition to this clinical direction, the NHMRC’s statement acknowledges the role of e-cigarettes in assisting some smokers in cessation efforts, particularly those who have not succeeded with other methods. However, it emphasises the existence of safer and more effective cessation aids. This acknowledgment presents a clinical dilemma, balancing potential benefits for individual patients against broader public health concerns.
Vaping research continues
The NHMRC update underscores the significant gaps in our understanding, particularly concerning the long-term impacts of e-cigarettes. This gap in knowledge calls for ongoing research to inform future clinical guidelines and public health policies. As practitioners, staying abreast of emerging research and integrating new findings into our practice is crucial.
The 2022 NHMRC statement is an essential resource for medical professionals navigating the complexities of e-cigarettes in clinical and public health contexts. It offers a comprehensive overview of current knowledge, balanced with a cautious approach to e-cigarette use. In our roles, we must continue to provide informed, evidence-based advice to our patients, contribute to public health discussions, and advocate for continued research in this rapidly evolving field.
The future of vaping in Australia
The responsibility of medical professionals in the context of vaping extends beyond individual patient care to encompass a broader societal commitment. Adhering to Australian guidelines and actively participating in the public discourse on vaping are crucial elements of this responsibility.
Medical professionals must ensure that their approach to vaping, particularly in terms of cessation strategies and patient counselling, is evidence-based and reflective of the latest research and regulatory standards. This adherence not only safeguards patient health but also reinforces the credibility and trustworthiness of medical advice in the community.
Simultaneously, there is a pressing need for medical professionals to engage in building public knowledge about vaping. Misconceptions and misinformation about vaping are rampant, often perpetuated through social media and advertising. Medical professionals, with their expertise and authority, are uniquely positioned to counteract these narratives, providing clear, accurate, and accessible information to the public.
National Health and Medical Research Council. CEO statement on electronic cigarettes (e‐cigarettes). Canberra: NHMRC, 2017. https://www.nhmrc.gov.au/sites/default/files/documents/attachments/statement‐electronic‐cigarettes.pdf
World Health Organization. Tobacco: e‐cigarettes. Geneva: WHO, 2022. https://www.who.int/news‐room/questions‐and‐answers/item/tobacco‐e‐cigarettes#:~:text=Electronic%20cigarettes%20(or%20e%2Dcigarettes,of%20nicotine%20and%20harmful%20emissions