Conflicting evidence is clouding the vaping issue

By Associate Professor Dr Muhammad Aziz Rahman

Vaping products are gaining in popularity globally, driven by the similarity in the sensory stimulation smokers get when using these electronic e-cigarettes compared to traditional cigarettes.

Recent national data shows that 11.3 per cent of people over 18 in Australia have tried vaping, with 64 per cent of current smokers having tried the devices. Similar vaping rates have been reported from the USA, Canada, New Zealand and the UK. Vaping has also gained popularity in developing countries.

Global debate continues regarding the effectiveness of vaping in helping people quit smoking. While many studies suggest that vaping is effective for reducing and cessation of smoking among current smokers, conflicting evidence exists among public health professionals and tobacco control advocates.

While one group of public health professionals may advocate harm reduction strategy by supporting the promotion of vaping for smoking cessation among current smokers who fail to quit using conventional methods, others favour complete non-promotion of vaping, as vaping may work as a gateway to smoking among non-smokers.

Furthermore, vaping is less harmful than cigarette smoking, but we know these products are not harmless, and we don’t know the long-term effects of vaping on human health.

Most e-cigarettes marketed globally contain nicotine which can be highly addictive. This addictiveness is a significant public health concern, especially if it attracts young people and those who haven’t been smokers before.

Due to such inconclusive evidence and different opinions from experts, regulations for vaping differs between countries. Tobacco control policies typically vary between developed and developing countries, which may impact the levels of vaping. While there has been numerous research in developed countries, evidence is still lacking from developing countries.

With this in mind, we aimed to compare the user profiles and perceptions of using e-cigarettes amongst users in Australia and Bangladesh as representations of a developed and a developing country. Comparing these issues between Australia and Bangladesh would provide evidence to assist in future global tobacco control policies for e-cigarettes. The study was recently published in the International Journal of Environmental Research and Public Health (IJERPH).

We conducted this study among members of different popular online forums in Australia and Bangladesh who were current or ex-users of e-cigarettes. A total of 422 people participated, comprising 261 (62 per cent) from Australia and 161 (38 per cent) from Bangladesh. More than half of the participants (58 per cent) from Australia were aged 31–50 years, with more than two-thirds (69 per cent) from Bangladesh aged 18–30 years.

Due to the increased prevalence of e-cigarette use among young people in this study sample from Bangladesh, there is a potentially high risk of users switching to regular cigarette smoking, undermining the tobacco control efforts. The e-cigarette users between the two countries also differed in gender, location of residence, marital status, levels of education, occupation and income.

Almost all of the participants in Australia and Bangladesh were using e-cigarettes daily (98 per cent and 88 per cent) and had nicotine in the e-liquid (92 per cent and 98 per cent).

However, we found that study participants from Australia were more likely to be exclusive users of e-cigarettes and less likely to use both cigarettes and e-cigarettes than the Bangladeshi participants. The dual use of cigarettes and e-cigarettes is a concern if the smokers do not quit and continue with both products.

Compared with the Bangladeshi participants, Australians were more likely to mention that the personal reasons for using e-cigarettes were the low cost, the good taste or flavour, and that the products were safe to use. They were less likely to cite the social or image aspect as a reason.

The use of e-cigarettes for social or image reasons among the sample of Bangladeshi participants in this study warrants urgent intervention to restrict access and supply, specifically among young people. It should also serve to promote health awareness in Bangladesh, as the potential risks of non-smokers using vaping as a gateway to smoking cannot be ignored.

The use of e-cigarettes as a smoking cessation aid was the predominant reason for use among Australian participants in this study, which indicated alignment towards the ‘harm reduction’ approach in Australian settings by facilitating the switch of the current smokers.

However, our findings indicate that such an approach would not be applicable in Bangladesh. Smokers in Australia need supportive strategies for accessing vaping for smoking cessation from their GP as a second-line of treatment following recent regulation changes. On the other hand, in Bangladesh, precautions need to be prominent not to promote e-cigarettes as a harm reduction tool for smoking cessation due to the risk of more potential harms than benefits.

This study is one of the few studies published so far that have compared perceptions of using e-cigarettes between developed and developing countries. However, our study sample was not representative of all Australians or Bangladeshi, and future research is needed in this area.

Dr Muhammad Aziz Rahman is an Associate Professor of Public Health and Associate Dean Research at the School of Health. Researchers who contributed to the study include Dr Bindu Joseph, Lecturer of Nursing, and Dr Naima Nimmi, PhD student, who is examining the issue of vaping among school children in Australia.

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