Global tobacco control has achieved remarkable success in reducing smoking, in a bid to safeguard public health. However, the proliferation of electronic cigarettes (e-cigarettes) has impeded the efforts by acting as a gateway to smoking in young people. Recent research in New Zealand suggested that e-cigarette use might have slowed down the decline in the youth smoking prevalence.
E-cigarettes are not banned in New Zealand. The Smokefree Environments and Regulated Products (Vaping) Amendment Act 2020 included measures that aim to prevent adolescents from using e-cigarettes, including banning e-cigarette sales to minors, banning e-cigarette use at schools, restricting flavours of e-cigarettes sold in general retailers, and restricting related advertising and sponsorship, etc. However, these measures failed to stop the surge in youth e-cigarette use in New Zealand. An interrupted time series analysis examined the trends in e-cigarette use in adolescents aged 14 to 15 years in the country between 2014 and 2023 and in cigarette smoking between 1999 and 2023. While the e-cigarette use prevalence increased generally, the rate of decline in the smoking prevalence decreased after the introduction of e-cigarettes in 2010.
Adolescent e-cigarette use in New Zealand surged between 2014 and 2023. The prevalence of ever use was 20.8% in 2014 and peaked at 42.7% in 2021 before falling to 37.5% in 2023. A similar trend was observed for regular e-cigarette use that the prevalence increased by more than 3.5 folds between 2015 (3.5%) and 2023 (16.4%), with a peak at 2021 (20.2%). The prevalence of daily e-cigarette use increased from 1.1% in 2015 to 10.0% in 2023. On the other hand, declining trends were observed for ever, regular and daily cigarette smoking. The prevalence decreased from 68.4% in 1999 to 29.6% in 2011 and 12.2% in 2023 for ever cigarette smoking, from 28.6% to 8.2% and 2.8% for regular cigarette smoking, and from 15.6% to 4.1% and 1.2% for daily cigarette smoking.
Despite decreasing prevalence of cigarette smoking in adolescents, the decline slowed down as e-cigarette use surged. The decline per year became smaller since 2010 compared with the projected trends with the hypothetical absence of e-cigarettes. Without e-cigarettes, the prevalence of ever, regular and daily cigarette smoking was projected to be much lower, reaching 6.6%, 1.8% and 1.0% respectively. The findings suggest that e-cigarettes may contribute to rather than displacing cigarette smoking in adolescents.
The World Health Organization recommends countries/jurisdictions where e-cigarettes have been banned to strengthen the implementation of the ban. To prevent a new wave of smoking in young people, Hong Kong has banned the import, promotion, manufacture, sale, and possession for commercial purposes of e-cigarettes, as well as heated tobacco products (HTPs), since 30 April 2022. The possession of e-cigarette and HTP substances in public places will be banned since 30 April 2026. The Government should review to further ban the possession in private places, and the possession of e-cigarette and HTP devices to offer more comprehensive protection of young people against harms of smoking.