18.3 Prevalence of e-cigarette use

Last updated: April 2024

Suggested citation: Greenhalgh, EM, Jenkins, S, Bain, E & Scollo, MM. 18.3 Prevalence of e-cigarette use. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2024. Available from: https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-3-extent

 

In many countries, including Australia, the use of e-cigarettes is growing, with the highest proportions of users among current smokers. This section summarises:

 

See Section 18.9 for a detailed discussion of predictors of e-cigarette uptake and use.

18.3.1 Trends in use of e-cigarettes in Australia

The National Drug Strategy Household Survey asked respondents about e-cigarette use for the first time in 2013, and from 2016 onward, asked additional questions about frequency of use.

18.3.1.1 Ever use of e-cigarettes

Prevalence of ever use of e-cigarettes among Australian smokers, non-smokers (including ex- and never smokers) by age group and gender since 2013 is set out in Table 18.3.1.

Table 18.3.1 Ever use of e-cigarettes by smoking status and age, 2013 to 2022–23

*Estimate has a relative standard error of 25% to 50% and should be used with caution
# Statistically significant change between 2019 and 2022–23.
(a) Smoked daily, weekly or less than weekly.
(b) Ex-smokers and never smokers combined; i.e., includes both those who have never smoked more than 100 cigarettes and those who have smoked more than 100 cigarettes but report no longer smoking at time of survey
Note: The question about lifetime use of electronic cigarettes was modified in 2016 and may have impacted how people responded question. 
Sources: National Drug Strategy Household Surveys 2016 key findings, Table 81 and 2022–23 Table 3.12

In 2022–23, about one in five people (19.8%) aged 14 and over reported having ever used e-cigarettes. At 48.8%, ever use was highest among young adults aged between 18 and 24 years, with lower use among older age groups. The proportion of people who had ever used e-cigarettes significantly increased between 2019 and 2022–23 both among adult smokers and non-smokers, and across all age groups except for the oldest.

Between 2019 and 2022–23, there was a large increase in the proportion of ever vapers who had never smoked prior to their first vape, particularly among young adults. Among Australians aged 18–24 who were ever vapers in 2022-23, the majority (57.6%) had never smoked before vaping for the first time—see Figure 18.3.1.

Figure 18.3.1 Smoking status at time of first vape, ever vapers, Australia, 2022–23
Source: AIHW National Drug Strategy Household Survey 2022–23, Table 3.282

18.3.1.2 Current use of e-cigarettes

Prevalence of current e-cigarette use by age group and smoking status is set out in Table 18.3.2. Between 2019 and 2022–23, current vaping almost tripled among the population 14 years and over, with an almost four-fold increase among those aged 18–24. One in five 18-24-year-olds reported currently vaping in 2022–23, up from one in 20 in 2019.

Table 18.3.2 Prevalence of current use of e-cigarettes (a) by age, 2016, 2019, and 2022–23 (%)

* Estimate has a relative standard error of 25% to 50% and should be used with caution.
** Estimate has a high level of sampling error (relative standard error of 51% to 90%), meaning that it is unsuitable for most uses.
# Statistically significant change between 2019 and 2022–23.
(a) Includes people who reported using electronic cigarettes daily, weekly, monthly or less than monthly.
(b) Includes people who reported smoking combustible cigarettes (manufactured and/or roll-your-own) daily, weekly or less than weekly.
(c) Includes those who have never smoked more than 100 combustible cigarettes (manufactured and/or roll-your-own), and those who have smoked this amount of combustible tobacco and report no longer smoking.
Source: National Drug Strategy Household Survey 2022–23, Table 3.32

Examining the age breakdown of e-cigarette users, in 2022–23, almost 60% of current vapers were aged under 30—see Figure 18.13.2.

Figure 18.3.2 Current use of e-cigarettes by age, Australia, 2022–23
Source: AIHW National Drug Strategy Household Survey 2022–23, Table 3.42

 

The 2022 ABS National Health Survey also collected data about use of e-cigarettes in Australia. In line with the National Drug Strategy Household Survey, vaping was most common among young adults aged 18–24 (see Figure 18.3.3).

Figure 18.3.3 Use of e-cigarettes by age group, Australia, 2022
Source: ABS National Health Survey, Table 14.3

18.3.1.3 Frequency of e-cigarette use

Frequency of e-cigarette use by smoking status in 2022–23 is presented in Table 18.3.3. More than one in ten (11.2%) smokers reported vaping every day.

Table 18.3.3 Frequency of e-cigarette use, people aged 14 years or older, 2022–23 (%)

(a) Smoked daily, weekly or less than weekly.
(b) Smoked at least 100 cigarettes (manufactured and/or roll-your-own) or the equivalent amount of tobacco in their life, and reported no longer smoking.
(c) Never smoked 100 cigarettes (manufactured and/or roll-your-own) or the equivalent amount of tobacco
Source: AIHW National Drug Strategy Household Survey 2022–23, Table 3.102

Among Australian adults aged under 25, there was a substantial increase in daily vaping between 2019 and 2022–23 – from about 2% of young men aged 18–24 in 2019 to 8.5% in 2022–23, and from fewer than 1% of young women of the same age in 2019 to 10.3% in 2022–23. Across both genders, this is an almost six-fold increase. Significant increases in daily vaping were also seen among males aged between 25 and 49, and among women aged 25 to 59—see Figure 18.3.4.

Figure 18.3.4 Daily use of e-cigarettes by age, Australia, 2019 and 2022–23
Note: Dotted columns indicate estimate has a relative standard error of 25% to 50% and should be used with caution. Striped columns indicate estimate has a high level of sampling error (relative standard error of 51% to 90%), meaning that it is unsuitable for most uses.
Source: AIHW National Drug Strategy Household Survey 2022–23, Table 3.92

18.3.1.4 Use of e-cigarettes by state/territory

Looking at use of e-cigarettes in each state and territory, in 2022–23, current (i.e., daily, weekly, monthly, or less than monthly) use of e-cigarettes among Australians aged 14+ ranged from about 4% in Tasmania to about 8% in New South Wales—see Figure 18.3.5. Current use had significantly increased since 2019 in all states except Tasmania.2  

Figure 18.3.5 Use of e-cigarettes by state/territory, Australia, 2022–23
Source: AIHW National Drug Strategy Household Survey 2022–23, Table 9b.82

 

Current use was consistently most common among young adults—see Table 18.3.4. Note however that data in the smaller states and/or older age groups may be less reliable, as indicated by the asterisks.

Table 18.3.4 Current e-cigarette use by state/territory and age group, 2022–23 (per cent)

* Estimate has a relative standard error of 25% to 50% and should be used with caution.
** Estimate has a high level of sampling error (relative standard error of 51% to 90%), meaning that it is unsuitable for most uses.
n.p. not published because of small numbers, confidentiality or other concerns about the quality of the data.
Source: AIHW National Drug Strategy Household Survey 2022–23, Table 9b.122

18.3.1.5 E-cigarette use among Aboriginal and Torres Strait Islander peoples

Researchers have also examined the extent of e-cigarette use and understanding among Aboriginal and Torres Islander peoples in Australia. The National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) found in 2018–19, 8.1% of Aboriginal and Torres Strait Islander adults had ever used e-cigarettes, though the majority were not current users. Men and women did not significantly differ in pattern of e-cigarette use.3 Among smokers about one in five (21%) had tried e-cigarettes in 2013–14. Forty-one per cent had never tried e-cigarettes, and the remaining 38% had not heard of the products.4 E-cigarette use was found to be concentrated in the young adult population, those aged 18–24 and 25–44 had a 2–3 fold greater prevalence of lifetime usage than adults over 45. The prevalence of e-cigarette use was also 3–4 fold higher in major city and regional areas compared to remote areas.4

18.3.1.6 E-cigarette use among priority populations

Use of e-cigarettes has increased among priority populations in Australia in recent years, including among low socioeconomic status groups, people who haven’t finished high school, the unemployed, regional Australians, and those who are gay, lesbian and bisexual.2 Unlike smoking (see Chapter 9), in 2022–23 use was fairly similar across socioeconomic and education levels. However use was more common among some priority groups; for example one in five (20.6%) gay, lesbian and bisexual people reported currently vaping (see Figure 18.3.6) compared with 6.1% of heterosexual people.2 People with a mental health condition were about twice as likely to currently use e‑cigarettes (12.3% compared with 5.8% of people without mental illness).5

Figure 18.3.6 Current use of e-cigarettes among priority populations, Australia, 2022–23
Source: AIHW National Drug Strategy Household Survey 2022–23, Table 3.11; Table 3.12;2 and web report.5

18.3.1.7 E-cigarette use among Australian teenagers

Among Australian secondary school students, in 2022–23, 30% reported that they had ever used an e-cigarette. Older students (16- and 17-year-olds) exhibited a higher prevalence of ever-use (43%) compared to younger students (12- to 15-year-olds) at 24%. Girls also reported a higher prevalence of ever-use (35%) than boys (25%). Concerning recent usage, 16% of students had used an e-cigarette in the past month, 5% had used e-cigarettes regularly (using e-cigarettes 20 or more days in the past month), and 3% had used e-cigarettes daily in the past month. Recent e-cigarette use (past month, regular and daily use) was also more prevalent among older students and girls. Of the students who had ever used an e-cigarette, more than two-thirds (69%) reported that they had never smoked a tobacco cigarette before their first vape. One in five (20%) of these students who had vaped but never smoked, reported later trying tobacco cigarettes—see Figure 18.3.7.6

Figure 18.3.7 Previous tobacco smoking (before trying an e-cigarette) among Australian secondary school students who have used e-cigarettes, 2022–23
Source: Australian Secondary Students’ Alcohol and Drug Survey 2022–236

 

In 2022–23, 13% of all Australian secondary students had used e-cigarettes exclusively in the past month, while 3% reported having concurrently used e-cigarettes and tobacco cigarettes (dual use). Older students (16-and-17-year-olds) were more likely than younger students (12-to-15-year-olds) to report dual use.6

A survey conducted in NSW in 2021 of teenagers aged 14–17 found that about one-third of the sample (32%) had ever vaped, 16% had vaped in the past month (49% of ever-vapers), and 5% reported vaping between 10 and 30 days of the last 30 (15% of ever-vapers). As NSW was under lockdown restrictions due to COVID-19 at the time of data collection, respondents were also asked about their typical vaping habits. During a typical month, 62% of ever-vapers reported vaping at least once and 19% 10–30 times. More than half (54%) of the ever-vapers had never smoked before they first tried vaping. Being older, Aboriginal and Torres Strait Islander, and smoking were associated with a greater likelihood of vaping.7 A small online survey of 13–19 year olds conducted by the Commissioner for Youth and Children in South Australia in 2022 found that two in three respondents had tried vaping. Among those who had tried vaping, almost one in four reported vaping on most days.8

18.3.1.7.1 E-cigarette use among Aboriginal and Torres Strait Islander teenagers

The 2018–19 National Aboriginal and Torres Strait Islander Health Survey found that 3.8% of Aboriginal and Torres Strait Islander adolescents had ever used e-cigarettes. However, this may underestimate the prevalence of e-cigarette use as adults are often present during NATSIHS data collection.3 A 2017 survey of Australian secondary students (which provides a more accurate picture of use among teenagers)9 found that 21.6% of Aboriginal and Torres Strait Islander students reported ever use of e-cigarettes, which was significantly higher than non-Indigenous students (13.5%). Vaping was more common among males than females, and among older than younger students. Ever use of e-cigarettes was higher among Aboriginal and Torres Strait Islander students who had ever smoked cigarettes compared to never smokers. Although vaping was most common among smokers, one-third (33%) of vapers had never smoked when they first tried an e-cigarette.10

18.3.2 International prevalence of e-cigarette use

International Tobacco Control (ITC) Surveys data show wide variation in the prevalence of use of e-cigarettes between countries surveyed, which may be attributable to a range of factors, including but not solely differences in regulatory approaches (see Sections 18.13 and 18.14).11-14 Dual use (i.e., people who both smoke and use e-cigarettes)continues to be a common pattern of use (see also Section 18.7). 

Figure 18.3.8 shows results from national surveys on the prevalence of ever, current and daily e-cigarette use in Australia, New Zealand, Great Britain, the US, and Canada for the most recent survey year for each country. Daily vaping appears to be highest in New Zealand, with one in ten people reporting that they use e-cigarettes every day.

Figure 18.3.8 Prevalence of e-cigarette use in in Australia, New Zealand, Great Britain, USA and Canada.
Sources: AIHW National Drug Strategy Household Survey 2022–23;2 New Zealand Health Survey 2022/23;15 UK Office for National Statistics – Opinions and Lifestyle Survey;16 US Behavioral Risk Factor Surveillance System;17 Canadian Tobacco and Nicotine Survey18  

18.3.2.1 International prevalence of e-cigarette use among adolescents

As with adults, the prevalence of e-cigarette use among adolescents varies widely between countries. Across WHO regions, the Global Youth Tobacco Survey has found that current e-cigarette use among 12–16 year olds ranges from 3.3% in Southeast Asia to 10.8% in the Western Pacific (7.8% in the Americas, 9.3% in Europe, 9.9% in Africa, and 10.6% in Eastern Mediterranean).19 For a discussion of the predictors and correlates of e-cigarette use among young people, see Section 18.9.

Figure 18.3.9 shows the prevalence of ever, current, and daily (or ‘once a week or more’ in England) e-cigarette use among students aged around 14-15 years from national surveys in Australia, New Zealand, the USA, Canada, and England from the most recent survey year for each country. As indicated in the notes below the figure, there are methodological differences between surveys. However, these surveys do suggest some variation in use of e-cigarettes among young people in these English-speaking countries. For example, the prevalence of daily vaping among students in New Zealand is about three times the rate of that in Australia for students the same age.

Figure 18.3.9 Prevalence of e-cigarette use among 14-15 year olds in Australia, New Zealand, USA, Canada and England.
Sources and Notes:
  1. Australia: Additional analysis from The Australian Secondary Students’ Alcohol and Drug (ASSAD) survey, which is a triennial survey of 12-17-year-old students and measures teenage substance use in Australia. In 2022/2023 it had a sample size of 10,314 students, including 2,001 (weighted n=1,874) year 9 students.20 Current e-cigarette use is defined as past month use. Year 9 students (generally aged 14-15 years) were selected.
  2. New Zealand: The ASH Year 10 Snapshot Survey21 is an annual survey of students on their smoking and vaping behaviours and attitudes. In 2023, it had a sample size of 29,260 students. Current use is defined as at least monthly.
  3. US: The High School Youth Risk Behaviour Survey22 is a biennial survey of students in grades 9-12 with a sample size of 17,232 students in 2021, including 4,646 grade 9 students. Current use is defined as past month use. Students in 9th grade (aged 14-15 years) were selected.
  4. Canada: the Canadian Student Tobacco, Alcohol and Drug Survey (CSTADS)23, 24 is a periodic survey funded by Health Canada. The most recent survey included more than 61,000 students in grades 7 to 12, including 11,055 grade 9 students. Current use is defined as at least once in the past 30 days. Students in grade 9 were selected.
  5. England: The Smoking, Drinking and Drug Use Among Young People Survey25 is a biennial survey of secondary school students in years 7 to 11 (aged 11 to 15). In 2021 it had a sample size of 9,289 students, including 2,424 15-year-olds in the e-cigarette analyses. Current use is defined as those who reported that they “sometimes use electronic cigarettes, but I don’t use them every week” or “use electronic cigarettes regularly, once a week or more”. Once a week or more was the highest frequency of use asked about in the survey. Students aged 15 years were selected.

Relevant news and research

For recent news items and research on this topic, click here. ( Last updated June 2024)

References

1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2016 key findings. 2017. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-key-findings/contents/summary

2. Australian Institute of Health and Welfare. Data tables: National Drug Strategy Household Survey 2022–2023 – 3. Electronic cigarettes and vapes. Canberra: AIHW, 2024. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey/data

3. Thurber K, Walker J, Maddox R, Marmor A, Heris C, et al. A review of evidence on the prevalence of and trends in cigarette and e-cigarette use by Aboriginal and Torres Strait Islander youth and adults. The Australian National University: Aboriginal and Torres Strait Islander Health Program; National Centre for Epidemiology and Population Health; Research School of Population Health, 2020. Available from: https://openresearch-repository.anu.edu.au/bitstream/1885/210569/1/Aboriginal%20cigarette%20ecigarette%20prevalence%20trends_2020.pdf

4. Thomas DP, Lusis N, Van der Sterren AE, and Borland R. Electronic Cigarette Use and Understanding Among a National Sample of Australian Aboriginal and Torres Strait Islander Smokers. Nicotine & Tobacco Research, 2019; 21(10):1434–40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30053109

5. Australian Institute for Health and Welfare. Mental health and use of alcohol, tobacco, e–cigarettes and other drugs.  2024. Available from: https://www.aihw.gov.au/reports/mental-health/mental-health-alcohol-drugs#People-with-a-mental-health-condition.

6. Scully M, Bain E, Koh I, Wakefield M, and Durkin S. ASSAD 2022/2023: Australian secondary school students’ use of tobacco and e-cigarettes. Centre of Behavioural Research in Cancer, Cancer Council Victoria, 2023. Available from: https://www.health.gov.au/sites/default/files/2023-11/secondary-school-students-use-of-tobacco-and-e-cigarettes-2022-2023.pdf

7. Watts C, Egger S, Dessaix A, Brooks A, Jenkinson E, et al. Vaping product access and use among 14-17-year-olds in New South Wales: a cross-sectional study. Australian and New Zealand Journal of Public Health, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36156328

8. Connolly H and Commissioner for Children and Young People. Vaping Survey: Key Findings – What do young people in South Australia think about current responses to vaping and how to better respond? ,  2022. Available from: https://www.ccyp.com.au/wp-content/uploads/2022/07/Screen-Vaping-Survey-Key-Findings-Report.pdf

9. Barrett E, Marmor A, Maddox R, Thandrayen J, Johnson F, et al. Prevalence by proxy: Estimating youth smoking prevalence using nationally representative household surveys. International Journal of Epidemiology, 2021; 50(Supplement_1). Available from: https://doi.org/10.1093/ije/dyab168.061

10. Heris C, Scully M, Chamberlain C, and White V. E-cigarette use and the relationship to smoking among Aboriginal and Torres Strait Islander and non-Indigenous Australian Secondary Students, 2017. Australian and New Zealand Journal of Public Health, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36121281

11. Gravely S, Fong GT, Cummings KM, Yan M, Quah AC, et al. Awareness, trial, and current use of electronic cigarettes in 10 countries: Findings from the ITC project. International Journal of Environmental Research and Public Health, 2014; 11(11):11691–704. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25421063

12. Gravely S, Fong GT, Cummings KM, Yan M, Quah AC, et al. Correction: Gravely, S., et al. Awareness, Trial, and Current Use of Electronic Cigarettes in 10 Countries: Findings from the ITC Project. Int. J. Environ. Res. Public Health 2014, 11, 11691-11704. International Journal of Environmental Research and Public Health, 2015; 12(5):4631–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25922990

13. Lee C, Yong HH, Borland R, McNeill A, and Hitchman SC. Acceptance and patterns of personal vaporizer use in Australia and the United Kingdom: Results from the International Tobacco Control survey. Drug and Alcohol Dependence, 2018; 185:142–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29448147

14. Li L, Borland R, Cummings KM, Gravely S, Quah ACK, et al. Patterns of Non-Cigarette Tobacco and Nicotine Use Among Current Cigarette Smokers and Recent Quitters: Findings From the 2020 ITC Four Country Smoking and Vaping Survey. Nicotine & Tobacco Research, 2021; 23(9):1611-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33693833

15. New Zealand Ministry of Health. New Zealand Health Survey 2022/23.  Available from: https://www.health.govt.nz/nz-health-statistics/surveys/new-zealand-health-survey.

16. UK Office for National Statistics. 2022 Opinions and Lifestyle Survey. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/datasets/ecigaretteuseingreatbritain

17. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Available from: https://www.cdc.gov/brfss/index.html

18. Health Canada. Canadian Tobacco and Nicotine Survey.  Available from: https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey/2022-summary/2022-detailed-tables.html

19. Sun J, Xi B, Ma C, Zhao M, and Bovet P. Prevalence of E-Cigarette Use and Its Associated Factors Among Youths Aged 12 to 16 Years in 68 Countries and Territories: Global Youth Tobacco Survey, 20122019. American Journal of Public Health, 2022; 112(4):650–61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35319939

20. Centre for Behavioural Research in Cancer. Australian Secondary Students' Alcohol and Drug (ASSAD) survey: E-cigarette ever use and past month use 2014-2022/23: customised report. Melbourne, Australia: Cancer Council Victoria, 2023.

21. Action for Smokefree 2025 (ASH). ASH Year 10 Snapshot Survey 2023: Topline – Youth smoking and vaping.  2023. Available from: http://ash.org.nz/

22. Centers for Disease Control and Prevention. High School Youth Risk Behavior Survey, 2021.  Available from: https://www.cdc.gov/healthyyouth/data/yrbs/index.htm

23. NHS Digital. Smoking, Drinking and Drug Use among Young People in England, 2021.  2022. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2021

24. Physicians for a Smoke-Free Canada. Public Use Micro File of the Canadian Student Tobacco, Alcohol and Drug Survey (CSTADS) is now available. 2024. Available from: https://smoke-free-canada.blogspot.com/2024/04/data-from-canadian-student-tobacco.html.

25. Government of Canada. Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS) 2021-2022 Public Use Microdata File (PUMF). 2024. Available from: https://open.canada.ca/data/en/dataset/1f15ca45-8bfd-4f9c-9ec6-2c0c440e69c2