18B.3 Prevalence of e-cigarette use

Last updated:  November 2022  

Suggested citation: Greenhalgh, EM, Bain, E, Jenkins, S & Scollo, MM. 18B.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; 2022. Available from:  http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes

 

In many countries, including Australia, the use of e-cigarettes is growing, with the highest proportions of users among current smokers.1-5

18B.3.1 Trends in use of e-cigarettes in Australia

The National Drug Strategy Household Survey asked respondents about e-cigarettes for the first time in 2013, and in 2016 and 2019, asked additional questions about frequency of use. Prevalence of ever use of e-cigarettes among Australian smokers, non-smokers (including ex- and never smokers) of various age groups and totals for persons 14 years and over and 18 years and over for all three survey years is set out in Table 18B.3.1.

Table 18B.3.1 
Lifetime e-cigarette use by smoking status and age, 2013, 2016 and 2019  

 

Sources: National Drug Strategy Household Surveys 2016 key findings, Table 82 and 2019, Table 2.195
*Estimate has a relative standard error of 25% to 50% and should be used with caution  
# Statistically significant change between 2013 and 2016, or between 2016 and 2019.     
^ 2013 survey youngest age group included 12–17-year-olds however 12 & 13-years olds were not surveyed in 2019   
(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.   

About 11% of the general population aged 14 and over reported in 2019 having ever used e-cigarettes. At 26.1%, 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 2013 and 2016 both among adult smokers (from about 18% to about 31%) and non-smokers (never + ex-smokers; from about 2% to about 5%), and across all age groups except for the oldest. Between 2016 and 2019, ever use increased further among adult smokers (from about 31% to 38%) and among non-smokers (from about 5% to almost 7%).  In 2016, the highest rates of ever use appeared to be among 18–24-year-olds (49.1% and 13.6% of smokers and non-smokers, respectively, compared to 30.8% and 4.7% in the total adult population). In 2019 rates of ever use among 18­–24-year-olds had increased to 63.9% of smokers and 19.6% of non-smokers.

Frequency of e-cigarette use by smoking status in 2019 is presented in Table 18B.3.2. The proportion of never smokers who had also never used e-cigarettes decreased between 2016 and 2019, with 94.8% of adult never smokers reporting that they had never tried e-cigarettes in 2019 (compared with 96.1% in 2016 and 98.7% in 20136 ). Among ex-smokers, 11.4% reported ever use, compared with 7.5% in 2016 and 3.1% in 2013.6

More than one-third of smokers had tried e-cigarettes in 2019, and 7.8% reported current use (daily, weekly, or monthly).

Table 18B.3.2 
Frequency of e-cigarette use, people aged 14 years or older, 2019 (per cent)

 

Source: National Drug Strategy Household Survey 2019, Table 2.225
*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
(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

 

Frequency of current use of e-cigarettes by age group and smoking status in 2016 and 2019 is set out in Table 18B3.3.

Table 18B.3.3 
Prevalence of current use of e-cigarettes (a) by age, 2016 and 2019 (per cent)  

 

Source: National Drug Strategy Household Survey 2019, Table 2.25
*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 2016 and 2019.
(a) Includes people who reported smoking 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.

The 2020–21 ABS National Health Survey also collected data about use of e-cigarettes in Australia (noting that data collection, including response rates and sample representativeness, was impacted by COVID-19). Almost one in ten (9.3%) people aged 18+ had ever used an e-cigarette, and 2.2% reported currently vaping. In line with the National Drug Strategy Household Survey, vaping was most common among young adults aged 18–24 (see Figure 18B.3.1). Those aged 18–44 years were twice as likely as people aged 45 years and over to report current vaping (3.2% vs. 1.5%). Men were more likely than women to have ever used (11.3% vs. 7.5%) or currently used (2.9% vs. 1.6%) e-cigarettes. Among smokers, 8.9% reported current vaping, and 23.8% were former vapers.7

 
Figure 18B.3.1 Use of e-cigarettes by age group, Australia, 2020–21
Source: ABS National Health Survey 7

 

The NSW Population Health Survey estimated that in 2021, 16.2% of adults had ever used e-cigarettes and 5.5% were current (daily or occasional) users. In 2020–21, use of e-cigarettes was highest among persons aged 16-24 years, for both ever use (32.7%) and current use (11.1%). Males were more likely than females to have ever used e-cigarettes (37.4% compared to 27.7%).8 The Victorian Smoking and Health Survey found that between 2018–19 and 2022, ever use of e-cigarettes increased from 17.0% to 22.0%; current use doubled from 3.0% to 6.1%; and regular use more than doubled from 1.6% to 3.5%. The largest increases were among those aged under 30, particularly women aged 18-24 years (2.8% to 15.2%). In 2022, one-quarter of current e-cigarette users were never smokers (25.0%), 28.7% were former smokers, and almost half (46.3%) were current smokers.9

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.12 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.13 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.13

See Section 18B.12 for a detailed discussion of predictors of e-cigarette uptake and use.

18B.3.1.1 E-cigarette use among Australian teenagers

Among Australian secondary school students, in 2017, 14% reported that they had ever used an e-cigarette. Use was higher with age, from 4% of 12-year-olds to 21% of 17-year-olds, and boys (17%) were significantly more likely than girls (10%) to report ever-use. Four percent of students had used an e-cigarette in the past month, including 2% who reported using them three or more times over this period. Of those who had tried e-cigarettes, younger students were more likely to have used them recently. About 37% of 12-to-15-year-old users and 27% of 16-and-17-year-old users reported vaping at least once during the past month. Younger vapers were also more likely to have used e-cigarettes at least three times in the past month (12–15: 16%; 16–17: 10%). Two percent of students reported using e-cigarettes three or more times in the past month, with no difference by age group. Of the students who had ever used an e-cigarette, about half (48%) reported that they had never smoked a tobacco cigarette before their first vape.  A quarter of these students who had vaped but never smoked, reported later trying tobacco cigarettes—see Figure 18B.3.2.14  

    

Figure 18B.3.2 Previous tobacco smoking (before trying an e-cigarette) among ever e-cigarette users, Australia, 2017
Source: Australian Secondary Students’ Alcohol and Drug Survey 2017 14

 

In 2014, 3% of all Australian secondary students had used e-cigarettes exclusively, while 11% reported having concurrently used e-cigarettes with tobacco cigarettes and/or shisha-tobacco. Of the 14% of students who had ever used an e-cigarette, 12% used them exclusively, 55% had used shisha-tobacco, and 65% had smoked tobacco cigarettes at least once in their lifetime. Of the 20% of students who had smoked tobacco cigarettes in their lifetime, 47% had ever used e-cigarettes.15

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.16 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.17

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.12 A 2017 survey of Australian secondary students (which provides a more accurate picture of use among teenagers)18 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.19

18B.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 18B.8 and 18B.9).20-23 Dual use (i.e., people who both smoke and use e-cigarettes)continues to be a common pattern of use (see also Section 18B.6). Current use of e-cigarettes among adult never smokers appears to be consistently less common than among smokers. 

Table 18B3.4 shows results from national surveys on the prevalence of e-cigarette use among adults and, where data is available, by smoking status.

Table 18B.3.4 Prevalence of use of e-cigarettes (per cent) by country and frequency of use
 

^Frequency of use unless otherwise specified

18B.3.3 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).44 . Table 18B3.5 shows results from an international review45 a European study46 as well as a number of national surveys on the prevalence of e-cigarette use among young people. For a discussion of the predictors and correlates of e-cigarette use among young people, see Section 18B.12.

Table 18B.3.5 Prevalence of use of e-cigarettes (per cent) among young people by country and frequency of use
 

^Frequency of use unless otherwise specified

 

Figures 18B.3.3 and 18B.3.4 show the prevalence of e-cigarette use (ever use and current use) for students aged around 14-15 years* from national surveys in Australia, New Zealand, the USA, England and Ireland since 2014. As indicated in the notes below the figures, there are methodological differences between surveys in the different countries. However, these surveys do suggest a substantial increases in current use of e-cigarette in these English-speaking countries over the past few years.

* Irish students are slightly older on average (15-16 years).

 

Figure 18B.3.3 Prevalence of ever use of e-cigarettes in 14-15 year olds since 2014 in Australia, New Zealand, England, USA and Ireland

 

 

 

Figure 18B.3.4 Prevalence of past month e-cigarette use in 14-15 year olds since 2014 in Australia, New Zealand, USA and Ireland
Sources and Notes:
  1. Australia: The Australian Secondary Students’ Alcohol and Drug (ASSAD) survey is a triennial survey of 12-17 year old students and measures teenage substance use in Australia, with approximately 20,000 students per wave 54 . Ever use of e-cigarettes is measured by asking “Have you ever used battery operated electronic cigarettes (e-cigarettes)?” In 2014, current e-cigarette use was defined as past month use and was measured using the question “How recently have you used battery operated electronic cigarettes?” with the response frame “Last 4 weeks”, and in 2017 was calculated from the question “During the past 30 days, on how many days did you use e-cigarettes?” Year 9 students (aged 14 and 15 years) were selected.
  2. New Zealand: The ASH Year 10 Snapshot Survey 55 surveys 20,000-30,000 students each year on their smoking and vaping behaviour and attitudes. The survey was not carried out in 2020 due to Covid-19. Ever use of e-cigarettes was measured using the question “Have you ever tried an e-cigarette or vape, even just a few puffs or vapes?” We calculated current e-cigarette use from the question “How often do you use e-cigarettes or vapes now?” by combining the responses for “at least once a day”; “at least once a week”, and “at least once a month”.
  3. England: The Smoking, Drinking and Drug Use Among Young People Survey 48 , 56-58 is a biennial survey of secondary school students in years 7 to 11 (aged 11 to 15), with approximately 12,000-14,000 students per wave. Ever use of e-cigarettes was measured using the question “Tick the box which best describes you. Think about times when you may have had a puff or two as well as using whole electronic cigarettes”. Ever use was calculated combining the responses for “I have used electronic cigarettes only once or twice”; “I used to use electronic cigarettes but I don’t now”; “I sometimes use electronic cigarettes, but I don’t use them every week”; and “I use electronic cigarettes regularly, once a week or more”. Current use was defined as regular or occasional use. Students aged 14 and 15 years were selected.
  4. US: The High School Youth Risk Behaviour Survey 59 is a biennial survey of students in grades 9-12 (with a sample size of approximately 13,000 per wave) and monitors priority health behaviours and experiences among students in the US. Ever use was measured using the question “Have you ever used an electronic vapour product?” Current use was calculated by students who had reported using e-cigarettes on at least one day during the past 30 days before the survey. Students in 9 th grade (aged 14-15 years) were selected.
  5. Ireland: Data came from the Irish results of the European Schools Project on Alcohol and Other Drugs 60 , 61 , a European school survey that collects data on substance use among 15-16 year old students (slightly older than the other comparator countries) in as many European countries as possible. The Irish sample comprised approximately 2,000 students per wave. Ever use was measured using the question “Have you ever used e-cigarettes?” Current use was defined as past month use and calculated from the question “How often have you smoked e-cigarettes during the last 30 days?” Note that confidence intervals were not published for the Irish prevalence rates.

 

Relevant news and research

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References 

1. Dai H and Leventhal A. Prevalence of e-cigarette use among adults in the United States, 2014-2018: Research letter. Journal of the American Medical Association, 2019. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31524940

2. 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

3. Centers for Disease Control and Prevention. QuickStats: Cigarette Smoking Status Among Current Adult E-cigarette Users, by Age Group—National Health Interview Survey, United States, 2015. Morbidity and Mortality Weekly Report, 2016; 65:1177. Available from: http://dx.doi.org/10.15585/mmwr.mm6542a7

4. Action on Smoking and Health. Use of e-cigarettes (vaporisers) among adults in Great Britain. ASH,  2019. Available from: https://ash.org.uk/wp-content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf

5. Australian Institute of Health and Welfare. Data tables: National Drug Strategy Household Survey 2019 - 2. Tobacco smoking chapter, Supplementary data tables. Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data

6. Centre for Behavioural Research in Cancer. Analysis of Australian Institute of Health and Welfare National Drug Strategy Household Survey, 2013 [computer file; Australian Data Archive, The Australian National University]. 2016.

7. Australian Bureau of Statistics. Smoking: 2020-21 financial year.  2022. Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/2020-21

8. Chan G, Leung J, Gartner C, Yong HH, Borland R, et al. Correlates of electronic cigarette use in the general population and among smokers in Australia - Findings from a nationally representative survey. Addictive Behaviors, 2019; 95:6–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30784874

9. Jongenelis MI, Brennan E, Slevin T, Kameron C, Jardine E, et al. Factors associated with intentions to use e-cigarettes among Australian young adult non-smokers. Drug Alcohol Rev, 2019; 38(5):579–87. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31317596

10. Wamamili B, Lawler S, Wallace-Bell M, Gartner C, Sellars D, et al. Cigarette smoking and e-cigarette use among university students in Queensland, Australia and New Zealand: results of two cross-sectional surveys. BMJ Open, 2021; 11(2):e041705. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33563621

11. Twyman L, Watts C, Chapman K, and Walsberger SC. Electronic cigarette use in New South Wales, Australia: reasons for use, place of purchase and use in enclosed and outdoor places. Australian and New Zealand Journal of Public Health, 2018; 42(5):491–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30152006

12. 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

13. 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

14. Guerin N and White V. Secondary school students’ use of tobacco, alcohol and other drugs in 2017: Second Edition. Cancer Council Victoria, 2020. Available from: https://www.health.gov.au/resources/publications/secondary-school-students-use-of-tobacco-alcohol-and-other-drugs-in-2017

15. Williams T and White V. What Factors are Associated with Electronic Cigarette, Shisha-Tobacco and Conventional Cigarette Use? Findings from a Cross-Sectional Survey of Australian Adolescents? Substance Use and Misuse, 2018; 53(9):1433–43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29336657

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Borland R, Murray K, Gravely S, Fong GT, Thompson ME, et al. A new classification system for describing concurrent use of nicotine vaping products alongside cigarettes (so-called 'dual use'): findings from the ITC-4 Country Smoking and Vaping wave 1 Survey. Addiction, 2019; 114 Suppl 1:24–34. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30702175

25. New Zealand Ministry of Health. Annual Update of Key Results 2020/21: New Zealand Health Survey.  2021. Available from: https://www.health.govt.nz/publication/annual-update-key-results-2020-21-new-zealand-health-survey

26. European Commission. Special Eurobarometer 506: Attitudes of Europeans towards tobacco and electronic cigarettes (S2240_506_ENG).  2021. Available from: http://data.europa.eu/88u/dataset/S2240_506_ENG

27. Organisation for Economic Co-operation and Development and Health Division, Non-medical determinants of health: use of vaping products. Paris: OECD; 2021. Available from: http://www.oecd.org/els/health-systems/health-data.htm.

28. Action on Smoking and Health. Use of e-cigarettes among adults in Great Britain. ASH UK,  2022. Available from: https://ash.org.uk/resources/view/use-of-e-cigarettes-among-adults-in-great-britain-2021

29. World Health Organization. Global Adult Tobacco Survey.  Available from: https://www.who.int/teams/noncommunicable-diseases/surveillance/data

30. Kilibarda B, Krstev S, Milovanovic M, and Foley K. E-cigarette use in Serbia: Prevalence, reasons for trying and perceptions. Addictive Behaviors, 2019; 91:61–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30473245

31. Pan L, Morton J, Mbulo L, Dean A, and Ahluwalia IB. Electronic cigarette use among adults in 14 countries: A cross-sectional study. EClinicalMedicine, 2022; 47:101401. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35497060

32. Statistic Canada. Canadian Tobacco and Nicotine Survey, 2021.  2022. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/220505/dq220505c-eng.htm

33. Cornelius ME, Wang TW, Jamal A, Loretan CG, and Neff LJ. Tobacco product use among adults—United States, 2019. Morbidity and Mortality Weekly Report, 2020; 69(46):1736.

34. Bertoni N, Szklo A, Boni R, Coutinho C, Vasconcellos M, et al. Electronic cigarettes and narghile users in Brazil: Do they differ from cigarettes smokers? Addictive Behaviors, 2019; 98:106007. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31247536

35. Cavalcante TM, Szklo AS, Perez CA, Thrasher JF, Szklo M, et al. Electronic cigarette awareness, use, and perception of harmfulness in Brazil: findings from a country that has strict regulatory requirements. Cad Saude Publica, 2017; 33Suppl 3(Suppl 3):e00074416. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28954048

36. Action on Smoking and Health UK. Use of e-cigarettes among young people in Great Britain. 2021. Available from: https://ash.org.uk/information-and-resources/fact-sheets/statistical/use-of-e-cigarettes-among-young-people-in-great-britain-2021/

37. Zavala-Arciniega L, Reynales-Shigematsu LM, Lozano P, Rodriguez-Andrade MA, Arillo-Santillan E, et al. Patterns of awareness and use of electronic cigarettes in Mexico, a middle-income country that bans them: Results from a 2016 national survey. Preventive Medicine, 2018; 116:211–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30261244

38. Zhao Z, Zhang M, Wu J, Xu X, Yin P, et al. E-cigarette use among adults in China: findings from repeated cross-sectional surveys in 2015-16 and 2018-19. Lancet Public Health, 2020; 5(12):e639–e49. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33271077

39. Tabuchi T, Gallus S, Shinozaki T, Nakaya T, Kunugita N, et al. Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol. Tobacco Control, 2018; 27(e1):e25–e33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29248896

40. Chang Y, Cho S, Kim I, and Khang YH. Socioeconomic Inequalities in e-Cigarette Use in Korea: Comparison with Inequalities in Conventional Cigarette Use Using Two National Surveys. International Journal of Environmental Research and Public Health, 2019; 16(22). Available from: https://www.ncbi.nlm.nih.gov/pubmed/31766232

41. Driezen P, Nordin ASA, Hairi FM, Yee A, Tajuddin NAA, et al. E-cigarette prevalence among Malaysian adults and types and flavors of e-cigarette products used by cigarette smokers who vape: Findings from the 2020 ITC Malaysia Survey. Tobacco Induced Diseases, 2022; 20:32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35431719

42. Ministry of Health and Welfare’s Health Promotion Administration. Adult Smoking Behavior Survey (ASBS).  2021. Available from: https://www.hpa.gov.tw/EngPages/Detail.aspx?nodeid=1077&pid=6202

43. Jordan Health Ministry and World Health Organization. Jordan smoking rates highest in world amid claims of big tobacco interference.  2020. Available from: https://www.theguardian.com/world/2020/jun/23/jordan-smoking-rates-highest-in-world-amid-claims-of-big-tobacco-interference

44. 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

45. Yoong SL, Hall A, Leonard A, McCrabb S, Wiggers J, et al. Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis. Lancet Public Health, 2021; 6(9):e661–e73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34274048

46. ESPAD Group. ESPAD Report 2019: Results from the European School Survey Project on Alcohol and Other Drugs. Luxembourg 2020. Available from: http://www.espad.org/

47. Action for Smokefree 2025 (ASH). ASH Year 10 Snapshot Survey 2021: Youth vaping in Aotearoa New Zealand.  2022. Available from: https://assets.nationbuilder.com/ashnz/pages/309/attachments/original/1645674087/2021_ASH_Y10_Snapshot_Vaping.pdf?1645674087

48. 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

49. Action on Smoking and Health. Use of e-cigarettes (vapes) among young people in Great Britain. ASH UK,  2022. Available from: https://ash.org.uk/wp-content/uploads/2022/07/Use-of-e-cigarettes-among-young-people-in-Great-Britain-2022.pdf

50. Health Canada. Canadian Student Tobacco, Alcohol and Drugs Survey 2018-19. 2019. Available from: https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html

51. Cooper M, Park-Lee E, Ren C, Cornelius M, Jamal A, et al. Notes from the Field: E-cigarette Use Among Middle and High School Students - United States, 2022. Morbidity and Mortality Weekly Report, 2022; 71(40):1283–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36201370

52. Malta DC, Gomes CS, Alves FTA, Oliveira PPV, Freitas PC, et al. The use of cigarettes, hookahs, electronic cigarettes, and other tobacco indicators among Brazilian schoolchildren: data from National School Health Survey 2019. Rev Bras Epidemiol, 2022; 25:e220014. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35703716

53. Chinese Center for Disease Control and Prevention. Tobacco control: 2019 China’s national youth tobacco survey.  2020. Available from: https://www.chinacdc.cn/jkzt/sthd_3844/slhd_12885/202005/t20200531_216942.html

54. Centre for Behavioural Research in Cancer. Australian Secondary Students' Alcohol and Drug (ASSAD) survey: E-cigarette ever use and past month use 2014-2017: customised report. Melbourne, Australia: Cancer Council Victoria, 2022.

55. Action for Smokefree 2025 (ASH). ASH Year 10 Snapshot Survey 2021 results.  2022. Available from: https://www.ash.org.nz/

56. NHS Digital. Smoking, Drinking and Drug Use Among Young People in England - 2018. England 2019. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2018#chapter-index

57. NHS Digital. Smoking, Drinking and Drug Use Among Young People in England - 2016. England 2017. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2016

58. NHS Digital. Smoking, Drinking and Drug Use Among Young People in England - 2014. England: NHS, 2015. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2014

59. Centers for Disease Control and Prevention (CDC). 1999-2019 High School Youth Risk Behavior Data.  2019. Available from: http://nccd.cdc.gov/youthonline/ Accessed on [5th May 2022]

60. Taylor K BK, Keogan S, Whelan E, Clancy L. ESPAD 2015: European Schools Project on Alcohol and Other Drugs in Ireland. Ireland: TobaccoFree Research Institute, 2016.

61. Sunday S KS, Hanafin J, Clancy L. ESPAD 2019 Ireland: Results from the European Schools Project on Alcohol and Other Drugs in Ireland. Ireland: TobaccoFree Research Institute, 2020.