WHO warns of global e-cigarette health threat, as WA survey shows teens use growing rapidly

Jeremy Lasek –  PHAA


Today marks International Youth Day (IYD). IYD is celebrated on 12 August each year to bring youth issues to the attention of the international community and to celebrate the potential of youth as active members in the global society.

The advent of electronic cigarettes (e-cigarettes) has amassed a new generation of child and adolescent nicotine users globally. By design, the burgeoning e-cigarette industry has attracted a young and naïve consumer base, crafting colourful designs and sweetened flavours while harnessing social marketing and influencing.

Last week the World Health Organization (WHO) released a new report warning e-cigarettes and other novel nicotine and tobacco products threaten progress in the fight against tobacco use across the globe. The report finds governments are no match for the influential tobacco industry.

For the first time. The WHO is presenting new data on electronic delivery systems, such as e-cigarettes and heated tobacco products.

The head of the WHO’s Tobacco Free Initiative, Dr Vinayak Prasad, says the tobacco industry is now marketing these products to children and adolescents with e-cigarettes coming in more than 15,000 different flavours. To date, only three countries have banned the use of flavours, the WHO report says.

Internationally, online retailers have become an accessible means to purchase e-cigarettes, with web traffic to online stores buoyed by social media and other marketing strategies such as online promotion codes, reward schemes and new customer discounts. Of concern, there are few barriers to purchasing by young people. One US study reported that two-thirds of online vendors had no age identification requirements at all, and even when websites ask consumers to confirm their age, verification is easily falsified.

While the extent of online e-cigarette purchases by Australian children and adolescents is unknown, estimates suggest that at least one-quarter of e-cigarettes obtained by adults are purchased online. Plausibly, this could be higher among tech-native children and adolescents.

In a first of its kind in Australia, in February 2020, an audit was conducted of Australian online e-cigarette retailers that advertised delivery in Perth. After excluding 17 retailers that were located internationally, deactivated, or social media based, 30 eligible online retailers were identified and audited. Of these, 15 were based in Western Australia (WA) and 15 interstate.

Among high school students in WA, ever-use or experimentation with e-cigarettes has grown to 14%.

In the audit, only half (50%) of the retailers required age verification, which often required users to confirm they were over 18 on providing their age and date of birth. While there are no age requirement laws for e-cigarettes sold in WA, such laws do exist in other states, and all Australian states and territories require age verification for the purchase of combustible cigarettes.

Of concern, almost one-quarter (23%) of the websites audited provided information on where and how to purchase liquid nicotine, which is illegal to sell in Australia; many websites included links to partnering international stores to assist clients in skirting Australian regulations. A number of websites (13%) also described to users how to mix liquid nicotine with purchased manufactured products.

An unexpected finding was the inconsistencies in product displays. More than half of stores displayed images of products containing nicotine (57%), despite nearly three-quarters of retailers (73%) stating they not sell nicotine-containing products. In WA retailers, where it is illegal to sell complete e-cigarette devices, 27% of websites marketed such products. It is unclear whether online stores are actually selling these illegal products or whether their advertising has carelessly used incorrect images.

A clear theme identified via the audit was the variety of promotional tactics used to attract sales. This included promotional codes (13%), discounting (60%), competitions and prizes (13%), free shipping (53%), loyalty schemes (17%), and advertising material supplied by a manufacturer (63%).

It is interesting that many of these advertising strategies are reminiscent of the now-outlawed tactics once used for combustible tobacco products. Manufacturer advertising materials, in particular, have already been linked to e-cigarette uptake among young people elsewhere.

Consistent with US evidence, product health information was scant. Only 13% of the WA websites provided any health or safety information, compared with 33% of interstate stores. Among those that did include health-related information, it is pertinent to note that several cited a website known for recent e-cigarette industry funding.

The findings of this first audit of its kind in Australia has highlighted significant concerns in the online retailing of e-cigarettes in Australia. Children and adolescents who wish to purchase e-cigarettes in Australia face few obstacles and the plethora of promotional strategies used by retailers is disturbing. These issues are plausibly attributable to poor industry self-regulation, as well as gaps in state and federal legislation relating to e-cigarettes, though it should be noted that the Australian Therapeutic Goods Administration is currently exploring options which could significantly dampen access through online retailers.

In the meantime, further research is needed to illuminate the scale of e-cigarette e-commerce in Australia, and greater scrutiny of product content disclosure, promotional tactics and youth access is warranted.

Regulators are encouraged to continue carefully examining loopholes and to increase measures for online retailers which avert the purchasing and uptake of e-cigarettes by children and adolescents.


This blog is based on an article published in the  ANZJPH by Nicholas Wood, Cancer Council WA

Photo Credit: Ruslan Alekso from Pexels

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