Population-Level Coexistence of Smoking and Vaping Across the Life Course in Australia: Implications for Midlife and Ageing-Related Health Burden

Abstract

Objectives

This study examines how smoking and vaping are distributed across the life course in Australia and evaluates whether population-level patterns are consistent with substitution or coexistence, providing a life-course perspective on nicotine exposure and ageing-related health burden.

Methods

Using nationally representative, cross-sectional data from the Australian Bureau of Statistics National Health Survey 2022, population-weighted prevalence of current smoking and vaping was analysed across age and sex groups using a descriptive framework. Absolute differences and vaping-to-smoking prevalence ratios were computed, with robustness checks using alternative age groupings.

Results

Vaping prevalence exceeds smoking only among adolescents aged 15–17 years. From early adulthood onward, smoking prevalence remains higher at all ages, with the gap widening across the life course. Among adults aged 45–64 years, smoking exceeds vaping by 11.7 percentage points. Patterns are consistent across sex and alternative specifications.

Conclusions

Smoking and vaping coexist in an age-structured pattern rather than indicating population-level substitution, demonstrating that newer nicotine products have not displaced smoking among adult cohorts. Smoking-related risk therefore remains concentrated among populations entering later life.

Implications for Public Health

These findings challenge assumptions that vaping is reducing smoking-related harm at the population level and highlight the need for age-targeted policy responses. Tobacco control should adopt a dual strategy combining youth vaping prevention with targeted smoking cessation for midlife adults to reduce future ageing-related health burden.