Nicotine vaping can significantly reduce health inequalities for low-income and Indigenous communities, suggests a new study published in the Addiction journal, which I co-authored.
My colleagues and I examined trends in daily smoking and vaping in Australia and New Zealand from 2016 to 2023. We found that smoking declined up to three times more rapidly in disadvantaged and Indigenous communities in New Zealand compared to Australia, reflecting New Zealand’s higher vaping rate.
In New Zealand, people who smoke have easy access to a wide range of regulated vaping products and flavors, which are sold as adult consumer products through licensed retailers—just like cigarettes and alcohol. This is similar to the approach taken in countries such as the United States and Canada, except that New Zealand government messaging fully embraces vaping as a harm reduction strategy.
Australia, on the other hand, has adopted a highly restrictive, medicalized approach, designed primarily to deter youth vaping. Legal vapes are available only through pharmacies, often requiring a doctor’s prescription. Most flavors are banned, though enforcement efforts have largely failed to curb a booming illicit market.
Smoking in New Zealand’s Māori population declined nearly three times faster than in Australia’s Indigenous population between 2019 and 2023.
The recent decline in smoking in New Zealand’s disadvantaged communities has been remarkable. In the seven years in question, smoking prevalence in the lowest socioeconomic quintile fell three times faster per year than in Australia (12 percent per year versus 4 percent), mirroring a dramatic difference in vaping rates (15.8 percent versus 2.8 percent in 2023).
Historically, people on low incomes quit smoking at a significantly lower rate than others. However, in New Zealand, the recent decline in smoking within these communities outpaced that of the general population.
Similarly, smoking in New Zealand’s Māori population declined nearly three times faster than in Australia’s Indigenous population between 2019 and 2023 (16 percent per year versus 6 percent per year). This trend aligns with the higher daily vaping rate among Māori (23.5 percent) compared to Indigenous Australians (6.5 percent).
The accelerated decline in Māori smoking is in stark contrast to poor outcomes for marginalized communities from traditional cessation treatments and public health campaigns. In Australia, intensive efforts under Close the Gap and other initiatives have had disappointing results: Smoking rates in the most disadvantaged quintile are three times higher than in the most advantaged quintile—and the gap is widening.
Smoking, which is increasingly concentrated in disadvantaged groups, is a leading driver of health inequalities in the form of disproportionate impacts from smoking-related disease and death. Smoking is responsible for half the difference in life expectancy between societies’ most and least advantaged groups.
Our study highlights vaping’s potential to reduce these disparities by providing an effective, far less harmful alternative to smoking for high-risk populations.
Smoking also imposes severe financial burdens on disadvantaged communities. Australia and New Zealand have the highest-priced cigarettes in the world. In Australia, vaping costs on average about 20 percent of the cost of smoking retail cigarettes. The average person who makes the switch to vaping illicit products will save over $9,000 AUD ($5,600 USD) per year—money that can then be redirected towards needs like food, clothing, improved housing and an otherwise healthier lifestyle.
The impacts of the two countries’ policies on their general populations are also markedly different. New Zealand’s overall smoking rate plummeted by an astonishing 10 percent per year—dropping from 14.5 percent to 6.8 percent over the seven-year study period. In contrast, Australia’s smoking rate declined by only 5 percent per year, from 12.2 percent to 8.3 percent.
These declines closely reflected the vaping rates in each country: In 2023, 9.7 percent of New Zealand adults vaped daily—nearly three times Australia’s rate of 3.5 percent. In both countries, the age group with the highest vaping rate, young adults, also had the fastest decline in smoking.
We can infer that the decline in smoking in New Zealand is almost certainly linked to the high vaping rate and government support for tobacco harm reduction. Of course, “cross-sectional” studies like this cannot definitively prove that vaping was the cause. Numerous other inter-country differences could have an influence on changes in the smoking rate. However, alternative explanations are unlikely for a number of reasons.
A more consumer-friendly regulatory model with government support could dramatically reduce smoking rates in Australia and other nations with harsh restrictions.
One is that Australia and New Zealand have broadly similar tobacco control policies and demographics. What’s more, our research examined a wide range of other potential contributing factors during the study period—and found no good evidence that any played a significant role. These included changes in tobacco taxation and cigarette affordability; standardized plain packaging for cigarettes; the COVID-19 pandemic and associated economic downturn; and the availability of heated tobacco products (in New Zealand only).
If vaping is the key driver of New Zealand’s success, as appears overwhelmingly likely, then our conclusion must be that a more consumer-friendly regulatory model with government support could dramatically reduce smoking rates in Australia and other nations with harsh restrictions. There is clear potential for other countries to use vaping as a means to reduce both the health gap and financial stress for low-income and Indigenous communities.
The solution isn’t to ban vaping or to push it underground. It’s to regulate it sensibly—encouraging people to switch from smoking while implementing reasonable safeguards to protect youth. New Zealand has shown what works. It’s time for other countries to pay attention.
Top photograph by Elsa Olofsson via Flickr/Creative Commons 2.0. All graphics based on study data by Colin Mendelsohn.
Mendelsohn CP, Beaglehole R, Borland R, Hall W, Wodak A, Youdan B, Chan GCK. Do the differing vaping and smoking trends in Australia and New Zealand reflect different regulatory policies? Addiction 2025. DOI: 10.1111/add.70006
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