Vaping widening inequities in youth smoking

The rise of vaping in Aotearoa, New Zealand may be slowing progress in reducing smoking and widening inequities between Māori and Pacific adolescents and others of the same age.

Published in The Lancet Regional Health – Western Pacific, the study analysed data on vaping and smoking from almost 600,000 year 10 students aged 14 to 15 years.

“The emergence of vaping appears to have undermined progress in reducing regular smoking, especially among Māori and Pacific youth who were already facing disproportionate tobacco-related harm,” says Dr Lucy Hardie, a population health researcher at Waipapa Taumata Rau, University of Auckland.

The researchers, who were from the Universities of Otago, Auckland and Sydney, and the Daffodil Centre for cancer research, compared smoking trends for different ethnicities from 2003 to 2009 (before vaping became common in Aotearoa) with those from 2010 to 2024 (when vaping became increasingly common).

“We found that the introduction of vaping may have impacted young Māori more than other groups, as progress in reducing smoking slowed more in young Māori than in the other groups,” says Hardie.

Between 2003 and 2024, rates of regular smoking among 14 to 15-year-olds declined substantially for Māori, Pacific, European, and Asian adolescents. However, these declines in smoking slowed for Māori, Pacific, and European youth after vaping emerged in 2010.

Māori health and public health researcher Associate Professor Andrew Waa from the University of Otago said the findings are especially concerning for Māori and Pacific youth, who already have much higher rates of smoking and vaping than their peers.

We sometimes hear that e-cigarettes might be a harm-reduction device for Māori and Pacific youth, by reducing or stopping them from smoking,” Waa says.

“Our study shows the opposite. Rather than supporting claims that vaping reduces harms for Māori and Pacific youth, vaping has substantially added to them. It has become a major additional source of nicotine dependence, carries its own health risks, and appears to have led to more adolescents smoking.”

In 2024, regular smoking among 14 to 15-year-olds was approximately 6.2 percent for Māori, 3.3 percent for Pacific, and 2 percent for European adolescents. However, the study found that if each group’s pre-2010 smoking trend had continued, the estimated 2024 prevalences would have been 4.2 percent for Māori, 1.8 percent for Pacific, and 0.7 percent for European adolescents.

For every 1,000 students, there were 20 more Māori, 15 more Pacific and 13 more European students smoking regularly in 2024 than there would have been if pre-2010 smoking trends had continued.

Waa says the implications extend beyond biomedical harm and into Indigenous rights and obligations under Te Tiriti o Waitangi and international frameworks.

“Before colonisation, Māori were free from nicotine addiction. Today, nicotine from cigarettes and vapes undermines Māori self-determination by embedding dependence within our communities.”

He says governments have duties under Te Tiriti o Waitangi and the WHO Framework Convention on Tobacco Control to reduce health inequities and protect Māori youth from commercial determinants of health.

“Policies that enable easy access to vaping products don’t just miss the mark on health – they also fall short of Te Tiriti o Waitangi commitments and Aotearoa’s international obligations to address inequities affecting Indigenous peoples.”

Waa said urgent action is needed to align policy with those obligations.

“We should be closing the door on all sources of nicotine dependence, not opening new ones. Protecting Māori youth is a Te Tiriti o Waitangi obligation, and protecting all young people is a core public health responsibility.”