'You’ll see vapers everywhere in Europe'. Well, ... no

Every traveller forms impressions about patterns of frequently or seldom seen cultural differences when visiting other countries. You see far fewer women than men on the streets of more conservative Islamic nations, lots of very obese people in the American midwest and in some Pacific island nations, bizarre haircuts in Tokyo, and uncountable motorcycles in Hanoi.

Because I’ve worked for so long in public health, I naturally look out for interesting differences in health-related behaviours and product availability. Portion sizes in French restaurants are often modest, while Argentinian steaks look like they have been cut from a brontosaurus. Motorcyclists in Indonesia are frequently helmetless and very commonly leave the straps undone. And Australia seems to have a bizarrely huge range of milk options compared to the simple full cream and light choices available in most other places.

People often pass on observations about differences in smoking between places they’ve visited and Australia: “Smoking in Indonesia is like travelling back 50 years in time!” and “It seems like it might be almost compulsory to smoke in China” are two I get often, although in Asia (with the exception of Japan), smoking by women is rarely above low single digit prevalence – it is Asian males who do the smoking.

I’ve just returned from a holiday in France and Spain. I’ve spent time in both countries since the 1970s, including seven months living in Lyon in 2006. On this trip, I was very curious to check out what I’d read and heard has been a rapid and very widespread uptake of electronic (e-)cigarettes in Europe, particularly in France where French authorities estimate that between 1-2 million French vape daily. I’d been told that e-cigarette shops were everywhere and that seeing people vaping was very common. I would see the future of smoking in France, apparently.

My wife and I spent many hours every day walking around Paris (six days), Lyon (two), the Corsican towns of Bonifacio, Ajaccio and Calvi (eight days), Nice (one), Barcelona (two) and Madrid (four). We agreed to compete in spotting the highest number of people vaping, with the incentive for the daily winner being to pick where we’d eat that night. We also looked out for shops selling e-cigarettes. All sightings had to be called as they occurred, not just a winning number announced at the end of the day.

My Fitbit recorded that I walked 232km in this time. In Paris, we covered a wide diversity of arrondissements, from the north and west African areas of Château Rouge, Barbès Rochechouart, and Saint Denis, to chic St-Germain des Prés, the tourist and gay mecca of the Marais, and where we had our apartment, Bastille. We were observing in all places and at all time periods: breakfast coffee shops, afternoon bars, evening outdoor restaurants and constantly as we walked around.

Over the 23 days, we saw just 20 people vaping: 15 in Paris, one in Lyon, one in Calvi, one in Barcelona and two in Madrid. By contrast, we saw many people smoking almost everywhere we looked at any time of day. Far too many to count. At a guess, the ratio would have been at very least many hundreds of smokers to one vaper.

This exercise was of course not in any way scientific. But there was simply no avoiding the broad conclusion. Public vaping appeared to be very, very marginal compared to smoking in France and Spain.

Colleagues in Barcelona told me that in early 2013 there had been a rapid explosion in the number of e-cigarette retailers in Spain, many linked to an Italian franchise holding out fast buck hopes to those who had been laid off work and had termination money to invest in their future. There were an estimated 2,000 outlets across the country by Christmas.

But today there are only about 400. We saw none, although tobacconists were selling e-cigarettes. Health Department intelligence says many vapers were rapidly disillusioned by hype from store owners that they would be able to easily quit. In France, I saw a few dedicated vape gear shops, and several dope paraphernalia outlets displaying vaping equipment and juices. But these were uncommon.

There are limited data on people who have vaped in Australia. Daily smokers were most likely to have ever used an e-cigarette in the last 12 months, with 15.3% ever using and 1.8% of former smokers reported ever using an e-cigarette in a recent year. But this includes many curious one-off or very occasional users. We have no good data on the population prevalence of serious, daily vapers in Australia. If there are many out there, they seem to be quite a private lot, if our observations are indicative.

It’s increasingly common in Australia to realise that you’ve been in a big crowd for hours and seen next to no one smoking. Vaping here is far less evident. I have probably seen less than twenty people vaping in Australia, and I get out quite a bit. I live in Sydney’s inner west where there are many early adopters of edgy trends. For nearly eight years I’ve been in a pub rock band, and often go to listen to others. I’ve never seen a single vaper at or outside any pub. There is a large disconnect between the hype about the exponential rise in vaping and what we actually see around us.

Vaping has many DIY, hobby-like features like modifying the apparatus, mixing e-juice blends and in Australia, where sale of nicotine-containing juice is illegal, importing such supplies. These issues should make it highly fertile for widespread use of social media by vapers. However, the leading vaping chat room, Aussie Vapers, has 10,377 registered users, but tellingly, only 877 are listed as active.

The Twitter account for the New Nicotine Alliance Australia, which promotes itself as a leading advocacy group for e-cigarettes in Australia has only 283 followers. I get trolled by vaping activists who I instantly block or mute, but am aware of only three Australian trolls among these each with tiny followings.

Globally, there are many small-time entrepreneurs and some larger ones who have invested heavily in e-cigarette commerce. It is in their interests to talk-up a momentum toward vaping and to relentlessly spin its impact as positive. In England, leading addiction researcher Prof Robert West has been collecting monthly data on the prevalence of vaping since 2011. He reported in August that the rapid rise in those who vape may have plateaued.

Disturbingly, he also reported that the large majority (over 80%) of e-cigarette users (as with nicotine replacement therapy smokers) also continue to smoke and that the most recent monthly data for August show the lowest percentage of English smokers trying to quit since 2007 (31.6% down from a high of 42.5% in 2007).

While a small minority of e-cigarette users succeed in stopping smoking, recent English data following up a cohort of smokers at 12 months show that across all daily e-cigarette users, 83% were still vaping and smoking at 12 months and that there were no statistically significant differences in successful quitting between smokers who used or did not use e-cigarettes.

There are certainly many smokers who attribute their stopping smoking to e-cigarettes. But the net impact of e-cigarettes may be one of holding more dual-using smokers in smoking than might have otherwise quit.

Editor’s note: please ensure your comments are courteous and on-topic.