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Nicotine vaping products (NVPs) have never been legal to sell as consumer products in Australia. However, a substantial illicit market in NVPs developed with retailers selling these products under the pretence of retailing nicotine-free vaping products (NFVPs), which were legal to sell in most states and territories until July 2024. Australia implemented a ‘light touch’ medicines regulation approach for NVPs in October 2021, in response to public concerns about a growing number of young people vaping while retaining access to NVPs for smoking cessation purposes. Substantial changes to the model were made throughout 2024, including the ending of general retail sales of NFVPs, strengthening the quality requirements for NVPs and dropping the prescription requirement for low-dose (≤20 mg/mL) NVPs. There have been several challenges to encouraging uptake of the model among both consumers and health practitioners, including low acceptability, concerns about legal liability and competition with a substantial illicit NVP market. Assuming the reforms implemented federally and by the states and territories are able to effectively curtail the illicit supply, it is unclear whether current consumers who are accessing NVPs illicitly will migrate to the legal pathway or stop NVP use. Success of the medical regulatory model will depend on support from NVP manufacturers, health practitioners, the public and policy makers. Other countries who may be considering implementing a ‘light touch’ medicines regulation model can learn from Australia’s experience.

Australia’s import ban on disposable vapes started 1 January 2024.1 While retailers are permitted to sell down their existing stock, it is apparent that some Australian suppliers have continued to import these products with 13 tonnes of disposable vapes recently seized by Australian Border Force.2 Continued imports despite the ban have been encouraged by Chinese manufacturers offering Australian importers insurance to cover potential seizure of the products at the border.3 Suppliers in neighbouring Aotearoa/New Zealand have also stated they ‘have no intention of stopping’ exporting vapes to Australia via their online shop.4 Australian retailers are continuing to offer disposable vaping products and are now also promoting rechargeable versions of popular disposable devices with replaceable pods to avoid the import ban at a price similar to the disposable version. Regulators who are considering implementing bans on disposable vapes need to ensure their regulations anticipate potential industry responses such as producing rechargeable/refillable versions at a similar price as substitutes for banned products as well as preparing for non-compliance among suppliers. Additional reforms include restricting flavours to tobacco, menthol and mint, reducing the permissible nicotine concentration and requiring plain pharmaceutical packaging for vaping products.6 Despite the proposed reforms being announced in May 2023, including ending vaping product supply outside of pharmacies, new vape shops continued to open in Australia,7 suggesting regulators may have substantial work ahead to enforce the new restrictions.

Correspondence to Dr Marita Hefler, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0811, Australia; marita.hefler@menzies.edu.au The COVID-19 pandemic which originated in China in late 2019 has spread rapidly and taken much of the world by surprise, creating a health and economic emergency likely to have significant impacts for many years. Governments are pumping money into their economies through stimulus packages and income support, where previously austerity was the order of the day.5 6 In the private sector, car makers are pivoting to making medical equipment,7 alcohol companies are manufacturing hand sanitiser8 and digital transformation across many sectors is being fast-tracked,9 among other examples of business adaptation.10 The COVID-19 pandemic is an extraordinary event requiring extreme measures due to the potential for healthcare systems to be overwhelmed. According to British American Tobacco (BAT), consumers continue to purchase tobacco products, even in the hardest hit areas. The increased risk of severe outcomes for smokers hospitalised with COVID-19,16 and the reductions in hospitalisations generally that result from quitting smoking,22 23 may provide the impetus for restricting cigarette sales while health services are strained to the breaking point, as has been called for by the New York State Academy of Family Physicians.24 In one Australian state, alcohol sales have already been limited because the health service cannot spare the resources to address alcohol-related issues during this pandemic.25 COVID-19 shutdowns have enforced numerous constraints on people that restrict liberty and fulfilment of basic human needs.

ObjectiveWe examined Australian tobacco purchasing trends, the average self-reported price paid within each purchase type and the association between type of tobacco product purchased and participant characteristics, including quit intentions, between 2007 and 2020.MethodsWe analysed data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007–2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (nsample=5452, nobservations=11 534). The main outcome measures were type of tobacco products purchased: RYO, carton, pack or pouch size and brand segment. Logistic regression, fit using generalised estimating equations, was estimated the association between the outcome and participant characteristics.ResultsThe reported price-minimising purchasing patterns increased from 2007 to 2020: any RYO (23.8–43.9%), large-sized pack (2007: 24.0% to 2016: 34.3%); shifting from large-sized to small-sized packs (2020: 37.7%), and economy brand (2007: 37.2% to 2020: 59.3%); shifting from large (2007: 55.8%) to small economy packs (2014: 15.3% to 2020: 48.1%). Individuals with a lower income, a higher nicotine dependence level and no quit intention were more likely to purchase RYO and large-sized packs.ConclusionRYO, large-sized packs and products with a low upfront cost (eg, small RYO pouches and small-sized economy brand packs) may appeal to people on low incomes. Australia’s diverse tobacco pack and pouch sizes allow the tobacco industry to influence tobacco purchases. Standardising pack and pouch sizes may reduce some price-related marketing and especially benefit people who have a low income, are highly addicted and have no quit intention.

Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This study explores the relationships between catchment specific sociodemographic parameters and biomarkers in wastewater generated by the respective catchments. Domestic wastewater influent samples taken during the 2016 Australian census week were analyzed for a range of diet, drug, pharmaceutical, and lifestyle biomarkers. We present both linear and rank-order (i.e., Pearson and Spearman) correlations between loads of 42 biomarkers and census-derived metrics, index of relative socioeconomic advantage and disadvantage (IRSAD), median age, and 40 socioeconomic index for area (SEIFA) descriptors. Biomarkers of caffeine, citrus, and dietary fiber consumption had strong positive correlations with IRSAD, while tramadol, atenolol, and pregabalin had strong negative correlation with IRSAD. As expected, atenolol and hydrochlorothiazide correlated positively with median age. We also found specific SEIFA descriptors such as occupation and educational attainment correlating with each biomarker. Our study demonstrates that wastewater-based epidemiology can be used to study sociodemographic influences and disparities in chemical consumption.

The media have reported community concerns about tobacconists that are using ‘candy’ and ‘lolly’ advertising to promote their stores, for example, a store named ‘Tobacco Candy Mart’.6 This may be considered a type of ‘advertising by association’ because children are likely to be attracted to toys and confectionery that are placed near tobacco advertising or signage, thus increasing children’s exposure to tobacco products.7 This is likely to normalise tobacco products as normal consumer goods.8 9 Figure 1. Photo: Sisay Derso Mengesha Some tobacconists in Australia are prominently selling confectionery,15 toys and other products designed to appeal to children and using cartoons on their signage and external shopfronts.13 These practices make these tobacconists eye-catching for children, conflate the acceptability and normality of youth-oriented products with tobacco1 and potentially contribute to misperceptions of the health risks of tobacco products.1 Stronger regulation of tobacco retailing is needed to prevent the use of window and entrance displays and signage that are particularly attractive to children. Tob Control 1998; 7: 129–33. doi:10.1136/tc.7.2.129 12 Kraak VI, Story M. Influence of food companies’ brand mascots and entertainment companies’ cartoon media characters on children’s diet and health: A systematic review and research needs.

Background/aimsRegulatory schemes for tobacco retailing help restrict the supply and availability of smoked tobacco products. Tobacco retailer density and the proximity of tobacco outlets to youth spaces, such as schools, are greater in more disadvantaged areas. Exposure to tobacco retailing normalises smoking and increases ease of access, thus increasing smoking uptake and undermining quitting. To inform future policy, we conducted a global scan of combustible tobacco retail regulatory schemes (We use the term schemes to refer to any kind of relevant initiative, policy, regulations or legislation that we found).MethodsAll types of English language records concerning the regulation of commercial tobacco product availability were considered, including peer-reviewed journal articles, key reports and policy documents. The key features of regulatory schemes were documented. In addition, we contacted key informants in different countries and regions for advice on additional sources and undertook targeted searching in regions where we initially found little data.Results/findingsAlthough many countries have well-established and comprehensive tobacco control programmes, tobacco retail policy that actively addresses the availability of tobacco is underutilised. Many jurisdictions have implemented a minimum purchase age and restricted point-of-sale advertising and marketing. Other tobacco retailing regulations also included licensing systems with licence fees, caps on licences and restrictions on store location, type and retailer density/proximity. A very small number of jurisdictions have ended tobacco retailing altogether.ConclusionsAt a minimum, policy-makers should implement licensing schemes, licence caps and proximity limits and invest in robust monitoring systems and compliance enforcement. Tobacco products’ ubiquity is incompatible with its status as a dangerous addictive substance and does not align with tobacco endgame goals.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. [...]fewer countries achieved the highest level of monitoring tobacco use in 2022 than in 2014 (74 in 2022 compared with 82 in 2014). Tobacco product regulation (Article 9) and measures beyond the minimum requirements of the WHO Framework Convention on Tobacco Control (FCTC; Article 2.1) were a key focus at the 10th Conference of the Parties of the WHO FCTC (COP10), which was held on February 5–10, 2024. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and World Health Organization;

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. A systematic review of survey data from 2014 to 2021 reported that 7.7% of young people aged under 26 years currently use ENDS [2], and rates in countries with a sales ban are no lower than in those without bans (e.g., 9.0% in Mexico and 6.7% in Thailand) [4]. Gateway or common liability? A systematic review and meta-analysis of studies of adolescent e-cigarette use and future smoking initiation. Kim J, Lee S, Chun J. An international systematic review of prevalence, risk, and protective factors associated with young people’s e-cigarette use. Gateway or common liability? A systematic review and meta-analysis of studies of adolescent e-cigarette use and future smoking initiation.

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.