Trends in vaping prevalence and mental health associations among Australian youth: Cross-sectional analysis 2016–2023

BACKGROUND: Growing international concern about youth vaping highlights the need for comprehensive surveillance, particularly given associations between vaping, smoking, and mental health. This study examined trends in vaping prevalence and associated factors among Australians to inform policy responses. METHODS: Repeated cross-sectional analyses used the National Drug Strategy Household Surveys (2016, 2019, 2022/23) with nationally representative samples (N > 20,000 per survey). Analyses focused on young people aged 14-25 years, examining vaping and smoking prevalence, frequency, mental health indicators, and smoking cessation patterns. Chi-square tests assessed temporal trends; logistic regression models examined associations between at least weekly vaping and mental health variables, adjusting for demographics. RESULTS: Current vaping prevalence among 14-25-year-olds increased from 2% in 2016 to 4% in 2019 to 17% in 2022/23; daily vaping increased from 0.7% to 7% over the same period. In 2022/23, 62% of young people who had ever vaped had never smoked before initiating e-cigarette use. Young people with mental health disorders or high psychological distress had approximately three times the odds of weekly or more frequent vaping. Although some young people used e-cigarettes for smoking cessation, only 1-3% ceased both smoking and vaping, and over half were unable to stop or reduce vaping in the previous year. CONCLUSIONS: Youth vaping has increased substantially in Australia between 2019 and 2023, particularly among those with mental health challenges. Policy responses should prioritise co-designed interventions with young people, clinician training, evaluation of cessation strategies, and strengthened school-based prevention programs.