As Wimmera's higher smoking rates continue to cause concern among health authorities, the new danger for young people is vaping with targeted advertising posing a toxic threat.
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New data released by the Australian Bureau of Statistics (ABS) covering Australian smoking trends on Monday has revealed just over one in five (21.7%) people aged 18-24 years had used an e-cigarette or vaping device at least once.
The same report showed just under one in twelve (7.6%) people aged 15-17 years had used an e-cigarette or vaping device at least once.
Alcohol and Drug Foundation spokesperson Laura Bajurny said social media had huge impact on the rising trend, with apps like Instagram and TikTok difficult to regulate.
"If you get on somewhere like Instagram and you search hashtags 'vape', you'll get a lot of images and it's a hard space to regulate because you have some things that are user generated content," she said.
"Then we have people who are paid influencers, and there's all kinds of regulatory issues with influencers being paid but not promoting that they're being paid - or whether that actually has any impact on how people see the content anyway, even if they know it's essentially an ad."
The Grampians health region in recent years had one of the state's highest smoking rates with one in five adults smoking, according to a 2020 Cancer Council Victoria survey.
While smoking in the region has slowly decreased, Ms Bajurny said e-cigarettes were not a healthy alternative.
"The biggest concern is that we don't quite know yet what the long term impacts are because it's still quite a new technology and there's a lot of difference between the different liquids ... we're not sure what the long term impacts are going to be," she said.
The data on e-cigarettes, from the 2020/21 ABS national health survey, was collected for the first time following the inclusion of questions on e-cigarette in the annual survey.
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E-cigarette use was more common among 18 to 24-year-olds than any other demographic surveyed.
Those under the age of 45 were three times more likely than over-45s to have used an e-cigarette.
The ABS report noted vaping numbers in young people may be underrepresented because responses were provided by an adult in the same household or due to reluctance to report use.
Vapes are heavily regulated in Australia, with nicotine vapes unable to be purchased without a prescription, and both nicotine and non-nicotine vapes allowed to be purchased only by people aged 18 and over.
Ms Bajurny said young people were accessing vapes via neighbourhood dealers or - most often - online stores.
"There is a pretty clear targeting of young people, whether that's looking at the range of flavours that are available, it's a massive range of flavours and a lot of them are very candy and fruit focused," she said.
"The packaging of the devices and the liquids can really look quite appealing to young people, it's all kinds of bright colours, and the imagery that's used."
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Quit Victoria launched a new campaign last year to help parents and teachers combat a rise in teenage vaping.
Quit Victoria director Sarah White said in the campaign launch that parents too often felt they were "in the dark" on health risks of vaping.
"Most people don't know that there are no quality or safety standards for e-cigarettes or e-liquids, which means their manufacture, contents and labelling are unregulated," Dr White said.
Dr White said most parents and teenagers did not realise it was illegal to sell e-cigarette devices or liquid to under-18s - even if products claimed to not contain nicotine.
Manufacturers and retailers of tobacco products and e-cigarettes don't care about your kids' health," Dr White said.
"They're just desperate to get a new generation of kids hooked on nicotine, which is why they promote flavours like peach, popcorn, crème caramel and bubble gum to kids - just to stay in business."
The Alcohol and Drug Foundation offers advice on speaking with young people about vaping, noting the issue is best tackled in a casual setting, approached calmly, and is based in fact.
Ms Bajurny said more broadly, positive health outcomes were interconnected.
"There's lots of positive protective factors in the lives of young people - they've got good family relationships, that they're involved in school, they've got social and leisure opportunities," she said.
"All of those things can contribute to making it less likely that young people we'll use alcohol and other drugs, including nicotine."
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