Population-Level Coexistence of Smoking and Vaping Across the Life Course in Australia: Implications for Midlife and...

ObjectivesThis study examines how smoking and vaping are distributed across the life course in Australia and evaluates whether population-level patterns are consistent with substitution or coexistence, providing a life-course perspective on nicotine exposure and ageing-related health burden.MethodsUsing nationally representative, cross-sectional data from the Australian Bureau of Statistics National Health Survey 2022, population-weighted prevalence of current smoking and vaping was analysed across age and sex groups using a descriptive framework. Absolute differences and vaping-to-smoking prevalence ratios were computed, with robustness checks using alternative age groupings.ResultsVaping prevalence exceeds smoking only among adolescents aged 15-17 years. From early adulthood onward, smoking prevalence remains higher at all ages, with the gap widening across the life course. Among adults aged 45-64 years, smoking exceeds vaping by 11.7 percentage points. Patterns are consistent across sex and alternative specifications.ConclusionsSmoking and vaping coexist in an age-structured pattern rather than indicating population-level substitution, demonstrating that newer nicotine products have not displaced smoking among adult cohorts. Smoking-related risk therefore remains concentrated among populations entering later life.Implications for Public HealthThese findings challenge assumptions that vaping is reducing smoking-related harm at the population level and highlight the need for age-targeted policy responses. Tobacco control should adopt a dual strategy combining youth vaping prevention with targeted smoking cessation for midlife adults to reduce future ageing-related health burden.