Once teens pick up any nicotine product, they're more likely to try others
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New research published today reveals that Australian high school students have put their health at risk by using a range of nicotine products, including vapes, tobacco and nicotine pouches, with higher cigarette and nicotine pouch use reported among male students.
Public health experts say the findings demonstrate why all levels of government must prioritize protecting young people from the predatory tobacco and nicotine industries, prevent the illegal sale of these products, and fund evidence-based education and mass media prevention campaigns discouraging all forms of nicotine consumption, particularly among minors.
The research, published today in the Australian and New Zealand Journal of Public Health, is one of the largest and most recent surveys to examine patterns of lifetime e-cigarette, tobacco cigarette and nicotine pouch use among Australian adolescents.
Led by the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney, it draws on a sample of 1,848 students ages 14–18 from 20 schools across New South Wales, Queensland and Western Australia.
The study found that more than 12% of teens had used e-cigarettes in their lifetime, almost 6% had used tobacco, while 3.5% had used nicotine pouches.
More than 2% of all respondents had used all three—with use of each product interrelated. In particular, nicotine pouches, a newly emerging nicotine product of concern, were rarely used in isolation. Among adolescents who had used nicotine pouches, 82% had also vaped and 71% had smoked cigarettes.
Compared with females, males had nearly three times greater odds of nicotine pouch use and more than one and a half times greater odds of cigarette use. Nicotine pouch use was reported by 4.8% of males, compared with 1.5% of females, and tobacco cigarette use was reported by 6.9% of males, compared with 4.1% of females.
Lead author Dr. Lauren Gardner, senior research fellow at the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney, says the study shows the need for targeted strategies to prevent teenage nicotine addiction and support young people who want to quit.
"The teenage years are a critical period for preventing nicotine use—it's the period when the brain is most susceptible to addiction, which they can then carry for life. Our study shows that teenage boys may benefit from targeted support.
"Many teens who have used one nicotine product have also tried others, so we need effective prevention strategies that address shared risk factors for nicotine use more broadly, rather than focusing on just vaping or smoking," Gardner said.
The research team's "OurFutures Vaping Prevention Program" is one such example, targeting core skills that apply to all nicotine product use, including assertive communication, managing peer pressure, uncovering deceptive marketing, critical thinking and appropriate help-seeking.
Gardner stressed that the data represented lifetime use and therefore may represent experimentation rather than ongoing use, but it provided important insights into patterns of use.
"This survey data differs from other surveys that look at current smoking, vaping or nicotine pouch use—we can't determine whether teen nicotine use is ongoing or in what order the products were used, but the findings clearly show that use of these products is closely interconnected," Gardner said.
Previous studies have shown that teenagers who vape are five times more likely to go on to try cigarettes. This study builds on that finding, showing that teenagers aren't just using one product, but are often trying a combination of nicotine products as they enter this experimental phase of life.
Associate Professor Raglan Maddox, from the Australian National University and co-convener of the Tobacco, Alcohol and Other Drugs Special Interest Group within the Public Health Association of Australia, says governments must continue to enhance measures to protect the youngest generations from nicotine addiction.
"The tobacco and nicotine industry keeps finding new products and new ways to keep nicotine in people's lives. Nicotine pouches are the latest example.
"This study shows the problem is bigger than any one product. Young people are being exposed to cigarettes, vapes and nicotine pouches, so our response needs to deal with all of them—not just one at a time.
"We must do more to protect young people's health, including strengthening prevention, running sustained mass media campaigns, maintaining pharmacy-only vape sales, and strong enforcement against retailers illegally selling these products.
"Strong tobacco price and tax measures should also be retained as part of a comprehensive tobacco control response to help prevent children and young people from taking up smoking."
Publication details
Lauren A. Gardner et al, Patterns of lifetime e-cigarette, tobacco cigarette and nicotine pouch use among Australian adolescents in the period after the 2024 vaping reforms: A cross-sectional survey, Australian and New Zealand Journal of Public Health (2026). DOI: 10.1016/j.anzjph.2026.100591
Journal information: Australian and New Zealand Journal of Public Health
Clinical categories
Preventive medicineChildren's healthPediatricsCommon illnesses & Prevention Provided by University of Sydney Who's behind this story?
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