Abstract
Background: Ethnic inequities in health and mortality in Aotearoa/New Zealand have been driven in part by historic and ongoing inequities in smoking prevalence, with Māori and Pacific peoples most affected. Although overall smoking rates among year 10 students aged 14–15 years have declined substantially in recent decades, recent analyses suggested that e-cigarette use (vaping) may have slowed the decline in ever- and regular-smoking, while having little or no impact on daily smoking. However, it remains unclear whether these patterns differ for Māori, Pacific, European, or Asian adolescents.
Methods: Interrupted time series analyses of the Snapshot Survey data (2003–2024; n = 588,143) to assess changes in smoking trends before and after the emergence of vaping in Aotearoa among 14–15-year-old Māori, Pacific, European, and Asian adolescents.
Findings: From 2003 to 2024, ever-, regular-, and daily-smoking prevalence declined substantially among Māori, Pacific, European, and Asian adolescents. However, the rates of decline in ever-smoking slowed significantly from 2010 onwards—coinciding with the emergence of vaping in Aotearoa—for Māori (p = 0.025), European (p < 0.001), and Asian (p = 0.018) adolescents. Similarly, declines in regular-smoking slowed significantly for Māori (p = 0.012), Pacific (p = 0.003), and European (p < 0.001) adolescents. A significant change in the rate of decline in daily smoking was observed only for European adolescents, who showed a small slowing (p = 0.004). Findings were robust to different time series interruption-points (change-years) and controlling for cigarette affordability.
Interpretation: We found no evidence that vaping is displacing adolescent smoking among any of the four ethnic groups analysed. On the contrary, our findings suggest that the emergence and rise of vaping in Aotearoa may have undermined progress in reducing regular-smoking among Māori, Pacific, and European adolescents, but with more serious implications for Māori and Pacific youth.