How smoking, vaping and alcohol contribute to Australia's health status (VCE HHD Unit 3 AoS 1)

What this dot point is asking

This is new key knowledge in the 2025 study design: "the contribution to Australia's health status of smoking and vaping, alcohol, overweight and obesity, nutritional imbalance". This page covers smoking, vaping and alcohol; overweight, obesity and nutritional imbalance has its own page.

The VCAA FAQ (updated February 2026) explains that although the study design does not list diseases, this key knowledge "requires students to link these factors to health outcomes". For smoking and vaping, students "are expected to recognise that smoking is a risk factor for cancer and heart disease". The first exam on the new design asked exactly this: "Explain two ways in which smoking/vaping may affect health outcomes in Australia" (2025, Question 4a, 4 marks).

To answer well you need three things for each risk factor:

1. The mechanism: what the substance does to the body.
2. The condition: a named disease or injury.
3. The indicator and direction: which health status indicator changes, and whether it goes up or down.

Tobacco smoking

How smoking harms health

Tobacco smoke contains thousands of chemicals, including carcinogens, carbon monoxide and nicotine.

• Cancers. Carcinogens damage the DNA of cells, leading to uncontrolled cell division and tumours, especially lung cancer and cancers of the mouth, throat and bladder.
• Respiratory disease. Smoke damages the airways and alveoli, causing chronic obstructive pulmonary disease (COPD, including emphysema and chronic bronchitis) and worsening asthma.
• Cardiovascular disease. Smoking damages blood vessel walls and promotes plaque build-up (atherosclerosis), raises blood pressure and makes blood more likely to clot, increasing coronary heart disease and stroke.
• Other effects. Reduced immune function, poorer wound healing, and harms in pregnancy (low birthweight), plus second-hand smoke harms to others.

Smoking's contribution to health status: the data

Why does tobacco still cause so much burden if fewer people smoke? The AIHW explains that burden remains high "due to the long lag times between smoking and developing diseases such as cancers and chronic respiratory conditions" and the remaining risk among people who smoked in the past. Today's lung cancer and COPD deaths largely reflect smoking decades ago.

Vaping (e-cigarettes)

What vaping is and how it harms health

E-cigarettes heat a liquid, usually containing nicotine, flavourings and other chemicals, into an aerosol that is inhaled. The NDSHS 2022-2023 found more than half of e-cigarettes used contained nicotine.

Health concerns include:

• Nicotine dependence, which is particularly harmful to the developing adolescent brain and can lead to tobacco smoking in people who did not previously smoke.
• Respiratory irritation and exposure to chemicals in the aerosol.
• Poisoning and burns from liquids and devices.
• Mental health effects, including anxiety and stress associated with dependence and withdrawal.

Because vaping is recent, its long-term contribution to disease is not yet well measured. The AIHW's 2024 tobacco estimates explicitly exclude nicotine vaping; nicotine vaping and vaping illicit drugs will be assessed for inclusion as risk factors in the next major burden of disease update (2026).

Vaping trends

• Current e-cigarette use among people aged 14 and over nearly tripled, from 2.5 per cent in 2019 to 7.0 per cent in 2022-2023 (NDSHS).
• Among 18 to 24 year olds it quadrupled from 5.3 per cent to 21 per cent, and among 14 to 17 year olds it rose more than five-fold, from 1.8 to 9.7 per cent.
• The ABS National Health Survey 2022 found 14.4 per cent of adults had ever used an e-cigarette or vaping device.
• Vaping is concentrated in young people, the opposite of tobacco smoking, which is more common in older age groups. In 2022-2023 daily smoking among 18 to 24 year olds had fallen to 5.9 per cent.

The policy response (context for health promotion)

The Australian Government introduced staged vaping reforms: a ban on importing disposable vapes from 1 January 2024; from 1 July 2024, the Therapeutic Goods and Other Legislation Amendment (Vaping Reforms) Act 2024 prohibited the importation, domestic manufacture, supply, commercial possession and advertisement of disposable and non-therapeutic vapes; and from 1 October 2024, adults aged 18 and over could buy therapeutic vapes with nicotine concentrations of 20 mg/mL or less from pharmacies without a prescription, where the pharmacist judges it clinically appropriate, while under-18s need a prescription (TGA). The National Tobacco Strategy 2023-2030 set targets of daily smoking below 10 per cent by 2025 and 5 per cent or less by 2030. These strategies are analysed in tobacco health promotion.

Alcohol

How alcohol harms health

Alcohol is a depressant and a toxin. Its effects are both short-term (from single occasions of heavy drinking) and long-term (from regular drinking over years).

Alcohol's contribution to health status: the data

The NHMRC's Australian Guidelines to Reduce Health Risks from Drinking Alcohol (2020) advise that healthy adults drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day; that people under 18 should not drink alcohol; and that women who are pregnant, planning a pregnancy or breastfeeding should not drink. A standard drink contains 10 grams of pure alcohol.

Linking to indicators: ready-made chains

Use these as models, always stating the condition and the direction.

Linking to the dimensions of health and wellbeing

Questions may ask about health and wellbeing rather than health status. Examples:

• Physical: reduced lung function and fitness, lowered immune function (smoking); injury and liver damage (alcohol).
• Mental: nicotine or alcohol dependence, increased anxiety and stress during withdrawal, impaired decision-making when intoxicated.
• Emotional: difficulty managing emotions when intoxicated; mood swings associated with dependence.
• Social: conflict with family, isolation, or loss of employment linked to alcohol misuse; exclusion from smoke-free social settings.
• Spiritual: loss of sense of purpose or meaning associated with addiction.

Variations between groups

Smoking and alcohol also help explain variations in health status (see factors contributing to variations):

• Sex: males bear a much larger share of alcohol-attributable burden (5.5 compared with 2.6 per cent of total burden in 2024).
• Age: vaping is concentrated among young people, smoking among older people.
• Socioeconomic status and remoteness: smoking is more common in lower socioeconomic groups and remote areas, contributing to higher rates of lung cancer, COPD and cardiovascular disease.

When you use these factors, trace behaviours back to sociocultural, commercial and environmental influences, such as marketing, affordability, stress, social norms and the retail availability of tobacco and alcohol, rather than presenting them as simple individual choices.

Connecting to the rest of the course

These risk factors link directly to the health-as-a-resource question on the 2025 paper ("how reducing rates of smoking/vaping may act as a resource", see benefits of health and wellbeing), to the social model of health and Ottawa Charter in Unit 3 AoS 2, and to the Unit 4 global trend of "increased world trade (global distribution and marketing of tobacco products, e-cigarette products and processed foods)".