“I started vaping out of curiosity and it was everywhere. E-cigarettes are scarily easy to access and convenient to hide so, unfortunately, using it all the time was a possibility and it turned into a bit of an addiction,” says a grade 12 student in Cape Town, with a parent who buys her supplies. “Being stressed makes me crave it more.”
The popularity of e-cigarettes among high school pupils, university students and young adults up to 35-years-old in SA has soared, and new studies, locally and internationally, show that vaping is linked to stress.
Suspending them from school and punishment won’t help them to stop. We need to help them cope.
— Professor Richard van Zyl Smit, UCT pulmonologist
“Vaping is a coping strategy to deal with life and stress,” says UCT pulmonologist Prof Richard van Zyl Smit. “I think our high school pupils are under an enormous amount of pressure, and if you talk to the principals and counsellors at schools, these are not your reprobate kids who are vaping behind bicycle sheds. They are the high-achieving kids.
“We were asked why we don’t use the first team water polo guys to be anti-vaping role models at one school, but no. They are the ones vaping.”
Nearly a third of high school pupils reached for their e-cigarettes five minutes after waking up, while 60% vaped within the first hour of being awake, a UCT study this year found.
Vaping has increased by:
- 900% over six years among high school pupils, the UCT study found; and
- tenfold over the last 10 years among 16 to 35-years-old, University of Pretoria research found.
Vaping and stress
One in four grade 12 pupils were vaping, and they usually started with friends at about 15 years old, says Van Zyl Smit. But stress, anxiety and addiction are the most common reasons why they continue vaping, the study revealed.
Pupils identified “friend, stress, buzz, flavour” as reasons to keep puffing in the pilot study of some 5,500 pupils in three provinces in publicly and privately funded high-income schools. Ongoing research with about 15,000 more pupils in nine provinces looks likely to confirm these findings, Van Zyl Smit says.
A new study of Canadians, aged 15 to 30-years-old, found that those who used e-cigarettes were “more than twice as likely to report experiencing chronic stress” than those who did not.
“Vaping is not an effective way to cope with stress, but stress and anxiety can trigger vape cravings, and make it harder for a user to quit,” stated Dr Teresa To, a senior scientist at The Hospital for Sick Children in Toronto.
Quitting is tough because most vapers use nicotine-infused liquids or pods and nicotine is addictive. “A single pod can contain up to the same amount of nicotine as a pack of 20 regular cigarettes,” warns a Lancet-linked journal, eClinicalMedicine.
Why is popularity soaring?
The rising popularity of e-cigarettes is supported by its social acceptance and ease of purchase.
“Vaping is about social inclusiveness rather than exclusiveness ... friends say they feel good vaping, ‘Why don’t you try it?’ It is about an internal drive to participate rather than external peer pressure to do it,” says Van Zyl Smit.
And buying e-cigarettes is easy: at the corner shop, a kiosk, online or a 16th birthday present from parents. For example, a cafe down the road from two high schools in Newlands, Cape Town, is reportedly the biggest supplier to pupils though it is illegal to sell to under 18s.
Prof Olalekan Ayo-Yusuf, head of public health at Pretoria University, says a buffer is needed between high schools and e-cigarettes outlets to control exposure.
SA had a jump in the sale of fruit flavoured e-cigarettes linked to the launch of the Vuse brand and a concert streamed during lockdown in 2021, with publicity on TikTok, he says.
“We need to cut advertising to young people and stop glamorising it,” he says, noting the sale of fruit flavours went up and tobacco flavours down after the concert, according to their online survey and sales data suggested.
“If you were trying to quit smoking, you would want tobacco flavours,” he says, challenging the myth that vaping marketing is intended to help smokers quit. “Why would you need billboards for that?”
The accessibility of e-cigarettes affects how widely they are used, with 40% of vaping shops located near university campuses, and a proven link between using e-cigarettes and living near a shop, says SA Medical Research Council scientist Dr Catherine Egbe, a specialist in tobacco control.
Why is vaping a health hazard?
Vaping is an immediate threat to the developing brain, learning and concentration of young adults and a long-term risk to their lungs and hearts, says Van Zyl Smit. But most of the pupils, at some 20 schools where he has spoken, know nothing about the harms of vaping.
“Nicotine harms the lungs, immune system and cardiovascular system, but what is most concerning is the impact on the dopamine reward centres in the brain,” he says. “This interferes with your neurobiological development and potentially causes long-term issues for concentration, poor memory, depression and anxiety. Your brain is focusing on that need for a reward rather than learning.
“The newer vaping devices have changed their structure to make nicotine more easily absorbed quickly,” he says, and vaping delivers many toxic chemicals to the lung, he warns. Cherry, cinnamon and vanilla flavours are known to be toxic.
The UCT study also found that dual usage in vapers was common, with a quarter vaping and using cannabis, and 17% vaping and using tobacco.
Meanwhile, the University of Pretoria team found that e-cigarette use was associated with compromised nutrition among users, who spent about R250 a month on e-cigarettes. “We found the consumption of unhealthy food is more common among e-cigarette users (and smokers) than among non-vapers,” says Ayo-Yusuf.
Protecting the next generation
SA already has a generation in high school addicted to vaping who need help quitting, says Van Zyl Smit. “Suspending them from school and punishment won’t help them to stop. We need to help them cope.”
More than half the students in the UCT study had tried to quit and failed, and they requested help with anxiety (39%) and cravings (20%) for future quit attempts.
They need psychosocial support and potentially additional nicotine replacement therapy, and vaping products need urgent regulation, the research team recommended. Education and prevention among youngsters are also priorities.
Public hearings are taking place on the proposed changes to the Tobacco Products and Electronic Delivery Systems Bill of 2018, which is set to introduce tighter regulation on e-cigarettes, on which the tax has gone up.
The new CEO of British American Tobacco, Tadeu Marroco, even told The Financial Times of London: “We need to have better regulations ... we have issues related to youth access and the environment.”
SA needs to act now, says Van Zyl Smit, to avoid repeating history. “The tobacco rolling machine was invented in 1890 and it took up to 1950 to prove smoking causes lung cancer. We already have enough red flags on e-cigarettes that we need to control their use.”
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.