Why is teenage vaping an international public health concern?

In the past decade, vaping has increased among all age and demographic groups and is more popular than traditional cigarettes among high school students. E-cigarette use among teens more than doubled over the past six years.

Teenage vaping is a significant problem due to 

• the addictive nature of nicotine
• easy accessibility of vaping products
• lack of awareness about health risks
• misleading marketing
• the potential gateway to smoking and other substance use

What did the studies find?

• Young adults who vape nicotine are six times more likely to initiate cigarette use than those who have never vaped.
• In South Africa, over 25% of matric learners use vaping devices. 
• Almost 30% of high school respondents reported using their vaping device within an hour of waking. 
• Nearly a quarter are unable to go through a school day without vaping. 
• The average age at which teenagers started vaping was 14.7 years.

Why are we concerned about teenage vaping?

• A teenager’s brain is not fully developed, making the introduction of nicotine even more dangerous during this critical developmental stage. 
• The brain area responsible for cognitive and impulse control (the prefrontal cortex) develops more slowly than other brain parts. The maturation process continues until 25 years of age. 
• Until their brains have matured, adolescents are more likely to take risks, be influenced by their peers, and be motivated by rewards. 
• Nearly 9 out of 10 adult smokers started before age 18, and 98% began by age 26. If initial nicotine use can be delayed until after the brain development stage, it will reduce nicotine addiction and related damage. 
• Young people who would not otherwise use nicotine or tobacco are vaping. This could lead to a quick onset of nicotine addiction during brain development, causing physical and emotional damage.
• The developing brain is also vulnerable to peer group pressure and marketing strategies focusing on flavourings and bright packaging.

What are the damaging effects of teenage vaping?

• Respiratory health: Young people using e-cigarettes are twice as likely to suffer from a chronic cough than non-users. Lung damage from vaping is called E-cigarette or Vaping-Associated Lung Injury (EVALI). A US investigation found that the average age of EVALI patients was 21. This is related to many harmful chemicals in vaping products.
• Cardiovascular health: Long-term use of electronic cigarettes or vaping products can significantly impair the function of the body’s blood vessels, increasing the risk for cardiovascular disease. Vaping is also associated with increased blood pressure.  
• Mood disorders: Nicotine use can contribute to the development of mood disorders, such as depression and anxiety
• Cognitive health:  Nicotine can interfere with the development of the prefrontal cortex and other brain regions, leading to long-term negative consequences for learning, memory, and attention.
• Gateway to other substance use: Vaping can also serve as a gateway to other substance use, including tobacco and cannabis (weed) and can lead to other substance use disorders. Vaping cannabis has the most overall destructive impact on physical and mental health.
• Impulsivity: Nicotine dependence can increase impulsivity, leading to risky behaviours and decision-making, contributing to negative mental health outcomes.
• Oral health: A Korean study found that e-cigarette use was significantly associated with gum disease and that vaping may not be a safe alternative to smoking for oral health.

What are the harmful substances in vaping?

• Nicotine: Nicotine is highly addictive and can harm the developing brain, leading to long-term negative consequences for learning, memory, and attention.
• Aerosol: Vaping produces an aerosol, which can contain harmful chemicals and particles, such as heavy metals, volatile organic compounds, and ultrafine particles. These particles can be inhaled deep into the lungs and cause respiratory problems.
• Flavourings: Vaping products often come in various flavours, which can contain harmful chemicals, such as diacetyl, linked to lung disease.
• Formaldehyde: Formaldehyde is a carcinogen produced when vaping at high temperatures.
• THC: Some vaping products contain THC, the primary psychoactive ingredient in marijuana, which can negatively affect brain development and increase the risk of addiction.

What can be done about teenage vaping?

Addressing these issues requires a comprehensive approach involving education, regulation, and availability of treatment resources.

Legislation:

According to The Centre for Disease Control and Prevention (CDC), increasing the unit price of tobacco products is an effective strategy for curbing youth and adult smoking. From 1 June 2023, vaping products in South Africa will be included in the tax net with a flat excise duty rate of R2.90/ml. This can lead to a 138% increase in vaping products, which can be more expensive than cigarettes. However, concerns exist that this can lead people to switch to cheaper tobacco products that have infiltrated the South-African market since lockdown. 

Schools:

Interventions should include educational campaigns to provide information on the dangers of vaping to prevent teenagers from starting and assist those who have already started.  Teenagers who already developed a problem will need to be made aware of resources available to assist them, as craving and withdrawal symptoms can be challenging to manage.