Packaged in “fun flavours” and seen as socially acceptable and less harmful than tobacco, vaping is rising at an alarming rate among South African teenagers, putting them at risk of addiction and harm to their developing brains and mental health.
In a survey conducted in 52 high schools across South Africa, 17.82% of the learners between grades 8 and 12 reported currently using vaping products with 47% vaping within the first hour of waking, suggesting high nicotine addiction. In addition to this 36.7% reported having tried vaping previously.
As with the nicotine in conventional cigarettes, research has shown that the nicotine in vapes or e-cigarettes can cause severe impairment to the growing teenage brain, leading to cognitive difficulties, mental health issues including depression and anxiety, and increased risk of violent behaviour, other substance use, and suicidal thoughts and attempts.[i]
According to a South African study[ii], at least a quarter of South African Grade 12 learners admit to vaping regularly, both as a social activity and stress-coping mechanism, and usage filters down through all high school grades to primary school learners.
While teenagers are well-attuned to the health and addiction risks of conventional cigarettes, the real risks of vaping are obscured by funky flavours and packaging, aggressively youth-targeted marketing and misconceptions about safety, warns member of the South African Society of Psychiatrists (SASOP), Dr Nokuthula Mdaka.
“The brain is still developing up until the age of about 25. The adolescent brain is particularly susceptible to nicotine, which not only ‘primes’ the brain for addiction but also harms the areas of the brain involved in attention and learning, mood regulation and impulse control.”
“Young people, and adults as well, have the misconception that vaping is less harmful than tobacco use and underestimate the risks. There is a cloud of misinformation around the health impacts of vaping, which leads people to believe it is harmless, or even ‘beneficial’, to the extent that parents even buy vaping devices for their children,” she said.
Dr Mdaka added that concerns about the rise and potential harm of vaping amongst teenagers extends to “non-nicotine” vapes – as they are similarly habit-forming with potential to lead to other substance use, mental health issues, and they carry similar physical health risks from the chemical components over and above nicotine.
High school learners taking up vaping have reported that they do so to cope with stress and anxiety, amid the multiple academic and life stressors facing teenagers today. ii
However, Dr Mdaka said teens and their parents needed to be aware that vaping may be being used as a coping mechanism for an underlying psychological problem that could worsen if not addressed.
The relationship between vaping and mental health is “bi-directional”, she said, since teenagers who are experiencing underlying mental health issues may be at risk of using vaping as a coping strategy which in turn could worsen the symptoms of pre-existing conditions such as depression and anxiety. i
“There is substantial published evidencei that teenagers with existing depression or depressive symptoms are more likely to begin vaping, while the incidence of depression, considering suicide and suicide attempts are higher in teenagers that do vape, than in those who don’t.
“While vaping may be used or seen as a anti-stress coping mechanism, research shows that it in fact worsens mental health, and that mental health improves after quitting any form of tobacco or e-cigarette use,” she said.
With vaping not bound by the restrictions on advertising and marketing of tobacco products and the ban on sale to under-18s, she said the products were being directly targeted at young people and were becoming seen as integral part of youth lifestyle and culture that is socially acceptable to young people and adults.
Novel fruit, candy and dessert flavours specifically appeal to teenagers and young people, while aggressive marketing targets youth via social media platforms such as TikTok, influencers and celebrities, and events linking in with their interests and popular culture.
“That half of vape shops in South Africa are within a 5km radius of a tertiary education institution campus[iii] comes as no surprise.
“The danger in the ready availability of vaping products is that young people are being exposed to the harmful effects of nicotine and showing signs of addiction at increasingly earlier ages. In addition to incurring earlier damage to physical health and brain development which could impact on their learning ability and future potential, it is also opening the door to further harmful substance use, potential addiction and mental harm,” she said.
A further concern arises from a local study[iv] that found a link between vaping and poor nutrition in young people aged 18-34, with half of vape users consuming unhealthy foods, as well as having lower fruit and vegetable intake than non-smokers and non-vapers. The main factors were money spent on vapes rather than on healthy food, and perceptions that vaping could assist in weight loss.
While vaping is promoted as a means to stop conventional cigarette smoking, Dr Mdaka said the evidence was unconvincing, and could lead to individuals smoking more as vaping appears to be more socially acceptable.
She pointed to the 2022 South African E-Cigarette Survey, iii which found that one in five (19%) users with no previous smoking history started smoking conventional cigarettes only after using e-cigarettes, while only one in eight (13%) quit conventional smoking after taking up e-cigarettes.
According to the Tobacco Data Control Initiative, which led the survey, vapes, e-cigarettes and similar products pose health risks to both users and those exposed to the “second-hand” aerosol emissions, whether they contain nicotine or are nicotine-free. The products have been shown to contain toxicants, carcinogens and flavouring chemicals which can affect the eyes, cause allergic reactions, contribute to fatigue and depression, and affect the respiratory, digestive and central nervous systems. iii
While marketers of vaping products claim that the aerosol emitted is “nothing more than water vapour”, studies have shown that the particles delivered by vapes are similar to those of cigarettes, and that they reach deep into the lungs and cross into the circulatory system. Vaping products also contain more than 20 harmful and potentially harmful chemicals at significantly higher levels than in conventional cigarettes.iii