Address SA’s adolescent vaping catastrophe

As the vaping crisis intensifies among teens in South Africa, public health researchers at the University of Cape Town (UCT) have urged government to urgently implement the Tobacco Products & Electronic Delivery Systems Control Bill to avoid a national vaping epidemic.

The bill aims to bring vaping products into the regulatory net and protect the youth from a potential nicotine catastrophe. According to a research paper – co-authored by a team of multidisciplinary researchers at UCT and Utrecht University in the Netherlands and published in The Lancet’s eClinical Medicine – the vaping tally among young South Africans is alarmingly high.

The study, which is said to be the largest of its kind in South Africa, surveyed 25 000 pupils at 52 different fee-paying high schools around the country. It aimed to investigate just how common vape use is among teenagers, the factors that are driving it, and the extent of young people’s addiction. Researchers used a mixed-method research approach – combining both quantitative and qualitative data to understand the vaping behaviour among the sampled teens.

“In South Africa, where tobacco control has made strides, the rapid rise in vaping among adolescents is a new public health challenge. As a multidisciplinary team, whose work intersects on public health matters, we wanted to quantify the burden. We were further driven by global alarm bells, like the World Health Organization’s 2023 warning about e-cigarette promotion targeting the youth, as well as local gaps in knowledge,” said co-author Samantha Filby, who is based in the Research Unit on the Economics of Exercisable Products in UCT’s School of Economics.

Cause for concern

In South Africa vaping was anecdotally rising among teens. However, Filby said, researchers had no hard data on its scale and the driving factors. What they knew was that the United States call teen vaping an epidemic and studies from the United Kingdom report that 20.5% of 11–17-year-olds have tried it. So, it was important to obtain accurate, local data.

“We suspected similar trends here, especially with aggressive marketing from e-cigarette companies aimed at the youth,” she said.

And researchers were 100% correct. The study revealed that just under 17% of the sampled learners currently use a vape. Among them, 38.3% reported that they vape every day and more than half of the current vape users indicated that they use their vapes more than four days per week. However, Filby noted that the study wasn’t just concerned with vaping frequency among the youth. Researchers also wanted to understand how symptomatic pupils’ vaping behaviours are for addiction to vaping. So, they also asked the following questions: How long do you wait between waking up and vaping? Can you get through the entire school day without vaping? Do you feel anxious or angry if you are required to wait a long time before vaping? Do you use a nicotine or non-nicotine vape?

The responses to these questions yielded startling insights. Almost half (47%) of the learners who currently vape indicated that they use their vape within the first hour of waking up, which Filby described as “highly symptomatic” of addictive behaviour. About 11.8% of the teen vapers reported that they can’t get through the school day without vaping, and 24.9% reported that they feel anxious or angry if they need to wait a long time before they are allowed to vape. Alarmingly, 88% of the learners who currently vape reported that they use vapes that contain nicotine.

“We used this information to construct a novel vape dependence score that could help us identify the proportion of vape users who are highly vape dependent.”

“We used this information to construct a novel vape dependence score that could help us identify the proportion of vape users who are highly vape dependent. On our scoring system, 60% of the sampled adolescent vapers exhibit high vape dependence,” she said. “This underscores vaping as a significant addiction for a large portion of young users and highlights the urgent need to strengthen prevention efforts.”

Weighing in on these alarming statistics, Professor Richard van Zyl-Smit, the study’s lead author, said that the extent of use and dependence on nicotine is something researchers had never encountered with traditional cigarettes in the past.

Debunk the ‘dangerous’ myth

Addressing the current crisis is possible with the right interventions, Filby said. And it all starts with debunking the “dangerous myth” that vaping is safe. She said basic education around the harms of vaping is essential and these interventions must be implemented at primary school level to conscientise children from a young age. The key message should always underpin one central theme: vaping is not safe; it’s highly addictive. In addition, Filby said, providing young users addicted to vape with tailored psychosocial support to overcome their addiction is crucial.

But interventions require a comprehensive understanding of the addiction, the psychological dependence and the social context of these high school learners, which makes it a complex engagement, added Professor Van Zyl-Smit.

“What we need is regulation – to ban ads targeting youth and enforce age limits to reduce appeal and access.”

Further, Filby stressed that restrictions on vape marketing is equally important, which is where the Tabacco Products & Electronic Delivery Systems Control Bill comes in. According to the preamble, the bill aims to regulate smoking, the sale and advertising of tobacco products and electronic delivery systems; and to prohibit sales via vending machines, as well as to children.

“What we need is regulation – to ban ads targeting youth and enforce age limits to reduce appeal and access. Vape products are so easily accessible because you can even order them on the Checkers Sixty60 or UberEats mobile apps. The restrictions on vape marketing, which the bill provides, can aid in debunking the myth that vaping is safe and assist with deglamourising vaping among our youth,” she said.

Involve parents, teachers and healthcare professionals

But it doesn’t end there. Parents, teachers and healthcare professionals have a crucial role to play to ensure teens and adolescents don’t become addicted to vaping. And effective education is step one – on the burden of the vaping crisis and its effects on an individual’s health and well-being.

“We want to ignite action, push lawmakers to regulate vaping, equip schools, parents and the public health community with the knowledge that there is need to intervene.”

She said parents and teachers must be more aware of the signs of vaping and the underlying issues (peer pressure, the need to conform with societal norms and coping with anxiety, depression and stress) to be able to deal with the crisis effectively in the home and in class. Similarly, she added, healthcare professionals should start enquiring about the vape use among teen patients during routine check-ups and facilitate the first step to monitoring their sign up and adherence to various programmes to ensure they stop vaping.

“We want to ignite action, push lawmakers to regulate vaping, equip schools, parents and the public health community with knowledge that there is need to intervene and shift public perception towards the reality that we do have a public health crisis in the making, and we need to address it,” Filby said.