Easy access, lack of regulation and ignorance of risks are all to blame for the startling prevalence of vaping among South African high school pupils, warn experts, whose study has revealed that one in six of the pupils use e-cigarettes within half an hour of waking up every day.
“They can vape anywhere, any time – in chapel, in class, in the bathroom… The vapour evaporates and smells like mint or cherry chewing gum,” says UCT pulmonologist Professor Richard van Zyl-Smit, lead author of the first big national study – released this weekend – which exposes the high use of e-cigarettes across South African schools.
“We found an enormous amount of vaping, it is off the charts,” he said. About 80% of the vapes being used contain nicotine, according to the survey of 25 000 pupils in 52 low- and high-fee schools across genders and eight provinces.
It showed vaping increased by grade, ranging up to half (46%) of matrics and grade 11s. School affluence did not influence its popularity, reports TimesLIVE.
Many vapers are star students, said Van Zyl-Smit, who has spoken at schools. “In my conversations with principals, it’s not the reprobate bunch, it’s their high-performing academics, the first water polo team, their leaders.”
Easy access to vapes and easy concealment allow pupils to puff all day, unlike smoking: “It is a free for all.”
Teens who bond over e-cigarettes can quickly become dependent on nicotine to relax and cope with anxiety and stress, the study found.
“When they start vaping, it’s social, it’s engagement, it’s fun, it’s curiosity and then very quickly, we see it transition to a coping strategy and heavy addiction,” said Van Zyl-Smit.
The mother of a 1st team rugby and water polo player aged 15 said peers and a lack of information shaped his habit. “If he is in a social setting where his friends are not vaping, his own desire (to perform in sport) keeps him clean, though he vapes recreationally at parties,” she said.
Nearly half (46%) of the teens surveyed seemed unaware of their addiction. The study, published in The Lancet’s eClinicalMedicine, did not include non-fee schools, given a lack of internet access and budgetary constraints.
Many parents are unaware of the dangers of vaping – to the adolescent brain, developing lungs and mental health – even giving children vapes as a “safer option” than cigarettes, said Dr Sharon Nyatsanza, deputy director of the National Council Against Smoking. “They misunderstand how harmful it is.”
Westerford High School teacher Clinton Classen said: “Some parents question why the school would take action against their children when caught vaping, because they allow it at home.”
Pharmacotherapies like nicotine patches or Varenicline – tested for adults but “off label' for adolescents – and behavioural interventions are urgently needed to help teens stop, the study concludes.
“How can we teach adolescents about behavioural techniques when they are craving nicotine and climbing the walls?” Van Zyl-Smit asked, adding they have a lower tolerance for distress than adults. “There is a significant chemical addiction and we know punishment for addiction does not work.”
He called for urgent regulation of the industry, not yet under health or tobacco laws, to restrict marketing and access to vapes for under-18s.
This regulation has nothing to do with adult use and harm reduction. I always separate the two,” he said.
Education is key, particularly in adolescent spaces such as TikTok, he added.
Study details
Electronic cigarette usage amongst high school students in South Africa: a mixed methods approach
Richard van Zyl-Smit, Samantha Filby, Gurveen Soin, Jacqueline Hoare, Asya van den Bosch, Sebastian Kurten.
Published in eClinical Medicine on 29 November 2024
Summary
Background
The WHO has highlighted that: “promotion of e-cigarettes has led to marked increases in e-cigarette use by children and adolescents.” The long-term neuropsychiatric and psychological consequences of substance abuse in adolescence is well recognised. Limited data exists on the adolescent burden of vaping-related nicotine addiction and behavioural and/or psychological dependence to guide pharmacological or behavioural interventions to stop electronic cigarette usage.
Methods
A self-administered brief electronic survey was provided to a large, sample of high school students from January to October 2023 in South Africa. Questions on vaping usage, initiation, reasons for continuation and indicators of physical and psychological dependence were asked. A mixed methods approach was used to obtain and analyse quantitative and qualitative responses.
Findings
A total of 25 149 students from 52 South Africa schools completed the survey. 45.8% identify as female, 51.7% male, 0.3% transgender, 2.1% do not identify with a gender. Current vaping was reported by 16.83% (95% CI: 16.47–17.30), with 36.71% reporting ever using a vaping product (95% CI: 26.06–37.36). The odds of vaping increased by grade but not with increasing school affluence. 47% vaped within the first hour of waking suggesting high nicotine addiction. Vaping initiation reasons of: ‘social influences’ and ‘curiosity’, changed significantly to ongoing motivations of: ‘enjoyment’, ‘managing mental distress’ and ‘addiction’ to nicotine. Paired quantitative/qualitative responses regarding stress and dependence showed inconsistencies at the individual student level.
Interpretation
Vaping in the schools surveyed was high and increased by grade but was not associated with school level affluence. Drivers for vaping initiation change significantly to persistence drivers with significant nicotine addiction. Adolescent perceptions (qualitative/quantitative) are frequently incongruent suggesting that mixed methods evaluations are required to understand individual level drivers of vaping. Urgent interventions tailored to this population are required. Nicotine addiction may require “off-label” pharmacotherapies alongside tailored behavioural interventions utilising the expressed concerns, psychological and dependence measures elicited from adolescents.
TimesLIVE article – Vaping in high schools sky high with addiction rampant (Restricted access)
See more from MedicalBrief archives:
Vaping among teens at SA’s affluent schools ‘a significant problem’
New vaping rules and taxes planned for South Africa
Vaping scourge among children prompts long-term health effects study