Vaping has become a scourge among children that’s as alarming as cigarette smoking used to be, both in SA and worldwide, with experts saying few of the consumers have any idea of the effect this could have on their health as children as young as eight are being treated for nicotine addiction, writes MedicalBrief.
A recent survey by the University of Cape Town's pulmonary division and the UCT Lung Institute in nine high schools across three provinces – private and government – found the average age of initiating vaping was 15, the habit among pupils ranging from 6.2% for grade 8s to 26.5% for those in matric.
Teenagers said they had never been asked for their IDs when buying vapes at their local stores, and as a consequence of the ease in purchasing these, many had become addicted.
A number of youngsters are now being seen at long-term rehabilitation programmes for behaviour related to substance abuse.
In Scotland, experts say that teachers and parents are raising concerns about nicotine addiction in under 12s, with the government consulting pharmacy officials about nicotine addiction treatment for children amid concerns that they’re using vapes from as young as eight-years-old.
Many of the nicotine-replacement therapies available are licensed only for children aged 12 and over, but, said health authorities, there were reports of youngsters as young as eight using vapes who might need support.
According to data from the Scottish Health Behaviour in School-aged Children survey, published in June, 3% of children aged 11 and 10% of those aged 13 reported being current users of e-cigarettes in 2022, and 4% of children aged 11 and 16% of those aged 13 reported having tried vaping at least once.
Sheila Duffy, chief executive of charity ASH Scotland, told The Pharmaceutical Journal that there was an “alarming upsurge of children across Scotland using e-cigarettes”.
“We have heard about parents taking their 11- and 12-year-old children to GPs due to concerns about nicotine addiction through vaping, and some teachers have raised alarm about vaping in primary schools,” she said.
In South Africa, the situation is almost as alarming, with the UCT questionnaire finding that of the adolescents vaping, more than half (54.5%) had attempted to quit but expressed a need for further resources to help with anxiety (39%) and cravings (19.8%) in these attempts.
With very little legislation about vaping in SA, research like an upcoming Manchester Metropolitan University study might yield results that could lead to global developments in this uncertain space.
The British university is to conduct an 18-month study into the long-term health effects of vaping, in particular, scrutinising the impact on the cardiovascular system.
While many scientists believe that vaping is less harmful – long term – than smoking, Manchester Metropolitan’s researchers will measure the elasticity of blood vessels (the higher the elasticity, the healthier) among non-smoking, smoking and vaping participants, as well as fitness tests to determine cerebral blood flow and each person’s ability to take in oxygen.
The study follows reports that UK Government Ministers plan to ban disposable vapes after local councils, paediatricians and public waste campaigners called for making the sale of these devices illegal due to health and environmental factors.
BusinessLIVE reports that the UK is not alone in this endeavour, with Australia, Germany and New Zealand having passed legislation prohibiting e-cigarettes in various forms, while France has also announced its plan to ban all disposable vapes.
Highlighting the details of the Manchester Metropolitan University research, Dr Maxime Boidin, a senior lecturer in cardiac rehabilitation at the university, said clinical experts have already seen some short-term symptoms of vaping, like coughing, lung dysfunction and chest infections.
“We hope our findings will help to inform guidelines and regulations on the sale of e-cigarettes in the future,” she said. “We also hope to help the general population better understand what they are putting in their bodies and any potential risks that come with that.”
Nurse and specialist wellness counsellor Samantha Heald’s research into the effects of vaping is not encouraging.
“Vapes contain chemicals like formaldehyde, which is linked to cancer, and acrolein, a weed killer that’s known to be linked to irreversible lung damage. They often contain THC (tetrahydrocannabinol), CBD (cannabidiol) and other chemicals that give a flavour. Ultrafine particles can also be found in them and even heavy metals such as nickel, tar and lead.”
Britian’s NHS says vaping “has been associated with a positive process of withdrawal from smoking and if used to reduce nicotine intake, is suggested to be more effective than nicotine patches and gum”.
Targeting youth
The WHO reports that “the tobacco industry relentlessly targets young people with tobacco and nicotine products, resulting in e-cigarette use increasing and nine out of 10 smokers starting before 18”.
In the US, teenage vaping is just as worrisome, and in a step further, Juul – once the “coolest vape” around – is ensnared in litigation involving billions of dollars in legal settlements after being blamed for hooking teens on e-cigarettes.
A flood of illicit e-cigarettes arriving from China (where flavoured vapes are outlawed), in dayglo colours and fruit, ice cream and slushy flavours, accounts for a major share of the estimated $5.5bn e-cigarette market in the country.
The never-ending influx of these, some offering 5 000 or more puffs per device or escalating nicotine levels, has exposed a gaping lapse in enforcement by the US Food and Drug Administration (FDA), which has authorised only a handful of the hundreds of options available in stores nationwide.
Politicians, two dozen state Attorneys-General and even the Big Tobacco companies have stepped up their calls for the agency to get the situation under control.
The Independent reports that in signs that it is finally cracking down, last week the FDA determined that six Vuse Alto e-cigarettes do not “meet the public health standard”, and, thus, must stop being marketed in America.
Three mixed-berry and three menthol flavours were among those that have been banned.
A statement from the agency said that marketing denial orders (MDOs) had been issued to the makers of the Vuse Alto e-cigarettes: RJ Reynolds Vapor Company.
The statement said the FDA had found that the risks associated with Vuse Alto e-cigarettes “outweigh the potential benefits, such as helping cigarette smokers quit”.
Matthew Farrelly, PhD, the FDA’s director of the Centre for Tobacco Products Office of Science, said that there’s simply not enough evidence to claim the public are better off with access to the six Vuse Alto e-cigarettes.
Toxic chemicals
“E-cigarettes produce dangerous chemicals like acrolein, acetaldehyde, and formaldehyde, some of which can cause cardiovascular disease and lung disease,” according to the American Lung Association (ALA).
Acrolein, in particular, which is used to kill weeds, can cause acute lung injury, and may lead to asthma or lung cancer. Research has also shown that two “primary ingredients” in e-cigarettes – vegetable glycerin and propylene glycol – are toxic to cells.
RJ Reynolds immediately challenged the FDA’s decision, with the parent company of RJ Reynolds, British American Tobacco, saying the agency’s ruling “flies in the face of proven science”, and that it would challenge the ruling in court, reports The New York Times.
Sales mushrooming
Flavoured vape sales have surged in the US by 60% over the past three years, to 18m vaping products a month in June from 11m a month in early 2020.
“The FDA should not be having any of these flavoured e-cigarettes on the market,” said Yolonda Richardson, president of the Campaign for Tobacco-Free Kids. “It just needs to do its job.”
When the FDA received expanded authority to regulate e-cigarettes in 2016, the objective was to draw a new line in public health: smokers would have an alternative to traditional cigarettes, and tobacco use among minors would remain at historic lows.
Seven years on, nearly 40% of e-cigarette users are 25 or younger, according to the US Centres for Disease Control and Prevention (CDC).
And of the 2 000 or so vaping and e-cigarette products on the market, the agency has only given the green light to about two dozen of them, and it still has to deal with a backlog of applications.
There are few places where the problem feels more pressing than in high school bathrooms, where students crowd the stalls between classes to get a nicotine fix.
Teenage vaping rates have fallen roughly by half since their height during the Juul craze of 2019, to about 14% of high school students last year from nearly 28% at their peak, surveys show. Those rates were based on survey responses in which students said whether they had vaped within the past 30 days.
Yet, while a growing body of research shows that vapes may not be as toxic as cigarettes, they are still far from healthy, particularly for adolescents who become addicted to nicotine while their brains are still developing.
The American Heart Association has raised the alarm about possible cardiovascular effects from e-cigarettes and called for more research.
One recent meta-analysis reported higher heart attack risks in e-cigarette users than in those who did not vape or smoke anything. (Cigarette smokers had the highest risk.)
In recent years, the market has begun to move toward high-volume vapes advertising 5 000 to 6 000 puffs – with about as much addictive nicotine as is in a carton of cigarettes.
Calls for change have grown louder. In a letter in August, 30 state Attorneys-General urged the FDA to do more to deter youth vaping and to ban all but tobacco-flavoured e-cigarettes.
Smoking rooibos
Meanwhile, Reuters reports, it seems that rooibos is the new tobacco, in the industry’s bid to counter a looming ban by the European Union on flavoured heated tobacco products.
While vigorously defending the ban of its Vuse Alto products in the US, BAT is now selling heat sticks made from nicotine-infused substances like rooibos tea in nine European markets, although health experts warn their safely is unclear.
The industry has produced “heat-not-burn” sticks containing tobacco for years, aiming to avoid the toxic chemicals released via combustion.
These products have helped mitigate falling demand for traditional cigarettes due to rising health awareness and heavy taxation in some markets.
While BAT plans to roll out its rooibos-infused product globally, experts have warned there may be unknown risks linked to inhaling the tea.
“Anything that burns or is vapourised and inhaled into the lungs probably will cause some effects,” said Erikas Simonavicius, a research associate at King’s College London.
Tobacco companies, including BAT – the first to reveal what its zero-tobacco sticks are made of – have yet to publish research showing the health implications of rooibos or other zero-tobacco sticks, Simonavicius said.
Rival Philip Morris International (PMI) will start rolling out a zero-tobacco stick later this year, it said recently, also declining to reveal what the product is made from, or to comment on its health implications.
PMI CEO Jacek Olczak said its zero-tobacco sticks could avoid the regulatory scrutiny faced by tobacco products.
BAT’s zero-tobacco sticks are not subject to current EU tobacco rules, the company said, meaning it can sell rooibos sticks in flavours like peppermint and tropical fruit even after a ban on flavoured heated tobacco products is implemented across the bloc later this month.
Rivals Imperial Brands and Japan Tobacco International declined to comment on whether they will launch zero-tobacco sticks.
Researchers said it was important to provide a wide variety of alternatives to smokers, but these needed to be properly regulated to ensure they do not tempt more people to consume nicotine.
“The way to prevent that is to be very strict about how these products are marketed and displayed,” said Lion Shabab, a professor of health psychology at University College London.
Reuters article – Big Tobacco turns to rooibos tea to counter upcoming ban (Open access)
BusinessLIVE article – Researchers to probe long-term health effects of vaping (Restricted access)
See more from MedicalBrief archives:
Parent, sibling attitudes among top influences on teenage vaping
Teenager’s lungs collapse four times from vaping
Forty UK children hospitalised for vaping disorders
Judge approves multi-million dollar class action settlement against vaping giant
Vaping among teens at SA’s affluent schools ‘a significant problem’