Before school, during break, in class, in the bathroom. Even in chapel, high school pupils are secretly vaping.
“They can vape anywhere, any time. The vapour evaporates and it smells like mint or cherry chewing gum,” says UCT pulmonologist Prof 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 one in six (17%) of high school pupils use e-cigarettes – nearly half within an hour of waking - and 80% of their vapes 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.
“Almost everyone I know has either tried it or does it regularly. It’s just become part of the culture, like you’re at a party, or even just hanging out, and someone’s always got a vape,” said Jules, 17, a co-ed pupil in Cape Town.
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,” he said.
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.
Jules echoed this: “It’s not that I like vaping, it’s more of a habit now. At first I liked the different flavours and it seemed more chill than smoking, but with time it became something I did without thinking. Sometimes it feels like a way to take a break or relax, especially during stressful moments like exams.”
The mother of a first 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 do question why the school would take action against their children when caught vaping since they allow it at home.”
Van Zyl-Smit urged parents to ask their children why they vaped. “They need to talk about the health risks and how they can help them to stop.”
Pharmacotherapies such as 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.
— 5% of adolescents use cannabis
“This regulation has nothing to do with adult use and harm reduction. I always separate the two,” he said.
The tobacco industry has repeatedly raised obstacles to the Tobacco Products and Electronic Delivery Systems Control Bill — which would shield children from the promotion of smoking, said Nyatsanza.
The bill, introduced in 2018, is set for further public consultations.
Education is key, particularly in adolescent spaces such as TikTok, said Van Zyl-Smit.
Jules said: “I think a big part of why vaping is so common is because it’s marketed in a way that feels harmless, especially to teens. The flavours, the designs, it all feels very targeted. I’d say to anyone thinking about starting: Don’t!”
Van Zyl-Smit said: “We need to cut down availability and prevent the next generation from starting. We failed with cigarettes. Let’s not repeat the same mistake.”
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