Despite a new global review showing e-cigarettes are dangerous and addictive, experts say calls to ban them are misguided and could backfire.
The major review by the Australian National University, released last month, found that the use of e-cigarettes or vapes was rapidly increasing in Australian youth, causing “addiction in a new generation of users”.
Vaping and e-cigarette use was reportedly highest among young people aged 18-24, with studies showing users are three times more likely to become cigarette smokers.
Alcohol and Drug Foundation knowledge manager for policy and advocacy, Laura Bajurny, said the expansion of e-cigarette use among young people was disappointing.
“Around 14 per cent of 12-to-17-year-olds have used an e-cigarette – around 32 per cent of these students have used one in the past month,” she said.
“The outcome we hoped to see from vaping was for people to move from cigarettes to vaping nicotine instead. When we see young people start vaping who were not previously cigarette smokers – that’s worst-case scenario.”
Royal Melbourne Hospital paediatrician Dr Anthea Rhodes said e-cigarettes were being bought online and sold in the schoolyard.
“They’re really marketed to teenagers and even younger children with their packaging, flavouring – even the actual design.”
Brightly coloured devices and confectionary flavours, like jelly donut, bubble gum and candy rainbow, are drawing in the younger demographic, emphasising the need for effective drug and alcohol education programs.
New regulations “could backfire”
Buying vaping products without a prescription was made illegal in October 2021 by the TGA – a move Ms Bajurny said might have been misguided.
“I think that the TGA had the best intentions, but the outcome has not been what they intended,” she said.
“We are seeing an increase, especially in young people … at least experimenting with vapes. Risk-taking, especially in adolescence, is very appealing. ‘Oh, I’m the cool kid cause I’m doing the thing they told me not to do’.
“People are going to acquire nicotine e-liquids the same way you get anything else that’s prohibited – [vapes are] not hard to get.”
Eastern Health medical registrar Dr Mitchell Munnings said prohibition was unlikely to be effective in discouraging young people from vaping.
“I think, traditionally speaking, when you ban things it doesn’t really do its intended job,” he said. “People will find a way … you’re just encouraging people to find different avenues, and potentially more harmful avenues.”
“That process needs to be much more collaborative with younger patients … you need to educate and say, ‘It’s not going to be a problem that you may see in the next six months or six to 12 months, but it is something that could be a problem down the line’.”
Vape use not just about stopping smoking
Dr Shoeman said while adults were using vapes to stop smoking, the majority of young people had different motivations.
“It’s the same trend we saw in the 60s with cigarettes, except it’s now with vapes,” she said.
“Young people are using it as a gateway drug, and they will soon move onto bigger and more harmful substance intake,” she said.
The ABS, National Health Survey 2020-2021 data found that 21.7 per cent of people aged 18-24 had used a vaping device at least once.
The ADF 2020-2021, reports that 64 per cent of 18–24-year-olds have tried vaping and 63 per cent reported receiving their last e-cigarette from a friend.
Campus nurse at Swinburne University Tracey Rutter said younger generations didn’t seem to be aware of the effects vaping could have on their future health.
“I believe the health impacts are similar to cigarettes which contain invisible risks that people can only see in the long-term,” Ms Rutter said.
“I don’t believe young people understand the full extent of the potential health effects throughout their lifespan. I think the effects and consequences need to be closely monitored.”
University of Melbourne student Wu Jia Tan said they had been vaping for more than a year, despite being aware of the side effects.
“I started using it when I moved to Australia because it is more accessible to get it here than back in my hometown,” Tan said.
Swinburne University student Kris Nguyen said he had experienced more immediate side effects from e-cigarettes, which he has been using for five years.
“It makes me feel dizzy in a few seconds and nauseous when it is too much nicotine.”
Many current education programs not effective
An ADF 2019 review of school-based drug education programs found that of 39 international programs, only three demonstrated a positive effect on behaviours.
The review found poor quality education and program design increased student knowledge but did not affect their behaviour toward drugs and alcohol.
Ms Bajurny said focusing on the risks and dangers of vaping made it seem more like this “really exciting thing to do”.
“Schools should be making sure that they’re educating young people in a boring fact-based way about vaping, that doesn’t glamorise it and run the risk of backfiring.”
This also includes equipping parents with knowledge and information so they can have open and honest conversations with their young person.
Mother to three young children Francesca Staskowski said schools should be responsible for educating children on drugs and alcohol.
“They are better equipped to deal with this topic than parents are. They have the resources to bring in programs and people who actually know how to properly teach kids about drugs and alcohol,” she said.
“Kids need to be educated on the real damage that drugs and alcohol can do to health, mental state and family relationships so that they don’t seem appealing,” she said.
The deputy principal and head of wellbeing at an inner-Melbourne all-girls school, Jane Smith*, said her school was aiming to take a preventative approach.
“We’re sharing information with parents on what to look out for, talking with students about the chemical compounds within vapes and the uncertainty of any long-lasting effects,” she said.
However, Ms Smith said suspension for vaping was a justified punishment. “We do consider it serious, and we want it to be a deterrent,” she said.
Harsh punishment could worsen mental health issues
Ms Bajurny said punishment for vaping was not the right approach for students already potentially struggling with mental health or home issues.
“If we suspend or, worst-case scenario, expel those kids, we are making those problems so much worse.”
Angliss Hospital Nurse C.K. Hew said improving awareness would be more beneficial than regulations.
“I don’t think increasing regulations would help … it’s more important to provide education and warnings of the health risks.”
Sensors, harsh repercussions “not working”
Several Melbourne schools have begun trialling high-tech sensors in campus bathrooms to deter young people from vaping. The sensors alert teachers to the behaviour and provide security footage of the students involved in the act.
A year 12 VCE student at Our Lady of Mercy College, Kyra Gioras, said despite her school installing sensors and discussing repercussions, she was yet to see change.
“You still see it around campus, whether it’s in someone’s pocket or they are smoking in the corner of the bathroom to prevent being detected,” she said.
Ms Gioras said she finds it “frustrating” that schools are not seeing that their approaches “are not doing enough”.
Penola Secondary College educator Luke Vraca said deterrents like vaping sensors and repercussions were not improving student behaviours.
We are not helping the students quit this toxic behaviour, we are simply telling them to do it elsewhere.
“If students want to do it, they will find a way,” he said.
Lack of safety standards on contents
The lead author of the ANU review, epidemiologist and public health physician Professor Emily Banks, said she was concerned about the popularity of e-cigarettes among young people.
“Young people are being sold a lie that e-cigarettes are just harmless water vapour,” she told the ABC. “They are not harmless water vapour. They contain a lot of chemicals, and there’s evidence that they’re harmful to health.”
The ANU review found some of the health risks included poisoning, seizures, burns and injuries, lung injuries, and addiction.
Ms Bajurny said there are risks with both nicotine and non-nicotine vapes because the contents are not regulated.
“We don’t often know what’s in the e-liquids, in what ratios, even some of the devices can be dangerous. There have been incidents of devices exploding in people’s faces.”
The Australian Council on Smoking and Health said there are currently no safety standards for e-cigarette devices or liquids in Australia, and the unregulated products may still contain nicotine despite being labelled otherwise.
The Therapeutic Goods Association and Better Health Victoria also alluded to the lack of safety standards, warning that e-cigarettes were “unapproved products” and “may not be labelled thoroughly or accurately”.
Melbourne GP Dr Suska Schoeman said that Australians should expect to see a large rise in health effects for young people as a direct result of vaping addiction.
“Palm oil traces can be found in e-cigarettes and with too much inhalation vape users will develop bronchiectasis which is similar to pneumonia; the body will go into respiratory failure,” she said.
“This is reliant on individual susceptibility and genetics, but young people must know their limits.”
*Not her real name
Reporters: Amos Adams Jones, Claudia Harvey, Edmund Fong, Hamish McMillan, Joshua Grobbelaar, Tran Thanh Vy Nguyen, Sasha Formston, Tarryn Vogels, Trinh Tu Ho, Zoe Malliaris. Edited by Nicole Henman.