Youth vaping – worrying epidemic or divisive distraction from smokefree goals? | #parents | #teensvaping

It’s turned allies against each other, with accusations of misleading and alarmist data. It’s seen doctors who’ve spent 40 years battling smoking suddenly arguing alongside Big Tobacco. Now new research suggests wealthy, white teens who’ve never smoked are increasingly hitting the juice. Nikki Macdonald investigates whether vaping is stopping kids smoking, or just getting them hooked another way.

“I was a teen nicotine addict,” Charlie declares.

He was 11 when he first started vaping. Scootering at the skate park, he saw the older kids sucking on their nifty gadgets, blowing clouds of sweet vapour.

“The main appeal to me was that it smells good, it tastes good,” says Charlie, now 14.

Is vaping stopping teens smoking, or just getting them hooked another way?
Is vaping stopping teens smoking, or just getting them hooked another way?

“You think it’s pretty harmless. Like, I would never dare smoking a cigarette. It’s the way that people sell, or tell you about it. They’re so enthused about it: ‘And it’s good for you and it’s completely harmless and so on’. So that’s the thing that hooked me in.”

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The skate-park kids told him how to buy the devices and their sweet hit online. First he used his mum’s credit card. Then he’d buy prezzie cards.

He’d track the courier and pull a sickie from school once it neared his house. They only once asked for ID. He said it was for his mum. They handed over the package.

“They’re so easy to get your hands on.”

Cotton candy, blue raspberry, peach coconut ice tea – any flavour you can think of, Charlie says he’s tried it. He tried out more than 30 different vaping devices in the two years he was addicted. The nicotine made him feel good.

“It was something to do, like it’s another skateboard, scootering, biking activity. It’s something you like to do and that you’re passionate about.”

Vape juice comes in an array of flavours, with evocative names and imagery.
ROSA WOODS/STUFF

Vape juice comes in an array of flavours, with evocative names and imagery.

And when the 24mg/mL nicotine juice stopped giving him a buzz, he stepped up to 60mg. He couldn’t vape around his mum, so he took it to school “so I could get a fix”.

“If I didn’t hit it every 30 minutes, I would get out of control,” Charlie says. “Like start breaking up and crying. I s… you not. That’s what I did and I was so embarrassed by it.

“I lose my appetite. I won’t eat. I won’t do anything.”

Back at home, his mother Linda wondered what had happened to her gentle son. He wasn’t sleeping, showering or doing his schoolwork.

“He was just a little s… and just didn’t care about anything. It really affected our whole family. I didn’t know what was wrong with him, why he was acting so revolting. He’d never been defiant or horrible before.

“I took him to counsellors and then he finally admitted he’d been vaping every single day at school. That horrified me.”

He didn’t understand that the vapes contained nicotine, Linda says. To kick the habit, they progressively dialled back the vape’s nicotine content. He hasn’t vaped now for several months.

“I’m a single mum. It’s been really horrible seeing my baby just going through this terrible cycle in his life that could have been avoided.”

Asked whether he would ever have taken up smoking, Charlie is unequivocal.

“Never, never, never. Because my mum was a pack-and-a-half-a-day smoker and that was an absolutely horrible experience for me and my sister. I know what it does – my mum couldn’t even walk to her car … That’s hard for us kids to watch.”

Associate Health Minister Jenny Salesa announced in 2018 that the government would regulate the vaping industry. The law will finally come into force in November.

Associate Health Minister Jenny Salesa announced in 2018 that the government would regulate the vaping industry. The law will finally come into force in November.

Lies, damn lies and statistics

Kids like Charlie have fuelled fears about the rise in youth vaping. Everyone agrees teens who’ve never smoked a durry should not be inhaling nicotine. But that’s about where the consensus ends.

The new Vaping Amendment Act, which comes into force in November, aims to make e-cigarettes less appealing and available to teens, by banning advertising, toughening up the R18 sales limit and restricting flavours sold outside specialist vape shops – such as at dairies and supermarkets – to tobacco, menthol and mint.

But submissions reveal the chasm between health experts. Some call for tighter restrictions to prevent a new generation of addiction; others argue alongside tobacco companies, that the cure is more harmful than the disease.

Otago University health researcher Jude Ball's research shows many vaping teens have never smoked.

Supplied

Otago University health researcher Jude Ball’s research shows many vaping teens have never smoked.

Otago University public health researcher Jude Ball falls into the cautious camp.

Her analysis of the Youth19 survey of 7700 13-18-year-olds in Auckland, Northland and Waikato found vaping bucks both the trend of youth smoking – which is concentrated in Māori and Pacific and poorer communities – and of young people doing less drink, drugs and sex.

Almost half of regular vapers – defined as vaping monthly or more – had never smoked. Of those who vaped at least weekly, almost one-third (32 per cent) had never tried a cigarette.

The Youth19 data showed that teens who had tried smoking were more likely to vape at least monthly. But because most young people (85 per cent) have never smoked, non-smokers still make up half of regular vapers.

Supplied

The Youth19 data showed that teens who had tried smoking were more likely to vape at least monthly. But because most young people (85 per cent) have never smoked, non-smokers still make up half of regular vapers.

At poorer schools, vaping and smoking rates were similar, with about one in 14 children doing each more than monthly. But in wealthier schools, vaping far outstripped smoking, with only one in 45 teens smoking regularly, but one in 10 vaping more than monthly.

“What’s really clear in the Youth19 findings is that the demographic patterns for vaping are quite different from smoking,” Ball says.

“Vaping is clearly appealing to a wider cross-section of young people, particularly when you look at the high decile schools. Smoking is very rare in those schools now, yet vaping is quite common. So in this group it’s clearly not a matter of vaping displacing smoking. It’s clearly a new and different trend.”

That would explain why principals of wealthier schools have been speaking out about youth vaping. Auckland Grammar headmaster Tim O’Connor last year called it an epidemic among his pupils.

Micheal​ Brown, counsellor at St Peter’s private school in Cambridge, said he was dealing with 70 addicted kids.

In July, decile 10 Wellington College held an information evening, warning parents that junior students know how vapes work and where they can buy them. They think “less harmful” means “totally OK for you” and that vapes are just flavoured water vapour.

Presentation slides say numbers of students taking up vaping, having never previously smoked, are “rapidly increasing”, and regular vapers more than quadrupled at the school, from 2.4 per cent in 2018 to 10.6 per cent in 2019. That’s still below the national average of 12 per cent.

Wellington College principal Gregor Fountain refused to discuss the issue. Neither O’Connor nor Brown returned Stuff’s call.

A presentation to Wellington College parents said regular vapers quadrupled at the school in 2019.

ROSA WOODS/STUFF/Stuff

A presentation to Wellington College parents said regular vapers quadrupled at the school in 2019.

The mushrooming numbers of young people vaping come as no surprise to Otago University public health professor Janet Hoek​. The void between Associate Health Minister Jenny Salesa’s promise to regulate the industry in 2018, and the new law, was filled with “outrageous” marketing targeting young people, Hoek says.

“It’s used lifestyle themes. It’s positioned the devices as fashion accessories rather than cessation tools. So I think the companies that have been promoting vaping have not been focusing on people who want to quit smoking. They’ve been focusing on recruiting an entirely new, young cohort of nicotine-dependent users.”

The vape shop next to Linda’s work is lit up “like a toy arcade”, with music pumping. “It’s to attract kids,” she says.

Vapes are promoted as fashion accessories

Stuff

Vapes are promoted as fashion accessories

Flavours have youth-friendly names such as just juice, mango smoothie and boosted chocolate shake. The $30 Smok Novo device, which Charlie says is most popular with his friends, comes with different coloured cobra plated panels “for a striking masterpiece”.

And – as Charlie discovered – the R18 restrictions proclaimed by online vape shops are weak at best. Most simply require you to tick a box saying you’re 18 to enter the site. NZVapor requires a date of birth – Stuff entered a date in 2023 and could still progress to payment.

The new law bans all vape advertising and sponsorship, to the delight of Hoek and Ball. But not all health experts agree.

In its submission, Action for Smokefree 2025 (ASH) accused the Youth19 researchers of being “alarmist” and “misleading” for suggesting many high school vapers are non-smokers.

Action for Smokefree 2025 chairman professor Robert Beaglehole says the risks of youth vaping are exaggerated and new restrictions will hurt smokers by making switching to vaping more difficult.

ROSA WOODS/STUFF

Action for Smokefree 2025 chairman professor Robert Beaglehole says the risks of youth vaping are exaggerated and new restrictions will hurt smokers by making switching to vaping more difficult.

ASH chairman, public health epidemiologist professor Robert Beaglehole, has spent four decades campaigning against Big Tobacco. Now he’s fighting alongside them, advocating for fewer restrictions on vaping. Preventing general retailers such as dairies selling any flavours other than tobacco, menthol and mint is a mistake, he says.

What makes vaping regulation complicated is that it’s part of a bigger picture, in which New Zealand is failing in its goal to slash adult smoking to five per cent by 2025. (About 14 per cent smoke now.) Vaping is the great strawberry-scented hope – a satisfying substitute for cancer-causing tar and smoke.

Beaglehole believes the new law is overly restrictive, exaggerating vaping’s risk to young people and putting that ahead of the much more immediate risk from smoking, which kills 4000 Kiwis every year.

He argues the Youth19 survey just shows young people experimenting as young people do. What matters is daily vaping, as that suggests dependence, and that’s not covered in the Youth19 data.

For 20 years, ASH has surveyed about 27,000 14- and 15-year-olds nationwide about their smoking habits. Vaping was added in 2015. The survey’s daily vaping figures, reported in the Lancet in January, showed a different pattern.

Smokers were massively more likely than non-smokers to vape regularly and daily vaping rates were highest among young Māori and poorer schools – the same communities that still have higher smoking rates.

The authors concluded there was no youth vaping epidemic in New Zealand.

But while daily vaping rates were static between 2017 and 2019 at low-decile schools, they tripled at schools in deciles 8-10.

And the percentage of non-smokers who now vape daily doubled in the past year, though it remains very low at less than 1 in 100 teens. The number of students who had never smoked but now vape weekly increased from 138 in 2018 (0.6 per cent) to 327 in 2019 (1.5 per cent).

Vaping is touted as a way for adult smokers to switch to a less harmful nicotine hit.

123rf

Vaping is touted as a way for adult smokers to switch to a less harmful nicotine hit.

Ball doesn’t buy the “nothing to see here” argument.

“Talking about an epidemic of nicotine addiction is probably overstating it. But to say everything is all fine in the youth smoking and vaping space, is also overstating it. We’re somewhere in the middle.”

It’s not just different research groups who disagree. ASH’s former board member, health researcher Allan Wyllie​, wrote that he resigned because “the policy direction being advocated for on behalf of ASH could not be justified and a more cautious approach was required”.

“People have gone to polar extremes almost about this,” notes Otago University associate professor of paediatrics Philip Pattemore. “I feel very sad about this myself, because we did have a united smokefree lobby.”

In Taranaki, an old ambulance has been turned into a “vape rescue vehicle", which displays the often-repeated claim that vaping is 95 per cent safer than smoking. (File photo)

Andy Jackson/Stuff

In Taranaki, an old ambulance has been turned into a “vape rescue vehicle”, which displays the often-repeated claim that vaping is 95 per cent safer than smoking. (File photo)

Is it harmful?

In Taranaki, a “vape rescue vehicle” delivers Naki Nekta in shades of anzac biscuit, peanut butter cup and trippinon mango. Above the picture of the busty nurse offering an emergency vape is a bold statement: “Vaping is 95 per cent safer than smoking”.

The often-repeated claim comes from a Public Health England estimate in 2015. Middlemore Hospital respiratory doctor Stuart Jones says it’s “completely incorrect”.

“Vaping is not a safe consumer product. The only reason it’s got traction with the Ministry of Health is because it’s been brought into the country on the back of ‘This will be useful to help people stop smoking’.”

Middlemore Hospital respiratory specialist Stuart Jones fears vaping will cause a new wave of airway damage in a previously smokefree generation.

Supplied

Middlemore Hospital respiratory specialist Stuart Jones fears vaping will cause a new wave of airway damage in a previously smokefree generation.

Pattemore says the number is meaningless, without any information about dose and frequency of use.

“It’s like saying cars are 95 per cent safer than bicycles – for whom, at what speed, what exposure?”

Pattemore points out that, while many flavour chemicals have been cleared for use in foods, that doesn’t mean they’re safe to inhale.

“A peanut in your lung is different from a peanut in your stomach.”

Paediatrician Philip Pattemore laments the fact youth vaping has split the formerly united smokefree lobby.

Kirk Hargreaves/Stuff

Paediatrician Philip Pattemore laments the fact youth vaping has split the formerly united smokefree lobby.

What is beyond dispute is that vaping is safer than smoking. Jones says vape juices have fewer known carcinogenic chemicals than smoke, so should cause fewer cancers.

When his long-term smoking patients with chronic lung problems switch to vaping, their symptoms generally improve. But he advises them to try to quit vaping as well, because inhaling the heated chemicals can inflame the airways, causing coughing and shortness of breath, and – in the long-term – scarring and obstruction.

Jones also worries about the 50 per cent of vapers who carry on smoking. Because vaping damages airways in a different way to smoking, and research found smoking just one cigarette a day can do almost half the damage of a pack a day, doing both could be a double whammy, he says.

While everyone agrees vaping is less harmful than smoking, experts say it's too early to know its long-term effects.

Kirk Hargreaves/Stuff

While everyone agrees vaping is less harmful than smoking, experts say it’s too early to know its long-term effects.

He fears teens will see vaping as less harmful, leading to airway damage in a generation who would have been smokefree.

Beaglehole, however, says the immediate risk to smokers far outweighs any future risk to new vapers, and while he doesn’t want to see a new generation of nicotine-addicted teens, that’s “at the lower end of the spectrum” of harms.

“It’s not like alcohol, it’s not like dangerous driving, it’s not like unsafe sex. It’s not going to do people a lot of harm.”

Charlie’s mum Linda disagrees: “That’s bulls…”

The gateway argument

The arguments both for and against vaping rest on a gateway theory. Supporters argue it’s a gateway out of smoking. Critics say that – for non-smokers who become addicted to the nicotine – it could be a gateway into smoking, undoing decades of work reducing youth smoking rates.

The hundreds of reformed smokers who submitted on the law show vaping clearly helps some individuals kick the habit. Jewel Peters had been smoking since she was 14 and no longer gets bronchitis or pneumonia since she switched to vaping.

Former smoker Tom Morawetz now walks 3km a day. Switching was the second best thing the 63-year-old has ever done, after marrying his wife.

Asthmatic Aramoana du Feu, who had been smoking since she was 10, says vaping saved her life.

But smoking rates have not suddenly fallen off a cliff, as Ball points out.

“It’s clearly working for some individuals, which is awesome. But we’re not really seeing big population-level effects. Certainly, it’s not proving to be the silver bullet it was thought it would be.”

Beaglehole argues that’s because, in the absence of clear legislation, vaping hasn’t been effectively promoted as a quit tool.

The Lancet study reporting the ASH survey results hypothesised that vaping was displacing smoking in young people. The accompanying ASH press release went as far as to present that as fact. But the data does not seem to support the claim.

Vape juice often comes in sweet flavours with evocative names. (File photo)

Hamish McNeilly/Stuff

Vape juice often comes in sweet flavours with evocative names. (File photo)

While daily smoking among year 10 pupils fell from 2.4% to 2.1% from 2015 to 2019, that was far outweighed by the increase in daily vaping, from 1.1% in 2015 to 3.1% in 2019.

Even among young Māori, who are the biggest smokers, daily smoking continued its slow decline, reducing by just 0.2 percentage points between 2015 and 2019. Vaping, however, increased by 3.7 percentage points.

In 2019 alone, the ASH survey showed daily smoking increased in almost every category of teens – reversing a 20-year decline.

Some vape devices are barely bigger than a memory stick and come with refill pods.

Craig Mitchelldyer/AP

Some vape devices are barely bigger than a memory stick and come with refill pods.

That adds fuel to the alternative theory – that young vapers could graduate to smoking. American research found teens who had vaped were four times more likely to start smoking. What’s not clear is whether those kids would have smoked anyway.

Switching from vaping to smoking seems illogical. Teens ditched ciggies because they stopped being cool. Vaping, on the other hand, has ever-changing technology, slick graphics and evocative names, and doesn’t make you reek.

Ball concedes kids like Charlie are unlikely to move from vaping to smoking. But for a teen who borrows a friend’s vape and gets a taste for nicotine, then goes home to a family or whanau of smokers, that’s not such a leap.

“When you come home and you’ve got that craving feeling, what are you going to do? … You might ask your cousin or aunty for a cigarette.

“So I think the risk of taking up smoking is probably not that great among middle class white folk who do not move in smoking circles. But for young people that do, I think that transition is possible.”

Hāpai Te Hauora tobacco control advocacy manager, Stephanie Erick, worries vaping restrictions could push young Māori back into smoking. (File photo)

Chris Skelton

Hāpai Te Hauora tobacco control advocacy manager, Stephanie Erick, worries vaping restrictions could push young Māori back into smoking. (File photo)

But Stephanie Erick worries tighter restrictions on vaping could push Māori teens the other way. The Hāpai Te Hauora tobacco control advocacy manager says rangatahi growing up in multi-generational smoking families will almost inevitably take up cigarettes.

“They’ve been smoking at intermediate or primary, they’ve come to college and decided ‘Oh, I’ll vape instead’. But then of course their vape is confiscated because schools are freaking out about vapes. And because the schools don’t understand the student or their background, or the susceptibility of these children to cigarettes, they’ve confiscated the vape, so the students have just gone back to cigarettes.

“That’s sad. I know this is going to be hard for a lot of people to hear, but sometimes it could be best to have a young person supported to stop smoking by using vapes.”

A worker tests an e-cigarette on the production line at Kanger Tech, one of China's leading manufacturers of vaping products.

Kevin Frayer/Getty Images

A worker tests an e-cigarette on the production line at Kanger Tech, one of China’s leading manufacturers of vaping products.

One of Erick’s concerns about the new law is that preventing dairies selling the fruit and dessert flavours favoured by ex-smokers “safeguards the monopoly of the most dangerous product”.

“If you were hanging out for a smoke and feeling the nicotine withdrawals, what would you do? You need a smoke, so you go and get one. It’s easier, you just need to pop down to your local store.”

One thing everyone agrees is that cigarette sales should also be more tightly restricted.

“I think there’s been far too much focus on vaping,” Erick says. “It’s distracted everyone and you can see it in the smoking rates. We haven’t seen a significant drop in the last four years and I believe it’s because everyone’s been focused on vaping instead of sticking to our core business.”

British American Tobacco owns the Vuse vape brand.

Nikki Macdonald/Stuff

British American Tobacco owns the Vuse vape brand.

The fingers of Big Tobacco

Vaping in New Zealand started as a homegrown affair, with small manufacturers. Then Big Tobacco moved in. British American Tobacco owns Vuse and Philip Morris makes Veev vapes and heated tobacco products.

In its 2019 annual report, BAT reported “new categories” revenue grew by 37%, with vaping bringing in 226m pounds.

And while the company has a youth access prevention strategy, the report promises long-term growth through “a range of innovative and less harmful products that stimulate the senses of new adult generations”.

ASH said the entry of tobacco companies was accompanied by “irresponsible campaigns and marketing stunts”. Pattemore questioned their harm reduction spin.

“If a tobacco company is interested in harm reduction, why are they still producing, marketing and selling cigarettes? They are producing the harm and they are producing the harm reduction. That does not make sense.

“I find it very disturbing that most of the vaping products in NZ are now produced by cigarette companies. We have learned not to trust them before and I don’t trust them an inch now.”

Beaglehole admits it’s odd to find himself arguing alongside the companies he has fought for 40 years. He’s sympathetic to his colleagues’ distrust, but won’t let it get in the way of helping smokers quit.

“If we could encourage the industry to transition themselves away from the most harmful products, to the less harmful products, would I be concerned? No, I’d say great.”


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