Smoking has continued its 20-year downward trend, yet nicotine consumption is higher than it’s been for years.
Aggressive industry marketing and lack of regulation has made New Zealand one of the world leaders in youth vaping rates. You’d be lucky to walk down any street without inhaling the sickly-sweet vapor expelled from someone else’s lungs. One vape can contain the same amount of nicotine as 20 cigarettes, depending on nicotine levels and vape size, resulting in children as young as 10 becoming addicted to nicotine.
Vaping can be a helpful tool for people wanting to quit smoking. But it's also created a whole new market, targeting youth. As a society, we know alarmingly little about vaping and its implications for our tamariki’s health and wellbeing.
In our latest episode of Consume This, we investigated New Zealand’s youth vaping epidemic. You can listen to the full podcast episode below.
Ollie (not his real name), 17, from the Coromandel, says he first started vaping when he was 10 years old and quickly became his school's vape dealer.
His introduction to vaping occurred at his local skate park when he noticed some older kids with vapes. The social pressure of wanting to fit in made the idea of vaping appealing. Once he gave it a go, he was hooked.
“As you start, you get this feeling of happiness, sort of like a buzz. And you think, oh, I can stop when I want. But no, you can't because your initial times of vaping, you'll feel like you're on top of the world. You'll feel so relaxed out. It hooks you and there's no doubt about it.”
“...then I started to rely on it a bit. And when I say rely on, I mean, I couldn't really go an hour without”.
The problem with vaping is that nicotine levels can be very high, depending on the type of vape being used. So what starts as casual experimentation for non-smokers can lead to dependance quickly. Nicotine can disrupt the formation of brain circuits that control attention, learning, susceptibility to addiction, mood and impulse control.
A 2022 survey conducted by Te Whatu Ora (Health New Zealand) and Hā Collective - a core group of young people, schools and experts - revealed that 78% of daily vapers vaped because it helped them to feel relaxed. Daily vapers also reported experiencing stress more frequently than non-vapers who took part in the survey.
Additionally, daily vapers are less likely to speak to their parent(s) or another adult about the stress they experience (29% of daily vapers saying they might talk to their parents compared to 56% of non-vapers).
The 2022 ASH Year 10 Snapshot Survey showed that out of the 42.7% of Year 10 students who have ever tried vaping, 39.8% said they vaped “just to give it a try”.
Sheena Millar, the principal of Onslow College in Johnsonville, says they were seeing a massive reduction in smokers in schools, only for it to suddenly be replaced and then overtaken by the number of vapers instead.
"About 40% of students are regularly vaping ... but it'd be even higher if you're talking socially.” said Millar.
Ollie says, “I never knew someone at my school that smoked, but vaping ... if you saw the most innocent, naive 13-year-old girl, the quiet girl, the smart, the A+ student girl, she was vaping.”
The most concerning thing to Millar is that these young vapers will argue quite stridently that there's no negative health implications. But that’s not what Millar and other teachers have observed. They’ve seen irritability and aggravated behaviors as side effects of nicotine withdrawals in their students.
“You'll say to them, what was that about? That's not how you usually interact with other people. And when you unpack it, some of them will say, well, I just couldn't organise to have my vape”.
Millar says these students are sitting in class thinking about how to get out of class to go and get their next puff. “There are kids who excuse themselves in class to go to the bathroom to have a vape ... It's very high impact for those kids.”
They then must try and reengage with the lesson, all while thinking about how they’re going to get their next hit in the next class. “So it becomes this self-fulfilling disengagement kind of prophecy.”
When Ollie speaks about withdrawals from vaping, it becomes very clear that there’s a problem here. “If I went a day without it, I would cry. I would break down. And it's horrible. Your brain isn't sitting right. You are almost shaking and you are mentally ruined until you have that sort of relief and feeling of relaxation, of calming down.”
Eventually Ollie was caught supplying vapes in his school. He was also being disruptive in class, a symptom of his nicotine withdrawals. Eventually, this played a large part in him being expelled from school.
“Some schools threaten kids with expulsion if they are caught vaping” Millar says.
She sees this approach as doing more harm than good.
“ ... We do things that we know aren't going to solve the problem; just move the problem. And I feel like we've got a little bit of a tsunami coming if kids continue the way they are.”
Vibe is a health and social support service for young people aged between 10 and 24 years in the Hutt Valley. They have over 5000 young people registered with their service.
Beau Woodson, who at time of our interview was AOD CEP clinician at Vibe, goes through an alcohol and drug checklist with his 13- and 14-year-old patients. He says when he gets to the question around tobacco “ … without fail, they're almost offended that I asked them if they've ever smoked”.
But then when he asks if they vape, they say yes.
“They don't make that connection that it's the same kind of thing. They would never touch a cigarette, yet they're jumping straight into a pack a day minimum worth of nicotine habit on day one of vaping.”
A concerning trend Woodson is beginning to see is people using cigarettes to break the vaping cycle. An 18-year-old told him that he couldn’t control his vaping, and even though he hated the way cigarettes tasted, he’d started smoking to see if they’d help him quit vaping.
Woodson has seen parents buy vapes for their children, and when he asks how much nicotine is in the vapes, they have no idea.
“There's no connection realising how much actual nicotine sits within those vapes”.
Unlike other countries, in Aotearoa we’ve had a largely unregulated vaping industry.
Public Health Analyst, Candace Bagnall points out the World Health Organisation (WHO) doesn't define e-cigarettes as a tobacco product.
“WHO’s decision basically said to countries: you can define it as a tobacco product or not. It's your call.” says Bagnall.
To understand the current vaping epidemic, we need to go back to 2017, when it was assumed that vapes were tobacco products and therefore legislated for in our Smokefree Environments (1990) legislation. Tobacco company Philip Morris International (PMI) faced charges laid by the Ministry of Health (MoH) over a new battery powered tobacco product they were selling called Heets.
It was essentially a type of e-cigarette that worked by heating tobacco instead of burning it. As far as the MoH was concerned, Heets were illegal. Philip Morris, however, disagreed. Philip Morris won the court case. The result meant there were no proper regulations for these products and the Ministry realised that new legislation was needed to protect minors and ensure consumer safety. This was the catalyst for a nationwide vaping free-for-all, and in the two years it took to put the legislation in place, the tobacco and vaping industry marketed aggressively to young consumers.
*No data collected in 2020 due to COVID-19 disruptions.
“They did the usual stuff that they used to do with tobacco. Taking products to music festivals that youth went to, that sort of thing.” said Bagnall.
Retailers gave away products for people to try, youth influencers were paid to market it on social media as being ‘fun’ and ‘harmless’. Add that to the bright, shiny packaging and flavours like ‘Peach gummy candy’ and it’s easy to see why so many people found it appealing.
“They could say pretty much what they liked. They had arrangements with youth radio stations whereby the products were given away free if people guessed songs correctly and all of that kind of stuff.” Bagnall said.
In November 2020, a range of regulations came into effect, instantly cutting off the industry's ability to openly advertise, sell products to minors, and distribute free samples. But by then, vaping had already spread rapidly amongst our youth. It was the cool thing to do.
Smoking kills two-thirds of long-term users, making tobacco one of the most harmful consumer products that has ever been invented. There's a broad agreement that yes, vaping is less bad than smoking, but that's about as far as the consensus goes on this issue.
Bagnall says, “Vaping, well, we just don't know. We know it's less harmful, but how less harmful? You're still taking stuff into your lungs, vapor with a whole lot of chemicals, but we just don't know.
“It worries me that people are hearing messages of harmlessness or safety rather than relative harm, which is a very difficult concept to communicate to the general public.”
Dr Jude Ball, Senior Research Fellow at the Department of Public Health, University of Otago, says while vaping carries lower health risks than smoking, it is not harmless.
“Recent reports have highlighted the risk of acute lung injury in vapers, as well as chronic risks to cardiovascular, respiratory and oral health.
“Since e-cigarettes have only been widely available for about ten years and respiratory illnesses caused by exposure to toxic substances may only show up decades later, the impacts of long-term use are still unknown.”
“Our findings show that vaping of nicotine has emerged as a new public health risk to adolescents, the vast majority of whom would otherwise be nicotine-free and smoke-free. Thousands are now being exposed to vaping harms and potential nicotine addiction.”
Aotearoa has a higher youth vaping rate than any comparable country. In Australia you need a prescription to purchase a vape containing nicotine. This is implemented with the idea that vapes be used for their intended purpose – to help smokers quit cigarettes. Many New Zealand health experts are in favour of implementing something like this here.
Ironically, in Australia, some youth are accessing vapes without a prescription simply by ordering them online from stores based in New Zealand.
Since regulations came in to limit advertising and selling to minors, various mystery shopping investigations have uncovered physical stores that continue to sell to minors. Then there's online ...
Before the regulations came in, Ollie bought his first vape online. “There was no ID, no questions about it.”
You can even buy disguised vapes, specifically designed to look like objects that wouldn’t be out of place in a school bag or a teenager's bedroom.
“You can buy a hairbrush vape. It looks like a literal hairbrush that you get from the warehouse, but you can unscrew it and there's a disposable vape in there.”
It has been illegal for under 18’s to buy vapes since the regulations came into force in November 2020, but that doesn’t stop online retailers selling their product to them. Buying vapes online is still very easy to do: simply tick a box to say you are over 18 and you can purchase a vape from most online stores.
And that’s because this is something that’s hard to monitor. From what we've been told, delivery drivers don't always check the recipient’s ID. Ultimately it is the seller’s obligation to take reasonable precautions and exercise due diligence to check that they are not selling a regulated product to a person under 18, for example by checking ID and having an R18 declaration on entry to the website as suggested on the Vaping Regulatory Authority’s website. In practice, there is minimal oversight and enforcement of R18 restrictions to monitor this.
The Minister of Health Dr Ayesha Verrall noted that “youth vaping rates are too high and we need to strike a better balance”.
The MoH released a public consultation document at the start of the year outlining proposals to strengthen vaping product regulation. It proposed setting lower maximum nicotine levels in disposable vapes. Disposables are the most popular vapes amongst youth, for their simplicity and low price point.
The current nicotine concentration limit in New Zealand is 20mg/mL for freebase nicotine and 50mg/mL for nicotine salt products. The level of freebase nicotine in the UK and the EU aligns with New Zealand’s - 20mg/mL - however, the UK legislation recommends the same level for nicotine salt products. This makes the New Zealand requirements for nicotine salt levels more than twice as high as the limit in the UK and EU.
These two separate limits reflect that some vaping substances use nicotine derived by tobacco by itself, as a freebase, while others mix the nicotine with an acid, such as benzoic acid, creating a salt.
The new proposals suggest a lower limit of 35 mg/mL. That’s still 75% higher than the EU rule. The MoH proposal also includes limiting the marketing of flavours and setting proximity restrictions so vape stores can’t be right next to schools.
Dr Jude Ball states that regulators need to strike the right balance so that e-cigarettes are easily available to smokers wanting to switch, but youth uptake is minimised. Measures that would likely reduce youth vaping without greatly impacting smokers wanting to switch, include:
On March 15 2023 the period for experts to submit feedback on the proposal closed. The Minister of Health will take these into consideration before moving forward with the proposal.
This article was made possible with generous support from the Ministry of Health.
If you want help to stop vaping support is available via Quitline on 0800 788 788 or via text on 4006.
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