Sam Filby and Richard van Zyl Smit

It's become common to see children, some in school uniforms, vaping. The World Health Organization cites enticing flavours and targeted marketing as key reasons for this trend. In the US, e-cigarettes are the most commonly used tobacco product among middle and high school students aged 12 and older, with 5.9% reporting use.

In the UK, surveys indicate that 20.5% of children aged 11–17 have tried vaping, with 7.6% currently vaping. Similar usage rates of 3.3% to 11.8% have been found in South-East Asia, while evidence on vape use among adolescents in Africa is scarce.

A recent study published in The Lancet’s eClinical Medicine found that vaping among South African pupils is alarmingly high. The research surveyed over 25,000 high school students across 52 schools in eight of South Africa’s nine provinces, estimating that 16.8% of the sampled learners currently use e-cigarettes. Research shows conclusively that children should not use these products due to health risks. The findings indicate that high rates of adolescent vaping are not restricted to high-income countries.

Harmful impact on young minds and bodies

In a 2016 report, the US Surgeon General called vaping among young people an “urgent public health problem.” One reason is that these products commonly deliver nicotine, which harms the developing brain and can have long-term effects on learning, memory, and attention. Nicotine is addictive, and addictive behaviour is associated with the development of mental illness, exacerbating mental health problems in some adolescents. Non-nicotine vapes are also harmful; specific flavours like cherry, cinnamon, and vanilla can damage lung lining and blood vessels.

Surveying South African schools

Schools in major centres like Cape Town, Johannesburg, Pretoria, and Durban, focusing on fee-paying schools were approached. Researchers indicated they could not include less-resourced or non-fee-paying schools lacking easy internet access.

The schools were categorised into three brackets:

lower-fee (annual fees between R20,000 and R40,000),
medium-fee (R40,000 to R90,000), and
high-fee (more than R90,000).

In our sample, 17% attended lower-fee schools, 64% mid-fee schools, and 19% high-fee schools. Additionally, 31% attended co-ed schools, 41% all-boys’ schools, and 29% all-girls’ schools.

Students were asked about their use of four products in the 30 days preceding the survey: e-cigarettes, tobacco cigarettes, cannabis, and hookah pipes. Those who vaped answered additional questions about their vaping history and habits, including reasons for starting and continuing to vape. This data allowed us to study e-cigarette use, nicotine dependence, and the mental health and social stressors associated with vaping among a large sample of South African high school learners.

Alarming rates

The study found that 16.8% of high school learners surveyed were currently using e-cigarettes, with much lower rates of tobacco cigarette use (2%), cannabis use (5%), and hookah pipe use (3%). The proportion of learners reporting e-cigarette use increased by grade: around 9% of Year 8 students reported using vapes, rising sharply to an average of 29.5% among Year 12 pupils. Some schools reported usage rates as high as 46% among year 12 pupils. Among those who vaped, 38% vaped daily, and over half reported vaping four or more days per week. Approximately 88% used vapes containing nicotine, with 47% vaping within the first hour of waking, suggesting nicotine addiction. It is estimated that up to 61% of high school learners who vape could be seriously addicted to nicotine.

Reasons for vaping

The primary reasons for starting vaping differed from those for continuing. Just over half (50.6%) cited social influences (family, friends, peer pressure) as reasons for starting. About 20% began vaping to cope with stress and anxiety, while 16.2% did so out of curiosity. Common reasons for continuing included coping with anxiety, depression, or stress (28.4%) and addiction (14.9%). Less than 10% identified social influences as a reason for continued use. Notably, 46% did not list addiction as a reason for continuing, despite habits aligning with those of highly addicted individuals, suggesting a lack of awareness about addiction.

What needs to be done

Our research underscores the urgent need for a coordinated public health response to the vaping crisis among high school learners. The South African government must pass the Tobacco Products and Electronic Delivery Systems Control Bill to prevent vapes from being sold near schools or online. The bill’s advertising restrictions may help deglamorise vaping, reducing curiosity among young people.

The dangerous myth that “vaping is safe” must be debunked. Helping addicted teenagers quit vaping is crucial. Punishing students for vaping is unlikely to be effective. Parents should be more aware of vaping signs and underlying issues. Healthcare professionals should inquire about vape use during routine checkups, and school counsellors should teach coping strategies to help teens navigate challenges.

* Filby is a research Officer, Research Unit on the Economics of Excisable Products, University of Cape Town

*Smit is Associate Professor and Consultant Pulmonologist , University of Cape Town

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