Vaping among young people – our best defence is self-defence

It's hard to recall a time when nicotine came under as much scrutiny as it has in the past few years. You may find yourself being arbitrarily categorised into one of two camps when it comes to views on e-cigarettes (the small battery-powered devices widely known as ‘vapes’): the pro-vapers or anti vapers. The tobacco harm reductionists or the child protectionists. Save the smokers or save the children?

In truth, behind this rather unfair dichotomy lies a common goal that we drug and alcohol clinicians and researchers share: to reduce harms associated with substance use.

So where do we find ourselves on the e-cigarette front in Australia? As we highlight in our commentary “Vaping among young people – our best defence is self-defence” [1], rates of e-cigarette use have risen sharply among young people in only a few years. Around 20-30% of young people (aged 16-24 years) report lifetime use of vapes [2, 3]. Daily use is around 5%. These figures may seem modest when viewed in isolation, but it is the staggering pace of the increase in use that is cause for concern: ever use has increased almost three-fold from 2013 to 2019 [4].

E-cigarettes were originally designed as a combustion-free nicotine delivery system to help smokers quit. The advent of these devices came as a welcome alternative to smokers who found conventional therapies ineffective and expensive. Recent evidence suggests that nicotine e-cigarettes may help people to quit, and are similarly as effective as conventional drugs varenicline and cytisine [5]. Understandably then, the Australian Government have made efforts to tread the fine line between tobacco harm reduction and prohibition by making nicotine e-cigarettes available to smokers as a quitting aid via a prescription-only pathway while “prevent[ing] adolescents and young adults from taking-up nicotine vaping products …” [6].

Unfortunately, this approach has abjectly failed. The prescription pathway is underused and a barely concealed black market for nicotine vapes has emerged. Most e-cigarette users, regardless of age or intent, access e-cigarettes via illicit means, including via convenience stores and petrol stations [3]. More concerningly still, reports of e-cigarette harms among young people have emerged and include acute and chronic respiratory harms [7], increased onset of anxiety and depression [8] disruptions to sleep [9] and academic performance [10].

If supply reduction is unlikely and nicotine vapes remain easily accessible, we must turn to effective demand reduction to reduce harms associated with e-cigarette use in Australia [1]. As we outline in our paper [1], e-cigarette prevention programs aim to support and empower young people by arming them with the skills, resources, confidence and self-efficacy needed to reject substances, to help provide support to friends with problematic substance use and to identify when they need to seek help. Specifically, such programs should:

• be embedded in school curricula (or other existing frameworks if provided in other settings, e.g. sporting clubs);
• form part of a broader drug and alcohol program and not be considered in isolation due to the strong interrelationship between substances;
• Focus on general psychosocial development and pro-social life skills, not on specific substances;
• Impart specific skills, such as problem solving, resistance and assertiveness skills;
• Be codesigned by peers.

The newly released NSW Ministry of Health Guide to Support Young People to Quit E-Cigarettes [11] may also assist clinicians and other practitioners to support young people who are seeking help with their e-cigarette use.  

Emily A. Stockings

The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine, The University of Sydney, Sydney, Australia.

References

1. Stockings EA, Gardner LA, Newton NC. Vaping among young people-Our best defence is self-defence. Drug Alcohol Review. 2024;43:355-8.
2. Gardner LA, O'Dean S, Champion KE, Stockings, Rowe A-L, Teesson M et al. Prevalence, patterns of use, and socio-demographic features of e-cigarette use by Australian adolescents: a survey. Med J Aust. 2023;219:332-4.
3. Watts C, Egger S, Dessaix A, Brooks A, Jenkinson E, Grogan P et al. Vaping product access and use among 14–17-year-olds in New South Wales: a cross-sectional study. Aust N Z J Public Health. 2022;46:814-20.
4. Tobacco in Australia, 18.3 Prevalence of e-cigarette use. 2023.
5. Lindson N, Theodoulou A, Ordóñez-Mena JM, Fanshawe TR, Sutton AJ, Livingstone-Banks J, et al. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses. Cochrane Database Syst Rev. 2023;9:CD015226.
6. The Therapeutic Goods Administration. Nicotine vaping product access. 2022 [cited 11 May 2023]. Available from: https://www.tga.gov.au/products/medicines/prescription-medicines/nicotine-vaping-products-hub/nicotine-vaping-product-access#:~:text=On%2021%20December%202020%2C%20the,nicotine%20pods%20and%20liquid%20nicotine.
7. McConnell R, Barrington-Trimis JL, Wang K, Urman R, Hong H, Unger J et al. Electronic cigarette use and respiratory symptoms in adolescents. Am J Respir Crit Care Med. 2017;195:1043-9.
8. Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med. 2017;96:73-8.
9. Merianos AL, Jandarov RA, Choi K, Fiser KA, Mahabee-Gittens EM. Combustible and electronic cigarette use and insufficient sleep among U.S. high school students. Prev Med. 2021;147:106505.
10. Dearfield CT, Chen-Sankey JC, McNeel TS, Bernat DH, Choi K. E-cigarette initiation predicts subsequent academic performance among youth: Results from the PATH Study. Prev Med. 2021;153:106781.
11. NSW Ministry of Health, Guide to Support Young People to Quit E-Cigarettes, Centre for Population Health, Editor. 2023: St Leonards. p. 27 September 2023.