One in six high school students in SA are using e-cigarettes and almost half of them reach for a vape within an hour of waking up, suggesting they are highly addicted to nicotine, the largest survey of its kind to date has found.
More than 25,000 students from 52 schools across SA were included in the research, published in the Lancet medical journal.
The research confirms an explosion in teen vaping exposed in a pilot study in six SA schools released in 2023. More than a third (36%) of the respondents in the latest survey said they had tried vaping at some point.
“Vaping is a major problem — not in every school but in many. We have to help these scholars stop and prevent more starting,” said the study’s principal author Richard van Zyl-Smit, a pulmonologist at UCT and Groote Schuur Hospital.
The latest research adds weight to public health advocates’ call for e-cigarettes to be regulated, as the devices are sold in SA without restriction.
Parliament is considering the draft Tobacco Products and Electronic Delivery Systems Control Bill, which aims to tighten tobacco control and subject e-cigarettes to the same restrictions. The legislation is also before the National Economic Development and Labour Council (Nedlac), which is expected to weigh in on the socioeconomic implications of the bill.
“The tobacco bill is crucial. We have to reduce access (to vapes) — online, malls and cafes. Just think about alcohol — if you could buy at any age from any shop there would be mayhem,” Van Zyl-Smit said.
High school students from schools in all the provinces except North West completed an electronic questionnaire, in which they self-reported on their e-cigarette use.
The results showed vaping increased by grade and varied widely between schools. The mean vaping rate was 8.5% among grade 8s and 29.5% of grade 12s: mean prevalence among grade 8s ranged from 1%-36.8% and among grade 12s from 11%-46.6%.
The vaping rate was not associated with the affluence of the school, but as the sample did not include non-fee schools it largely excluded children from SA’s poorest communities.
High school students reported much lower reported rates for their use of tobacco cigarettes (1.9%), cannabis (4.9%) and hookah pipes (3%).
Further research was needed to understand how to help students quit vaping, said Van Zyl-Smit. “We need to think hard and fast and start helping,” he said.
Just more than half (50.6%) of the students who vaped said they started using these products due to social influences from friends and family, peer pressure, or the need to fit in. When asked why they continued to use these products, a third (33.1%) cited enjoyment, taste and exploration, with 5.1% specifically mentioning flavours.
Just under 2% of vapers reported starting at eight years or younger, while the majority said they started vaping at 14 (25.6%) or 15 (23.2%).
“The study reflects the cost of inaction: 47% of children (who) vape (do so) within an hour of waking up — a clear sign of addiction. This highlights our failure to protect children from nicotine addiction and the urgency of the tobacco control bill,” said National Council Against Smoking deputy director Sharon Nyatsanza.
“For the first time, e-cigarettes will be regulated in SA, closing a critical gap. Key parts of the bill aim to deglamorise vaping to curb its youth appeal. Further delays leave children unprotected and undermine the purpose of the tobacco bill,” she said. The bill has been in the pipeline since 2018, and is before parliament’s portfolio committee on health.
“We call on Nedlac to use the study to guide its processes (as it provides) irrefutable evidence of the public health risks and the urgency of the issue,” she said.
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