Vape appeal

Vape appeal

Bubble gum and blueberry ice – how Big Tobacco is using lax laws to target a new generation (and what medical professionals can do about it).

It’s a Saturday night on a sunny December evening and throngs of young people are gathered in Manly Beach, Sydney. In between drinking cocktails on an outdoor deck and eating plates of food, diners take out slim looking devices that look like highlighters and smell like fruit. In less than five seconds, the vape is back in their pockets and no one – certainly not the busy servers – bat an eye.

Like other tobacco products, the use of e-cigarettes is prohibited in smoke-free areas, such as commercial outdoor dining areas. However, unlike cigarettes – which emit a pungent and distasteful smell – no one seems to notice or even mind that diners around them are inhaling nicotine from these devices.

The difference in reaction quite possibly speaks to the public perception of vaping. 

“There is a view among young people that because it’s vapour, that it’s just water,” said Carolyn Murray, Director of Public Health at NSW Health. “What we know is that the majority of vapes that we see have nicotine in them and also contain chemicals which are harmful and can have large, long impacts.”

While there has been a decline in cigarette smoking rates among young people 16 to 24 years, there has been significant and dramatic increase in e-cigarette use among young people in this age demographic. 

In 2019/2020, 1 in 5 in this age group reporting using e-cigarettes, by the following year this had risen to 1 on 3. 

Why are e-cigarettes so popular?

E-cigarettes are battery operated devices that heat a liquid to produce a vapour when inhaled. 

The design of these devices has changed dramatically to appeal to new users. In 2019, new generation compact disposable e-cigarettes entered the market in NSW.

These devices contain anywhere from 300 to 10,000 ‘puffs’ and high concentrations of nicotine.

These disposable devices are easy to use and come in a variety of colours and flavours. They are small enough to conceal in a pocket and could be easily confused with a highlighter or a USB stick. Flavours include watermelon ice, blue raspberry, energy drink, passionfruit mango, cola lemon soda, to name a few. One online shop advertises the ‘Dinner Lady Disposable Vape’ – which is a very sleek vape pen that is “ideal for new and experienced vapers alike.”

A Generation Vape study, which looked at vaping product access and use among 14- to 17-year-olds in NSW found teenagers are readily accessing and using illegal, flavoured, disposable vaping products that contain nicotine. 

Among the 700 teens surveyed, 32% had ever vaped, at least a few puffs. Of these, more than half (54%) had never previously smoked.

Of the teens who had ever vaped and reported the type of device they used, 86% had used a disposable vape. Disposable vapes don’t require re-filling (unlike tank-style devices) and are activated by inhaling on the mouthpiece.

In addition to being easy to use, they are easy to access. 

Disposable vapes containing nicotine can only be legally sold in Australia by pharmacies to adult users with a valid prescription. And it’s illegal to sell vapes containing nicotine as well as those purporting to be ‘nicotine free’ to under 18s in Australia.

Despite this, teens are finding ways to get their hands on them. The Generation Vape study found almost two-thirds (70%) didn’t directly buy the last vape they used. The vast majority (80%) are obtaining these from friends. Of the 30% who did buy their own vape, almost half (49%) bought it from a friend or another individual and 31% bought it from a retailer – commonly a petrol station, convenience store or a tobacco shop. Teenagers are also sourcing vapes from online sites and social media platforms such as Snapchat, where people advertise ‘Vape drops.’

They are sold at retail shops for $20 to $30 and can be sourced online for $5. 

In the Generation Vape study, more than half (53%) of the teens who had ever vaped said they had used a vape containing nicotine, while 27% were unsure whether they had used a vape containing nicotine.

Even vapes claiming to be nicotine-free have been found to contain nicotine. The TGA tested nicotine vaping products and found of the 214 products recently tested, 190 contained nicotine.

Disposable vapes can have high concentrations of nicotine. Unlike cigarettes which contain free base nicotine, manufacturers use nicotine salts which allows for higher concentrations of nicotine without causing throat irritation to the user. 

How harmful are they?

The Australian National University published a key evidence report Electronic cigarettes and health outcomes: systemic review of global evidence (Banks et al. 2022), which found that the use of e-cigarettes can be harmful to health, particularly non-smokers and young people, and when used for purposes other than smoking cessation. While the impact of e-cigarettes on cancer, cardiovascular disease and mental illness are yet to be established, it is known that there are hundreds of chemicals in e-cigarettes including formaldehyde, heavy metals, solvents, and volatile organic compounds, in addition to nicotine which is highly addictive and can change the structure and function of developing brains in young people.

Vapes are now manufactured to deliver nicotine deep into the user’s lungs, which allows the nicotine to quickly get into the bloodstream and go straight to the brain – much faster than a cigarette, where it interacts with nicotinic acetylcholine receptors.

Other harmful impacts include seizures, nicotine poisoning and E-Cigarette Associated Lung Injury.

One teaspoon of liquid nicotine can cause irreversible damage or death to a child. NSW Poisons helpline reported that in 2021, more than 170 children in NSW were exposed to nicotine after puffing on a vape – including a four-week-old baby. Three out of four calls to the helpline concerned children aged between one and four. This was triple the number of calls made about children under the age of 15 in the previous year. Children often pick up the vapes, which are brightly coloured and attractive, and mimic the actions of their parents.

E-cigarettes are also a gateway to smoking tobacco. Non-smokers who vape are three times as likely to take up regular smoking as non-smokers who don’t vape. 

Not only are e-cigarettes harmful to humans, but they are also harmful to the environment – designed with single use plastics and lithium batteries, they contribute to pollution.

The evidence that e-cigarettes are effective smoking cessation tools is limited. 

E-cigarettes are a tobacco issue – studies reveal that those who use e-cigarettes are three times more likely to go on to tobacco smoking.

Advocacy

What can doctors do? NSW Health’s Ms Murray recommends health professionals familiarise themselves with the resources on the NSW Health website.

“The materials are designed for use by teachers, parents and young people and they provide a lot of current information for medical professionals to use in their discussions with young people.”

She also suggests that general practitioners broach the subject of vaping with patients who are
under 18. 

“It might be around what they are seeing at school, checking in whether they are being offered vapes, helping them find the language to say no to vaping and just being clear around what the evidence is showing us – because that is what young people ask us for.”

The AMA’s Federal Council passed the following resolution in December 2022:

The AMA demands enhanced regulatory measures to curb the proliferation of recreational non-nicotine vaping products, which include, but are not limited to:

• Implementing similar regulation to tobacco products, such as health warnings, better labelling, plain packaging, and tobacco licences.

• A targeted Federal response to monitor and act on illegal advertising and promotion of vaping products, particularly online and on social media.

• Better enforcement of existing State and Territory regulation to help block illegal vape sales both online and through shopfronts.

The AMA had also previously called for the following measures:

• reducing the concentration limit from 100mg/ml to 20mg/ml, and introducing limits on the flavours and volume of nicotine that can be prescribed or ordered, 

• banning the importation of nicotine vaping products through the Personal Importation Scheme, 

• adding Nicotine Vaping Products to Real Time Prescription Monitoring programs, 

• restricting the use of Medicare smoking cessation items to a patient’s usual doctor, consistent with previous advice provided by the AMA.