Vaping and young people
The increasing popularity of inhaling e-cigarettes, known as vaping, has led to questions and concerns around the health impacts – especially for young people.
Both nicotine-based products and nicotine-free products can be vaped, and while the extent of the harm is not yet clear, evidence suggests that vaping is not risk-free.
This mini-bulletin has been developed to help parents, and those working with young people, understand the issues and potential risks of e-cigarette use – so they can have a constructive conversation with a young person that they may be concerned about.
- what is vaping?
- what are the established harms?
- vaping in Australia
- vaping amongst young people
- having a conversation with young people.
What is vaping?
Vaping refers to the use of an electronic device (e-cigarette) to heat liquids and produce a vapour, which is then inhaled – mimicking the act of smoking.
The following substances can be vaped:
- nicotine (which is the main psychoactive drug in tobacco)
- nicotine-free ‘e-liquids’ made from a mixture of solvents, sweeteners, other chemicals and flavourings
- other drugs, e.g. THC (cannabis) e-liquids.1
Vaping devices come in a variety of shapes, sizes, and styles.
The first generation of devices released in 2003 resembled cigarettes and were mostly disposable; second-generation devices looked like pens, were rechargeable, and used cartridges or tanks for the liquid; the third generation (‘mods’) are larger devices with bigger batteries and refillable tanks; and the current generation of devices (‘pods’) are significantly smaller, often resembling USB sticks.
Research suggests that contemporary vaping devices may be more harmful to health than earlier-generation devices. They can be modified to deliver a higher, more harmful concentration of nicotine, and have larger batteries that can heat e-liquids to higher temperatures, producing more toxic chemical particles in the inhaled vape cloud.2, 3
Some people use e-cigarettes to reduce or quit smoking. However, there is not enough evidence to support their use for this purpose. In fact, the Therapeutic Goods Administration (TGA) has not approved any e-cigarettes to help people quit smoking.4
What are the established harms?
Is vaping nicotine safer than smoking combustible tobacco?
Combustible tobacco refers to any tobacco product that is smoked, such as ready-made cigarettes, roll-your own cigarettes, cigars or cigarillos.
It is the nicotine in these products that causes the mild stimulation feelings smokers get.
Tobacco creates the taste, and is responsible for the majority of harmful chemicals and carcinogens (can cause cancer).5
Some evidence points to the replacement of tobacco smoking with nicotine-containing e-cigarettes as less harmful due to reduced exposure to the chemicals and carcinogens in tobacco6-8, however, they are not completely harmless.
Nicotine on its own is still a toxic substance and regular vaping of it can lead to dependence.
Nicotine can damage DNA, promote tumours, and is linked to a number of different cancers.9
It is also important to understand that nicotine e-liquids also contain a wide range of other chemicals, additives and flavourings which can be potentially hazardous. The long-term health consequences of these substances are not yet fully understood.10
What about nicotine-free e-liquids?
Although labelled as ‘nicotine-free’, some e-liquids can still contain traces of nicotine.11 Some users may also add their own nicotine to non-nicotine flavoured e-liquids.12
Even without nicotine, these e-liquids contain a mix of unregulated chemicals and additives that are potentially harmful. Some chemicals that have been found include: volatile organic compounds (common in paint and cleaning products), ultrafine particles (which are damaging to lungs), metals such as nickel, tin and lead, 2-chlorophenol (used in disinfectants) and certain carcinogens.11, 13
Two ingredients commonly found in THC (cannabis) e-liquids are vitamin E acetate and diacetyl. Both have been linked to a number of lung injuries in the United States known as ‘popcorn lung’ or EVALI.1
There have been no reports of similar lung injuries in Australia to date, however, as of February 2020, the US had recorded 2807 hospitalisations and 68 deaths.14
|Sale||Advertising and promotion|
|VIC||Devices may be sold without nicotine||No promotion allowed for e-cigarettes. Internal display of vaping items also not allowed, with the exception of certain specialist retailers|
|NSW||Devices may be sold without nicotine||No promotion allowed for e-cigarettes. No advertising inside store or in public|
|QLD||Devices may be sold without nicotine||No promotion allowed for e-cigarettes. No advertising inside store or in public|
|WA||Devices cannot be sold, nicotine-free e-liquids can||No restrictions on promotional material|
|SA||Devices may be sold without nicotine||No promotion allowed for e-cigarettes. No advertising inside store or in public|
|NT||Devices may be sold without nicotine||No restrictions on promotional material|
|ACT||Devices may be sold without nicotine||No promotion allowed for e-cigarettes. No advertising inside store or in public|
|TAS||Devices may be sold without nicotine||No promotion allowed for e-cigarettes. No advertising inside store or in public|
- Cao DJ, Aldy K, Hsu S, McGetrick M, Verbeck G, De Silva I, et al. Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury. Journal of Medical Toxicology. 2020;16(3):295-310.
- Pepper JK, MacMonegle AJ, Nonnemaker JM. Adolescents’ Use of Basic, Intermediate, and Advanced Device Types for Vaping. Nicotine & Tobacco Research. 2019;21(1):55-62.
- Yingst JM, Foulds J, Veldheer S, Hrabovsky S, Trushin N, Eissenberg TT, et al. Nicotine absorption during electronic cigarette use among regular users. PLOS ONE. 2019;14(7):e0220300.
- Therapeutic Goods Administration. About e-cigarettes [updated 17 March 2020; cited 2020 September 8].
- National Cancer Institute. Harms of Cigarette Smoking and Health Benefits of Quitting: U.S. Department of Health and Human Services [updated 19 December 2017; cited 2020 25 August].
- National Academies of Sciences E, Medicine, Health. Public Health Consequences of E-Cigarettes. In: Eaton DL, Kwan LY, Stratton K, editors. Public Health Consequences of E-Cigarettes. Washington (DC): National Academies Press (US); 2018.
- Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, et al. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. American Journal of Preventive Medicine. 2017;52(2):e33-e66.
- St Helen G, Liakoni E, Nardone N, Addo N, Jacob P, 3rd, Benowitz NL. Comparison of Systemic Exposure to Toxic and/or Carcinogenic Volatile Organic Compounds (VOC) during Vaping, Smoking, and Abstention. Cancer Prev Res (Phila). 2020;13(2):153-62.
- Grando SA. Connections of nicotine to cancer. Nature Reviews Cancer. 2014;14(6):419-29.
- Pisinger C, Døssing M. A systematic review of health effects of electronic cigarettes. Preventive Medicine. 2014;69:248-60.
- Chivers E, Janka M, Franklin P, Mullins B, Larcombe A. Nicotine and other potentially harmful compounds in “nicotine-free” e-cigarette liquids in Australia. Med J Aust. 2019;210:127-8.
- Cox S, Leigh NJ, Vanderbush TS, Choo E, Goniewicz ML, Dawkins L. An exploration into “do-it-yourself” (DIY) e-liquid mixing: Users' motivations, practices and product laboratory analysis. Addictive Behaviors Reports. 2019;9:100151.
- Office on Smoking and Health. About Electronic Cigarettes (E-Cigarettes): The Centers for Disease Control and Prevention; [updated 24 February 2020; cited 2020 31 August].
- CDC. Outbreak of Lung Injury Associated with the Use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. 2020 [cited 2020 June].
- Banks E, Beckwith K, Joshy G. Summary report on use of e-cigarettes and relation to tobacco smoking uptake and cessation, relevant to the Australian context. National Centre for Epidemiology and Population Health: Australian National University; 2020.
- Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2019. Canberra: AIHW; 2020.
- Guerin N, White V. ASSAD 2017 Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances. Centre for Behavioural Research in Cancer: Cancer Council Victoria; 2018.
- Greenhalgh E, Jenkins S, Scollo MM. Key Australian and international position statements on e-cigarettes, health, and options for regulation: Cancer Council Victoria; 2020 [updated July 2020; cited 2020 August 2].
- Therapeutic Goods Administration. Importation of e-cigarettes containing nicotine (and nicotine-containing liquids for use in e-cigarettes) [updated 25 October 2019; cited 2020 14 October ].
- Spindle TR, Hiler MM, Cooke ME, Eissenberg T, Kendler KS, Dick DM. Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students. Addict Behav. 2017;67:66-72.
- Chatterjee K, Alzghoul B, Innabi A, Meena N. Is vaping a gateway to smoking: a review of the longitudinal studies. International Journal of Adolescent Medicine and Health2018.
- National Academies of Sciences E, and Medicine,. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press; 2018.
- Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, et al. Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA pediatrics. 2017;171(8):788-97.
- Berry KM, Fetterman JL, Benjamin EJ, Bhatnagar A, Barrington-Trimis JL, Leventhal AM, et al. Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths. JAMA Network Open. 2019;2(2).
- Amin S, Dunn AG, Laranjo L. Exposure to e-cigarette information and advertising in social media and e-cigarette use in Australia: A mixed methods study. Drug and Alcohol Dependence. 2020;213:108112.
- Erku DA, Morphett K, Steadman KJ, Gartner CE. Policy Debates Regarding Nicotine Vaping Products in Australia: A Qualitative Analysis of Submissions to a Government Inquiry from Health and Medical Organisations. Int J Environ Res Public Health. 2019;16(22):4555.
- Pepper JK, Ribisl KM, Brewer NT. Adolescents interest in trying flavoured e-cigarettes. Tobacco Control. 2016;25(Suppl 2):ii62.
- Vasiljevic M, Petrescu DC, Marteau TM. Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study. Tobacco Control. 2016;25(e2):e107.
- Goldenson NI, Kirkpatrick MG, Barrington-Trimis JL, Pang RD, McBeth JF, Pentz MA, et al. Effects of sweet flavorings and nicotine on the appeal and sensory properties of e-cigarettes among young adult vapers: Application of a novel methodology. Drug and alcohol dependence. 2016;168:176-80.
- Cancer Council Australia. Parents right to worry about e-cigarettes and kids, says Cancer Council 2020 [cited 2020 19 February ].