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It’s not flavoured water

5 August 2021
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Phil Holstein still doesn’t know what changed so dramatically over the summer school holidays.
The Canterbury West Coast Secondary Principals’ Association president says when students returned this year, vaping suddenly hit schools in the area like “a wave”. Young people were using vaping products in class, ducking out to the bathrooms to use vapes in between classes – all made easier because the next generation of vaping products are more discrete, which means there are no tell-tale plumes.
“Around two years ago I was getting calls from my equivalent in Auckland: ‘What are you doing about the epidemic of vaping?’ And we said at that stage it wasn’t an issue.
“Until the beginning of this year and it hit us like a huge wave across all schools,” he says.
It came at a time when cigarette smoking in schools had dropped off.
“That’s what got us. The number of students smoking cigarettes had dropped significantly. So all of a sudden we thought, ‘Great, we are having a healthier generation.’ But now it has come back full force the other way,” he says.
It is at such a level, he was requested by the association to pen a letter to Minister of Health Andrew Little asking for “any support that can be offered to schools by way of legislation, strong messaging, education programmes and stop vaping programmes”.
“Currently we feel powerless,” he says. “We view this matter as an urgent nationwide issue.”

IT'S NOT FLAVOURED WATER

There is an erroneous perception from young people that vapes or e-cigarettes are just “flavoured water”, says Asthma and Respiratory Foundation NZ chief executive Letitia Harding.
Because vaping is a relatively new phenomenon, the long-term risks to health are not yet known, she says. But emerging research shows that vape products do affect lung health, the heart and circulatory system, and oxidative stress levels – even for nicotine-free products, says Letitia.
“You’ve got the by-products of these e-cigarettes, the main constituents being propylene glycol and vegetable glycerin – and those are not safe for your lungs. Then you have the by-products of them being heated at very high temperatures, like fine heavy metals and acetylene formaldehyde, and we know that is not good for your health,” she says
Vaping has been promoted as an alternative to smoking and a tool to help cigarette smokers quit. But Letitia notes that a recently published article from the Canadian Journal of Cardiology suggested that for every smoker who achieves cessation using electronic cigarettes, 80 adolescents will become addicted to nicotine.
Nicotine is not in all vaping products; however, some vaping devices contain the equivalent amount of nicotine to that found in a pack of cigarettes – about 50mg. Some young people are consuming these products within three hours, she says.
University of Otago professor and co-director of research group ASPIRE2025, Janet Hoek, says the “best evidence” we currently have shows vaping is less harmful than smoking.
“If you are smoking and can’t quit through other approved methods like NRT [nicotine replacement therapy], transition to vaping is an alternative likely to pose fewer risks.”
But, she says, young people are typically not in this category.
“For young people, they are moving in another direction. They are not transitioning from something worse to something less harmful. They are moving from a situation where they are breathing in fresh air and replacing it with something that has potentially harmful chemicals,” she says.
Furthermore, she notes, there has not been an accelerated decline in youth smoking, which is what would be expected if vaping was displacing smoking.
The Ministry of Health says it is “too early” to note the impact of vaping on smoking rates. A spokesperson said it was monitoring the uptake of vaping products and their health impact, including their long-term effects and effectiveness for smoking cessation. He says the New Zealand Health Survey 2019/20 found that 11.6 per cent of New Zealanders smoke daily, compared to 12.5 per cent in the 2018/19 survey.
He says the ministry advises that young people and non-smokers should not take up vaping.

"AGGRESSIVELY TARGETED"

With fruity flavours and sophisticated social media advertising, Professor Hoek says it is clear vaping products are “aggressively targeted” towards young people.
“If somebody has been smoking for 20 years and they are desperate to quit, how will a brand named ‘Unicorn’s Milk’ encourage them to switch to vaping? These are confectionery and dessert flavours. We are seeing the same phenomenon we saw with alcopops, which use very sweet flavours to appeal to young people,” she says.
Janet says highly addictive products – combined with sophisticated lifestyle marketing – have lured young people to vaping.Says Life Education Trust chief executive John O’Connell, “The Ministry of Health was very keen to introduce vaping for smoking cessation, but it’s had the completely opposite effect, with non-smokers taking it up and becoming addicted.”
He says the delay between when vaping was introduced (about 2017) and when regulation was put in place by the government (November 2020) left a window where the “flood gates opened”.
Before that, vaping products could be bought by those under 18.
“The horse has already bolted. We are trying to deal with a trend that is established. I am on a school board and it was five years ago that we were just getting rid of smoking in the toilets. That had all but disappeared and now schools are dealing with it again – it is just smoking under another name,” John says.

INDUSTRY GROWTH

The vaping industry is lucrative, says Letitia, with more than 480 specialist retail shops already listed with the Ministry of Health.
“I remember looking at projected global sales of vapes in 2017 sitting at about $45 billion by 2026. Now that has gone up to a projected $104 billion by 2028,” she says.
In November 2020, the Smokefree Environment and Regulated Products Act 1990 amendment came into effect. Provisions included restricting sales of vaping products to those ages 18 and older.
At the time, Minister of Health Andrew Little said the legislation was intended to “discourage young people from vaping while allowing smokers to continue using vaping to give up cigarettes”.
However, the “wave” reported in Canterbury schools would appear to suggest the new policies have not yet discouraged vaping among young people.

SMALL STEPS

Associate Minister of Health Dr Ayesha Verrall said a survey of Year 10 students highlighted that a third have experimented with vaping, but only around three per cent of them have vaped daily.
“Those who are vaping daily tend to have already been smoking tobacco. And the latest data shows around 2.3 per cent of teenagers between 15 and 17 years old vape daily,”
she says.
She says the changes to the act in November “strike a balance” between making sure vaping products are available to smokers who want to switch to a less harmful alternative “and ensuring these products are not marketed or sold to young people”.
The changes included restrictions on the flavours dairies and petrol stations may sell, which are limited to mint, menthol and tobacco, with only specialist vape stores able to sell others. Schools and early childhood facilities are also now required to be vape-free as well as smoke-free.
“And schools are also required to take all reasonably practicable steps to ensure that no person smokes or vapes in any part of their school,” she says.
She says the letter sent by Phil Holstein has been received and a response is being prepared.
“Regulating vaping products is a complex area, and we will have further announcements to make on this in the near future.”
The Ministry of Health spokesperson said it has met with the Ministry of Education to discuss the concerns relating to youth who are vaping and what opportunities there are to address those concerns.
“Discussions are ongoing and include what resources are required for young people, teachers and parents,” he says.
Letitia says supplementary data in an Action for Smokefree 2025 (ASH) survey of Year 10 students shows cigarette smoking has actually increased.
“Daily and regular cigarette use showed small increases from 2017 to 2019 – although small, these are the first increases in the two decades this survey has been running,” she says.

YES, I AM 18

Janet queries claims that most young people who vape are also smoking. She says the Youth19 Rangatahi Smart Survey health and wellbeing study found that many high school-age vapers are non-smokers and that nearly two-thirds of students who had ever vaped and nearly half of regular vapers had never smoked cigarettes.
She says in spite of the legislation, young people are still accessing vaping products, which she attributes largely to online sales.
“Google vaping and you’ll come up with a large number of online stores. The majority don’t have an effective age-verification process – you just tick a box and say, ‘Yes, I am 18’, which makes accessing vaping products very simple,” she says.She thinks the regulations need to go further to ensure age restrictions are effective, monitored and enforced. She would like to see vaping products removed from dairies, in particular, as young people often visit these stores. She also thinks plain packaging could lessen the appeal of vaping products to young people.
The Ministry of Health spokesperson says there is no plain-packaging requirement for vaping products but there are requirements for “harm messaging, warnings and some prohibitions”.
For Letitia, the government has not gone far enough with current and proposed legislation.
“Why have we allowed the market to be flooded, when we knew this was going to be a problem way back in 2017? It is ludicrous. We have always said that – it is ludicrous,” she says.

KNOWLEDGE IS POWER

Now that the trend among teens has been established, Letitia believes the most important countermeasure is for young people and parents to be educated on vaping and learn about what these products are.
“We know teenagers try these things; but the biggest problem is that they think they are without harm. Adults need to be aware that although vapes may be less harmful than cigarettes, they do have negative effects on health. If not, why do you think they [the government] are now trying to restrict them with regulations?
“Kids and teenagers think there is nothing wrong with them; that they are just fun, flavoursome water passed around at parties like they’re not a big deal. But they are a big deal. Let’s not wait 20 to 30 years from now to find out exactly how big a deal that is.

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