Vaping in children and teens: smoke without fire?

Published 06/12/2022   |   Reading Time minutes

E-cigarettes, also known as vapes, are battery powered devices which allow nicotine to be inhaled through a vapour (‘vaping’) rather than smoke.

Although e-cigarettes are often used as a tool to help quit smoking, vaping has increased in children and young people. The latest iteration of e-cigarettes, disposable ‘pod’ vapes, are proving particularly popular. Deborah Arnott, chief executive of Action on Smoking and Health (ASH), said:

The disposable vapes that have surged in popularity over the last year are brightly coloured, pocket-size products with sweet flavours and sweet names. They are widely available for under a fiver – no wonder they’re attractive to children.

The use of e-cigarettes by children and young people has raised concerns as evidence on the health risks is still emerging. Concerns have also been raised about the environmental impact of disposable vapes, with an estimated 1.3 million thrown away each week.

This article will look at to what extent e-cigarettes are prevalent, available and appealing amongst children and young people, and the potential consequences.

How popular is vaping in children and young people?

In the 2019/20 Student Wellbeing Survey of 11 to 16 year olds in Wales, 22% had tried an e-cigarette while 3% vaped at least once a week. The Mix, a support service for young people, found that 45% of 16 to 25 year olds in Wales had used an e-cigarette in the past 12 months.

ASH reported a more than 6-fold rise in use of disposable vapes amongst 11 to 17 year olds vapers from 2021 to 2022. Another study found that 18 year old ‘vapers’ using disposable vapes increased from less than 1% in 2021 to 55% in 2022. In adult vapers, disposable vape use increased from 2% to 10%.

How are children and young people getting hold of e-cigarettes?

Since 1 October 2015, it has been illegal to sell e-cigarettes to anyone under the age of 18 in Wales. However, according to ASH, shops are the main source of e-cigarettes for 11 to 17 year olds. Trading Standards Wales reported underage persons were able to buy e-cigarettes in 15% of attempted purchases. 7 out of 20 shops in Cardiff sold e-cigarettes to underage persons in a BBC Wales Investigation. ASH also found that 1 in 10 children purchased their e-cigarettes online. A loophole in legislation allows free samples of e-cigarettes to be given to people of any age.

Are children and young people being targeted?

The Tobacco and Related Products Regulations 2016 and UK Advertising Codes place restrictions on how and where e-cigarettes can be advertised. The regulations are clear that e-cigarette marketing must not appeal to people under 18. E-cigarette advertising is banned from television, radio, newspapers and magazines but, unlike cigarettes, is allowed on billboards, posters and at the point of sale.

Cancer Research UK found that young people who had never smoked or vaped noticed e-cigarette marketing more than adults who smoked, and more than a third of young people found e-cigarette marketing appealing.

Cancer Research UK also raised concerns that children and young people were being exposed to e-cigarette advertising on social media, which is less well regulated. The Independent British Vape Trade Association named TikTok as “the worst offender” for enforcing policies to prevent e-cigarette promotion to children. ASH also found that TikTok was the most common platform children had seen online promotion of e-cigarettes, followed by Instagram and Snapchat.

How harmful is vaping?

Instead of burning tobacco, e-cigarettes work by heating a liquid containing nicotine. This means the most harmful elements of tobacco smoke, tar and carbon monoxide, are not produced.

The latest evidence shows that in the short and medium term, e-cigarettes pose a small fraction of the health risks of tobacco cigarettes. However, vaping is not risk free, particularly for those who have never smoked, and can have negative effects on the heart and lungs. It is too early to tell the health effects of long term e-cigarette use.

Another potential concern from e-cigarettes is nicotine dependency, although the risk is thought to be lower than for smoking. The risk of nicotine dependency varies between e-cigarette products, with disposable ‘pod’ vapes allowing particularly high levels of nicotine to be inhaled and therefore greater risk. Children and young people are more likely to develop nicotine dependency than adults, and nicotine can impact their brain development.

Does vaping lead to smoking?

It is unclear whether e-cigarette use in children and young people acts as a gateway to tobacco smoking. 15% of 10 to 11 year olds in Wales who had tried an e-cigarette said they might or will take up smoking, compared to 2% of those who had never vaped. However, of 11 to 16 year olds in Wales who had tried both e-cigarettes and cigarettes, 83% had tried cigarettes first. A study in England found that e-cigarette use was not generally associated with smoking uptake.

How has the Welsh Government responded?

In 2015, the Welsh Government failed to gain enough support to ban the use of e-cigarettes in enclosed and public places under the Public Health (Wales) Bill (the legislation passed without inclusion of the ban in 2017). First Minister Mark Drakeford has called this failure one of his "biggest political regrets", and recently said that:

We are going back to see if we could rescue from what we lost, because the evidence of young people being drawn into nicotine addiction by e-cigarettes is really frightening

The Welsh Government’s ambition is for Wales to be smoke-free (less than 5% of adults smoking) by 2030. The Smoke Free strategy, published in July 2022, included an aim to:

increase the proportion of teenagers and young people who remain smoke-free by reducing the uptake of smoking, whilst also discouraging the uptake of e-cigarettes or other nicotine products in teenagers and young people.

In the Tobacco Control Delivery Plan 2022-2024, the Welsh Government said more work was needed to understand the influence of e-cigarettes on smoking up-take in children and young people.

Lynne Neagle, Deputy Minister for Mental Health and Well-being, said:

Reports of the increase in use of e-cigarettes by children is very concerning. We will also be looking at what more could be done to prevent their use by children and young people.

ASH believes more funding is needed to enforce the law against underage sales, and action should be taken to tackle child-friendly packaging and social media promotion.

Article by Bonnie Evans, Senedd Research, Welsh Parliament

Senedd Research acknowledges the parliamentary fellowship provided to Bonnie Evans by the Medical Research Council which enabled this Research Article to be completed.