Doctors have sounded the alarm about the rapid increase in vaping by students and young people, with research showing a link between e-cigarette use and anxiety and depression.

Youth mental health expert Dr Michael Bowden told a webinar audience of 1,300 parents and carers that young people with mental health issues were more likely to vape, become addicted to nicotine and have more anxiety and depression.

This “vicious cycle” meant the reason young people often said they vaped – to cope with stress – caused more stress when withdrawing from nicotine.

“There is some very early evidence which is linking e-cigarette use with both depression and anxiety in young people,” said Dr Bowden, NSW Health Child and Youth Mental Health Senior Clinical Advisor.

“There seems to be an effect going in both directions. Young people feeling depressed and anxious are more likely to use e-cigarettes as a coping mechanism.

“The opposite is also true. Vaping can have effects on mood and anxiety. We’re concerned about the effects of nicotine on the developing brains of young people and how they regulate emotions and deal with stress.”

Vaping is the inhaling of vapour created by a battery-operated e-cigarette (electronic cigarette), commonly known as vapes. The aerosols inhaled lodge toxic chemicals – including those found in nail polish remover and weed killer – deep in the lungs, increasing the risk and severity of respiratory problems such as asthma.

NSW Chief Health Officer Dr Kerry Chant told the webinar, co-hosted by the P&C Federation NSW, NSW Department of Education and NSW Health, that vaping was increasing every year, particularly among young people who were already the highest users of e-cigarettes.

“As a person who is passionate about public health I am gravely concerned about the issue of e-cigarettes,” she said.

The 2021 NSW Population Health survey of 16- to 24-year-olds revealed that one-third of young people surveyed had tried vapes, more than double the rate of 15.5 per cent three years earlier. More than 11 per cent of young people were current users in 2021, compared with 1.8 per cent in 2018.

Dr Chant said vapes were marketed to young people with appealing scents and packaging that looked like USB memory sticks or highlighter pens. The sales pitch led teenagers to think they were inhaling flavoured water, which is “clearly not true”, she said.

However, Dr Chant said testing by NSW Health revealed that more than 50 per cent of the non-nicotine vapes analysed did contain nicotine and “at very high levels”. One nicotine vape container is the equivalent of 50 cigarettes.

Dr Chant said 157,000 e-cigarettes with a street value of $3 million were seized by NSW Health and 12 retailers prosecuted between April 2021 and September 2022, but this was “the tip of the iceberg”.

“It feels like sometimes we’re fighting against a torrent of supply,” she said.

Under government retailing laws, it is illegal to sell e-cigarettes to anyone under the age of 18.

School principals, parents and community members are encouraged to report retailers selling vapes to minors to the NSW Health complaints line.

“There is no one silver bullet but empowering young people with education is really important,” Dr Chant said.

Education is the key

NSW Health and the NSW Department of Education developed the ‘Do you know what you’re vaping toolkit’ to inform young people of the risks associated with e-cigarettes, with evidence-based resources and educational materials also available for parents and teachers.

Renee West, NSW Department of Education Personal Development, Health and Physical Education (PDHPE) Curriculum Advisor 7-12, said there was a focus on education and awareness about vaping through the mandatory PDHPE syllabuses, with students from Year 5 – or younger – receiving drug awareness education. Vaping-specific resources have been developed for students in Years 7 to 12 and for their teachers.

“Drug education and prevention should always begin before young people are likely to face the situations when they do need to make decisions about drug use and before behavioural patterns have been established,” Ms West said.

She said parents could work with schools if they were concerned their children were vaping and advised them to have good communication, share worries, ask questions and be aware of students’ online and offline behaviours. Parents educated about vaping meant they could “debunk the misinformation” students received from social media and friends.

“Be a positive role model. We know that kids see, and kids do. Where children and young people are not exposed to vaping as normalised behaviour, they’re less likely to be curious or to try it,” she said.

P&C Federation NSW president Natalie Walker said parents were anxious about the increase in vaping by young people and wanted more information.

“As parents and carers, it's important to be informed and educated on issues that affect our children. That is why we were so happy to co-host a webinar on vaping with NSW Health and the NSW Department of Education,” she said.

“There is a real concern among parents and carers about the lack of regulations around vaping, the ease of access, and the health implications for our children.”

Ms West said peer-led interventions and strategies for vaping were in the early stages of development but had previously been pivotal in delaying the age at which young people started drinking alcohol and reducing the youth smoking rate.

“Seven in 10 young people aren’t vaping . . . how can we harness the power that those young people have to start making decisions?” she said.

A group of Western Sydney public high schools are working with the Western Sydney Local Health District’s Prevention Education and Research Unit on school-based prevention and health leadership strategies.

The Unpacking Vaping research pilot in 2021 with students, teachers and parents found that students took up vaping due to peer pressure, social media influencers, a belief that e-cigarettes reduced stress, and the incentivising product features.

Teachers interviewed estimated that anywhere between 20 per cent and 60 per cent of students across all secondary year levels were vaping.

The next stage of the research project will focus on student empowerment and peer-led interventions.

Harmful effects of vapes

Addiction medicine specialist Dr Bronwyn Milne said adverse health impacts from vaping included coughs, headaches, nausea, nicotine poisoning, lung injuries and respiratory distress.

Poor-quality batteries in e-cigarettes have overheated and caught fire, causing serious burns and injuries. Toddlers have been hospitalised after drinking the fluid in e-cigarettes left lying around.

The Sydney Children’s Hospital Network adolescent medicine head, Dr Milne said nicotine was highly addictive, especially to adolescent brains still developing up until their mid-twenties. Young people who vape were also three times more likely to start smoking cigarettes and many ended up dual users.

She said tell-tale signs that children and young people were vaping – or withdrawing from vaping – include irritability, anger, frustration and difficulty concentrating.

One question that parents could ask their children was, “How soon after you wake up do you have your first vape?”

“Many young people will keep their vape under their pillow and it’s the first thing they reach for in the morning,” she said.

“If they’re vaping within 10 minutes or 30 minutes, that’s a sign of nicotine dependency.”

• The webinar, ‘Vaping – what parents and carers need to know’, can be viewed on the NSW P&C Federation website.
• Do you know what you’re vaping toolkit