The study by UCT academics, Sam Filby Research Officer, Research Unit on the Economics of Excisable Products, and Richard van Zyl Smit, Associate Professor and Consultant Pulmonologist, was published in The Lancet’s eClinical Medicine publication this month.

The authors found that vaping among South African pupils is sky high - and a cause for health alarm bells to be ringing.

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They surveyed over 25,000 South African high school students across 52 schools in eight of the nine provinces. Students were asked about their use of four products in the 30 days preceding the survey: e-cigarettes, tobacco cigarettes, cannabis and hookah pipes.

Students who indicated that they currently vaped were asked additional questions about their vaping history and habits, and their reasons for starting and continuing to vape.

This is an excerpt from a report by in Filby and Professor van Zyl Smit in The Conversation, published on 6 March 2025

“Our study found that 16.8% of high school learners we surveyed were currently using e-cigarettes. There were far lower rates of tobacco cigarette use (2%), cannabis use (5%) and hookah pipe use (3%).

We approached schools predominantly in major centres like Cape Town, Johannesburg, Pretoria and Durban. All were “fee-paying” schools. We were not able to include less well-resourced schools without easy internet access or non-fee-paying schools.

Around 17% of pupils in our sample attended lower-fee schools, 64% attended mid-fee schools, and 19% attended high-fee schools. Around 31% of learners attended co-ed schools, 41% attended all-boys’ schools, and 29% attended all-girls’ schools.

Students were asked about their use of four products in the 30 days preceding the survey: e-cigarettes, tobacco cigarettes, cannabis and hookah pipes.

Research has shown conclusively that children should not use these products.

One reason for this is that these products commonly deliver nicotine. Nicotine use during adolescence harms the developing brain, with potential long-term effects on learning, memory and attention.

Nicotine is also an addictive substance. Addictive behaviour in general is associated with the development of mental illness, further fuelling the mental health problems experienced by some adolescents. Substance abuse can lower their inhibitions, leading to increased high-risk behaviours.

Non-nicotine vapes are also bad for health. The chemical composition of specific flavours such as cherry, cinnamon and vanilla have also been shown to cause damage to the lung lining and blood vessels.

The rising popularity of e-cigarette use among adolescents globally should make helping young people with quitting vapes a priority.

Among the learners who indicated that they vaped, 38% vaped daily, and more than half of the learners in our sample reported that they vaped four or more days per week.

Around 88% of pupils reported using vapes that contained nicotine. About 47% reported that they vaped within the first hour of waking up – this is highly suggestive of nicotine addiction. We estimate that up to 61% of high school learners who vape could be seriously addicted to nicotine.

Our research underscores the urgent need for a coordinated public health response to address the vaping crisis among high school learners.

The South African government must pass the Tobacco Products and Electronic Delivery Systems Control Bill. This legislation will ensure that vapes cannot be sold near schools or online.

The restrictions on the advertising of vaping products provided for in the bill may aid with this as well as the deglamorisation of vaping among young people – reducing the general curiosity that leads many young people to begin in the first place.

The dangerous myth that “vaping is safe” also needs to be debunked.

Finally, we need to help addicted teenagers to stop vaping.

Punishing students for vaping is unlikely to be an effective strategy. Parents must be more aware of the signs of vaping and the underlying issues driving it.

Healthcare professionals should ask young people about their vape use during routine checkups.

And school counsellors should teach coping strategies to help teens navigate life’s challenges.

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