A major new study involving over 25 000 students has sounded the alarm on a growing public health crisis in South Africa’s fee-paying high schools.
The research led by Professor Richard van Zyl-Smit reveals that e-cigarettes (vapes) have become the dominant inhaled substance among adolescents, often acting as a “gateway” or companion to cannabis and tobacco.
The study published in the South African Medical Journal (SAMJ), which surveyed 52 schools across eight provinces, found that 16.8% of students, nearly one in six, are current vapers.
36.7% of students reported having ever tried a vaping product.
This significantly outpaces the use of cannabis (5.1%), hookah (3.2%), and traditional cigarettes (2.1%).
Addictive patterns of student vapers
Among those who are current vapers, the study found addictive patterns from the vapers.
38.3% reported vaping every day, and more than half of students reported vaping four or more days per week.
88.1% of pupils reported using vapes that contain nicotine.
47% reported vaping within the first hour after waking up. 11.8% of students indicated that they cannot get through the school day without vaping.
And finally, 24.9% indicated that waiting a long time before they can vape makes them feel anxious or angry.
Why vape?
The study found that adolescents continue to vape to manage their emotional well-being and perceived physical needs.
Many young users turn to vapes to cope with stress, anxiety, and depression, while others use them to improve their body image, control their weight, or help them sleep.
Over time, these behaviours often evolve into a deep-seated dependency, as habit formation and addiction make it increasingly difficult for individuals to stop.
Social influence and peer dynamics play a major role, alongside environmental factors such as ease of access and general boredom.
Furthermore, an information gap persists where a lack of awareness or infrequent casual use leads many students to continue vaping simply because they want to, often without fully understanding the long-term health consequences.
Many students use vaping as a tool for enjoyment, exploration, and harm reduction.
They seek out the physical sensations, diverse flavours, and recreational pleasure associated with e-cigarettes to satisfy their curiosity.
Simultaneously, some adolescents view vaping as a substitution strategy, using it to stay off traditional cigarettes, reduce their alcohol consumption, or minimise other harmful addictive behaviours.
The ‘dual-use’ trap
Perhaps the most striking finding is that vaping is rarely an isolated habit. Researchers discovered a massive overlap between e-cigarettes and other substances:
- 81.2% of cigarette smokers also vape;
- 71.8% of cannabis users also vape;
- 34.3% of all vapers are “dual users,” meaning they use at least one other inhaled substance.
“These patterns suggest that adolescent vaping is not just isolated experimentation, but potentially indicates entrenched multi-substance use,” the study notes.
The data suggests that in these school environments, any student using cannabis or tobacco is almost certain to be vaping as well.
The ‘co-ed’ factor and ageing risks
The research also highlighted specific vulnerabilities based on school structure and age.
Students in co-educational (mixed-gender) schools showed significantly higher odds of cannabis use compared to those in all-boys schools.
Experts believe the social networks in mixed environments may normalise substance use more quickly.
Substance use increased significantly as students progressed from Grade 8 to Grade 12, peaking as older teens gained more autonomy and access to older social circles.
What needs to be done?
While tobacco is strictly governed by the 1993 Tobacco Products Control Act, e-cigarettes remain largely unregulated in South Africa.
This lack of oversight has allowed for aggressive social media marketing and the sale of flavoured products that reduce the perceived harm of vaping among youth.
The researchers are now calling for the urgent enactment of the 2018 Control of Tobacco Products and Electronic Delivery Systems Bill to curb marketing aimed at children.
The dangerous myth that “vaping is safe” also needs to be debunked.
“The dominance of vaping among sampled students mirrors global trends,” the report concludes, “but the prominent role of vaping in patterns of dual use underscores the urgent need to prioritise youth e-cigarette use in both policy and public health responses,” it said.
