There are so many different versions and flavours of vapes, it encourages young people to keep collecting and consuming.

E-cigarette use by young adults and teenagers is rising so fast in Australia it threatens to undo three decades of public health work to stamp out cigarette smoking and the associated health issues.

While the proportion of daily smokers has more than halved in the three decades since 1999, vaping use is heading in the opposite direction. E-cigarette use among 14 to 24 year olds has more than doubled from 2016 to 2019.

“I think we are going to see a massive jump in the number of kids who are vaping. Smoking was dying out and that's exactly why the tobacco industry and other retailers are looking for a new product to sell,” Dr Sarah White, director of Quit Victoria, warned.

White explained that tobacco smoking is now “de-normalised”, in that it's not considered culturally acceptable in Australia anymore. “But what we've got is vaping which is not de-normalised to the same extent because kids are getting hold of them. They taste nice. They look funky. They're on social media. So, there's not the same level of cultural lack of acceptance.”

'Vaping is coinciding with this over-awareness of body image and everything that comes with it.'

University student Susan*, 20, tried vaping for the first time as an 18-year-old in a club. "For the first few times, I did get like dizzy and a bit nauseous. I thought it sort of tasted good and just so many people do it. Pretty much all of my extended friends or friends of friends, I'd say like 70 per cent of them do it.”

But what are e-cigarettes? Commonly referred to as “vapes”, they are battery-powered or rechargeable devices that aerosolise a liquid that usually contains nicotine, flavourings and additives for inhalation. A disposable vape with a 2ml tank may contain 40mg of nicotine, an amount equivalent to a pack of 20 tobacco cigarettes.

The National Health and Medical Research Council has found that vapes can contain nicotine (even when labelled “nicotine-free”) and may include up to 200 additional chemicals. All e-cigarette users are exposed to chemicals and toxins that can harm your health.

Vapes are wildly popular and readily available in Australia. This is despite the fact they are illegal to purchase unless you have a medical prescription.

The concept of an e-cigarette was patented in the United States in 1965 however, it was not until 2003 that the first commercialised e-cigarette product was developed in China. Today, 90 per cent of e-cigarette products sold globally are made in China.

It’s not only young adults who have embraced vaping. White has received many phone calls from schools asking if Quit can send somebody to talk to students about the dangers of vaping after they have confiscated devices or caught children as young as five years old going to the toilets to vape.

“Look, in some ways, you can’t blame these kids. They see these nice smelling, bright-coloured devices ... So, in some ways it's not terribly surprising,” White said.

White recalled one story about a young child who was hospitalised after trying an e-cigarette. “The youngest we've had has been a five-year-old who ended up being hospitalised because he vaped. His seven-year-old brother's friend brought that to school and the little five-year-old ended up in quite respiratory distress.”

Big e-Tobacco

E-cigarettes have become popular among the younger generation, experts say, due to the way they are marketed by Big Tobacco and retail companies.

“I don't think any of this stuff is a mistake,” White said. “These companies don't do things, don't change packaging just for the hell of it. You know, they're doing focus testing. I've seen e-cigarettes with diamantés on them. I've seen e-cigarettes that are designed with Hello Kitty paraphernalia. We're seeing e-cigarettes hidden in hoodie draw strings, in lipsticks. You know, there's quite a lot of product innovation that's going on to attract people and also to make them really easy to hide so that you can still vape.”

The “companies” White refers to increasingly have links to Big Tobacco. The early e-cigarette market was dominated by small start-up companies but that is changing. The company NJOY, the independent and unrivalled market leader in 2012, filed for bankruptcy in 2016. Next came JUUL in 2017 with a sleek, portable e-cigarette (resembling a USB stick) that took off, making JUUL the largest retail e-cigarette brand in the US, with a market capitalisation of $15 billion. In 2018, Altria, one of the world’s biggest tobacco corporations, took a 35 per cent stake in JUUL as it expanded into markets in the UK and Canada. Other e-cigarette brands such as Logic, Vype and Blu are also subsidiaries of large tobacco companies such as Imperial Tobacco and Phillip Morris.

The tobacco companies have been keen to push the line that e-cigarettes are a tool to help people with smoking addictions kick the habit but new research challenges the claim. White explained that nicotine is what makes vapes addictive but e-cigarettes are inherently harmful whether they contain nicotine or not “because you are inhaling chemicals, many of which have been shown to cause organ damage and cancer, and you're inhaling heavy metals and you're inhaling fine particles”.

An American Heart Association review in June 2022 shows adolescents who vape risk permanent lung damage and are at higher risk of cardiovascular disease later in life.

Professor Jonine Jancey, who specialises in public health at Curtin University, has studied the way tobacco companies market vapes to appeal to young people. “Tobacco companies are saying that these are a cessation aid. Yet, what are the products being marketed as? They're slick, they're shiny, they come in different sizes and they can easily be used. They come in all these different flavours that are appealing to young people so you don’t get that nasty tobacco taste. I would ask, who really are they targeting their product at?”

University student Cindy*, 19, was 17 when she first tried vaping. “We just went to the city to drink. And my friend actually had an e-cigarette because she wanted to quit tobacco smoking. And so, she just kind of passed it to me and I was like, ‘Oh, I wanna try it’." Cindy’s friend has been trying to quit tobacco smoking for two years. She continues to smoke tobacco cigarettes and e-cigarettes.

Despite e-cigarette manufacturers’ claims, the NHMRC recently found e-cigarettes were not proven safe and effective smoking cessation aids, finding it was more common for smokers to become dual users (using both e-cigarettes and tobacco products at the same time) than quit if they used nicotine e-cigarettes.

Jancey noted: “Cigarettes have been around for hundreds of years or tobacco has. But we've only had 15 years of data to find out about the implications of e-cigarettes which is not a particularly large amount of time. So, the long-term health implications of e-cigarettes are really unknown.”

Quit Director White said: "[Vapers] are still addicted to nicotine. And they still have all the same triggers to smoke like the hand to mouth actions... These are dependencies that aren't necessarily just about the drug. They're about behaviours and triggers.”

A review of global evidence by Australian National University showed that there is strong evidence that non-smokers who use e-cigarettes are three times as likely to go on to smoke combustible tobacco cigarettes as non-smokers who do not use e-cigarettes.

While medical researchers are concerned by the behaviours and triggers of e-cigarette use, the psychological impact on young minds, through promotion on social media, is also under the microscope.

Associate Professor Katharina Wolf at Curtin University has researched the use and proliferation of vaping in Australia.

“Now, when I speak to my students, they wouldn't even think about smoking. It's not on their radar. It's something that's not part of Australian society anymore. And so, something else comes along which is quite attractive. I’m talking about very smart, sleek, and attractive devices that fit in with the desire to have the latest tech gadget,” Wolf said.

She went on to explain that flavouring of e-cigarettes is a significant part of Big Tobacco’s marketing strategy and works to hook younger people into smoking.

“Whilst on one hand, you've got the tobacco companies telling us that this is a way to actually help people quit smoking, we also of course see flavours like bubblegum and strawberry cheesecake and all these kinds of things emerging that are clearly not targeting existing smokers. They're trying to tap into those young smokers,” Wolf said.

University student Susan said she would "probably pull back [from inhaling] a tobacco cigarette, but if its blueberry flavour, then sure ... Smoking tobacco cigarettes are harder to get into because you need to brace yourself through the first part of it until you get addicted and then don't mind the tobacco flavour. But the fact that vapes are sold in every single fruit flavour under the sun means that there isn’t that gap to bridge.”

Wolf said that because there are so many different versions and flavours of vapes, it encouraged people to keep collecting and consuming.

Body image trap

Wolf believes different factors influence e-cigarette use among males and females. For males, she believes it’s the risk-taking aspect whereas, for females, it may be related to body image.

“Vaping is coinciding with this over-awareness of body image and everything that comes with it. Smoking is traditionally or was traditionally used by a lot of people to limit hunger cravings. And you see that coming out of our data as well on the research we've done on that,” Wolf said.

“That combination of being very body conscious and thinking you have to be really thin and lose weight, and then having that really techy flush solution that gives you access to something sweet that doesn't have calories attached, it's really attractive.”

She said social media has played a role in promoting sponsored content that glamourises e-cigarettes. “Vaping has been made very, very attractive through basically social media and especially the emergence of Instagram and TikTok, and the content that's been being shared there. A lot of that content that's out there is not branded as corporate content. It very much is positioned as user generated content. Although it's quite obvious that a lot of that a lot of that is sponsored.”

Wolf expressed her disappointment towards the tobacco industry and how self-proliferating this vaping epidemic has become for young people.

“The tobacco industry doesn't even have to push or position it [vaping] as such. It's very much about online user generated content and peer pressure... It's kind of self-proliferating and it’s worked extremely well. Because they found a niche... This was actually the first generation especially in Australia that was not exposed to cigarettes whatsoever and it's really going to get them hooked and potentially move them over to traditional cigarettes as well,” Wolf said.

In Australia, The Guardian has reported on tobacco company Phillip Morris International lobbying Federal government MPs to overturn the ban on the retail sale of e-cigarettes containing nicotine.

White thinks it's reprehensible that companies can “put profit over kids when we're talking about addicting them to something for life that's terrible and ruining their lungs”.

"They know what they're doing. The tobacco companies are actively trying to get around the law. They're using lobbyists to politicians. They're paying front groups. That's been proven. We cannot let them get away with it.”

* Names have been changed.