Sucking on an electronic device to inhale plumes of flavoured nicotine was cast by the Government as a tool to help Kiwis quit smoking tobacco. Now, experts say our youth are paying the price, with vape stores more common than many fast-food chains. Emma Russell reports.
When Kahu Pihema started vaping aged 14, she didn't see any harm.
"I was just doing it because all my friends were and it was a bit of fun," she told the Herald.
Now 16, Kahu can't go a day without vaping. The Gisborne teen vapes at school, during breaks at work, in bed and sometimes even in the shower.
"I didn't realise I was hooked until I tried to stop and became really sick, to the point I couldn't go to school," she said. "After a month of trying I started again."
Kahu, who also lives with asthma, is among the estimated one in five secondary school students who are addicted to vaping.
The figure has emerged from research by the Asthma and Respiratory Foundation, which surveyed more than 19,000 students in Years 9 to 13. Like Kahu, many have never smoked tobacco.
It's emerged after the Government announced people aged under 14 would not be able to legally buy tobacco from the end of next year, as New Zealand's Smokefree 2025 target edges closer.
Doctors warned the dangers of e-cigarettes to young people can't be ignored either, with one saying nicotine vaping is addictive and suggested increased risk of heart disease and cancer.
"The effects seem to be more long-term and there are many unknowns. Any damage to lung tissue ultimately reduces your capacity to work, live and exercise," Waikato ED doctor John Bonning said.
Paediatric respiratory physician Professor Philip Pattemore said: "Vaping with nicotine has been consistently associated with depression, ADHD and conduct disorders in adolescents, and nicotine exposure has been shown to impact learning and memory."
Though not everyone vaped with nicotine, the foundation's survey found 80 per cent of students who had taken up the habit were doing so with very high nicotine levels. Only 2.8 per cent of vapers reported using zero nicotine vapes.
To get a comprehensive picture of how vaping is affecting our young people, the Herald collated Ministry of Health data showing the locations of specialist stores. Our analysis revealed they have become more common than many fast-food chains, with many popping up in sight of schools.
Despite new regulations aiming to limit youth exposure to vaping, at least one in four schools are within 1km of a specialist store and around 80 are just 250 metres away.
Experts said that's the tip of the iceberg because the data didn't include dairies and supermarkets that also sell vaping products. Online stores were also a major problem, they added.
Although vaping has been deemed the lesser of two evils when compared to smoking tobacco, doctors said the many unknown impacts were a serious concern.
"I remember when doctors were seen advertising 'healthy' cigarettes," Bonning said. "They weren't seen as dangerous then. Just like with vaping now, we still don't know the long-term effects."
Principals were also increasingly fearful of the rising number of teens addicted to vaping and its impact on their ability to learn and mental wellbeing.
"As a school, we are dealing with vaping issues onsite on a weekly basis," said Peter Morton, associate principal of Rangitoto College on Auckland's North Shore.
On a bridge surrounded by mates, Kahu Pihema inhaled her first puff of a vape.
"I remember coughing a lot. I didn't like it, I guess I just did it because all my mates were doing it and I slowly got used to it."
Her mum, Sharon, said she didn't find out about her daughter's habit until two years later, after she was caught by a teacher vaping in the school bathroom.
"We were p***** off and disappointed because her older sister has really bad respiratory problems and we've spent heaps of time in hospital with her, so as a family we all knew how important it is to look after your lungs," Sharon said.
She realised telling her daughter to quit wasn't going to be effective because they were dealing with a nicotine addiction.
Seeking help from her GP and a smoking addiction service, Kahu was told to "try sucking on a pen".
"[The addictions service] said, 'We only help people quit smoking by getting them to vape, we don't help get people off vaping'," said Sharon.
"It's scary because we don't know what the long-term effects are. We have all these kids with nicotine addictions and we don't know what it's going to be like for them in five, 10, 20 years."
John O'Connell, chief executive of Life Education Trust, which delivers health and wellbeing programmes to young people, said the amount of nicotine many teenage vapers were inhaling daily was equivalent to that in half a pack of cigarettes.
"Secondary school principals are saying vaping has become an epidemic and a third of the primary school leaders we work with are citing it as an issue," said O'Connell.
Rangitoto College's Morton said the prevalence of students vaping was becoming increasingly concerning - and it was remarkably easy for them to get their hands on the products.
"They are sourced from older siblings, or simply by asking random members of the public to purchase on their behalf from suppliers. Sadly there are also some irresponsible vape shop workers allowing purchases. The accessibility of online purchases is an increasing problem also."
Morton said he and his colleagues were aware of students who admitted to being addicted to vaping because of the nicotine content.
"There is a direct correlation between the frequency of vaping and the nicotine dose used.
"The promotion of vape products is appealing to a younger audience and they are lured into use," Morton said.
Vape stores at every corner
Latest figures reveal 562 specialist vape stores across New Zealand, not including the dairies and supermarkets which also sell such products.
Herald analysis revealed examples of up to five specialist stores along a single street and 894 schools within 1km of at least one store.
Specialist stores tend to be near lower decile schools - there were 120 near decile one schools and 66 near decile 10 schools.
Hamilton Girls' High School has six vape stores within 1km, Takapuna Primary has five and Pacific Advance Secondary School in Ōtāhuhu, three.
Asthma and Respiratory Foundation chief executive Letitia Harding said vaping products were often targeted at kids walking home from school.
"[Vape stores] are interesting-looking and colourful with great names, they shouldn't be so close to schools because it's just easy access."
Harding raised concerns about youth vaping with the Ministry of Health in 2017. She was told repeatedly by officials that teens would not become addicted and it wouldn't be a problem, she said.
"I get calls from parents whose 12- and 13-year-olds are addicted and that's really frustrating when we predicted this four years ago," she said.
Vaping should have been offered only to people trying to kick smoking, as a free prescription available at pharmacies and medical centres with wraparound support, Harding said.
Australia has moved to tackle the availability of nicotine vaping products. Since October 1 they can be bought only with a doctor's prescription. Harding said she would be watching how that played out.
The public health sector seemed to have tunnel vision about vaping reducing harm caused by smoking, which was blinding them to how it affected young people, she added.
Wellington GP and medical director of the Royal New Zealand College of General Practitioners, Bryan Betty, said vaping could help people quit smoking, but the harm to young people could not be ignored.
"Vaping has taken off with the younger cohort, that's a real concern because it's moving way outside what vaping's role was meant to be, which was a sensation tool."
He was seeing worried parents with children aged younger than 11 who had taken up vaping because they saw it as a "cool thing to do".
"It's an emerging social issue that the Ministry of Health needs to get ahead of, because I suspect we will begin to see the harms of vaping in 20 years time."
Ministry of Health group manager for population health and prevention, Jane Chambers, said concerns about vaping products being sold near schools were raised as the Smokefree Environments (Vaping) Amendment Bill 2020 progressed through Parliament.
The bill took 620 days to get over the line after then Associate Health Minister Jenny Salesa promised to regulate the industry in November 2018. It banned the sale of vaping products to those under 18, limited the sale of flavours and made it illegal to vape in a car with children.
"However, the [select] committee did not recommend that a prohibition should be placed on the sale of vaping products close to schools. We know most young people obtain vaping products from friends and family, as they do with cigarettes," Chambers said.
The ministry was not aware of any "robust evidence of a significant problem with dairies selling vaping products unlawfully to minors", she added.
"Anyone who is aware of any retailer selling vaping products to minors should make a complaint to the local public health unit, which employs Smokefree enforcement officers."
In November 2019, Prime Minister Jacinda Ardern said the rules around vaping would stop children from taking up the habit.
"The idea that [vaping] takes a foothold with young people in particular, I think, would be deeply worrying," Ardern said.
Two years on, principals are deeply concerned about students who have never smoked a cigarette becoming addicted to vaping.
When the Herald put this to the Government, Duty Minister Carmel Sepuloni said any reports of tamariki vaping were "absolutely concerning" and they were taking action to address it.
"A new health promotion programme from the Ministry of Health, expected to be underway in March 2022, will be aimed at rangatahi and focused on supporting youth to make the decision not to vape," Sepuloni said.
"The appointed creative agency will co-design the programme with young people, specifically Māori and Pacific youth to ensure the messages and content resonates with them. Working with tamariki will also help to ensure the programme targets appropriate digital channels."
However, Sepuloni suggested she didn't agree with the results of the foundation survey, by pointing to the 2019/20 New Zealand Health Survey, which found only 5.8 per cent of teenagers aged 15-17 vaped daily.
Asked why vaping wasn't available only as a free prescription to help smokers quit, officials said they wanted it to be an alternative to cigarettes for as many as possible.
The Asthma and Respiratory Foundation released a report in November with recommendations to reduce the prevalence of vaping among young people.
They called for the legal age to buy vape products to be raised from 18 to 21, and a ban on front-of-store window advertising and product display by retailers.
Preventing the sale of vaping products within 1km of schools was also advised.
In the run-up to Christmas, Harding and O'Connell met ministry officials to discuss a joint campaign to educate teens about the dangers of vaping - similar to the foundation's Don't Get Sucked In campaign.
"We said, 'Why not work with us since we have already done extensive work in this space,' but they have decided to spend taxpayer money on creating a whole new campaign. They are not interested in listening," Harding said.
Chambers also cast doubt on the foundation's survey, saying the ministry was not aware of any robust evidence showing that one in five secondary school students were addicted.
"Vaping is intended as a less harmful alternative for smokers. Non-smokers, including young people, should not vape."
The ministry was working with an external provider on a programme to prevent youth from vaping, she added.
"The provider has been chosen because they have a strong track record of delivering programmes that are co-designed with the young people whose behaviour they seek to change. Don't Get Sucked In is a website. The ministry does not propose to create a website."
'Replacing one addiction with another'
ED doctor John Bonning said it was too early to know the long-term effects of vaping. Although it had been around a while, it had only really taken off in the last five years.
"To me, vaping is replacing one addiction with another.
"The effects seem to be more long-term rather than short-term where patients end up in ED.
"Any damage to lung tissue ultimately reduces your capacity to work, live and exercise."
"I would not recommend vaping to stop smoking."
Bonning was enormously concerned by the speed at which teens were taking it up.
"Marketing a highly addictive and without doubt harmful substance to teenagers is like sneaking them alcohol at the age of 13. I think it's terrible and schools have such a problem policing it."
His message to young people: "Vaping is not cool. It's causing acute damage to your lungs with each vape you take. It's causing damage to your ability to breathe and exercise. And it's addictive, and we think it will be similar to smoking in terms of its long-term effects, it is history repeating itself."
What is vaping?
• Electronic cigarettes are generally comprised of a tank with a built-in "atomiser'' - a coil of wire wrapped around a wick - and a battery.
• The tank is filled with "e-liquid'' or "e-juice", which comes in a range of flavours. Some e-liquids contain nicotine.
• This is absorbed into the wick while the wire is heated by the battery. The heat vaporises the liquid in the tank, which is then inhaled by the user who produces smoke-like vapour when they exhale.
• There are a vast array of vaping devices available, some looking like traditional tobacco cigarettes.