This story was published on May 27, 2023 and resurfaced as the Patrick Gower on Vaping documentary was released on Tuesday night.
If you put the vapes confiscated from intermediate schools in a single region in a pile, Megan Rangiuia imagines they would make a small mountain. The principal of Ilminster Intermediate in Tairāwhiti Gisborne pulls out a photograph of the vapes she confiscated off pupils at her school of 300. In any other setting, the plastic, colourful tubes might resemble an art work. But among 10- to 12-year-olds – tweens who are influenced by what is in vogue – Rangiuia noticed that vaping became cool about three years ago, inspired by the smoke signals coming from TikTok.
Australia has begun a war on e-cigarettes, alarmed that vaping has become a serious public health issue. In New Zealand, some health experts also want a war, while others are calling for something more like an intervention. On one side are anti-tobacco lobbyists such as ASH (Action on Smoking and Health), who argue that vapes help smokers quit and any restrictions will encourage a return to cigarette smoking. Against them, and arguing for war, are many doctors, educators and community workers who fear our liberal vaping environment has created a new generation of nicotine addicts – young people and nonsmokers who might never have touched a cigarette are now vaping regularly.
According to a November 2021 study of secondary school students by the Asthma and Respiratory Foundation, one in five teens uses an e-cigarette daily. Another study, by ASH, found the number of Year 10 students vaping daily tripled between 2019 and 2021. Māori women and girls are a particular concern to health groups – a quarter of Year 10 Māori wāhine vaped daily, up from 21% a year earlier.
There are concerns about rising nicotine addiction, the impact on adolescent brain development and other health effects (see “Health cloud”, page 18). The Royal New Zealand College of GPs is one of the medical groups calling for vapes to be regulated and offered as prescription-only, in line with Australia’s moves.
As the Smokefree 2025 goal looms, the burning question is, has the government prioritised smokers – dangling vapes as a means to get them off cigarettes – without giving enough thought to young vapers taking up the habit who think e-cigarettes are cool and harmless? There is also criticism that commercial interests have been put ahead of health ones: when the Ministry of Health set up a technical advisory committee on vaping in 2017, a third of its nine members were from the vaping industry.
Middlemore Hospital respiratory physician Dr Stuart Jones is concerned that vaping has replaced smoking as a public health issue. He worries about long-term health effects. “We’ve got ourselves in a bit of a mess in New Zealand. We’ve got 20% of secondary students vaping high levels of nicotine because we’ve been far too lenient about what is allowed here.’’
Debate is swirling like a cloud of watermelon-flavoured vapour as Health Minister Ayesha Verrall reviews 2700 submissions on proposed changes to the vaping regulations. The Proposals for the Smoked Tobacco Regulatory Regime were released in January and consultation closed in March. Suggestions include stopping specialist vape stores opening near schools and restrictions on flavour descriptions, so names that appear to target children such as “gummy bears’' and “cotton candy’' are banned. They come just 2½ years after the Smokefree Environments and Regulated Products (Vaping) Amendment Act came into force.
Asked about placing limitations on the sale of disposable vapes – the $10-a-pop e-cigarettes that are easy to buy and use because they are sold as one unit, pre-filled and pre-charged – a ministry spokesperson said: “The government has acknowledged the regulatory balance is currently not quite right,” and this had led to the further proposals.
Verrall told the Listener she is worried about the rise in youth vaping. “The intent of our vaping law is to strike a balance between preventing the uptake of vaping among children and young people and supporting people who smoke to switch to a less harmful product,” she says. “We do want to see a reduction in youth vaping and will look at all of the proposals.”
An announcement on regulatory changes is expected in the second half of this year.
On their own
Megan Rangiuia and many others interviewed by the Listener want action quickly, before more young people get hold of a device. Three years ago, she began confiscating vapes while also running education programmes in her school about the dangers of vaping.
Vaping at her school has dropped off, but not without a lot of hard work. And it’s hard for the kids, she says, because vape stores are alluring and the Tairāwhiti region is saturated – it has 29 vape stores (the country’s most per capita), including specialist retailers, dairies and petrol stations. On the city’s main street, there are eight.
Gisborne Intermediate principal Andy Hayward is similarly frustrated, as teachers regularly confiscate vapes. “Vaping has become a far bigger problem than smoking ever was,” he says. “Vaping is easier to hide than smoking and the flavours, packaging and variety are aimed at enticing kids. Having strawberry ice-cream, watermelon, and candy floss flavours shouldn’t be allowed. Many of these kids would never have smoked. Unfortunately, vaping has become cool. It smells nice and a whole lot of kids are trying it.’’
Schools dislike having to be punitive by confiscating vapes and in some cases suspending or standing down students regularly caught with vapes.
The devices are easy to get, despite the minimum age limit of 18 to buy them. Older siblings leave them lying around, or kids manage to buy them even though they’re too young. Disposable ones in particular appeal to the young.
Despite the efforts in Tairāwhiti, there is no formal education programme for those working on vaping in schools. The ministry says it has the Protect Your Breath website and its social media campaign to try to get young people off the habit. “Those choosing to quit vaping can discuss reducing their nicotine levels with a specialist vape retailer, their GP or other health professional,’’ a ministry spokesperson says.
The Asthma and Respiratory Foundation’s first Māori community liaison officer, Sharon Pihema, runs workshops in Tairāwhiti schools and the wider community, telling pupils as young as nine about the dangers of vaping. “I’m trying to get the key messages out there and to raise awareness,” she says, “but once you have kids who want to quit, there’s nothing out there – no resources, no support, no programme.”
Australia cracks down
As the government considers next steps, points most agree on are the need for stricter rules around access and availability, sales to under-18s and nicotine limits. Many also agree that disposable vapes need to be banned or restricted. Our current nicotine limits are high by international standards. The government is considering a proposal to reduce maximum nicotine levels in single use vapes to 20 mg/ml, which Verrall says is in line with the limit in the UK.
What was not in the consultation document were pharmacy-only vape sales, a restriction that Australia has just announced. Reforms there will include removing vapes from retail stores, plain packaging and plain flavour requirements, and bans on single-use disposable vapes and importation of non-prescription vaping products. Here, however, Action for Smokefree 2025 director Ben Youdan, of ASH, describes the Australian crackdown as “dangerous’', bringing the risk that vapers will return to smoking because cigarettes will be easier to buy than a vape. The 14% of young Australians who vape are a particularly vulnerable group, he argues: if they find it hard to get one, will they turn to cigarettes?
Our teens, he says, aren’t smoking at the rate they were two decades ago. In 2000, 15.2% of Year 10s smoked daily. That has dropped to an all-time low of 1.1%. A packet of cigarettes is now about $35.
If New Zealand restricts vape sales, he fears the country could see a rise in ex-smokers puffing again and young vapers moving on to cigarettes.
However, Youdan is also concerned about the rise in young people vaping and wants tighter controls on disposable vapes. “The gains from their convenience to adults who smoke and want to quit are not necessarily outweighed by how appealing they have been to young never-smokers.”
Wrong signals
In the Greater Wellington-Kāpiti-Wairarapa region, Catherine Manning and her team at the Takiri Mai te Ata Regional Stop Smoking Service are at the coalface helping people to get off cigarettes. But over the past few years, they have worked more with vaping addicts in schools and the community, even though they are not specifically funded for vaping cessation. Manning is angry that vaping has got out of control and that the first regulations in late 2020 – a ban on advertising and under-18 sales – came far too late. “There was a little eight-year-old girl who got stood down from school a few weeks ago. She had eight vapes in her possession. They’re stealing their future.
“The messages [out there] are unhelpful. What these kids hear is that vaping is not harmful.”
A team member, Chelus Knowles, works exclusively with rangatahi, whānau and schools in vaping support and education. Manning talks about many of the sad cases, like the 11-year-old boy found with 45 vapes in his school bag. “Organisations like ASH are sitting there fighting for a product that is creating profit off the back of our kids. I can’t even begin to tell you the enormity of this problem. Everyone who is working in the youth space will tell you that’s the case.’’
She argues ASH’s fears about smokers retreating to cigarettes are “a distraction. It’s the same argument the tobacco industry has, that smokers are going to get things on the black market [if restrictions are imposed]. It’s unhelpful for those who don’t work in our area of expertise, who are not Māori and not Pacific, who are creating these huge loud voices around what is best for us. It’s very paternalistic. Who decided that they were going to save us?’’
Trying to crush the vaping industry is Letitia Harding, who took over as CEO of the Asthma and Respiratory Foundation in 2017. Since then, she has been pushing for greater regulations and controls on vaping, and providing educational resources and support for schools and communities. She was recently awarded the Thoracic Society of Australia and New Zealand President’s Award for 2023 for her advocacy and education against vaping.
Harding wants the final 387,000 or so smokers to quit, but argues their needs have been put ahead of youth and non-smokers who misguidedly think a vape is harmless.
Based on ASH’s Year 10 smoking and vaping survey, she says, the number of young vapers using nicotine daily now far exceeds the number of that cohort who have kicked the smoking habit.
“The data does not show a displacement effect, and overall, daily use of nicotine has markedly increased from 2018 to 2021.’’
The survey shows daily smoking rates fell from about 2% in 2019 to 1.3% in 2021. But the vaping rate rose from 3.1% in 2019 to 9.6% in 2021.
“Vaping should be by prescription, with support to get off smoking. Now, for those few [smokers], we’ve exposed all our kids to this problem, which I think is a travesty.”
She is worried about the influence of tobacco giants on the vaping industry – Big Tobacco is both normalising vaping and recruiting the next nicotine-dependent generation, she says, through tactics such as product placement in Netflix programmes and Formula One motor-racing sponsorship.
At last count, there were 1264 vape stores in the country – double the number a year ago. According to an Official Information Act response Harding shared with the Listener, less than 2% of applications from specialist retailers to the Vaping Regulatory Authority have been declined. “They’re too easy to set up and they’re poorly regulated. It’s ridiculous we’ve got so many.’’
She argues the legal age should be raised to 21, vape stores banned within a kilometre of schools, disposables pulled off shelves and a moratorium imposed on new stores.
Education programmes targeting schools are needed, she says, along with support for addicts to quit vaping. “There are no services for those with a nicotine dependency. There is no national group that will help any young people who are dependent on vapes.”
Means to an end
Verrall proudly says the country is on the path to stamping out smoking, which causes the premature death of about 5000 New Zealanders a year. The percentage of people who smoke daily has fallen to 8% of adults, from 14.5% seven years ago. By April 1, 2025, the goal is that less than 5% will be smokers and those born after 2009 will not be able to legally smoke. Only cigarettes with very low levels of nicotine will be available.
“These are bold measures to get us to our Smokefree goal and I am unapologetic about taking these steps,” says Verrall. “There has been a dramatic reduction in smoking rates, and the availability of vaping is part of the reason for this reduction.’’
Youdan sees vapes as the best tool to whittle down rates of smokers and says a Cochrane analysis of international studies found they worked better than nicotine replacement therapy.
But Middlemore’s Stuart Jones disagrees. “The new Smokefree legislation will enable us to achieve our Smokefree goals within a few years, and they didn’t need vapes to be introduced.’’
Māori smoking rates have dropped, although Māori are still not quitting at the same rate as Pākehā. But the rising number of young Māori vaping – particularly wāhine – concerns many working in Māori health and addiction.
At Hāpai Te Hauora (Māori Public Health), National Tobacco Control Advocacy Service team lead Leitu Tufuga says vapes can help Māori to transition off cigarettes, “but we are now grappling with a surge of rangatahi vaping who are not using vape products as a quit tool’.’
A rangatahi issue
The agency’s Andrew Waa, a public health researcher specialising in Māori health and tobacco addiction, says addiction is “very much a part of the Māori colonisation story’' and vapes can help those who find it hard to quit cigarettes
“But there are a lot of people who didn’t smoke who are vaping,” says Waa.
“The vaping issue is very much an issue for rangatahi. Vaping should not be our legacy to that generation.”
The Otago University associate professor says it’s a “no-brainer’' to get rid of disposable vapes, as they’re cheap, designed for people who have never vaped, and young people like them.
Vapes need to be more appealing to smokers than cigarettes. “But they don’t need a lot of flavour choices and fancy packaging.”
Daily vaping rates are now the same as smoking rates among youth in the mid-2000s, he says, which means they are getting the same nicotine exposure or more.
“Yes, vapes are much less harmful for a smoker trying to get off cigarettes. But vapes taste good, there is not the harshness, and for those who have never smoked, it’s quicker to get addicted to vapes than to cigarettes.’’
The industry, which is predicted to grow to US$43 billion globally this year, needs to recruit new vapers, “and that’s our young people”. l