Vaping now in primary schools

Vaping in Australian schools is becoming widespread, with some students taking up e-cigarettes because they are seeing their peers vape.

Schools are increasingly expected to address an ever-expanding variety of societal issues affecting their students, ranging from physical fitness and obesity to bullying and mental health problems.

More recently, vaping has become a dominating concern that is impairing schools’ ability to deliver on their primary task of educating our young (here and here).

This state of affairs is occurring despite a regulatory system in Australia that bans the sale of e-cigarettes to minors, regardless of whether the devices contain nicotine.

Deceptive packaging

Adults can legally access nicotine e-cigarettes for cessation purposes with a prescription, and, in most states, they can also legally purchase non-nicotine e-cigarettes without a prescription. Whether an e-cigarette device is legal or not therefore depends on who is buying it and what it contains.

A confounding issue is that to side-step the legislation, e-cigarette packaging is often deceptive by either stating that the contents do not contain nicotine or under-reporting the amount of nicotine present.

This means that monitoring and enforcement of the legislation requires chemical testing to determine whether the products contain nicotine and that those choosing to access e-cigarettes without a prescription cannot know how much nicotine they are actually consuming.

And then of course there is the cocktail of other toxic substances in e-cigarettes, the harms from which have yet to be adequately measured or understood due to the relative recency of vaping.

“Rife” in schools

Recent studies show that vaping is now widespread in Australian secondary schools and is also becoming increasingly common in primary schools (here and here).

This is highly problematic for the health and wellbeing of young users due to the addictive nature of nicotine, the adverse effects of nicotine use on the developing brain, and the existence of a demonstrated pathway from vaping to cigarette smoking. A study recently published in The Medical Journal of Australia found the increase in young adults who use e-cigarettes undermines the claims that these products are designed for older smokers trying to quit.

Widespread student vaping also has substantial negative effects on classmates in the form of learning interruption and peer modelling.

Teachers report agitated and disruptive behaviour from students who vape before school and during breaks, and a primary motivation for young people to take up vaping is seeing their peers use e-cigarettes.

An Australian study that I co-authored showed that the most common areas on school premises where students observe their peers vaping are bathrooms and/or locker rooms (63%) and outside buildings, such as car parks and sports fields (53%).

Alarmingly, 26% reported seeing vaping occurring in classrooms. Schools are thus inadvertently becoming a major source of peer exposure to e-cigarettes, which in turn is fuelling the prevalence of youth vaping.

Students are readily sourcing e-cigarettes from peers, family members, online ordering sites, and retail stores. In a recent national survey, almost all of the sampled 15–17-year-olds reported that it is easy/somewhat easy to obtain e-cigarettes online (93%), and most reported that access via retail stores is easy/somewhat easy (81%).

Current regulations not strong enough

The current regulations are clearly not preventing widespread access among people aged under 18 years.

Of particular concern are reports of primary school students bringing their parents’ e-cigarettes to school. This highlights the critical importance of ensuring parents are appropriately engaged in vaping prevention efforts to close this access avenue.

Most school staff are concerned about student vaping, and few feel adequately supported to appropriately manage students who vape at school.

State governments and health agencies are responding by providing training and resources to assist school staff discuss the subject with their students and their families. Such efforts are much needed but must be constantly updated to accommodate the rapidly changing nature of the e-cigarette market.

The appearance of vaping devices is continually evolving, making them more difficult for school staff and parents to identify.

Current models resemble highlighter pens, lip gloss tubes, memory sticks, and necklace pendants. Some schools are installing vapour detectors in bathrooms, but e-cigarette devices and vaping techniques have evolved to minimise vapour output, making detection more difficult.

E-cigarettes are also evolving to become increasingly potent.

Ingesting the content a single disposable e-cigarette device is the equivalent of smoking 50 cigarettes.

It will take many years for the longer term effects of such high intake levels among children to become apparent, but the limited evidence available to date suggests multiple possible adverse outcomes, including poisoning, seizures, and lung injury.

How doctors can help

So what can doctors do to help stem the tide of child and adolescent vaping?

First, helping parents get off e-cigarettes can reduce exposure to vaping in the home and limit children’s access to the devices.

Patients can be encouraged to call Quitline on 13 78 48, which now provides cessation support specifically tailored to quitting vaping.

Second, equip yourself with the latest evidence and recommendations. Health agencies such as Quit and Lung Foundation Australia provide resources to assist health professionals understand and deal with patients’ vaping-related issues.

Third, be on the look-out for nicotine addiction symptoms among children and adolescents. These include coughing and wheezing, exacerbated asthma symptoms, decreased attentional capacity, and greater difficulty regulating their emotions (here and here).

Vaping is becoming increasingly common among both primary and secondary school students, and highly attractive and affordable vaping devices containing large amounts of nicotine are very accessible.

Previous assumptions about the age at which youth start using nicotine and in what quantities no longer apply.

Fourth, the Australian Medical Association (AMA) has been active in advocating for stronger enforcement of current vaping laws. Contact your local AMA branch for details on how you could assist with this action.

Fifth, the schools in your area are likely to be introducing a range of vaping-related policies, parent resources, and curriculum materials.

Engaging with school administrators to understand and support these activities could assist in presenting a united and consistent front in the battle to keep school children safe from e-cigarettes.

Without immediate change on a number of fronts, vaping risks causing great harm to many young Australians.

Professor Simone Pettigrew is the Director of Health Promotion and Behaviour Change at the George Institute for Global Health.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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