A troubling new study has revealed that South African high school pupils are vaping at dramatically higher rates than adults, raising fresh concerns about nicotine addiction among teenagers and the lack of effective regulation in the country.
Published in November 2024 in The Lancet journal eClinicalMedicine, the peer-reviewed study surveyed more than 25 000 pupils across 52 schools in eight provinces. Researchers found that 16.83% of high school pupils currently vape, nearly eight times higher than South Africa’s official adult vaping rate of 2.2%.
‘Unprecedented nicotine dependence’
The research was led by Professor Richard van Zyl-Smit from University of Cape Town and Groote Schuur Hospital, who described the levels of nicotine dependence among teenagers as “unprecedented”.
The findings become even more concerning in higher grades. Among Grade 12 pupils, vaping rates climbed to an average of 29.5%, with some schools recording figures as high as 46%.
Signs of nicotine addiction
Researchers also found that nearly half of teenage vapers reported using their vape within the first hour of waking up, a recognised sign of nicotine addiction.
The study revealed that:
- 36.71% of pupils surveyed had tried vaping at least once
- 16.83% currently vape
- 47% of teen vapers use nicotine shortly after waking
- vaping rates increase sharply with age and grade level
Unusual pattern
Experts say South Africa’s pattern is unusual compared to countries such as the UK and the US, where adult vaping rates are generally higher than youth rates because vaping products were initially introduced as smoking cessation tools for adult smokers.
According to vape retailer Ecigone, South Africa’s youth-to-adult vaping gap is among the widest recorded globally.
A spokesperson for the company said the issue points less to the products themselves and more to the lack of a functioning regulatory system controlling access.
Despite e-cigarettes technically being classified as prescription-only medicinal products in South Africa, they remain widely available in convenience stores, vape shops and online platforms, often with little restriction.
Regulation of e-cigarettes in pipeline
South Africa’s proposed Control of Tobacco Products and Electronic Delivery Systems Bill, first gazetted in 2022, aims to regulate e-cigarettes similarly to tobacco products. The bill includes proposed restrictions on marketing, online sales to minors and sales near schools, but it has yet to be implemented.
Further research published in the South African Medical Journal earlier this year found that vaping among teens is also closely linked to the use of other substances.
The follow-up study reported that:
- 34% of teen vapers also used at least one other substance
- 22% used cannabis
- 13.5% used hookah
- 10.1% smoked traditional cigarettes
Researchers also found higher rates of dual substance use in co-educational schools compared to single-sex schools.
Health experts warn that delayed regulation could make the problem significantly harder to contain as vaping becomes increasingly normalised among teenagers.
- A study published in The Lancet eClinicalMedicine found that 16.83% of South African high school pupils vape, nearly eight times the adult vaping rate of 2.2%, with rates reaching 29.5% in Grade 12 and up to 46% in some schools.
- Nearly half of teen vapers use nicotine within the first hour of waking, indicating high levels of nicotine addiction described as "unprecedented" by lead researcher Prof. Richard van Zyl-Smit.
- South Africa shows an unusual youth-to-adult vaping gap, attributed largely to ineffective regulation despite e-cigarettes being classified as prescription-only medicinal products but widely available without restriction.
- The proposed Control of Tobacco Products and Electronic Delivery Systems Bill aims to regulate e-cigarettes similarly to tobacco, including marketing and sales restrictions, but has not yet been implemented.
- Additional research shows teen vaping is linked to higher use of other substances: 34% use at least one other substance, including cannabis (22%), hookah (13.5%), and traditional cigarettes (10.1%), with higher dual use in co-educational schools.
A troubling new study has revealed that
Researchers also found that nearly half of teenage vapers reported using their vape within the first hour of waking up, a recognised sign of nicotine addiction.
- 36.71% of pupils surveyed had tried vaping at least once
- 16.83% currently vape
- 47% of teen vapers use nicotine shortly after waking
- vaping rates increase sharply with age and grade level
Experts say
A spokesperson for the company said the issue points less to the products themselves and more to the lack of a functioning regulatory system controlling access.
Despite e-cigarettes technically being classified as prescription-only medicinal products in
- 34% of teen vapers also used at least one other substance
- 22% used cannabis
- 13.5% used hookah
- 10.1% smoked traditional cigarettes
Researchers also found higher rates of dual substance use in co-educational schools compared to single-sex schools.
