Health concerns, fear of nicotine addiction and participation in sport are among the reasons South African high school learners choose not to vape or decide to quit, suggests a new study. Image: Renz Macorol/Pexels

Concerns about the health effects of vaping and nicotine addiction, along with a lack of appeal, are among the main reasons South African teenagers choose not to start vaping or decide to quit, according to a new international study involving a University of the Western Cape (UWC) researcher.

Co-authored by researchers from Utrecht University in the Netherlands and the University of Cape Town (UCT), the study, titled “Why Adolescents Choose to Stop or Never Start Vaping: Evidence From South Africa”, examined what motivates teenagers at high school level to never start using e-cigarettes or to stop vaping. Responses from over 11 000 learners at 52 fee-paying high schools across eight provinces were analysed as part of the study.

Among learners who had never vaped, 46% mentioned concerns about health and addiction as reasons for staying away from e-cigarettes. The same concerns were identified by 33.5% of those who had stopped vaping. Another important finding was that vaping appeared to lose its appeal for some adolescents over time. Lack of appeal was prominent among older learners who had stopped vaping, with 44% of Grade 12 learners who quit mentioning it as a reason. Sport, physical fitness and athletic performance also influenced some teenagers’ decisions. Overall, 13.5% of learners, mostly boys, who had never vaped and 14.4% of those who had quit, highlighted fitness or sporting considerations as the reason for never starting or quitting.

The research builds on an earlier survey of more than 25,000 learners conducted in 2023, which found that nearly one in six (16.8%) were current e-cigarette users, making vaping considerably more common than cannabis, hookah or cigarette smoking among those surveyed.

UWC researcher, Prof Maria Florence from the Department of Psychology, worked alongside lead researcher Asya van den Bosch and corresponding author Dr Sebastian Kurten, both from Utrecht University in the Netherlands, as well as UCT researcher Samantha Filby and pulmonologist Prof Richard van Zyl-Smit. The team analysed responses from 11,401 South African high school learners who had either never started vaping or had quit.

UWC researcher Prof Maria Florence co-authored the latest study. Image: Shelley Christians/UWC

Existing research has linked vaping, which is on the rise among young people, to respiratory symptoms including wheezing and shortness of breath, as well as conditions such as asthma and bronchitis. Nicotine-containing e-cigarettes have also been associated with cognitive harm among adolescents, with some studies reporting greater difficulties with concentration, memory and decision-making among users compared with those who have never used e-cigarettes.

Published in the journal Nicotine & Tobacco Research, the latest study found that only a few learners identified the cost or difficulty of accessing vaping products as reasons for avoiding or stopping vaping. Access and economic barriers were mentioned by only 2.6% of learners who had never started and 4.7% of those who had quit.

Researchers say the latest findings could help inform South Africa-specific prevention and cessation strategies, particularly as adolescent vaping continues to grow. They recommend combining education and awareness campaigns with measures that restrict young people's access to vaping products, including taxation and other economic interventions.

Prevention programmes may need to be tailored to different groups of adolescents rather than relying on a one-size-fits-all approach, given the findings. They argue that educational campaigns on the consequences of vaping and restricting access through increasing taxes on vaping products could be some of the options that might aid vaping prevention and cessation efforts.

“Some respondents also noted that they learned new things about vaping, which changed their minds, and they decided to stop. This suggests that our engagement in information and education is not a wasted opportunity,” said a South African principal investigator, Prof van Zyl-Smit.

Researchers concluded that the prominence of health and addiction concerns among these high school students highlights the importance of implementing awareness campaigns on the negative effects of vaping on health.

“With vaping losing appeal over time, reinforcing negative perceptions through ongoing education and health reminders might effectively support cessation efforts,” researchers concluded.