South Africa: Health professionals warn about adolescent vaping and mental health

According to a survey conducted in 52 high schools across South Africa, involving 25,149 students[1], 17.82 % of students, of the 4^e in the final year of high school, vape regularly, with a peak of 25 % among the final year students, and 47 % of these young people vape within the first hour of waking up, a sign of strong nicotine addiction[2]The survey also indicates that the phenomenon is even reaching primary schools. The South African Society of Psychiatrists (SASOPC) commented on these results, warning of the harmful consequences of this consumption for both the physical and mental health of young people, in a country where vaping products are still poorly regulated.[3].

Sasop psychiatrists highlight the link between vaping and mental health in young people

According to Dr. Nokuthula Mdaka, vaping is particularly attractive to young people. According to the survey, 36.7% of them reported having already tried vaping. Dr. Wisani Makhomisane warns of the impact on the physical health of these young people: The lungs are one of the problems. They're the part most directly affected. But there's also the brain, which is what SASOP is most concerned about. A conventional cigarette contains between one and two milligrams of nicotine, while a 5 % vape contains between 50 and 80 milligrams of nicotine, or even 137 milligrams. In other words, one vape is equivalent to 20 cigarettes in nicotine content. Added to this are other potentially toxic elements, particularly products used to enhance the strength of nicotine. Nicotine is a drug, a stimulant like cocaine. ".

Thus, it has adverse effects on brain development at a particular time in a young person's development, whose brain maturation continues until about age 25. According to the author, nicotine affects essential cognitive functions such as memory, learning, mood regulation, and impulse control. Dr. Wisani Makhomisane explains that " A young person has an immature brain because the frontal lobe, which is the part of the brain that thinks, analyzes, decides, and learns from mistakes, doesn't really mature until age 26. Anyone under 26 has an immature frontal lobe. So that's where impulsiveness comes from. " For Dr. Stacey Ocshe, nicotine provides temporary relief, but disrupts brain development and exposes adolescents to increased addiction: " Exposure to nicotine can alter neural circuits and neurotransmitter expression, which can lead to or worsen anxiety and depression. ". " There is a higher incidence of depression and suicidal thoughts among vapers. " she warns. " It affects learning, cognition and emotional stability. »[4].

Vaping is still poorly regulated by law in South Africa

The success of vaping among young people is partly explained by the products' attractive marketing: colorful designs and appealing flavors such as bubblegum, fruity, or dessert flavors. These flavors give the illusion of a harmless and trendy product. Targeting adolescents is carried out in particular through social networks and celebrities. The challenge of reaching this young audience lies precisely in the fact that during adolescence, decision-making and impulse control skills are still developing, which makes young people more vulnerable to addiction.

Although the sale of these products to those under 18 is illegal, teenagers easily access them, particularly through online purchases. Digital platforms, including those of major supermarket chains, offer these products without any real age checks, making them accessible.

The legislation is also unclear regarding the use of e-cigarettes in public places. Since they do not contain tobacco, tobacco laws cannot apply to them. The government is currently working on a bill, the Tobacco Product and Electronic Delivery System Control Bill, which is still being drafted. This bill aims to regulate the public use of cigarettes, address issues related to age restrictions, and regulate the sale of e-cigarettes online. Dr. Ocshe calls for " restrict access, regulate advertising and raise public awareness. ".

Dr. Makhomisane finally emphasizes the role of health education. As with alcohol or drugs, parents must set clear limits and say no. Less harmful does not mean safe. ".

South Africa is facing significant challenges in implementing measures to combat vaping and also measures to reduce tobacco consumption. While it is currently considering the introduction of plain cigarette packaging, as Burkina Faso, Ivory Coast and Mauritius have already done, it remains a country that is generally very vulnerable to tobacco industry offensives. In 2020, industry-backed groups successfully lobbied the government to keep cigarette taxes unchanged at 40 % of the retail price, knowing that the rate recommended by the WHO Framework Convention on Tobacco Control (FCTC) is 75 %[5]In 2024, Philip Morris International (PMI) also funded continuing medical education (CME) courses focused on harm reduction. These courses, aimed at healthcare professionals, presented e-cigarettes and heated tobacco products as safer options than traditional smoking.[6].

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[1]N. van Zyl-Smit R., Filby S., Soin G., Hoare J., van den Bosch A., Kurten S., “Electronic cigarette usage among high school students in South Africa: a mixed methods approach”, eClinicalMedicine, December 2024, Volume 78, 102970, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00549-2/fulltext

[2]Ntini Nandi, The Quick Interview | Vaping affects adolescents' mental health, Sowetan Live, published May 5, 2025, accessed May 5, 2025

[3]South African Society of Psychiatrists, Teen vapers risk harm to their mental health, accessed May 6, 2025

[4]Rahim Neelam, Vaping Crisis Among Teens Raises Mental Health Red Flags, Radio Islam, published May 4, 2025, accessed May 5, 2025

[5]Tobacco-free generation, Africa: Tobacco industry interference makes it difficult to implement anti-smoking measures, published August 5, 2023, accessed May 5, 2025

[6]Tobacco-free generation, Tobacco Industry's Infiltration into the Medical World, published January 11, 2025, accessed May 5, 2025

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