Has vaping become the 2022 equivalent of sneaking a fag round the back of the bike sheds? Sarah*, an English teacher and behavioural leader at a secondary school in the North of England, certainly thinks so.

“More and more, it’s becoming a massive issue in my school. We have kids vaping here on a daily basis. We suspect that it’s going on at every break time, every lunchtime, in every toilet. Our kids would never dare have a cigarette in the school toilets but they’ll vape because they know you can’t really smell it and you can’t really prove who it was,” she says.

It is illegal for children under the age of 18 to purchase or use e-cigarettes but that doesn’t seem to stop younger pupils getting their hands on them. Sarah says that, at her school, the problem is most common in Years 10 and 11, but that it is affecting Year 8 and 9 pupils, too.

And it’s not only happening in her school. In fact, the most recent figures from the UK charity Action on Smoking and Health (Ash) found that 11.2 per cent of 11- to 17-year-olds in the UK tried vaping in 2021. It’s less common in the under 16s: 6.5 per cent of 11- to 15-year-olds have tried vaping while, for 16-17 year olds, that rises to 23.2 per cent, and for 18-year-olds, it’s just under a third.

Although Ash’s findings suggest that few children and young people vape to look “cool” (just 1.2 per cent of 11- to 18-year-olds cited this as a reason for e-cigarette use in the Ash survey), Sarah believes that social media is responsible for normalising and glamorising the activity - and that this is having an impact on pupils’ habits.

“Socially, there has been a shift, where smoking is perceived as a dirty habit and vaping is seen as a desirable alternative,” she explains. “It’s all over social media, particularly TikTok. Influencers will be vaping in a TikTok video like they’re just having a drink. Kids are just really exposed to it. They see the people they aspire to be like doing it so they start vaping, too.”
 

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Sarah’s observations are echoed by a study published last year from researchers at the University of Queensland in Australia, which found that 63 per cent of e-cigarette content on TikTok portrays vaping in a positive light. The researchers estimated that a quarter of people in the videos appear to be under 18 and they say there is an “urgent need” for age restrictions on accessing such videos.

“Adolescents are susceptible to peer influence, increasingly via social media, and this is a concern when emerging evidence suggests vaping has detrimental effects on the developing brain, lungs and heart,” said study co-author, Dr Gary Chan.

It doesn’t help that vapes are not-so-subtly marketed to appeal to children and young people, with their bright colours and appealing flavours - think banana, bubble gum, lychee - which are reminiscent of products found on the sweet shelves.

Vaping as a gateway?

So, just how worried should teachers be? Opinion, it seems, is divided on that. The World Health Organisation released a report last year saying vaping is “harmful” and that regulation must be tougher to protect children and teenagers. It also warned that e-cigarettes could act as a “gateway” to conventional cigarettes.

In a 2020 study, published in the journal Addictive Behaviours, researchers found that 15- to 27- year-olds who had used e-cigarettes had seven times higher odds of becoming smokers a year later compared with those who had never vaped.

However, Dr Venetia Leonidaki, a clinical psychologist specialising in addiction, says that it is not yet clear whether the “relationship between vaping and smoking is causal or due to common liability, meaning that other factors may make certain individuals more vulnerable to both smoking and vaping”.

Deborah Arnott, Ash’s chief executive, agrees that the scale of the problem isn’t yet critical. She says that while, in the US, there’s “hysteria” about vaping being an “epidemic” among young children, “we don’t see that evidence so much in the UK”.

However, for those children who are vaping, what are the health implications?

Vapes work by heating a liquid that becomes a vapour, which users can inhale. They usually contain nicotine, the chemical which makes cigarettes addictive, but they don’t contain tobacco, the harmful, cancer-causing element of cigarettes.

The mechanism of creating vapour is also part of what makes them safer, in theory, says Arnott: “Smoking is highly addictive because you’re inhaling smoke into your lungs; it allows the nicotine to transmit very rapidly to the brain. It’s not quite the same with e-cigarette vapour. It tends to be slower,” she explains.

Vapes are marketed as the safer alternative to cigarettes and, in the UK, they are regulated by the Medicines and Healthcare products Regulatory Agency.

A review of the evidence to date, commissioned by Public Health England, reported that “best estimates show that e-cigarettes are 95 per cent less harmful to your health than normal cigarettes”.

But when it comes to the long-term effects that vaping might be having, particularly on younger users, the reality is that we don’t yet know much about this.

“There is moderate evidence to indicate that e-cigarettes have an adverse effect on physical health. Their adverse effects primarily impact on the cardiovascular and respiratory systems. However, we don’t know enough about how great this risk is,” says Leonidaki.

“Adolescence is a time when important changes happen in the brain and concerns have been reported about how nicotine from e-cigarettes could interfere with brain development. However, more research is needed before we can draw definite conclusions.”

Meanwhile, a recent study, published in the journal Thorax, found that exposure to second-hand nicotine from vaping is linked with a heightened risk of coughing, wheezing and shortness of breath in young adults - the participants in the study had an average age of 17 - who don’t vape or smoke themselves.

The role of schools

Beyond the health risks, there are also the behaviour implications that come with vaping in schools.

Anecdotally, for example, some teachers have reported students asking to use the toilets in the middle of lessons when, actually, they are skipping out to vape. And there is another layer of concern that is becoming apparent: vapes that contain illegal substances are finding their way into the hands of children and young people.

Recently, there have been cases of children needing emergency medical treatment in schools after unwittingly vaping fake cannabis oil laced with Spice (a substance containing synthetic cannabinoids, where the effects can be much stronger than natural cannabis - for example, breathing difficulties, heart palpitations).

Last May, ambulances were called to a high school in County Armagh, Northern Ireland in two separate incidents, whereby pupils had unwittingly vaped Spice after thinking they were purchasing THC (the main compound in cannabis) or cannabis oil.

Meanwhile, the recent Greater Manchester Testing and Research on Emergent and New Drugs report, found that teachers in the area have rushed children as young as 12 to hospital after they unknowingly vaped Spice. It’s reported that these children have been targeted by drug dealers on social media platforms, such as Snapchat.

A health service manager in Oldham told the report: “There has been [an] increase in referrals stating vape use. We have seen an increase in A&E attendances that states ‘vape unknown substance’ symptoms that suggest they have vaped Spice.”

Arnott also points to instances of young people in the US vaping vitamin E acetate from which “there are acute effects,” she says. “Vaping cannabis oil corrupted with vitamin E acetate has been associated with an outbreak of serious lung injury and death in the US, but it’s not linked to vaping legal nicotine-containing e-cigarettes,” she says.

She cautions that while we should not conflate “vaping nicotine-containing e-cigarettes with vaping Spice, vitamin E acetate or contaminated products”, there is still cause for concern here.

“Teenagers are risk takers, so they do all sorts of risky things, not just smoking or vaping,” she points out. “Is vaping so much worse than anything else? If you’re vaping unknown substances or toxic chemicals, then yes.”

So, what can schools do to tackle the problem? There isn’t a simple solution, although one teacher we spoke to is considering the installation of vape detectors in school toilets.

For Sarah, the problem is swallowing up swathes of staff time and resources. “We do on-the-spot bag searches regularly, we do searches of the toilets regularly. We search lockers and, if we find anything, the pupil is given a fixed-period suspension. It’s taking up a lot of staff time because it’s becoming an increasing issue,” she says.

Meanwhile, secondary school teacher Hetty Steele believes that education starts in the science classrooms. “Our science colleagues have a key part to play in discussing vaping devices when their curriculum covers the dangers of smoking,” she says.

“At our school, there is already a PSHE scheme of work in place that covers the dangers of both smoking and vaping. It might help to encourage our young people to think critically about the industry, and ask them to consider why large tobacco companies have bought e-cigarette brands, if vaping is meant to be a ‘safer alternative’ to smoking.”

Many schools will already be building this type of learning into PSHE schemes but, for Arnott, the greater worry will always be children and young people who smoke conventional cigarettes.

“Vaping in schools is clearly undesirable: it’s not risk-free, it’s age restricted and schools need to take firm action to stop it happening,” she says.

“However, at the same time, it is important that teachers make clear to children that by far the greatest risk to their health is from smoking. Two-thirds of those trying just one cigarette go on to become daily smokers and half of long-term smokers die prematurely after having suffered years of serious disease and disability caused by smoking.”

That isn’t to say that teachers should turn a blind eye to pupils sneaking off to vape behind the bike sheds - rather that keeping cigarettes out of schools should still be the most pressing concern.

*name has been changed.