E-cigarette use has risen sharply among South African youth, exposing them to a triple burden of potential adverse impacts: nicotine addiction, financial hardship and compromised nutrition.

These are among the troubling findings of research by the Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM) group within UP's School of Health Systems and Public Health, released on 30 May 2023 ahead of World No Tobacco Day (31 May) in line with the theme: “We need food, not tobacco”.

The preliminary research findings from a survey conducted in 2021 among 6 081 young adults aged 18 to 34 show an association between the use of e-cigarettes, or “vaping” devices, and potential health risks and socioeconomic consequences.

The research notes a possible link between e-cigarettes and poor nutrition, having found that the consumption of unhealthy food is more common among tobacco smokers and e-cigarette users than among non-smokers and non-vapers.

Just over 53.8% of smokers in the study reported unhealthy diets and the figure for e-cigarette users was 51.3%. The daily fruit and vegetable intake of both groups was also lower than for non-smokers and non-vapers.

This could be attributed to two main factors – the money spent on smoking and e-cigarette products and the perception among some adolescents that e-cigarettes can assist with weight loss.

“The youth surveyed reported a median monthly spend of about R250 on e-cigarettes,” says Professor Olalekan Ayo-Yusuf, Director of the Africa Centre for Tobacco Industry Monitoring and Policy Research, adding that the marketing strategies that e-cigarette companies use to target young people, enticing them to start “vaping”, are concerning.

“This not only increases the risk of addiction and adverse health effects, but also diverts limited resources away from essential food purchases, potentially comprising their nutrition and development,” he says.

The research found that e-cigarettes sales, especially the fruit-flavoured varieties, increased “exponentially” following the launch of British American Tobacco’s Vuse brand in an online, youth-friendly live-streaming concert in June 2021.

Closing the regulatory gap and raising public awareness

“E-cigarette use has become a significant public health concern in South Africa, particularly among the youth population who would otherwise not have picked up a nicotine addiction,” Prof Ayo-Yusuf says.

The ATIM advocates a comprehensive and multifaceted approach towards addressing the issue of e-cigarettes and unhealthy diets, based on raising public awareness, closing the current regulatory gap and making fruit and vegetable consumption easier and more attractive.

Efforts to raise public awareness should focus not only on the dangers and risks of using e-cigarettes but also on the benefits of consuming fruit and vegetables. These messages should be carried across in public health campaigns, in the school curriculum and social media campaigns, targeting young people in particular.

Social media campaigns should draw the attention of the youth to “the negative consequences of vaping and unhealthy dietary habits, particularly highlighting the potential interconnections between the two behaviours”, says Prof Ayo-Yusuf.

The ATIM’s second recommendation is to introduce restrictions on the sale, marketing and use of e-cigarettes.

“There is a regulatory gap in South Africa with regards to the sale, marketing and use of vaping products, which has allowed for their increased accessibility and attractiveness to the youth,” Prof Ayo-Yusuf explains.

To close the gap, legislation should be enacted to restrict the marketing and advertising of e-cigarettes, particularly that targeting youths. The ATIM suggests placing limitations on point-of-sale advertising and on advertisements for flavoured e-cigarettes.

Focus on retail shops and partnerships with farmers

It also recommends prohibiting e-cigarette advertisements near schools, recreational spaces and other places frequented by youths, and establishing “buffer zones” where the display and promotion of e-cigarettes are prohibited.

The third recommendation is to encourage young people to transition from vape shops – the most reported purchase channel – to fruit and vegetable shops.

Retail stores should increase fruit and vegetable options and be more youth-friendly in their options, such as by making point-of-sale displays more attractive and offering a wide range of fresh produce.

Partnerships between local farmers/vendors and schools and community centres should be encouraged to establish regular farmers’ markets to provide accessible and affordable options for youths to buy fresh produce.

“By implementing these proposed measures, we can address the rising sales of e-cigarettes among youths, mitigate their exposure to advertisements, and encourage healthier dietary habits,” Prof Ayo-Yusuf says.