A University of Cape Town-led study revealing startlingly high levels of vaping among South African high school learners – nearly 30% of Grade 12 learners reporting active use – adds weight to the debate over the Tobacco Products and Electronic Delivery Systems Control Bill.
The Bill, which was introduced in December 2022, is before Parliament, awaiting final approval. It aims to replace the Tobacco Control Act and align South African legislation with the World Health Organization’s Framework Convention on Tobacco Control.
The Bill seeks to address the rising health risks associated with smoking and vaping, particularly among young people. With the increasing popularity of e-cigarettes, it introduces stricter regulations on their sale and marketing, including limitations on flavours and packaging that may appeal to minors. Additionally, it mandates standardised tobacco product packaging with graphic health warnings and reduced branding to minimise the products’ appeal.
Other provisions are expanding smoke-free areas, removing tobacco and vaping product displays at points of sale, and banning vending machines selling these products.
While public health advocates strongly support the Bill, arguing that these measures are crucial for reducing smoking and vaping, the tobacco and vaping industries have raised significant concerns. They argue that the Bill could harm businesses, particularly small vape shops, and restrict consumer choice, suggesting that the regulations might be too stringent for alternatives to traditional cigarettes.
Vaping epidemic among South Africa’s youth
The study, which involved more than 25 000 learners across 52 schools, was published in The Lancet EClinicalMedicine.
The study found that 16.8% of high school learners have vaped in the past 30 days, with the prevalence increasing sharply by grade, reaching 29.5% among matriculants and in some schools as high as 46%. According to UCT, this is juxtaposed against significantly lower reported rates of tobacco cigarette use (2%), cannabis use (5%), and hookah pipe use (3%).
Interestingly, vaping rates varied across schools of different fee structures. Learners at schools charging annual fees between R20 000 and R40 000 had the highest vaping rates (19.5%), compared to 14.6% at schools charging more than R90 000 a year.
According to Professor Richard van Zyl-Smit – a pulmonologist, UCT academic and leading expert in tobacco and vaping research at Groote Schuur Hospital – the findings emphasise the highly addictive nature of vaping products.
“This rate of vaping is of particular concern among adolescents due to the highly addictive nature of nicotine,” says Van Zyl-Smit. “Nicotine use during adolescence can harm the developing brain, with potential long-term effects on learning, memory and attention. Alarmingly, it also increases the risk of progression to conventional cigarette smoking.”
The study’s approach to measuring addiction found that between 40% and 60% of learners who vape are likely addicted to nicotine, with many reporting withdrawal symptoms, such as needing to vape immediately after waking.
The research team emphasises that punitive approaches by schools and parents may not be effective. Instead, interventions should address nicotine addiction and provide support for emotional well-being and stress management.
“This data equips us with the evidence needed to shape policies that regulate access, marketing and advertising of vaping products to adolescents,” said Van Zyl-Smit. “Prevention must start as early as junior school, given the high rates already observed among Grade 8 learners.”
Vaping – how it affects life insurance
According to an article published on insurance.com, vaping involves inhaling a liquid solution from an e-cigarette or another electronic smoking device. Unlike traditional cigarettes, e-cigarettes produce an aerosol that users inhale or exhale. Though the aerosol does not contain tobacco, it does consist of nicotine and other toxic chemicals. Health officials warn those chemicals can adversely affect lung health.
Michael Blaha, director of clinical research at the Ciccarone Centre for the Prevention of Cardiovascular Disease at Johns Hopkins Medicine, says there are many unknowns about vaping, including what chemicals make up the vapor and how they affect physical health over the long term.
“People need to understand that e-cigarettes are potentially dangerous to your health,” says Blaha. “Emerging data suggests links to chronic lung disease and asthma, as well as associations between dual use of e-cigarettes and smoking with cardiovascular disease. You’re exposing yourself to all kinds of chemicals that we don’t yet understand and that are probably not safe.”
As the health risks of vaping become more widely recognised, the practice is increasingly influencing life insurance coverage and rates. In South Africa, as in many other countries, insurers typically treat vaping similarly to smoking when determining life insurance premiums. This is because both smoking and vaping involve the inhalation of nicotine, which poses health risks such as lung diseases that can shorten life expectancy.
Given these factors, insurance companies often classify individuals who vape in the same risk category as smokers, which can lead to higher premiums. For example, life insurers generally do not differentiate between smoking and vaping on their applications, so both can result in being categorized as high-risk.
In an article published on hippo.co.za, Arthur Zerf, head of iWYZE Life at Old Mutual iWYZE, explains that their definition of a smoker includes the use of tobacco, nicotine, or any nicotine-substitution products.
“This means not only cigarette, pipe or cigar smoking, but also the consumption of any products containing nicotine such as patches, chewing gum, vaping, snuff or other organic substances. Customers who vape are charged the same as customers who use any other tobacco, nicotine or any nicotine substitution products.”
Regarding claims for illness, insurers reserve the right to review the policyholder’s declarations. Zerf adds, “At claim stage, we are guided by the medical evidence provided for the claimable condition. If the evidence indicates that the client has a history of smoking and was a smoker at application stage, we reserve the right to review the original underwriting terms and possibly reconstruct the policy from inception with the correct rates keeping the premium constant.”
The approach to claims is consistent with how insurers assess risk at the underwriting stage, says Zerf.
“In a nutshell, smoker rates would be applied from inception.”
