Vapes - cool, colourful and unhealthy

They look like glow sticks, the e-cigarettes: they come in red, green, blue, yellow or pink. And they taste like sweets: gummy bears, apple, blueberries, cool mint or lychee ice. Some kiosks have them right next to the chewing gum. There are thousands of flavours on the market. What's more, the disposable Puff Bar e-vaporisers, which have been available since 2020, are cheap and practical: they are loaded and filled. You can start using these vapes, as young people call them, straight away and start vaping. They are so small that they fit in a trouser pocket and can be consumed inconspicuously.

Vapes are particularly popular with girls: 30 per cent vape at least once a month.

Influencers show how to form rings with steam in explanatory videos. Or they do great things and vape on the side. Some young idols are also launching their own vape brands. The suggestion is made: Vaping is cool and fun. Young people jump at it.

Vaping has experienced a hype over the past two years: while 15 per cent of young people said they had smoked e-cigarettes at least once in the past month in 2021, this figure had risen to 25 per cent by 2023. These are the results of the 2023 consumption survey conducted by Lungenliga Aargau, which surveyed 20,000 Swiss-German students aged between 15 and 19. 6 per cent of young people use e-cigarettes every day. Vapes are particularly popular among girls: 30 per cent vape at least once a month, 8 per cent daily. These are the results of the Lung League study.

Sale of vapes will soon be restricted

Studies that could explain the gender difference do not yet exist. Claudia Künzli, Head of Prevention at the Swiss Lung Association, suspects that girls are even more attracted to the fashionable design and the sweet and fruity flavours. «As nicotine stimulates the metabolism, it could be that they also use e-cigarettes to control their weight,» says Künzli. In addition, young women in particular feel more psychologically stressed, which increases the risk of consuming addictive substances.

E-cigarettes work with a chemical liquid, the so-called liquid, which is heated, vaporised and then inhaled with the help of a battery. This also makes it easier for young people to get started. This is because the vapour hardly irritates the throat, as Reto Auer, Professor of Family Medicine and Head of Substance Use at the University of Bern, explains. The first time you smoke a normal cigarette, you have to cough and most people feel sick. «That doesn't happen with vaping,» says Auer. «The nicotine salts contained in the liquid don't hurt, especially if menthol is added, which is the case in many blends.»

What's more, access to e-cigarettes is extremely easy. As vapes are currently still subject to the Foodstuffs Act, there are no age restrictions. Young people and even children can buy them freely from kiosks or order them online. And they are extremely affordable: for just under 10 francs, you can get an e-vaporiser that, according to the manufacturer, holds 1500 puffs. The legal framework will change in mid-2024 when the new Tobacco Products Act comes into force throughout Switzerland. E-cigarettes will then be treated in the same way as conventional cigarettes and may no longer be sold to under-18s.

Julian Jakob, assistant doctor in paediatrics and adolescent medicine at Inselspital Bern, is writing his dissertation on the effects of e-vaporisers on the lung health of adolescents. Until the work is completed, he cannot reveal anything about the results. However, he says that most of the hundred adolescents he surveyed stated that they vape «for fun».

A very high dose of nicotine

Are vapes a fun pastime - or a health hazard? Experts agree that they are not harmless. However, Reto Auer emphasises that inhaling the vapour from e-cigarettes is less harmful than inhaling tobacco smoke. «Smokers die from tar and not from nicotine,» says the doctor. «Nicotine doesn't kill you - but it is addictive.»

The problem: e-cigarettes, especially the disposable versions, contain much more nicotine than conventional cigarettes. «Disposable vaporisers contain the maximum permitted concentration of nicotine, namely 20 milligrams per millilitre - and sometimes even more,» explains doctoral student Julian Jakob. «That's a mega dose! » With just a few puffs, the young people inhaled a high dose of nicotine and experienced a pronounced nicotine kick. He suspects that more users become addicted in the long term as a result.

Nicotine activates the reward centre in the brain. It gives you energy and helps you to concentrate better. What is special about nicotine compared to other drugs is that the substance is broken down within just one to two hours. Then the body craves it again. «If you don't consume any more nicotine, you feel bad, irritable and less focussed,» says Reto Auer. The question is whether someone in a state of deprivation can resist going back for more. But he emphasises: «Not everyone who tries vaping immediately becomes addicted to nicotine.» This is mainly to do with their mental state.

Nicotine has a negative effect on the adolescent brain, which is not yet fully developed.

Claudia Künzli, Swiss Lung Association

Claudia Künzli from the Lung League points out that nicotine has a negative effect on the adolescent brain, which is not yet fully developed. If you start using nicotine at an early age, the addiction becomes ingrained. In fact, most adult smokers started smoking in adolescence. There are also nicotine-free e-cigarettes. But these are a marginal phenomenon, as the Lung League's consumption survey shows: only 8 per cent of young people stated that they had vaped nicotine-free at least once in the past month. Only 1 per cent used a nicotine-free e-cigarette every day.

Harmful substances in the liquid

In addition to nicotine, the liquid used by e-vapers contains chemical substances such as propylene glycol or glycerine, flavourings and heavy metals. Doctors Auer and Jakob say: «E-cigarettes are not good for your health - but they are less harmful than cigarettes. The harmful substances could be measured in the laboratory. Claudia Künzli from the Lung League speaks of a "toxic mixture» in e-cigarettes. In fact, a federal expert report from 2022 states that the liquid «contains potentially toxic chemicals that are usually also transferred to the aerosol and are therefore inhaled». Künzli emphasises that the current state of knowledge is that e-cigarettes are less harmful than conventional cigarettes and warns: «Long-term studies are lacking.»

Is vaping a gateway drug?

One important question is whether vaping acts as a gateway drug for smoking . This gateway effect is the subject of controversial scientific debate. For doctor and researcher Reto Auer, the fact that, according to the latest Lung League survey, the consumption of tobacco cigarettes has decreased over the past two years speaks against it. He says: «The figures could mean that there are young people who consume vapes instead of cigarettes.»

For adults who want to quit smoking, vapes can be a useful substitute drug.

Excerpt from the current study by Addiction Switzerland

The Lung League expert points out that the gateway effect may be delayed: «It could be that today's 15-year-olds don't start smoking cigarettes until they are 25. » The trend product e-cigarettes is simply still too young to make definitive statements - the experts agree on this point.

In fact, another study, «Health Behaviour in School-aged Children» by Sucht Schweiz, comes to a different conclusion: it compares the figures for 2018 and 2022 and finds that the consumption of cigarettes has not fallen in this period. If young people who would smoke anyway use e-vaporisers instead of conventional cigarettes, this is the better choice. And for adults who want to quit smoking, vapes can be a useful substitute drug. However, young people who would not otherwise smoke are not doing their health any favours.