Commentary: Vaping is worsening our teens’ mental health

SINGAPORE: Mr X looked at me sheepishly. “I’m back again,” he said.

For several years, he had been trying to quit smoking, and would see me for a medication that helped him kick-start smoking cessation. Despite his best efforts, he would relapse after several months, especially when confronted with high levels of stress.

Relating how he started smoking, he told me, “I regret taking that first puff when I was 17.”

Nicotine and cigarette addiction continue to be significant issues in our society today. The medical consequences of long-term smoking are well-documented. However, for our youth, a much bigger threat has surfaced: Vaping.

CANDY-FLAVOURED TRAP

Vaping is the act of inhaling vapour from an electronic device, usually an e-cigarette, which contains a liquid solution of nicotine, flavouring agents and other chemicals. This practice has become alarmingly widespread among young people globally, with an estimated 37 million children aged 13 to 15 using tobacco.

“History is repeating, as the tobacco industry tries to sell the same nicotine to our children in different packaging. These industries are actively targeting schools, children and young people with new products that are essentially a candy-flavoured trap,” said, World Health Organization’s director-general Dr Tedros Adhanom Ghebreyesus in a May report.

Despite being banned in Singapore, vaping is a similarly growing problem in the country. In 2023, 7,838 individuals were caught for the possession or use of vapes, a 60 per cent increase from 2022.

In the second quarter of this year alone, 2,530 individuals were nabbed for possessing or using vapes, a 30 per cent increase from the previous quarter. Nearly 700 students were referred to health authorities by their schools.

This highlights the pressing need to address this growing concern. Initially promoted as a safer choice than traditional cigarettes and a way to quit smoking, vaping has raised serious public health concerns.

THE APPEAL OF VAPING TO YOUNG PEOPLE

The increase in vaping among youths can be attributed to several factors.

First, the prefrontal cortex - the part of the brain responsible for decision-making - doesn’t fully develop until the mid-20s, making adolescents and young people more prone to impulsive behaviours like vaping without fully considering the long-term consequences.

Second, vaping has often been promoted as a healthier alternative to smoking, misleading many young people. Third, various flavours mask the harshness of nicotine, making the experience more enjoyable.

Peer pressure and the desire to fit in with social groups also play a significant role in the uptake of vaping among adolescents.

Unlike traditional smoking, vaping lacks a strong odour and dissipates quickly, making it easier for young people to hide their habit from parents, teachers, and other authority figures.

THE LINK BETWEEN VAPING AND MENTAL HEALTH

Research indicates a complex relationship between vaping and mental health, revealing several concerning aspects.

Vaping is often used by young people as a coping mechanism for underlying mental health problems such as anxiety or depression. The immediate gratification from nicotine can temporarily enhance mood and relaxation, reinforcing the behaviour of vaping, a concept known as operant conditioning. Over time, young people learn to associate vaping with positive feelings, increasing the likelihood of continued use despite potential negative consequences and creating a cycle of dependency.

However, any short-term relief provided by vaping does not address the root cause of their mental health issues. Additionally, regular vaping has been linked to increased levels of anxiety, depression, and stress, due to neurochemical changes induced by nicotine. Vaping has also been associated with an increased likelihood of suicidal thoughts and attempts among young people​​.

Nicotine exposure during the critical period when the brain is still developing can also interfere with cognitive function, memory, and attention, with potential long-term consequences on academic performance and overall mental well-being. Withdrawal symptoms further compound these problems, making it even harder for young people to quit.

Additionally, vaping raises significant concerns as a potential gateway to drug use. Adolescents who begin with vaping are more likely to transition to traditional cigarette smoking and other substance use, leading to serious implications for their long-term health.

PREVENTING THE FIRST PUFF

Quitting nicotine, whether from traditional cigarettes or e-cigarettes, is notoriously difficult. Nicotine addiction is powerful, and the relapse rates for those attempting to quit smoking are high.

It is estimated that 90 per cent of smokers who attempt to quit will relapse at some point, with many doing so within the first three months. Even after a year of abstinence, the relapse rate remains significant, ranging from 60 per cent to 90 per cent.

Many individuals trying to quit experience withdrawal symptoms such as irritability, anxiety, difficulty concentrating, and strong cravings for nicotine. These symptoms can make it challenging to maintain abstinence, leading to frequent relapses.

Research indicates that individuals who switch from smoking to vaping often continue to struggle with nicotine dependence. A study reported similar relapse issues among former smokers who transitioned to vaping, suggesting that the addictive nature of nicotine remains a significant hurdle​.

For young people, the challenge is even greater. The developing brain is more susceptible to addiction, and the social and environmental factors that contribute to vaping make quitting particularly difficult.

Singapore is already seeing a surge in mental health issues among youths, with a survey last year showing that one in 10 teens suffers from at least one mental health disorder.

It is crucial that health authorities implement comprehensive strategies, including stricter regulations, enhanced education on the risks of vaping and better mental health support.

These measures are essential not only to mitigate the harmful effects of vaping but also to prevent our youth from taking that first puff, whether it be a cigarette or an e-cigarette.

By addressing the root causes and providing robust support systems, we can help protect the mental and physical health of our young people and steer them away from harmful substances.

Dr Lim Boon Leng is a psychiatrist at the Gleneagles Medical Centre.