What is Vaping (JUULing)

The comeback of nicotine and THC products has been enabled by widespread misinformation wrapped in shinier packaging and flavours.

Vaping (or colloquially known as JUULing) refers to the use of e-cigarette (electronic device) that heats liquids to produce a vapour which is inhaled (ADF, 2024). The more recent generations are rechargeable that use cartridges for the liquid, or refillable tanks. The newest generations are smaller looking akin to a USB stick and have higher concentration of nicotine.

There are therapeutic vapes which are used for nicotine withdrawal, however those sold illegally are not therapeutically approved. Furthermore, e-cigarette products sold legally to adults in Australia have not been tested or approved by the Government.

Various substances can be inhaled including:

- Nicotine

- Solvents, sweetners, and other chemicals

- THC (Cannabis)

Additionally, according to the Cancer Institute NSW hundreds of toxic chemicals are found in the vapour including:

  • Formaldehyde – Used in disinfectant and known to cause cancer.
  • Chlorine – Found in disinfectant and known to cause lung damage.
  • Benzene – Used in bug spray and known to damage DNA.
  • Mercury – Found in batteries and known to damage fertility.
  • Acrolein – Used in weed killer and known to be toxic to the heart and lungs.
  • Arsenic – Used in poisons and known to damage internal organs.

For the full NSW government report see here.

Prevalence

In 2022-23 the The National Drug Strategy Household Survey (NDSHS) reported one in every five teens (aged 14 and over) had reported using an e-cigarette, while others have estimated up to 30% of secondary school students. Between 7 and 13% of 12-15 years olds have vaped in the past year, and 13-22% of 12- to 17-year-olds vaping in the last month. The prognosis is concerning with 10% of 18-24 year olds vaping daily.

Alcohol and cocaine are less popular than they were in the 1990s whereas the use of cannabis and hallucinogens are more salient and easier to obtain (Marijuana and hallucinogen use among young adults reached all-time high in 2021, NIDA).

Although there has been an overall decline in adolescent substance use, cannabis use has remained constant over the past ten years ranging from 7 to 21% for 12 and 18 year olds, with prevalence increasing with age. Broader estimations around illicit substance use suggest 30% of teens will binge drink, 8% will engage in heavy alcohol use, and 20% will use illicit drugs (National Institute on Alcohol Abuse and Alcoholism, 2023).

The Rising Popularity of Vaping Among Teens

Understanding why our teens turn to vaping can help us address the issue. Here are some common reasons why teens may choose to vape:

  1. Social influence (see Watts et al.,, 2024): It’s not news that teenagers are often influenced by their friends and social circles despite their stubborn proclamation of independent thinking (Watts et al., 2024). Vaping is "bussin" (exceptionally good) or “hits different” and the risk is excused as part of a “brat summer” (a carefree attitude - doing what you want without worrying about others’ opinion). JUULing is normalised and risks are downplayed in efforts to justify the behaviour. How many of us have heard the term “it’s not that deep”. Translated: it is just a bit of fun, a normal edgy thing for teens to do, a way to embrace being a teenager before adult responsibilities, with no real long-term harm.
  2. Curiosity: Teens may be curious about vaping or want to experiment with it. With vaping products widely available, easily hidden, and regulations poorly enforced it can be easy for them to try without fully understanding the risks involved (Brierley et al., 2024).
  3. Misleading Information: Many teens mistakenly believe that vaping is safer than smoking or that it doesn’t carry the same risks. Approximately two-thirds of teenagers (aged 15 to 24) who are vaping are unaware that JUUL always contains nicotine. Like cigarette marketing in its heyday, vaping advertisements insinuate a safe, clean, and positive experience, while diminishing substance effects for example: “A smooth vape without combustion. Just vape CBD, THC and terpenes without toxic smoke. It doesn't get healthier than this! Very easy to use and clean”. A validating message for teens seeking a minimally harmful way to be social and relevant.
  4. Social Media: It goes without saying (although I will state explicitly) that social media has a role to play in the normalisation of vaping, where vaping is viewed as a "fad" that can be stopped at any time. Research has found that teens who view influencers vaping are more likely to try it (Donaldson, S. I., et al., JAMA Pediatrics, Vol. 176, No. 9, 2022).
  5. Flavours: Flavoured e-liquids (e.g., fruit, candy, and dessert flavours) seem less harmful or more enjoyable, making vaping more attractive than traditional cigarettes. With flavours such as watermelon, blueberry sour, caramel, and pink lemonade it’s clear these are not aimed at the masses and only boost the popularity of vapes amongst tween and teen populations (Zhou et al., 2018).
  6. Stress Relief: Some teens use vaping as a way to cope with stress, anxiety, or other emotional challenges. The calming effects of nicotine or the act of vaping itself may provide temporary relief, even though it can contribute to mental health problems in the long run. Although this may resonate intuitively, the self-medication theory has received limited support and requires future research to validate this prediction.

Risks of Teen Vaping

The risks of vaping are significant, especially for young people whose brains are still developing (Winters, K. C., & Arria, A., Prevention Research, Vol. 18, No. 2, 2011). Here are a few key dangers associated with teen vaping:

  1. Nicotine Addiction: E-cigarettes contain nicotine, which is highly addictive. Nicotine use in adolescence can interfere with brain development, affecting memory, attention, mood, impulse control, and learning. It can also increase the risk of addiction to other substances later in life.
  2. Health Risks: While vaping is often marketed as a safer alternative to smoking, it is not without its risks. The inhalation of e-cigarette aerosol, which contains harmful chemicals like formaldehyde and acrolein, can cause lung irritation and damage. Long-term health effects are still being studied, but there is evidence linking vaping to respiratory issues and cardiovascular problems (i.e. coronary heart disease, arrhythmia, chest pain, shortness of breath, and palpitations).
  3. Mental Health Concerns: Some studies suggest that vaping may contribute to mental health issues such as anxiety and depression, especially when combined with nicotine addiction. The stress of managing addiction and dealing with the mood swings caused by nicotine withdrawal can exacerbate existing mental health challenges. Furthermore, many students may begin vaping to manage pre-existing anxiety, loneliness, stress or depression, which are in turn exacerbated in a cyclical fashion.
  4. Gateway to Other Substances ((McCabe, S. E., et al., JAMA Network Open, Vol. 5, No. 4, 2022): Teens who vape are more likely to try other substances, including alcohol and traditional cigarettes. Vaping may lower inhibitions and normalize the use of addictive substances, making it easier for teens to experiment with harder drugs. There is also the possibility that some children are biologically more sensitive to the effects of substances, increasing their vulnerability to developing an addiction.
  5. Academic and behavioural outcomes: Related to the possible mental health risks, kids who avoid regular substance use are more likely to succeed in school and to avoid problems with the juvenile justice system (Public policy statement on prevention, American Society of Addiction Medicine, 2023).

Motivations for quitting

It is estimated most students actively vaping want to quit (Zhang et al., 2022), with two thirds of students reporting attempts to quit in the last year.

Amato and colleagues (2021) conducted a qualitative study interviewing teenagers (aged 13–17 years) and young adults (aged 18–24 years) actively vaping. They identified a clear theme of regret, “I'm trying to quit because I'm starting to lose important people in my life and it sucks and I'm making my parents disappointed and I hate what it does to me”, and “Because it has changed me as a person and I don't want to die.”, or “…i got suspended in school, and this kinda crushed mybasketball career”.

From the interviews, Amato and colleagues identified the following reasons for wanting to quit vaping (in order):

  1. physical health (current and future)
  2. mental health and motivation
  3. financial cost
  4. fear of addiction
  5. social influence
  6. performance
  7. lack of positive reinforcement “I don’t even get buzzed anymore,”
  8. effects on physical appearance
  9. role modelling to younger siblings
  10. value judgement (for example fears of self-image “I don’t want to be known for juuling”)
  11. extrinsic motivation (pressure from family members, partners, or consequences)
  12. concerns for future
  13. uncertainty about effects, and
  14. projection of cigarette smoking.

"I'm making my parents disappointed and I hate what it does to me”

Screenshot 2025-05-22 at 3.53.57 pm

"I don't want to die"

Brief review of interventions

So, what can we (parents, guardians, educators, friends, and counsellors) do to help?

Let’s start by looking at what doesn’t work.

The well-intentioned efforts of programs pursuing abstinence through prohibition and punitive consequences, are largely ineffective. This is not to say, consequences should be cast aside. Certainly, positive role modelling and appropriate personal boundaries in the home help instil values and appropriate messaging regarding the harm of substance use. However, expecting or enforcing abstinence will rarely achieve its objective. Similarly, universal or information-only programs are not effective, likely due to homogenous messaging that overlooks personal relevance and multiple risk-taking behaviours (Tinner et al., 2022). Weighing up the pro’s and con’s of vaping with a teen who is not engaged nor interested in any illicit substance will be ineffective (and possibly harmful). Equally, providing information about vaping to a teen who is a heavy active user with no intention to quit, will likely result in disengagement.

Thus, personalised and targeted approaches seem to be most effective. Once behaviour, motive, and readiness are identified, the most appropriate interventions can be applied.

There are three main goals of interventions depending on the targeted audience: prevention, harm reduction (active users not yet wanting to quit), and cessation.

Prevention

Effective prevention efforts are those that target the biological, psychological, and social motivations for use at the individual level, and seek to provide healthy alternatives to achieve desired outcomes.

Prevention programs that teach “problem solving, decision making, cognitive skills to resist personal or media influences, ways to increase self-control and self-esteem, coping strategies for stress, and assertiveness skills” (p.) are found effective in reducing smoking behaviour (Thomas et al., 2015). Such that, programs may not focus on substance use. The PreVenture workshop for example, personalisaes material using interactive activities to help students’ identity cognitive distortions and practice healthy coping strategies relevant to them. This program has been associated with a delay in substance use and a decreased likelihood of trying illicit substances (Newton et al., 2022; Archives of General Psychiatry, Vol. 67, No. 1, 2010). Most validated preventative programs are school-based interventions that typically include drug and alcohol education, and interactive activities. Programs that span seven or more sessions, and facilitated by trained educators are most effective, however research is limited making conclusions cautionary at best (Song & Park, 2021).

“Unveil what you inhale - Vaping truths” - is an online e-learning module that seeks to teach

  • Outline what vapes are and how they work
  • Identify harmful ingredients found in vapes
  • Describe the short and long-term health impacts of vaping
  • Demonstrate ways to combat peer pressure around vaping.

Harm Reduction...When the horse has bolted

While all parents would like to prevent vaping in the first place, or achieve cessation, meeting the child where they are at, is better than not meeting them at all. As addressed above, youth are typically vaping to stay relevant in social circles or out of curiosity, yet it is clear many do not intend to become addicted and regret it when they are. The Youth Substance Use and Risky Behavior Lab at the University of Southern Mississippi insist a sensible and careful engagement with illicit substances is better than not addressing the problem.

So, when a vape is found tucked behind a hairdryer or in the sock drawer - don’t panic, take time to think through how you will have this conversation and try to look at both sides. Choose a calmer time in the day such as the evening, where you can dedicate attention to the conversation and actively listen. Deep conversations over breakfast are rarely a good idea. Try to keep the tone calm, open, and supportive.

Referencing an article, news story, asking what their friends think of vaping, or enquiring about issues at school that may be relevant to such choices, can open the conversation without a direct affront. Once walls are down, motivational interviewing a psychological technique that uses reflective questions can help identify motive for use, (un) willingness to change behaviours, and develop self-insight. Examples may include, ‘How much money do you spend on vaping / illicit substances?’, and ‘are there any negative things that have happened as a result of those choices?’, ' what is the opportunity cost?', '"where are you seeking information from to help inform your choices?", "can you show me?".

Programs that target problem solving skills help students make choices about their future and prepare them for adult life. The phrase “know over no” emphasises the empowerment of choice and autonomy over prohibition. Early evidence demonstrates acceptability of programs that improve knowledge and decision-making around drug use (Fischer, N. R., Substance Abuse Treatment, Prevention, and Policy, Vol. 17, 2022). (Meredith, L. R., et al., The American Journal of Drug and Alcohol Abuse, Vol. 47, No. 1, 2021).

Cessation

When teens are ready to quit, there are few validated smoking cessation interventions available (Liu et al., 2020). However, those that have been evaluated show promise. Some leverage technology to include interactive text messages, while others include nicotine replacement therapies, behavioural counselling and support groups, and pharmacotherapy approaches to help manage withdrawal symptoms. The choice is dependent on the individual, taking into account readiness to quit, age, motivators, and context.

Referral to NSW Quitline

Pave app by Cancer Institute NSW

My Quit Buddy- mobile app

ICanQuit- Online community with helpful tips to overcome cravings, reduce risk and to read the experiences and success stories of others.

Alcohol and Drug Counselling services - Group program + Free Counselling. Providing alcohol and drug counselling services, based on the Northern Beaches and North Shore of Sydney. We specialise in supporting young people aged 12-25 and their families.

Drug health services- 1300 031 131, Mon to Fri 8:30 - 4:30pm

Free online counselling - Counselling Online allows you to communicate with a professional counsellor about an alcohol or drug related concern using text interaction. This service is free for anyone seeking help with their own drug use or the drug use of a family member, relative, or friend.

How to Talk to Your Teen About Vaping

Addressing teen vaping requires open communication, understanding, and a proactive approach. Yet, despite general parent concern for vaping, a recent Australian survey indicates less than half of parents have discussed vaping with their teen.

Here are some practical tips for parents:

Start the Conversation Early

Don’t wait for your child to start vaping before bringing up the topic. Be curious and start talking about the dangers of vaping when your child is in middle school or early high school, even if they haven't shown any interest in it yet. Use teachable moments, such as news stories or articles, to raise awareness without being confrontational. This can set the stage for a more in-depth discussion later.

Be Informed

Before discussing vaping with your teen, educate yourself about the risks, the products, and the laws surrounding e-cigarettes. The more you know, the better you can answer questions and present facts in a non-judgmental way.

Stick to facts.

It can be tempting to overnormalise drug use amongst teenagers based on our own experiences and perceptions, and students tend to overestimate how many of their peers use substances (Dumas et al., 2014). The reality is majority of teenagers are not engaging in illicit substance use.

Listen Without Judging

If your teen confesses to vaping, try not to overreact. Instead, listen to their reasons for trying it or using it. Understanding why they vape can help you guide the conversation and avoid pushing them further away.

Set Clear Expectations

While it's important to listen and understand, it’s also crucial to set clear rules about vaping. Let your teen know that it’s illegal for anyone under 18 to buy or use e-cigarettes and that it’s not acceptable in your household. Or, should adult vaping be acceptable in your household, perhaps think about the explicit distinction between age-appropriate behaviours. Make your expectations clear but also explain why you hold these views.

Safety first

Some colleges in the United States you have adopted the ‘Good Samaritan policy’ that encourages disclosure of illicit substance use without the risk of negative repercussions. For parents, this notion presents an ethical dilemma, as this treads the fine line of permitting the behaviour or weakening the boundaries set. However, remembering that punitive punishments rarely achieve their long-term goal, clear expectations and boundaries can co-exist alongside the encouragement of disclosure.

It might go something like this “We / I do not permit vaping, as I am deeply concerned about the implications on your health. This means that should I find a vape [other substance] in the house, I will dispose of it (noting this is a relevant, and proportional consequence, and not punitive). This said, your safety is my main concern so if you or your friends find yourself in trouble regardless of whether illicit substances have been involved, you are to call me, and we/I will come to help.”

Encourage Healthy Coping Mechanisms

If your teen is vaping to cope with stress, anxiety, or peer pressure, encourage and model healthier alternatives. Be explicit with your own emotional awareness and management. Exercise, mindfulness, creative activities, or talking to a counsellor can help your teen deal with difficult emotions without resorting to nicotine. However, the development of self-insight, and shared understanding of their motives, worries, and thought processes are a prerequisite of behaviour change. Be prepared for slow progress as your child will not instantly download all their worries and fears the moment you ask.

Be a Role Model

If you smoke or vape, it’s especially important to model healthy behaviours. Teens are not only more likely to follow your example than listen to your advice, but their perception of potential harms related to vaping are significantly diminished (Egger et al., 2024). If you're trying to quit smoking or vaping, involve your teen in the process and share your journey.

Monitor Access and Social Circles

Be aware of where and with whom your teen spends time. If vaping is common in their social circle, they may be more likely to try it. Encourage them to engage in activities where vaping is not a norm, and consider monitoring their social media accounts to understand their influences.

Know When to Seek Professional Help

If your teen is struggling with nicotine addiction or using vaping as a way to cope with deeper emotional issues, professional help may be necessary. Consult your family doctor, a counselor, or a specialist in adolescent addiction.

Importance of confidentiality

Should you wish to refer your son to a school counsellor in the school, please bear in mind that confidentiality is associated with stronger adolescent connection and increases the likelihood of your son disclosing information that may open the pathway for appropriate support. The school psychologist / counsellor is trained in managing these disclosures appropriately and with your sons’ best interests at the forefront will make a deliberative call regarding disclosure. Should a safety concern arise, your psychologist will sensitively explain to your son the need to inform a trusted guardian, and you will be notified as such.

Conclusion

As a parent, you have the power to guide your teen through the challenges of social pressures, curiosity, and emotional turmoil that may lead them to experiment with vaping. By maintaining open communication, setting clear boundaries, and providing support, you can help your teen make healthy choices and avoid the risks associated with vaping.

Remember, it’s not about controlling your teen’s actions, but empowering them to make informed, responsible decisions for their health and well-being.

Should you be concerned about your child’s substance use (suspected or otherwise), mood, or general wellbeing, please speak to your GP, external psychologist, school counsellor, or team leader to discuss your concerns.

Practical Resources

Information and resources portal (General substance use)

Vaping Tool Kit

The Royal Children's Hospital. E-cigarettes, vaping and teens: Do parents know the dangers?

Webinar – what parents need to know – NSW Government

Vaping – what parents need to know – P&C

Motivational interviewing – what is it?

Facts on Vaping harm – Cancer Institute NSW

Young people and Vaping

Smoking and vaping - how to discourage your children

Vaping in Australia – Alcohol and Drug Foundation

What to do if your child is Vaping – Podcast with Maggie Dent and Paul Dillon

vaping-factsheet-young

e-cigarette-young-people-guide

vaping-factsheet-parents

Vaping-Conversation-Guide-For-Parents

vaping-nicotine-addiction-parents

vaping-parents-types

vaping-quit-support-parents

vaping-stress-and-anxiety

vaping-quit-support-young-people-factsheet

Other & Recommended Readings

References

Amato, M. S., Bottcher, M. M., Cha, S., Jacobs, M. A., Pearson, J. L., & Graham, A. L. (2021). “It’s really addictive and I’m trapped:” A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people. Addictive Behaviors, 112, 106599–106599. https://doi.org/10.1016/j.addbeh.2020.106599

Vaping is Unhealthy. Tips and Resources to Help Quit. (n.d.). https://www.psychiatry.org/news-room/apa-blogs/vaping-is-unhealthy-tips-and-resources-to-help-qui

Zhang L, Gentzke A, Trivers KF, VanFrank B. Tobacco Cessation Behaviors Among U.S. Middle and High School Students, 2020. J Adolesc Health. 2022 Jan;70(1):147-154. doi: 10.1016/j.jadohealth.2021.07.011. Epub 2021 Aug 20. PMID: 34930566; PMCID: PMC11093620.

Watts, L.L., Hamza, E.A., Bedewy, D.A. et al. A meta-analysis study on peer influence and adolescent substance use. Curr Psychol 43, 3866–3881 (2024). https://doi.org/10.1007/s12144-023-04944-z

Zhou, J., Zhang, Q., Zeng, D. D., & Tsui, K. L. (2018). Influence of Flavors on the Propagation of E-Cigarette–Related Information: Social Media Study. JMIR Public Health and Surveillance, 4(1), e27–e27. https://doi.org/10.2196/publichealth.7998

Winer, J. M., Yule, A. M., Hadland, S. E., & Bagley, S. M. (2022). Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Annals of Medicine, 54(1), 2123–2136. https://doi.org/10.1080/07853890.2022.2104922

Liu, J., Gaiha, S.M. & Halpern-Felsher, B. A Breath of Knowledge: Overview of Current Adolescent E-cigarette Prevention and Cessation Programs. Curr Addict Rep 7, 520–532 (2020). https://doi.org/10.1007/s40429-020-00345-5

Tinner, L., Palmer, J. C., Lloyd, E. C., Caldwell, D. M., MacArthur, G. J., Dias, K., Langford, R., Redmore, J., Wittkop, L., Watkins, S. H., Hickman, M., & Campbell, R. (2022). Individual-, family- and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years: a systematic review and meta-analysis. BMC Public Health, 22(1), 1111–1117. https://doi.org/10.1186/s12889-022-13072-5

Brierley, M.-E. E., Yaw, S. J. L., & Jongenelis, M. I. (2024). Perceptions of Australia’s e-cigarette regulations and recommendations for future reforms: a qualitative study of adolescents and adults. BMJ Open, 14(2), e081032–e081032. https://doi.org/10.1136/bmjopen-2023-081032

Song, R., & Park, M. (2021). Meta-analysis of the effects of smoking prevention programs for young adolescents. Child health nursing research, 27(2), 95–110. https://doi.org/10.4094/chnr.2021.27.2.95

Thomas, R. E., McLellan, J., & Perera, R. (2015). Effectiveness of school-based smoking prevention curricula: systematic review and meta-analysis. BMJ Open, 5(3), e006976–e006976. https://doi.org/10.1136/bmjopen-2014-006976

Egger, S., Watts, C., Dessaix, A., Brooks, A., Jenkinson, E., Grogan, P., & Freeman, B. (2024). Parent’s awareness of, and influence on, their 14–17-year-old child’s vaping and smoking behaviours; an analysis of 3242 parent–child pairs in Australia. Addictive Behaviors, 150, 107931-. https://doi.org/10.1016/j.addbeh.2023.107931

Dumas, T. M., et al., Addictive Behaviors, Vol. 90, 2019; Helms, S. W., et al., Developmental Psychology, Vol. 50, No. 12, 2014).

Newton, N. C., et al., JAMA Network Open, Vol. 5, No. 11, 2022

https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-11-cessation-interventions-to-help-people-quit-vaping

https://www.psychiatry.org/news-room/apa-blogs/vaping-is-unhealthy-tips-and-resources-to-help-qui

Alcohol and Drug Foundation