Quit Insights Clinical Series Podcast with Doctor Moya Vandeleur, about vaping and young people
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Our Quit Insights Clinical Series podcast guest was Doctor Moya Vandeleur, a respiratory and sleep physician at the Royal Children's Hospital in Melbourne, with a special interest in vaping and young people.
Vaping in young people is a topic of interest to so many health professionals at the moment. Can you tell us about your experience in this area?
I think it's a topic of interest because vaping unfortunately has become more prevalent in young people. I'm a respiratory and sleep physician and whilst we don't currently run a tobacco or vaping cessation clinic, in my everyday practice,I ask young people about whether they smoke, whether they vape. This is how it comes up as part of the consultation. When I reflect on the young people that I look after, many of them are referred for other issues, for instance, with insomnia. Then it comes up that they're actually using e-cigarettes. As we know, or as we'll talk about, nicotine is a stimulant, so perhaps that's actually contributing to their sleep issues. Unfortunately it’s a really important issue facing young people and those of us that look after young people as part of our practice, as either pediatricians or general practitioners, certainly are involved in this issue.
Has there been a big increase in the number of young people you've seen that are vaping?
We know from looking at the data that vaping has increased in recent times. In 2020, for instance, for young Australians 14 to 24 years, about 5% of that age group were using e-cigarettes regularly. Then that peaked in about 2023, where it was up at about 18 to 19% and it's sitting at about that level. So certainly it's an issue facing young people and causing health problems.
It's really important to keep in mind that e-cigarette use is more prevalent in certain populations; in Aboriginal and Torres Strait Islander people, in young people that have mental health issues, in young people who live in regional and remote areas.
I work at the Royal Children's Hospital, and you may be aware that we conduct National health polls regularly throughout the year. Recently we surveyed 1400 young people between 12 and 17 and their parents. In terms of current users of nicotine, it was about 12%. This seems in line with the national data mentioned earlier.
Can you tell us about the health risks of vaping, particularly for young people?
I think it's probably most digestible to break it down to the respiratory harms and nicotine related harms. We know that e-cigarettes contain lots of harmful chemicals that are not supposed to be inhaled. These can irritate the lungs, so certainly they can cause cough and sore throat. If you have asthma, they can cause a flare up of your asthma symptoms, so these are some short-term lung health risks.
We also know, however, that young people who regularly vape can experience more severe lung damage. There's a condition called EVALI (e-cigarette or vaping-use-associated lung injury) which occurs in some people who vape regularly, which consists of really significant damage to lung tissue that might result in hospitalisation and has even caused deaths. In terms of the long-term health risks of vaping, because it’s relatively new, the evidence is still evolving. But studies have shown that people exposed to vape aerosols have changes in their cell DNA that are similar to the changes that we see in people that have been smoking. We strongly suspect that people that are using e-cigarettes may end up with long-term increased risks for cancer.
The second health issue when it comes to e-cigarettes is that they contain nicotine, and nicotine is a highly addictive substance. It's one of the most addictive substances that you can expose yourself to and young people may become dependent. We believe that young people can become addicted or dependent on nicotine with lower exposure, than older people.
In terms of nicotine, the risks are if you're using it regularly and you cut back, you can experience withdrawal symptoms, which manifest as irritability and anxiety, issues with sleep and generally feeling unwell. Exposure over time to nicotine – whilst some young people will say that they're using e-cigarettes or nicotine to calm themselves – symptoms of withdrawal can have quite the opposite effect. We know that young people using nicotine are at risk for experiencing issues with their mental health. In my practice, I've become very aware of the fact that because nicotine is a stimulant, it can cause issues with sleep. Some young people that come to see me with problems sleeping, and then it comes out that they've been using vapes and that perhaps the nicotine is part of that (sleeping problem).
I should also mention that that the vape liquid contains nicotine, and that if people swallow that liquid, it can be deadly. In overdose, nicotine can cause nausea, vomiting, seizures and even death. There have been deaths in children who have been inadvertently exposed to nicotine by swallowing vape liquid as an accident. There are many health impacts from nicotine, but I think those effects on mood and on the brain in young people are really of concern.
What does the current research say about the gateway effect? Does vaping lead to smoking?
Yes, this is what the evidence shows. The majority of e-cigarettes that are available and accessible either online or through other ways contain nicotine. Nicotine is the addictive substance. We know that young people who have never smoked but who vape are about five times more likely to take up smoking. So that sort of evidence and those sorts of figures certainly highlight that gateway effect. That's an important factor when we think about e-cigarette use in young people, because we have seen in recent years a decrease in smoking levels in young people and now there's a bit of an uptick, and that's obviously a huge concern. We do think that vapes coming onto the market are part of this landscape.
Is this part of dual use as well – smoking and vaping?
Absolutely. Yes.
Do you think clinicians should start a conversation about vaping and quitting vaping with a young person?
We know that adolescents tend not to disclose risk-taking behaviour unless they're prompted, so it's really important to ask. I think that's the key. I would see each encounter with a young person as an opportunity to ask about e-cigarettes and to ask about smoking as part of a broader psychosocial screen or assessment. It's important, obviously, to see every encounter as the opportunity to talk about prevention as well. Ideally when we see an adolescent, we spend a part of the consultation with that person by themselves. We'd discuss with the young person and their parent about the concept of confidentiality and what the limits are to that. Then we use a HEADSSSS framework, a psychosocial assessment where we begin with questions about more comfortable issues such as “who's at home?”, “how school going?”, and then move to specific questions about risk-taking behavior that might be less comfortable - once you've built some rapport. I would recommend the simple AAH model of Ask, Advise, and Help. The key point is that each consultation with a young person is an opportunity to ask. If you don't ask, it's unlikely to be brought up.
What about follow up for young people?
If you see a young person and they disclose that they are regularly using e-cigarettes, what do you do? I've mentioned Ask, Advise, Help. If you are managing or supporting a young person who is nicotine dependent, and if you're referring out, for instance for support, or if you're going to provide that care yourself, follow up is so important. If, for instance, that young person on assessment is dependent on nicotine and you've decided to prescribe some pharmacotherapy. With nicotine replacement therapy, it's really important to see that young person back a few weeks later because having that support and that follow-up we know is crucial.
What have you found is the best way to support a young person to quit vaping?
What the evidence shows, and my experience, is that the best chance of quitting, when you're managing a young person who is dependent on nicotine, and using e-cigarettes regularly, is a combination of behavioral support and pharmacotherapy. Every young person is an individual, and the supports are going to look different. Some young people will be very open and comfortable to talk with their family and with their friends and to seek support in that way. Whilst I always would encourage young people to disclose and discuss their nicotine use with their parents and to involve them in that support, some young people are more comfortable to get professional support from Quitline, for instance., When I'm seeing a young person, I would refer with their permission, if we've discussed the idea of behavioural supports as this provides the best chance of success, if they're wanting to quit.
I would make a referral to Quitline on the spot in clinic if they're ready. Sometimes they're not. Sometimes it's go away and think about it and come back. It also depends on whether they've tried to quit before. Some young people, as we know, manage to stop using without external supports, without pharmacotherapy. Those young people who truly are dependent, many have already tried before they walk in the door.
We know the best chance is with professional support, so Quitline is a really good option. Obviously there are other online supports such as various apps that can provide support, or some young people might already be linked in with a psychologist, for instance. That's another way to seek and have behavioural supports.
In terms of pharmacotherapy, it's really important to highlight that if a young person is dependent on nicotine, that their best chance of success may be with prescribed nicotine replacement therapy. There's short-acting options, there's longer-acting options with patches. Using a patch, together with shorter-acting lozenges or gum for breakthrough symptoms tend to be, from my perspective, the most effective. You can prescribe NRT for young people over 12 years of age. It's really important to highlight that, because many clinicians might not have experience with prescribing.
The Thoracic Society of Australia and New Zealand (TSANZ) published a position paper, guidance document about supporting people to quit e-cigarettes last year. The RACGP also has an excellent resource for quitting traditional tobacco cigarettes and also e-cigarettes. These are useful resources for clinicians to use as guidance for prescribing.
We can reassure health professionals that those supports such as my Quit Buddy app or Quitline and NRT are applicable for young people?
Absolutely. Those things do exist.
Parents might be looking for information to support their young person through the quitting journey. Where do you suggest they go for facts and support materials?
That's such an important question, and there are lots of really good resources available now. The Quit website has some fantastic resources, so I would strongly advise them to have a look there. In terms of actually having a conversation with your child, conversation guide. I'd highlight that the Royal Children's Hospital also has some great fact sheets, some nicotine health information sheets for teens and children and for parents.
I think it's really important for parents to feel confident having that conversation with their child. We'd recommend when you're thinking about that, just choosing the right time to chat so that you've got enough time to actually have a conversation. So sometimes a car journey is a good one. Choosing a real-life example to bring it up. Maybe you've driven past someone who's vaping on the side of the road, or you just ask, you know, “do you see much on socials about vaping these days? You know, I heard it's going out of fashion” or “do any of your friends vape?” My number one tip is just to be open and curious and try not to be judgmental when you're having that conversation, because it's just important for your child to feel safe.
The last thing I'll say on that topic is not going to be a surprise; as mentioned earlier, we ran a Health poll recently at the Royal Children's Hospital, and we asked parents about what they knew about their young person, whether they were using nicotine or not. It was a paired survey. So we asked parents and we asked teenagers about their behaviour. What we found was that less than half of the parents of children who had disclosed that they were regularly vaping actually knew. If you have a chat and talk to your child about it, that's the best way to find out and to open up a conversation. And if they are using a nicotine product, then this may be first step to supporting your child to get some help.
Our thanks to Dr Moya Vandeleur for sharing these insights with us on a topic that is currently of great interest to health professionals.
References
H.Marshall, M.Vandeleur, E.Dean, et al., “Thoracic Society of Australia and New Zealand (TSANZ) Guidance for the Management of Electronic Cigarette Use (Vaping) in Adolescents and Adults,” Respirology30, no. 7 (2025): 605–622, https://doi.org/10.1111/resp.70066.
Carcinogenesis, 2026, 47, 1–14 https://doi.org/10.1093/carcin/bgag015
Further information
Quit Centre:
Research
Tobacco in Australia: Facts & Issues