Vape facts which most New Zealanders do not know but should..
(Some links have not pasted as a clickable link, but should be easily accessible in a search with the title cited. The vaper image is from Wikipedia.)
Introduction
The most respected medical clinics in the world, including the Mayo and Cleveland clinics, and the major global authorities on lung health state that the vape aerosols contain, as well as the usual nicotine component, hazardous chemicals in concentrations known to cause harm, particularly to the lungs but also to other organs. This information has been widely available since vapes were first manufactured. Australians and US citizens are told about it, but the only risk about which New Zealanders are clearly told is of nicotine. This is criminal given the hazards of the highly addictive practice of vaping and from which corporations and the government make substantial money.
The following brief article provides information all New Zealanders need to know, whether vapers or not, as we have had the second highest vape rate in the world, and, like the UK and Canada, have an ongoing youth vaping epidemic.
Serious conditions and diseases due to vaping are emerging and there is no ‘off-ramp’ with support services for NZ vape addicts. The Ministry of Health only provides a list of suggestions for vapers wanting to quit. Quitline support in NZ is just for tobacco smokers, and primary advice to them is, to vape.
Spreading the real information, about risks of vaping, and about how quitting is doable in just a few weeks and after the first three days it just gets easier, can stop all this in its tracks. Spread the word.. A simpler version may be needed for children. The first part is about risks and the second part about how to quit.
The substances in the inhaled aerosol include volatile organic chemicals (VOCs) called aldehydes, formed with the usual heating of the propylene glycol (PG) and vegetable glycerin (VG) in the vape liquid. PG and VG are needed in every vape to form the aerosol, enabling nicotine to pass deep into the lungs. These can in the concentrations involved in vaping cause serious diseases of the lungs and other organs, including cancer. Multiple other chemicals present in the vape aerosol are also highly hazardous to health.
New Zealanders are told that vapes (e-cigarettes) are much safer than tobacco because they do not include tar or as much carbon monoxide. Regarding safety this is simply untrue. Vapes do have less carbon monoxide and no tar, but they contain other highly toxic chemicals in significant amounts. Vapes may be found long term to have equally serious effects or less severe outcomes, but they are clearly a major health hazard. The presence of significant amounts of carcinogens and other disease-causing agents in the vape aerosol, the conditions like COPD (chronic obstructive pulmonary disease) already presenting from regular vaping, and some of the DNA changes seen strongly indicate serious long-term effects will also emerge. Comparing e-cigarettes and tobacco cigarettes is like comparing two different poisons.
The American Cancer Council has stated from the start that vaping is too hazardous to undertake even as a means of quitting tobacco cigarettes. This is a highly significant statement given that the latter are the major cause of lung diseases including lung cancer and are responsible for a high proportion of cardiovascular and other organ system conditions. Reputable clinics and major lung institutions also only recommend other tools for quitting tobacco.
Note that insurance companies treat vaping and tobacco smoking the same in terms of risk to health.
New Zealanders, including those who vape, are thus largely unaware of the basic known risks of regular vaping, primarily due to the understatement of these by the NZ government and Ministry of Health and because vape sellers are not legally required to state health risks, other than a mention of nicotine addiction. Other governments, including the U.S. and Australian, as mentioned explain these risks clearly and simply through online information to the public, and their information reflects that of the top medical clinics internationally. Unlike NZ these other governments also strictly regulate access to vapes and, in collaboration with local clinics, provide considerable encouragement, advice and support to those wanting to quit vaping. Note that the concentration of nicotine in NZ vapes sold over the counter is permitted to be extremely high at 20mg/ml in the liquid and 28.5 mg/ml in salt form. In Australia a concentration of 20mg/ml requires a doctor’s prescription. Nicotine is one of the most addictive substances known to science.
Regarding availability, in NZ vapes are easily accessed both online and through the many thousands of licenced sellers in local shops, petrol stations etc. NZ also has around 1400 licenced colourful and attractive specialty shops, with these in every shopping centre and a high percentage near schools. They market vapes as a desirable product, with many flavours which appeal to youth. Such availability and marketing make NZ one of the three outlier countries compared with most in the first world. The other two are the UK and Canada with similar access against W.H.O. (World Health Organisation) strong advice to tightly regulate or ban vapes, and as said both of these have very concerning ongoing youth vaping epidemics, like NZ.
The government has argued that their protocols are justified to help reduce tobacco smoking in the country. They have in fact helped to create a new generation hooked on another toxic tobacco industry product. We have for years had one of the highest vaping rates in the OECD. Note that the new regulations do not address any of the problems listed above and so are unlikely to be effective in reducing rates of vaping. This is discussed below.
This article attempts to help address aspects of the problem by clearly stating in Part One ‘the risks of vaping’ according to the most reputable clinical groups internationally, and in Part Two, ‘How to quit, in New Zealand’, it passes on some of the advice and tools these institutions provide for overcoming addiction to vapes and to nicotine. Links are provided to all relevant websites for more details on both topics.
Note that some NZ groups have made major contributions in this area, and they include the Asthma and Respiratory Foundation and the Vape Free Kids collective. However, the scenario of general ignorance and lack of assistance to quit, with easy access to vapes and high rates of addiction persists.
In New Zealand, if vapes are permitted to be sold, at the very least the following should be promptly done
1. the health risks clearly stated
2. proper advice and support provided for those wanting to quit vaping
3. availability tightly regulated
The health and socio-economic problems associated with vaping in New Zealand are already severe, and they are predicted to be considerably worse unless rapid steps are taken to tightly control the practice.
Some of the reported vaping rates in New Zealand:
20% of year 12 and 26% of year 13 students report vaping in the past 7 days - Asthma and Respiratory Foundation measures of 2022-23
Daily vapers - 25% 18-24 year olds, and 28.8% of Maori – and overall vaping rates are increasing. - Government Health Department survey of 2023-24 vaping in New Zealand
At the end of the article is a discussion about the New Zealand context and a small section on the biology of the lungs to help understanding of some of the information on risks.
Part One Vaping and health risks
The following about vaping and its effects is mainly from the Mayo Clinic site, Stop the vape: Plan to quit - Mayo Clinic Health System - Mayo Clinic Health System and the American Lung Association site, lung.org. As mentioned in the introduction, the US and Australia government sites include the main concepts, while the NZ government provides a short list and only addresses nicotine risks clearly.
(a link to the NZ material Vaping )
What is vaping?
Vaping is the use of an electronic cigarette which can deliver nicotine to your blood. These battery-operated devices use a metal element to heat a liquid solution and turn it into an aerosol or vapour which can be inhaled into your lungs.
The liquid must, as well as being heated, contain a specific chemical carrier or solvent to help form an aerosol and the ones used are propylene glycol (PG) and vegetable glycerin (VG). PG and VG are themselves hazardous to the airways in the concentrations required in a vape aerosol, but when heated as in a normal vape they break down to even more dangerous and carcinogenic aldehydes.
What is in a vape?
It is not just water vapour containing nicotine.
The "e-juice" that fills e-cigarette cartridges usually contains nicotine (which is extracted from tobacco), PG and VG, flavourings and other chemicals. Studies have found that even e-cigarettes claiming to be nicotine-free contain trace amounts of nicotine. Additionally, when the e-liquid heats up, as described more toxic chemicals are formed. E-cigarette composition and effects vary, but the following are common, with varying concentrations.
(Note: the pathways which the aerosol passes through to reach the blood and how lungs work are briefly described on the last page, in background biology, with links to graphics. Note that in each lung the pathway involves millions of tiny delicate tubes called bronchioles, each less than 1 mm diameter.)
1. Nicotine is the highly addictive substance found in most tobacco products and it is usually delivered in higher concentrations in e-cigarettes. Once the vape aerosol is inhaled, nicotine is absorbed into the blood stream and it quickly passes to the brain, stimulating receptors there to release a surge of dopamine, triggering a pleasure response. This motivates the vaper to continue to vape. With repeated vaping the brain develops ‘tolerance’, which is the need for more nicotine to get the same effect and stopping vaping resulting in unpleasant ‘withdrawal symptoms’. This involves the many other actions of nicotine on the body as well as that of increasing dopamine secretion. (The nature of addiction and how to become ‘unhooked’ is explained in Part Two.)
Nicotine is particularly harmful for adolescents whose brains are still developing. Early exposure to nicotine can affect a child’s attention control, learning, mood and impulse control. Long term, this can lead to cognitive deficits, increased susceptibility to various forms of addiction, anxiety, depression and impaired academic performance.
Nicotine effects on the body include particularly stimulation of the adrenal glands to secrete adrenalin, which increases blood pressure and heart rate, and this can contribute to cardiovascular disease.
2. Propylene Glycol (PG) and Vegetable Glycerin (VG)– One or both of these is in all e-liquids, such a chemical being necessary, as mentioned, to convert the e-liquid into an aerosol, the form which can be inhaled deep into the lungs. Though PG and VG are common additives in food and believed to be safe for ingestion, when inhaled they cause irritation and inflammation of the airways. This can exacerbate asthma and lead to lung diseases. These chemicals are used to make things like antifreeze, paint solvents and artificial smoke in fog machines.
3. When the e-liquid is heated PG and VG break down and form carcinogenic aldehydes, including formaldehyde, acrolein and acetaldehyde. Inhaling these chemicals can cause inflammation and damage of the airways and lung tissue, leading to chronic respiratory diseases as well as causing cancer.
Formaldehyde is used in industrial glues and for preserving corpses in funeral homes. Acrolein is a herbicide primarily used to kill weeds.
4. Flavouring Chemicals
Chemicals used to create flavourings may create buttery or creamy tastes, but they can be extremely hazardous. While less present in e-cigarettes currently on the market, the chemical acetoin can break down into diacetyl, which has been linked to bronchiolitis obliterans, or "popcorn lung" due to it being first discovered amongst workers in microwave popcorn factories. This is a serious and irreversible lung disease which damages the smallest airways in the lungs, leading to coughing, wheezing and shortness of breath. The bronchioles become blocked due to inflammation, constriction and scarring. Acetyl propionyl, also known as 2,3-pentanedione, often used as a substitute for diacetyl, has similar health risks. Even flavours considered mild or fruity may contain toxic compounds that produce free radicals and oxidative stress, contributing to cell damage and inflammation. Unfortunately, these appealing flavours in e-cigarettes are used as they can mask the harshness of the chemicals, making it easier for young users to start and continue using them.
5. Heavy Metals
The metal heating coils in e-cigarettes are typically made of alloys including the metals, nickel, chromium, cadmium and lead. Vape use involves heating the alloys to high temperatures resulting in release of the component metals into the aerosol, and these can then accumulate in the body. These substances are highly toxic. For example, lead is a neurotoxin and causes impaired development and neurological disorders. Chronic exposure to these heavy metals can also impair kidney function and increase cancer risk.
6. Volatile Organic Compounds (VOCs) in addition to the aldehydes already listed above
E-cigarette aerosols may also contain VOCs such as benzene, toluene and xylene. These are the same toxic chemicals found in gasoline and paint thinner. VOCs irritate the eyes, nose and throat, are carcinogenic and long-term exposure can damage the liver, kidneys and central nervous system.
7. Ultrafine particles, PM2.5 in the vape aerosol are inhaled deep into the lungs. These cause irritation, inflammation and scarring. Exposure to these is hazardous even at very low levels and increasing evidence suggests there is no safe level. Volatile organic compounds in regular and organic vaping liquids: a public health concern | Air Quality, Atmosphere & Health | Springer Nature Link
Author’s note
• The NZ Ministry of Health has regulations on amounts of some of the above, such as diacetyl, some aldehydes and heavy metals, but not all manufacturers comply and the regulations are difficult to enforce and In July last year a vape called ‘Suntree-vanilla cream’ was found to have 4 times the legal limit of the dangerous diacetyl which causes the serious bronchiolitis obliterans. Note – the aldehydes formed by heating PG and VG are not regulated, as PG and VG need to be present for the vape to function.
• Diethylene glycol is a highly toxic chemical used in antifreeze and brake fluids and causes lung damage. In NZ vapes trace amounts are permitted but it is otherwise prohibited. However it is found in higher levels in illegal poor quality vapes.
Second hand vaping.
People around someone who is vaping can breathe in the aerosol when the user exhales. The U.S. Surgeon General and the National Academies of Science, Engineering and Medicine have warned about the risks of inhaling second hand e-cigarette emissions, which are created when a vaper exhales.
In 2016, the Surgeon General concluded that second hand emissions contain, "nicotine; ultrafine particles; flavourings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead."
Diseases and pathological conditions emerging due to vaping (Note refs stated)
As stated, researchers have known for many years that the toxic chemicals in e-liquids are in concentrations known to cause harm, and both physicians and researchers have reported significant disease outcomes from vaping, both statistically and in terms of the serious nature of the conditions.
Patients with the following are showing up at doctor’s clinics attributable to regular use of normal vapes:
COPD (chronic obstructive airway disease), inflammation and infection of the lungs, asthma exacerbation and cardiovascular problems
The Asthma and Respiratory Foundation in N.Z. has reported frequently over the last few years the increase in vape-related worsening of asthma and in respiratory infections:
asthmafoundation.org.nz/your-health/e-cigarettes-and-vaping/vaping-some-more-facts#5
One of the most concerning of recent findings is that of the increased risk of COPD. This includes chronic bronchitis and emphysema with irreversible changes. Both conditions prevent gas exchange and create extreme breathlessness. Bronchitis blocks the airways largely due to the excessive mucous and inflammation causing swelling of the airway walls. In late stages this causes blood vessels of the lungs to constrict causing right side heart failure and inability to pump blood through the lungs. In emphysema the airway walls lose strength and collapse, trapping air when you breathe out so normal ventilation of the air sacs simply cannot occur.
The Mayo Clinic information about COPD https://newsnetwork.mayoclinic.org/discussion/chronic-obstructive-pulmonary-disease-risks-symptoms-and-prevention/
The following 4 year study showed that vaping increases risk of COPD by 2.3 times. Note - Tobacco smoking, another primary cause, increases chances by 5.0 times.
https://doi.org/10.1093/ntr/ntaf067 E-cigarette Use and Incident Cardiometabolic Conditions in the All of Us Research Program in Nicotine & Tobacco Research, Volume 27, Issue 9, September 2025, Pages 1651–1656
This next paper relates vaping to cardiovascular disease and death ‘A large body of epidemiological evidence has indicated that e-cigarettes are considered an independent risk factor for increased rates of cardiovascular disease occurrence and death.’
https://link.springer.com/article/10.1007/s00424-024-02925-0 Electronic cigarettes and cardiovascular disease: epidemiological and biological links in European Journal of Physiology (2024) 476: 875-888
Given the carcinogens in the heated aerosol there are of course serious concerns that in a few years mouth and lung cancers will start showing up.
The next study found that vaping causes DNA changes to tissues, in the mouth and airways, and impairment in various lung functions similar to those seen in tobacco smokers. The DNA changes are also seen in lung cancer patients.
https://doi.org/10.1158/0008-5472.CAN-23-2957Cigarette Smoking and E-cigarette Use Induce Shared DNA Methylation Changes in Cancer Res (2024) 84 (11): 1898–1914
As stated above, health insurance companies treat regular tobacco smokers and vapers the same in terms of their increased health risk
Does Vaping affect your insurance?
Some useful resources in the Mayo Clinic material are listed at the end. *
Part Two How can I quit, in New Zealand
A main message is that you can quit, and understanding what you may experience and how to manage triggers to vape and minimise symptoms of withdrawal can help ensure success. A piece of Cleveland Clinic advice below applies both to vaping and tobacco smoking, and it is that the withdrawal symptoms improve quickly, every day, after the third day following stopping.
As stated, the Government support in New Zealand for quitting vaping is negligible, with the primary assistance in Quitline being for those quitting tobacco, and the strong advice to them is to vape. So, unfortunately, those who wish to quit in New Zealand may need to manage the process themselves to some degree. Reading the material here, talking to your GP and getting simple support from family and friends may be your best option. Children obviously need much help in the process.
(Author note: Regarding the current NZ govt material on quitting vaping – see link below*. The content of this material includes some lists of symptoms and avoiding triggers to vape and these lists are useful but does not provide either enough information or, importantly, links to support services which help quitting vaping. As indicated, the support services via Quitline are directed exclusively to cessation of tobacco smoking not to stopping vaping, and vaping is recommended for this purpose with the risks of vaping in this context considerably understated, the primary message being that any health hazards due to vaping are not serious.
* Quit: Vaping )
The highly reputable Mayo or Cleveland Clinic sites or the US government site can be reliable guides for anyone trying to quit vaping and nicotine addiction, and these provide user-friendly plans of action. Again, these are US based and the kinds of resources mentioned here are not easily accessed in NZ.
Of the following sites each addressing how to quit, the Cleveland Clinic sites are possibly the most useful, but each of the following provide a slightly different angle even though the fundamentals are the same. There is some reiteration below of main concepts.
1. The Cleveland Clinic sites: How To Quit Vaping and the next with more detail, addressing both vaping and smoking is: Nicotine Withdrawal: Symptoms, Treatment & Side Effects
The following is content taken from both these sites.
Nicotine withdrawal is the collection of physical, mental and emotional symptoms you feel as nicotine leaves your body. As stated in Part 1, these symptoms occur because nicotine binds to receptors in your brain to release the chemical dopamine, the “feel-good hormone” and you develop tolerance, where you need more nicotine to get the same effect. When you stop taking the nicotine, you release less dopamine, which can negatively affect your mood and behaviour. Additionally, stopping the intake of nicotine can upset certain other chemicals in your body, leading to the more physical effects of withdrawal.
Nicotine withdrawal is not harmful to your health. It fades over time as long as you stay nicotine-free. The withdrawal symptoms vary from person to person. The severity of your symptoms depends on how long and how frequently you’ve used nicotine, the amount of nicotine you consumed with each use, your age, genetics and overall health.
When a person with nicotine addiction stops using nicotine they may experience:
Mood and behaviour changes:
· Urges or cravings for nicotine. This is the most common symptom.
· Feeling anxious, jumpy, irritable, grouchy or angry.
· Feeling frustrated, sad or depressed.
· Trouble sleeping.
· Trouble concentrating.
Physical symptoms:
· Headaches.
· Nausea.
· Dizziness.
· Increased appetite and weight gain.
· Constipation, gas or diarrhoea.
· Cough, dry mouth, sore throat and nasal drip.
How to quit vaping
A desire to quit using nicotine is an important and necessary first step. And you deserve a hearty congratulations for your commitment to quitting. (Your body — and wallet — will thank you for it!)
The ways to quit vaping are similar to the recommendations for ways to quit smoking. Having a plan for facing withdrawal symptoms before you stop nicotine may increase your odds of quitting for good.
This is the short list:
• Tossing out your vape pens and pods.
• Identifying habits and rituals that are associated with your habit and breaking those cycles.
• Distracting yourself with exercise and relaxation techniques.
• Building a support system.
• Talking with a healthcare provider about pharmacological options, like medication and nicotine replacement therapies like patches, lozenges and gums.
(Author note: This following paragraph is in italics as it relates to the US, not NZ, where, as said, quitting programmes are mainly for tobacco and advise using vapes.)
· Consider seeking out a smoking or tobacco cessation (quitting) program. There are several types, and they have many resources to help you through the process. If you don’t know where to start, reach out to your healthcare provider for help.
A more detailed list of strategies:
Managing physical nicotine withdrawal symptoms
Some strategies you can try to curb physical withdrawal symptoms include:
· Drinking fluid or eating fibre-rich foods to ease constipation.
· Drinking fluids, chewing gum or sucking on hard candy to ease dry mouth, cough and sore throat.
· Drinking lots of water and eating healthy snacks to try to prevent weight gain. When you eat, focus on eating rather than eating while distracted.
· Practicing good sleep hygiene to help with insomnia. Don’t drink caffeinated beverages several hours before bedtime. Listen to calming music and turn off electronic devices to help you sleep.
· Managing the mental, emotional and habitual aspects of nicotine withdrawal
Strategies for managing the mental, emotional and habitual aspects of quitting nicotine use include:
· Considering psychotherapy (talk therapy): During psychotherapy, a trained therapist can help you identify and change unhealthy emotions, thoughts and behaviours related to prior nicotine use. They can help you manage the mental and emotional withdrawal symptoms as well. (Author note: Again, these therapists may not be available in New Zealand, and the government advice to those helping people quit both tobacco and vaping understates risk of vaping. See the New Zealand context section at the end.)
· Getting active: Find some form of physical activity to keep your body — and mind — active. It can help with feelings of restlessness, boost your mood and may help with insomnia.
· Spending time with people who don’t smoke or vape: Tell people you’re quitting so they can encourage you and provide support. It may be difficult but try to avoid being around people who do smoke to reduce temptations.
· Keeping your hands busy: Find a favourite fidget toy or stress ball that will keep your hands active.
· Keeping your mouth busy: Substitute a straw, toothpick or cinnamon stick to replace the physical sensation of having something touching your lips and mouth. Chewing gum can also help.
· Getting rid of reminders: Throw away your ashtrays, lighters and other items that you used to consume nicotine.
· Trying relaxation techniques: Try methods like yoga, deep breathing, meditation or self-hypnosis when you feel anxious or have the urge to use nicotine.
· Distracting yourself in all ways possible: Create routines for your day to keep yourself busy. Lean on loved ones to help keep your mind off nicotine. If you’re having issues concentrating, limit activities that require strong concentration. Replace your ritual or habit of using nicotine with something else.
· Giving yourself grace: Quitting nicotine is very difficult. And the mental and emotional symptoms of withdrawal can make you feel out of control. Be kind and patient with yourself. Know that it takes time — and often several tries — to quit.
Dr. Choi, a Cleveland Clinic pulmonologist at the Cleveland Clinic, stresses that talking to a doctor about your addiction and your goals can be helpful. He summarises some of the major points in his experience.
“A doctor can help you find the best methods for treating your dependence. For teens and young adults, nicotine replacement therapies, like patches, lozenges and gums, are the primary treatments recommended. For adults, certain medications can also be prescribed to help kick the habit.
In addition to physical tools, there are social and mental aspects to vaping. Understanding your triggers and why you vape in the first place can help you give up the vape for good.
An important part of your quitting journey can come down to understanding why you vape. Sometimes, we have to go deeper and see what’s going on. Some people use vaping to self-medicate their anxiety or depression. Or are you trying to use vaping as a way to ‘fit in’? Knowing why you started vaping in the first place can help you overcome any underlying issues and increase your chances of success.
How long it takes you to quit will likely depend on a number of factors, including how much you vape, ingredients in your vape, why you vape, how long you’ve been vaping, your commitment to quitting.
My best advice for someone who is quitting vaping is to be patient and give yourself some grace. Quitting is a process. Nicotine is highly addictive. It may take you a few attempts, and that’s OK. Try again. And don’t hesitate to reach out for help.”
The following is a little extra from the Cleveland site addressing nicotine withdrawal in both smokers and vapers
The timing and intensity of nicotine withdrawal varies for each person. But in general, the nicotine withdrawal timeline goes as follows:
· Withdrawal symptoms begin four to 24 hours after your last dose of nicotine if you’ve been using it long-term.
· Withdrawal symptoms peak (are most intense) on the second or third day of being nicotine-free.
· Symptoms fade over days to three to four weeks. The symptoms will get a little better every day, especially after the third day following stopping.
Experiencing nicotine withdrawal is the toughest part of quitting smoking or other nicotine products. The first week after quitting is when you’re the most at risk of slipping up and returning to using nicotine. It may take several tries to quit. This is very common. You’re not alone.
In general, you’ll likely need to use several strategies to combat the cravings, physical symptoms and mental symptoms of nicotine withdrawal.
Nicotine replacement therapy (NRT) for cravings
Nicotine replacement therapy (NRT) involves using products containing low doses of nicotine — like gum and skin patches — to cut down on cravings and lessen withdrawal symptoms after you quit smoking. It’s a type of medication-assisted treatment (MAT).
NRT can help with physical withdrawal and craving symptoms. But it doesn’t address all the components of quitting smoking, like the mental, emotional and social aspects.
Your healthcare provider may also recommend taking one of two prescription medications (pills) for quitting smoking alongside NRT: varenicline or bupropion. They don’t contain nicotine.
Note: a NRT, Nicorette Quickmist, has recently been legalised in NZ for smokers and vapers trying to quit.
2. The Mayo Clinic link again: Stop the vape: Plan to quit - Mayo Clinic Health System This material is called “Journey to Wellness — A free self-guided healthy living program”, and can be accessed via the link below.
Note - The strategies always include encouraging ‘a natural dopamine high’ given the central role of dopamine in why one vapes and in nicotine addiction, explained in the material following.
This link: Mayo Clinic and its related publications, Mayo Clinic Health System and related wellness sources, describes how you can naturally increase dopamine levels through consistent, enjoyable lifestyle habits. Key strategies include regular exercise - especially, short, intense bursts -, fostering social connections, practicing mindfulness or meditation, spending time outdoors in nature, and achieving small, manageable goals to maintain motivation.)
Author note: A Harvard university paper is also about how to generate naturally feel-good neurotransmitters or hormones may be helpful, and includes the others, as well as dopamine. (Note, most of these substances act as both a neurotransmitter, which is a messaging signal between nerve cells, and as hormones, which are substances released from endocrine glands into blood. Both forms via their nerve or endocrine regulate function in many organs.) We make DOSE (dopamine, oxytocin, serotonin, endorphins) and cannabinoids endogenously (naturally in the body). Clicking on each of these in this link gives advice as to what optimises its secretion naturally. Undertaking these activities may assist the withdrawal phase and help prevent becoming addicted again to vapes or other modes of taking drugs. (Note - this article is about DOSE but some other studies indicate that exercise increases secretion of cannabinoids.)
3. Build My Quit Plan | Smokefree This is the US government site
The plan includes the following headings. For detail click on the link.
1. Choose your quit date
2. What is vaping costing you?
3. Why are you quitting?
4. Know your triggers
5. Choose strategies and tools to help you quit
(Author important note –
Again, there is reference to Help from Experts in this plan in 5., but the current NZ Quitline and Ministry of Health trained quit counsellors will not provide the same encouragement to quit vaping unfortunately. You will need to ask others, possibly your GP. See New Zealand context section at the end.)
4. Another highly reputable resource about quitting is that of the American Lung Association and their lung.org, also mentioned in Part 1. https://www.lung.org/quit-smoking/e-cigarettes-vaping
This American Cancer Society link may also be a useful site for information about both vaping and tobacco addiction and Why People Start Using Tobacco, and Why It's Hard to Stop | American Cancer Society
All this is very different from the NZ government advice, indicated in this online link to a PDF : NZ Vaping Cessation Guidance.pdf, and shows why in NZ you are unlikely to get proper assistance to quit vaping.
It is titled, Guidance for Health Workers supporting people to stop vaping and using vaping to stop smoking November 2024 Health New Zealand Te Whatu Ora
There are 5 bullet points to be emphasised to people giving up smoking (see page 31) :
“• Up to two in three smokers will die from smoking unless they stop (Banks et al 2015). • Smoking cigarettes involves the combustion or burning of tobacco, which creates cancer-causing substances. • Vapes heat e-liquids, which do not contain tobacco. The process of vaping does not involve the combustion or burning of tobacco. • Nicotine in any form of delivery can be addictive, but it does not cause cancer. • * Based on evidence from a small number of studies, with the longest follow-up duration being two years (Lindson et al 2024), there is no serious harm from nicotine vaping.”
Note – The 5 points happen to omit any hazards of vaping, and the final most important one denies any serious risk, completely refuting the most respected international clinical consensus and research findings.
There is in the whole PDF some information about risks of vaping, but the primary advice is, ideally you should not smoke or vape, but do not be too worried about health effects of vaping.
The NZ context
This section is about how and why the NZ government has adopted an extraordinary and illegal position regarding vaping, giving considerable support for the practice but understating risks, enabling easy access and providing negligible assistance to quit, all while there is an ongoing youth vaping epidemic.
Vapes were launched in New Zealand as the healthy, alluring and sexy alternative to tobacco. This was in large part from pressure, including a legal challenge, from the tobacco company, Philip Morris International, a major producer of vapes. Sales of tobacco, due to its reputation for causing disease and its high cost and reduced availability, had markedly dropped in NZ.
It became evident that many who took up vaping had never smoked and were not likely to, especially school children.
Mr Vaughan Couillot, President of the Secondary School Principals Association NZ, stated years ago, on RNZ Morning Report, when asked about mobile phone use in secondary schools, he was not worried about that but about vapes, which had become an epidemic and were causing serious problems in schools, and for children and parents. He said that tobacco smoking, due to reduced availability, serious health warnings and high cost of tobacco cigarettes, had no longer been an issue in secondary schools well before the new nicotine product, vapes, emerged. He said ‘To be perfectly honest, if we were going to invest money in legislation and implementing legislation, I think we should invest that money in the scourge that is vaping.’
Tobacco smoking is indeed a major health hazard, and as stated above, vapes may or may not eventually be found to be less dangerous than tobacco cigarettes, but they always presented a serious health risk to regular users.
Current NZ government cabinet ministers grossly understate risk, two publicly stating recently that vapes present 5% the risk of tobacco cigarettes. This is of course a complete falsehood. The current and previous governments have both claimed that their endorsement of vaping was to help people switch from tobacco. Given the risks of tobacco this was partly understandable, if reflecting unacceptable ignorance of the widely known hazards of vaping and that there were much safer ways of delivering nicotine to the blood, but there was no excuse for how vaping was introduced with concealing well-known risks and providing no support for quitting, no ‘off-ramp’. Other safer options were encouraged by other countries, and these generally included recommendation to overcome addiction to nicotine and at least to stop inhaling aerosols containing it. Note also the irresponsible permission of unusually high concentrations of nicotine in vapes sold over the counter in NZ.
The new regulations in New Zealand are mainly futile in reducing vaping. Banning disposables was made meaningless as there were many loopholes, for example merely adding a replaceable battery made a ‘disposable’ vape legal. Reducing visibility of vapes to the public at storefronts was a helpful if small measure, but it is not being properly implemented. Some vape stores appear as before with doors wide open and what looks like the original colourful array of vapes. (The boxes containing vapes are at the rear of the shop so the shop owners state they are not showing the product, even though it is very clear what they are selling so they are still breaking the law.) These colourful displays remain near schools, some only 100m from a high school. Vapes are highly available in local shops, service stations etc, and online.
Various clinicians have spoken out about the serious vaping problems in NZ. One in particular is Dr Bryan Betty, the Chair of General Practice New Zealand (GPNZ).
Note that ‘Vape Free Kids’ is a dynamic New Zealand group which includes parents confronting addiction to vapes in their own children. They have provided ongoing insight into the realities of school age vape addicts and have been campaigning widely for tight controls.
The NZ charity, the Asthma and Respiratory Foundation, mentioned throughout the article, has been immensely helpful undertaking research and publishing and campaigning for better protocols and government funded programmes for quitting vaping.
Other groups, including ASPIRE and ASH, and authors reporting about tobacco and vapes in the PHCC (Public Health Communication Centre) state they are concerned about vaping rates, but they do not state that providing both clear information about vape health risks and proper vape and nicotine quitting services for vapers should be a priority for the government. This with the weak new government regulations helps to ensure that NZ remains hooked. These groups have been allotted respect due to links to universities and their challenging tobacco smoking, but this lack of robust effort to help improve government vaping protocols is disappointing.
In summary, the NZ context:
That the vape packaging and the government online information about vaping do not require clear statement of known risks of the highly addictive and harmful practice, that NZ youth have been clearly targeted in the marketing and that colourful, attractive vape shops were allowed to set up near schools and remain there, that vapes are extremely easy to access, that there is an ongoing youth epidemic, that legal concentrations of nicotine are extremely and dangerously high compared with upper limits in other countries, that proper government-funded vape or nicotine quitting programmes are still not available for vape addicts wishing to stop, and that along with the tobacco-vape corporations the government makes considerable funds from the practice, including 15% off each sale, is with regard to the government action extraordinary, highly irresponsible and illegal. There is clear indication that the tobacco-vape industry has had a major influence on the government and the NZ public are getting a very raw deal.
The ongoing NZ vaping protocols, including the new weak regulations, unless fundamentally changed will ensure a new generation of users and many others remain hooked on vapes, and they and NZ overall will suffer an associated ‘tsunami’ of health, economic and social consequences.
If the NZ government protocols were responsible this paper would not be necessary of course, and we could all breathe more easily in every sense.
Some background biology of the lungs
Firstly, visualise the airways. They branch many times after the trachea, like an inverted tree, ending in millions of tiny delicate tubes called bronchioles, each less than 1 mm wide. The tubes feed moist oxygen-rich air into approximately 350 million air sacs, each less than 0.5 mm diameter and with a thin wall where oxygen passes into the surrounding blood vessels. This part of the lungs, where oxygen and carbon dioxide exchange occurs, has an immense surface area, of around 50-75 square meters, about half the size of a tennis court.
The tiny tubes need to be able to widen and shrink with each breath in and out. These tiny vital structures are easily and collectively damaged by exposure to the chemicals in the vape aerosols.
This link contains some useful graphics:
How the Lungs Work - The Respiratory System | NHLBI, NIH
Healthy lung - https://share.google/onJFdHQGCg3WyfG6A
Each pair of lungs is large, extending from above the collar bone to the bottom of the ribs. The job of them is to provide oxygen to blood and remove carbon dioxide from it. Oxygen is required to get energy out of food, similar to a fire which needs oxygen to release heat and light energy from wood or other fuel. Our cells trap the energy released from food molecules, like glucose, when they are each broken down to 6 carbon dioxide and 6 water molecules. The energy released is cleverly transferred to other molecules (ATPs) each of which act like a little battery. When the cell needs to do anything active, like contracting a muscle cell or brain cells communicating with each other, the ATP is opened and energy released.
Each glucose molecule releases enough energy to ‘load up’ around 36 ATPs.
This is the simple equation for energy extraction from glucose, a major fuel for us and a breakdown product of carbohydrate digestion in the gut.
Glucose + Oxygen → Carbon Dioxide + Water + Energy
C6H12O6 + 6O2 → CO2 + H2O + energy
Without adequate oxygen we simply cannot do the activities of normal life.
We are vulnerable however given the design of the airways. They can easily be damaged if we inhale significant amounts of certain chemicals. Unlike the digestive tract which can cope of course with many substances the extremely delicate airways cannot, being suited simply to air.
A dramatic example is someone exposed to intense smoke as in a house fire, They can appear to have survived but then die several days later purely from the irritant effects of the smoke causing inflammation of the airways.
With exercise or stress which require more energy we need to take deep breaths and fill our lungs. Breathing deeply has other functions and of course feels good even when we are not exercising..
* Some useful resources in the Mayo Clinic material
These include links to other websites, reports, educational materials, toolkits and more information on e-cigarettes. Visit Lung.org/ecigs to view the American Lung Association's statement on E-cigarettes, learn facts and download resources for parents, schools and teens.
(Note – these are US based, so although helpful, do not direct you to places or people within New Zealand who can help you understand, and, if wished, to quit vaping. For information about NZ resources see below in Part Two and in The NZ context.)
• Talk to Your Child About Vaping: A Guide for Parents, Guardians and Caregivers
• U.S. Department of Health and Human Services
• https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette
• American Lung Association's Truth About E-Cigarettes Brochure
• U.S. Surgeon General's Know the Risks: E-cigarettes and Young People
• Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion's Facts about Electronic Cigarettes
• U.S. Food & Drug Administration's Vaporizers, E-Cigarettes and other Electronic Nicotine Delivery Systems (ENDS)
• "The Real Cost" Youth E-Cigarette Prevention Campaign
• Minnesota’s Department of Health E-Cigarettes and Other Vaping Products
Mary MacGibbon PhD
PhD in Dept of Medicine, Uni of Sydney
Retired lecturer in health sciences, including for postgraduate Cardiothoracic Specialist Nursing
March 2026