December 11, 2023 • 33 mins
E-cigarette use, or vaping, has quickly become a regular habit for many teenagers in Australia and around the world. Associate Professor Michelle Jongenelis talks about the rise of vaping and what steps the government needs to take to curb its widespread misuse. And we ask her: is there a better way to convince young people that vaping might not be the best idea?
Discover more about this topic here.
Featuring Associate Professor Michelle Jongenelis. Michelle is a Clinical Psychologist with expertise in health promotion and behavioural science.
Credits: Hosted by Associate Professor Cassie Hayward and Professor Nick Haslam. Produced by Carly Godden and Louise Sheedy. Mixed by David Calf.
See omnystudio.com/listener for privacy information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nick Haslam (00:00):
This podcast was made on the lands of the Wurrundjeri people,
the Woiurrung and the Boonwurrung, and we would like to pay respects
to their elders, past and present and emerging.
From the Melbourne School of Psychological Sciences at the University
of Melbourne, this is PsychTalks.
(00:23):
Hi there. I'm Professor Nick Haslam and you're joining us
for PsychTalks, a series that profiles pioneering research in psychology. Each
episode we pick the brains of one of our experts
here at the Melbourne School of Psychological Sciences. And to
help us do this, I'm joined by Associate Professor Cassie Hayward.
Cassie Hayward (00:37):
Hello again, Nick.
Nick Haslam (00:39):
So we're on the topic of e-cigarettes or vapes and
what's being done, or what the best research says ought
to be done to control their use and misuse.
Cassie Hayward (00:46):
Yeah, and it's just it's a bit of a mystery
to me as to how teenagers in particular can get
their hands on them so easily. I mean, you see
vapes for sale in shops almost everywhere. So we're keen
to explore the history of vaping and go over some
tips on how to talk to your kids about it.
Nick Haslam (01:00):
Mm, because simply saying, Oh, well, they're addictive. Perhaps isn't
going to work anymore. That's according to our guest Associate
Professor Michelle Jongenelis.
Michelle's research specialises in health related behaviours, including tobacco control,
and she's a regular advisor on this to not for
profits and importantly, the Australian Government.
Cassie Hayward (01:18):
Michelle, thank you for joining us today. We're fascinated to
get into this topic of vaping. But before we start
on the nitty gritty details, can you just give us
a little bit of an introduction about yourself and how
you came to be working in tobacco control?
Michelle Jongenelis (01:32):
Yeah, sure. So it was serendipity. Actually. I did a
master's and a PhD in clinical psychology and upon finishing
my PhD started working with a professor who was, uh,
doing some pro bono work for
Cancer Council WA and obviously Cancer Council WA and the Cancer Council
Federation deal broadly with what things cause cancer. And what
can we do to prevent that? And obviously, tobacco control
(01:53):
is a huge issue there. So that's how I found
myself getting into it in terms of the vaping, specifically
about 2016, I started working in this space, and here
I am now still working in it. Unfortunately, I wish
we had solved the problem?
Cassie Hayward (02:07):
Yes, and hopefully, maybe in five years, we won't be having
this podcast re aired. But let's see how we go.
But we hear a lot about vaping in the news
and in social media. But I think there are still
a lot of misperceptions about what vaping actually is, what
is allowed, what's not allowed. How have we got to
where we are? Can you just tell us a bit
of a quick history of vaping? If there is such
(02:28):
a quick history?
Michelle Jongenelis (02:29):
No thing there's a quick history with vaping. I guess it
started, y ou know, a few decades ago, the son of
two smokers who had died from smoking had decided to
create a a harm reduction product, I guess, in the
form of, uh, electronic cigarettes. So that's the original sort
of genesis of these products. And then, of course, as
you know what happens with most things, the industry sort
(02:51):
of started really diversifying and sort of seeing this as
an opportunity to get a new generation addicted to nicotine.
Obviously, their core consumers, being smokers, were dying. How do
we get more money through the door? How do we
appease our stakeholders and our shareholders. And so there was
a big investment in electronic cigarettes from the tobacco industry
that happened around 2013. And then since then we've just
(03:13):
seen obviously, the issue become increasingly more prevalent with particularly
among youth, because the industry then started marketing to that
age demographic.
Cassie Hayward (03:22):
And you talked about electronic cigarettes. I think there's also
some confusion about the terms. What's an electronic cigarette? What's
a vape? What is the difference?
Michelle Jongenelis (03:30):
There is no difference. That's another sort of industry tactic.
So they wanted to obviously move people away from thinking
that electronic cigarettes were bad. Let's create a new term
for it, so people don't actually know sort of think
that the two are related. And that's how the term
vape was coined. So vape, electronic cigarettes. They are exactly
the same thing.
Cassie Hayward (03:50):
Michelle. Just on this, the wording around vaping. We use vaping,
and it's very much different to the word smoking or cigarettes.
Has that been a conscious kind of word choice from
the industry to separate vaping from smoking, which, you know,
if you've grown up in Australia, you have very kind
of negative views about smoking. But then this thing vaping
(04:10):
is something very different.
Michelle Jongenelis (04:12):
I believe it is. So if you think of the
word vaping, it essentially sort of the connotation that you
get is vapour. Oh, it's just water vapour. And that's
something we hear a lot from kids and certainly, you know,
a couple of years ago there were some people in
some surveys that I conducted who said, 'Isn't it just
like putting your mouth over a kettle like, isn't that
just what it is?' And so I think definitely the
(04:32):
industry is using that term the vaping to separate it
from smoking and give the impression that it's actually OK.
And we've seen that as well. Where in the industry
has now obviously invested in what's called heated tobacco products,
which aren't available well, I'm sure you can get them
in Australia at some point, but they're not legally available
in Australia any means. But they are big over in
(04:53):
Europe in particular. So I was in Italy recently, and
certainly in Rome, 75% of the people who I saw
were smoking were using these new heated tobacco products, not cigarettes.
Now, heated tobacco products are essentially a cigarette that they've
put into a metal casing, but they're not calling them cigarettes.
They're calling them heat sticks. So the industry is really
playing around with a lot of language here to try
(05:16):
and sort of distract people from the fact that this
is just nicotine. This is just a harmful product. It
looks different. It looks flashy. It's in a colourful packaging,
but it is still just harmful.
Cassie Hayward (05:27):
Literally smoke and mirrors?
Michelle Jongenelis (05:28):
Exactly. Yes.
Cassie Hayward (05:32):
And then what about the regulations and laws? Again, I
think it's an area where there's a lot of confusion
and you see vapes being sold in toy shops and
milk bars and shopping centres, and you can see 12
year olds walk in and come out with vapes. So
what are the current regulations and how are they allowing
(05:53):
that kind of behaviour?
Michelle Jongenelis (05:55):
Yes, so in Australia at the moment we have, thankfully,
nicotine was always considered a poison by the Therapeutic Goods Administration.
So this means that Australia was able to classify nicotine
containing e-cigarettes or e-cigarette products as a prohibited good. So
it was always prohibited unless you had a prescription from
your GP to say that you were using it for
smoking cessation purposes or I guess, you know, quit smoking,
(06:17):
which is what most people would call it. Non nicotine products, though,
are available to those over 18. And so that's why
we're seeing these stores pop up that are selling supposedly
non nicotine. But we know when we take them back
to the lab, about 75% of them do contain nicotine.
Cassie Hayward (06:35):
And you say that that's available to over 18 consumers.
But we know that kids can walk into those shops
and buy them.
Michelle Jongenelis (06:41):
Absolutely, yeah, so there definitely needs to be some more enforcement,
particularly in Victoria. Victoria is now, I think, the only
state in Australia to not have a positive licensing scheme,
which means anyone can basically sell these products, they don't
have to register.
We don't know who's selling it or not. All the
other states do have a positive licensing scheme. So it
makes it tricky with enforcement because nobody can just go
(07:02):
into a store because we don't know what stores are
selling it. What stores aren't so we're hoping that the
Victorian Government makes some changes there very soon.
Cassie Hayward (07:09):
Hi, listeners. Just a quick qualifier here from Michelle. Like Victoria,
New South Wales, also doesn't have a positive licensing scheme, however,
it does have a negative licensing scheme. This means sellers
have to notify the New South Wales Government if they
plan on selling e-cigarettes. But they don't need a licence
per se, and they can be banned from selling vapes
if they're found to have breached the licensing conditions.
(07:31):
OK, let's get back to it.
Nick Haslam (07:33):
That's extraordinary. The idea that these things are being sold
as if they don't have nicotine, but they do. I mean,
do the purveyors, and do the purchasers have a sort
of nudge, nudge, wink, wink? They know it's got nicotine,
but they pretend it doesn't? Or is it just people
are generally mystified about?
Michelle Jongenelis (07:47):
No, it's generally for the retailers who are selling these products,
it's behind the counter. So there was a recent report
yesterday showing that these
products are being kept in pizza boxes to make it
look like it's actually pizza. But they open the pizza box,
and here you go a wide variety of nicotine vapes.
So often when you walk into the store, what you're
seeing is the non nicotine variety, the supposed non nicotine, and then
(08:09):
if you go to the counter and say, actually, you know,
I'm looking for a nicotine one. Here's the pizza box
full of the nicotine ones.
Yeah, and we certainly know that people aren't going out deliberately,
really to purchase non nicotine. So I ran some focus
groups earlier this year at random with adolescents, young adults
and adults. And I said, What do you think about
the fact that non nicotine products are available? And they
sort of looked at me blankly and went, what do
(08:30):
you mean? There are non nicotine products available? Why would
anyone want that? We want the heads spins that comes
from the nicotine. Why are you telling us this?
So they were really sort of. There was a lot
of negative sentiment around the non nicotine stuff being available. So
both retailers know they're selling it, and purchasers want actually
to buy the nicotine stuff.
Cassie Hayward (08:48):
I just think it's extraordinary, like if a corner shop
was selling a soft drink, but it turned out that 75%
of those drinks had alcohol in them. It wouldn't be allowed,
so it just seems crazy to me that these non
nicotine vapes that actually have nicotine in them are allowed
to be sold.
Nick Haslam (09:03):
But what would be wrong with having a non nicotine vape?
I mean, isn't it just smelly vapour?
Michelle Jongenelis (09:10):
Yes, well, that's what a lot of the certainly the
adolescents would say. Actually no. So what we know from
the research so far is that it's not just the
nicotine in these products that's harmful. It's actually a whole
bunch of other chemicals and the flavourings as well. So
there are certain flavourings, particularly the cherry flavouring uh, that
are particularly harmful.
And I think that's been a problem with Australia's focus
(09:31):
on nicotine. Nicotine is that it's giving this perception that
the non nicotine ones must be fine, which it's actually not,
which is why the government has now introduced or plans
to introduce reforms to make it so that both non
nicotine and nicotine varieties are prohibited from being used.
Nick Haslam (09:48):
Do you mean the recent reforms in May 2023?
Michelle Jongenelis (09:52):
Yes, I do.
Nick Haslam (09:53):
Right, so that's where I was going with this, the
drivers for these reforms. It sounded initially like you were
saying it was just to control the substance of nicotine
as you would, but it's obviously beyond that. It's also
health focus and it's, I mean, who are you marketing a
cherry flavour to? It's not people my age.
Michelle Jongenelis (10:09):
No, and it's not smokers either. I mean, very few
smokers say, Oh, look to quit, I absolutely need the
unicorn vomit flavoured e-liquid. How dare you take that away
from me? So while there is, you know there's some
evidence or certainly anecdotal evidence that smokers say, you know
the flavourings actually do help. Broadly when we look at
the systematic reviews and the matter analysis there, there is
no evidence that flavourings actually do contribute to more successful
(10:32):
quitting attempts. So that's what our recommendations has been to
government is, you know, we need to be restricting the flavourings,
just like we
been doing with tobacco cigarettes over the years. We need
to be putting these into similar to plain packaging as well.
So if you walk into a store, these things are
brightly coloured. There's cartoons on them. A smoker isn't wanting that.
It's really it is targeted toward youth. So a lot
(10:54):
of the recommendations we're making are about finding that balance
between how do we protect youth from potentially taking up
these products? And then how do we still provide access
to smokers who want to use these products to quit.
Nick Haslam (11:07):
So going back to your personal history, you said you
had a slightly strange path to get to where you
are now. And you started as a clinical psychologist. Do
you think that has had any influence on the way
in which you do this work? Or have you just
flipped over to the dark side and become a health psychologist?
What does being a clinician do to affect how you
approach this topic, if anything?
Michelle Jongenelis (11:29):
Yeah, I mean, I think when you work at the
public health level, you're working at the population level and
then when you're working clinically, you're working one on one.
So it's often me having to sort of balance how
I'm feeling across the board because obviously, you know, we
do hear stories of smokers saying, but hey, this is
helping me quit. Which is why I think the approach
that I'm taking is we can still have these products
(11:53):
be accessible to smokers at the individual level while controlling
access at the population level.
So I've sort of tried to merge both sides of
me together to create this viewpoint as opposed to being
very pro vaping or very anti vaping. I guess I
hate that dichotomy because it creates this sort of false debate,
but that's sort of how I've managed to deal with it.
Nick Haslam (12:15):
So what's actually in these e-cigarettes?
Michelle Jongenelis (12:18):
I mean, who knows? Right. These products are are being
imported from, you know, some developing countries. We don't know
where they're being made. They could be being made in
people's bathtubs. You know, we have actually have no clue.
So we do know that, you know, with the tests
that we've conducted in Australia, there are about 200 chemicals
in these vapes. Formaldehyde is a big one and then
(12:39):
others whose names I can't pronounce. Nicotine is often in
vapes as we know. Flavouring. So just a whole bunch of additives, chemicals.
And then, of course, the added element of vapes that's
different to smoking is the device itself. So the device
itself is often made of metal, so then you get
degradation so you get heavy metals like zinc that can
(12:59):
be ingested as well.
Nick Haslam (13:01):
So it sounds like there's a really good rationale for
these reforms, but you're clearly saying that it's not enough.
It hasn't gone far enough. So what more do we
need to do to deal with this problem in Australia,
in particular?
Michelle Jongenelis (13:13):
Yes. So the reforms that were announced by the government
back in May are a good next step. So back
in October 2021 they made it the prescription model, essentially,
which is, you know, the only country in the world
that has this prescription model. If you are wanting to
quit smoking using an e-cigarette, visit your GP get a prescription,
go to your pharmacist, fill that prescription. Now
the issue with that is obviously the fact that the
(13:37):
non nicotine ones are still available and there's fewer controls
at the border. People can still import these products. So
we've had a mass sort of importation of supposedly non nicotine
varieties that we know contain nicotine. And so the next
step of reforms which we are really excited about, is
the prohibition of both non nicotine and nicotine varieties unless
they are being used as a therapeutic product under medical supervision.
(14:01):
So that was the big ticket item. And then, on
top of that, there were what we call the more
demand side things. Restricting the flavourings so the current consultation
out at the moment is restricting flavourings to tobacco or menthol,
menthol mint, and then also pharmaceutical -like packaging. If these
products are to help people quit, then we're going to
put them in pharmaceutical-like packaging.
(14:22):
So no more bright colours. And there were also some
changes around reducing the nicotine concentration. So Australia had allowed
up to 100 milligrams per ml, which is five times
the legal limit in the European Union, the UK. So
the government is now suggesting we actually align with those
countries and only allow 20 milligrams per ml.
We're getting rid of the awful disposal e-cigarettes. So they
(14:43):
came onto the market in 2018 2019. And that's when
we really saw youth use skyrocket. So, apart from these products,
being just horrific for the environment, they also are based
with nicotine salt highly addictive, highly palatable. So the government
is making steps to completely prohibit the disposable products, too.
Nick Haslam (15:03):
So it sounds like we're ahead of the curve a
little bit in this country, or are we catching up?
What's the current overall judgement?
Michelle Jongenelis (15:10):
We're just taking a different approach to things. Obviously there
are other countries that have legalised these products the UK,
the US, New Zealand. The approach that we're adopting is
the precautionary approach which is consistent with The World Health Organization.
It always has been, so that's the idea that until
we get more information about how harmful or not harmful
a product is, we should be cautious about allowing that
(15:31):
product to be widely sold or available on the market.
I say we're ahead of the curve because what these
countries are seeing as a result of legalisation is skyrocketing
youth use. And so they allowed free for all and
now they're having to implement reforms to restrict those products.
I think certainly this will make Australia reclaim its position
(15:52):
as a world leader, not just in tobacco control but
also in vaping control.
But globally consumption is still going up. I believe. I
think I saw a stat somewhere that there's over 80
million users at present, 10 times up from 10 years
earlier when your history started. Is it any different here?
Is it flattened out or?
No. So use is also increasing here. Despite the sort of restrictions
(16:15):
that came in in October 21 we are hoping that
these new reforms will start flattening the curve there because
the increases that we're seeing in Australia are predominantly in
the adolescent young adult group. So what we would call
recreational vapers and not using it to quit, and these
reforms are directly targeting, you know, the recreational use.
Cassie Hayward (16:35):
It's devastating to hear about kids vaping and I think
also when we think about how young they are being
exposed to it. But is there good data on the
prevalence of vaping in young people? Do we know where
it's at? In terms of how many of them are
have tried it, regularly do it.
Michelle Jongenelis (16:51):
We know that if we communicate the message that these
things are being used widely, then it creates a social norm.
We don't have any good prevalence data because Covid threw
out all our monitoring. So the last sort of year
that we collected data on secondary school students was 2017.
We're hoping that the data from last year comes out
this year or next year, but we've got estimates of
(17:12):
you know, at least a third of adolescents and young
adults having ever used these products and about 14% being
regular users. So that's using monthly.
Nick Haslam (17:22):
So you said earlier that under the proposed or actual reforms,
you could still have vapes prescribed for certain medically appropriate uses.
I forget your exact wording there. So that is for
smoking cessation purposes. Is that a good use for vapes,
are vapes shown to be effective in reducing smoking?
Michelle Jongenelis (17:40):
I mean, the jury is still out there. The recent sort
of systematic review conducted by Emily Banks at ANU found
that there is limited evidence for the effectiveness of e-cigarettes
as a smoking cessation aid. And then even within that
there are certain types of e-cigarettes that are better than others. So,
like the disposable ones have not been found to be
(18:00):
effective or nicotine concentrations above 20 milligrams don't actually add
extra benefit.
So for those reasons, they haven't been approved by the
Therapeutic Goods Administration yet. But also, the vaping industry hasn't
actually put any product to the Therapeutic Goods Administration for approval.
And so that's why in Australia we really do need
(18:21):
to control access. If you are planning to use these products,
then you do need to use it under medical supervision
because they haven't been tested for quality safety efficacy. They
haven't gone onto the TGA's registry.
Cassie Hayward (18:33):
Well, I think the fact that you find that non
nicotine vapes have nicotine in them demonstrate the lack of
kind of regulation and oversight of the products in general.
Michelle Jongenelis (18:44):
Exactly, and the new reforms that are coming out as well.
There's a provision in there that even though these products
are being used for smoking cessation purposes with your doctor,
that doesn't mean that the product that you are using
can just be any product it needs to be approved.
Or it needs to meet the guidelines of what they
call the TGA's TGO 110 which is essentially a product standard.
(19:06):
So it needs to at least meet Australia's product standards.
You can't just be bringing in a random product and saying,
This is for smoking cessation and I have a prescription.
Nick Haslam (19:14):
So you said that a lot of young people are
using the vapes. So what are the drivers? Why are
kids going in for this? They are not obviously using
it for smoking cessation in most cases, why are they
doing it?
Michelle Jongenelis (19:25):
I mean, the most common answer that we get is
they're just curious right. And that curiosity' s obviously stemmed
from the very good marketing that the industry does and
the flavourings and I wonder what this would taste like. Um,
which is another common reason, you know, I use it
because I think they taste good in terms of, you know,
wanting to initiate. We do have some, um, reports that
(19:46):
kids are using it to make
moderate their anxiety or moderate the depression. Obviously, we know
from the research that e-cigarette use over the longer term
actually worsens depressive symptoms. So, you know, there's this emotion
regulation aspect to it that might be happening. The curiosity aspect.
Kids just wanting to experiment. And then, of course, social
(20:08):
norms not wanting to miss out peer pressure, all of
that sort of stuff.
Nick Haslam (20:12):
So they actually think it's good for them?
Michelle Jongenelis (20:14):
Uh, actually, no. So they do recognise that there are
health harms. So again, in the focus groups I conducted
earlier this year, I asked them, What do you guys
know about e-cigs? And they said, Oh, yeah, Look, we
know it's bad for you. We've seen the posters at school,
but we just ignore them. So there's this knowledge there
that these things aren't entirely harmless, but, hey, it's fun.
It tastes good. The flavourings are nice. Why not do it?
Cassie Hayward (20:37):
And it seems like that kind of curiosity in kids
is ever present in any generation. It's the smoking a
cigarette behind the, you know, the shed at school in
the seventies is now this kind of trying of vape.
But it seems like they are now more addictive, that
that curiosity could very quickly escalate into something more now,
compared to, say, in previous generations.
Michelle Jongenelis (20:59):
Yeah, I mean, the issue with vaping is that what
we know from the research is that you more likely
to then take up tobacco cigarettes after, so it doesn't
just have the potential to stop at vaping. It could
then escalate into tobacco cigarette use, which is something that
the Cancer Council recently found that for the first time
in three decades, we've seen an increase in smoking prevalence
among adolescents that coincides with the increase in vaping. So
(21:21):
we are really, really concerned about that. But yes, it
could just be experimentation. But then we know for a
lot of kids, it might not be, and it has
the potential to escalate.
Cassie Hayward (21:30):
What can parents do if they're worried about their kids
either starting to vape or know that their kids are
vaping and want to stop? Maybe starting with the prevention first,
how can a parent kind of prevent their kids from
or is it just inevitable that kids are going to experiment?
Is there anything parents can do to stop their kids
going down this vaping path?
Michelle Jongenelis (21:49):
I mean, I think in terms of prevention, it's about
having open conversations that don't involve lecturing.
So, you know, I've heard that there's this thing called vaping.
I've heard it's a thing at school. Is it coming
up at your school? How do you feel about it?
So just engaging in those sort of open ended questions
and and seeing how they feel, then if you were
to sort of sit them down and and tell them
(22:10):
about all the harms of vaping, probably not going to
make a difference. So that's where I would recommend to
stop just having those open conversations.
If you have a child who is using vapes, then
you know, finding out why they're using vape. So something
I always say is never tear down a wall before
first understanding why it's been built. And if this wall
(22:30):
has been built to cope with anxiety and you're suddenly
taking that away from your child, there are, you know,
there are consequences with that. So asking your child, why
are you vaping? If it is because of anxiety, do
they need to get some mental health support? Do they
need to learn other strategies to cope with anxiety? Is
it a social norm thing? Is it that it's happening
at school
and they're feeling pressured? Does that mean that as a parent,
(22:52):
you need to go to the school and sort of
talk through it? What else can we be doing here?
So I think finding out first why they're vaping will
then give you an idea of what to do and
how to cope with it. If they are addicted to nicotine,
then obviously going and seeing a medical professional or calling
the Quitline . And certainly the Quitline has reported an
increase in the number of children and parents calling the
(23:13):
Quitline because their kids are addicted to nicotine.
Cassie Hayward (23:16):
And when should parents start having those conversations? They're probably
one of those awkward conversations that parents don't want to have.
But what kind of age should they start? At least
broaching that topic of Hey, I've heard this thing. Is
it at your school?
Michelle Jongenelis (23:29):
Yeah, so I don't want to say primary school, but
we are getting reports that kids in late primary school
are starting to vape. So I would probably say late
primary school and you don't necessarily have to have indepth
conversations that,
you know, ask too many questions. It's it's more just Hey,
there's this thing. Is it a thing at your school?
And that could be the end of it. That could
be the end of it.
Cassie Hayward (23:49):
Yeah, and I presume some of those tactics around understanding
why the kids are vaping and trying to work on that,
that that could be used for adults who find themselves
vaping as well. Are those same tactics for quitting vaping
relevant to the adults who want to as well?
Michelle Jongenelis (24:05):
Yeah, absolutely so here we sort of talk about the
classic behaviour change techniques, what motivates you to vape and
then how can we sort of flip the script around that.
Setting goals, making it so that you are potentially using
other things to modify cravings. So a lot of the
stuff that is helpful in the smoking space actually comes
(24:26):
in helpful here. So chewing gum, getting out of the house,
getting out and about, doing something, distracting yourself. All of
those sort of techniques that have been found to work
for smokers could also work for vapers.
Cassie Hayward (24:37):
So, Michelle, in terms of these reforms, is there some
spending allocated in there for mass media communication to kids,
to parents, to teachers, to adults around the dangers of vaping?
Michelle Jongenelis (24:50):
Yes, so the government has recognised that there hasn't been
a national mass media campaign, even in the tobacco space,
for almost a decade I think. So they've committed 63
million to mass media campaigns not just for vaping but
also tobacco control. And I think what's going to be
really important with those
campaigns is making sure that we get the messaging right.
So there's a sort of sense, certainly with tobacco that
(25:13):
you know a lot of the ads over the years
have been focusing on the health harms because at the
moment it really is just adult smokers who are caring
about that.
With vaping, i t's a completely different approach because kids don't
care about cancer. Because they're not going to get cancer
for 40 years, and that's if they get cancer. We
don't know. So the traditional approach to campaigns needs to
(25:33):
sort of change. So, you know, at the Melbourne Centre
for Behaviour Change, we do a bit of communication work
as you know, and we sort of wanted to figure
out what messages could we look at for kids.
And in the focus groups we did earlier this year,
the messages that they seem to connect with the most
with vaping was around what chemicals are in there and
(25:54):
not just these contain formaldehyde. They were very clear that
they wanted to know what formaldehyde then does. So it's
not that they don't want to know the health harms.
It's just it has to be sort of with some
extra information, so you'll see a few campaigns that might
come out that will say it contains formaldehyde and this
is what formaldehyde does.
There's certainly some campaigns in New South Wales that talk about
(26:14):
nail polish remover and all of that sort of stuff,
So the chemicals one came up really strongly. Also, the
concept of dependence. Kids were really worried about becoming dependent
on these products. Interestingly, they weren't worried about addiction. They
sort of said, Oh, you can get addicted to anything.
It was the dependence and the consequences of dependence on
(26:36):
their life. So it means I might not be able
to play football as well as I used to, or
I might not be able to make out for as
long as I used to. That was another common one
we got in the focus groups. Um, so I think
dependence chemicals. They were the main sort of themes for consequences.
Cassie Hayward (26:52):
Fascinating, just like wording choices. And on your point in addiction.
I think kids are forever being told they're addicted to
social media. So I think that term has probably become
less scary to them because they don't see their social
media use as a problem.
Michelle Jongenelis (27:07):
Um, I completely agree. I was surprised with the focus
groups as well that the dependence word got a better
response than the addiction word. Um, and I think you're right.
I think kids have become desensitised to the word addiction,
and they're using it in everyday language. You know, I'm
addicted to this, I'm addicted to that, not realising what
addiction is, whereas dependence suddenly introduces this different concept. And
(27:27):
maybe in five years time they'll be desensitised to dependence,
and we'll have to pick a different word. But I
think that's really important because a lot of the stuff
we're talking about at the moment is around 'You will
become addicted'. That's just not resonating. So I think we
need to try a different approach.
Cassie Hayward (27:39):
I also love the focus on the short term harms,
as you say. They don't care about what happens in
40 years time, but they will care if they can't
keep playing footy or can't run as fast. And I
think that's probably tips that parents can keep in mind
as well, in terms of reasons why they might want
to try to quit. You know, not about the health harms,
but
(28:00):
you want to keep playing footy. You wanna keep playing netball,
You wanna keep playing soccer? For sure. This is gonna
stop your ability to do that.
Nick Haslam (28:06):
You want to keep making out.
Cassie Hayward (28:07):
Yeah, that's one of those awkward conversations that parents don't
want to have. I think they'll focus on the sport, but, yes,
really interesting to see that there are, and I think
we all have that kind of short term focus in
any kind of behaviour, change issue, but much more kind
of present for kids in terms of their age. When
you're talking about you know something that might happen when
they're 60 that's just absolutely, absolutely in the far, far
(28:29):
future for them. But but those short term risks are
are much more impactful for them.
Michelle Jongenelis (28:35):
For sure.
Cassie Hayward (28:35):
But another big part of it, in terms of how
especially young people are being exposed to this is advertising
and the visibility of vapes on social media, where there
are far fewer ways to regulate that type of exposure.
We can ban ads on TV. Not that kids these
days watch TV, but we can ban the ads on TV.
We can ban advertising in billboards and those other more
(28:57):
formal forms of advertising.
And there doesn't seem to be huge a huge amount
of regulation in terms of vape content that you know
you're seeing the same thing that you saw with cigarettes
in the seventies in terms of popular artists and singers
using vapes in their music videos, which is now just
all on social media. Is there any concern around that
side of things in terms of regulating that content?
Michelle Jongenelis (29:19):
I mean, definitely. I think social media has presented a
big issue not just for vaping but also in terms
of alcohol and gambling and all the harmful industries. You know,
we're not seeing the things that the kids are seeing because,
you know, kids are on TikTtok and we're not on
TikTok . Well, at least I'm not. I don't know
about you two. So you know, certainly that's something that
we have presented to the government as a particular issue.
(29:40):
And I do know that the reforms that are about
to become legislated for tobacco really knuckles down on some
of that advertising and specifically mentions that digital advertising.
How that looks like in terms of how it's enforced
is a different story. Because you're right. Kids are able to,
you know, buy products that hide their IP, and they
can just get access to stuff anywhere around the world.
(30:01):
So I think this is an issue that we're battling globally,
is how do we manage the digital marketing space?
Cassie Hayward (30:05):
And I think it's also even if we are on TikTok.
I am a little bit, but we're not seeing what
the kids are seeing. The algorithms are so smart that
I'm not getting the content that a 14 year old
kid is getting anyway. And if they're interested in vaping,
they're going to eventually get to vaping content and then
get fed more vaping content. So even if a parent
is on TikTok thinking, Oh, yeah, there's not much vaping
(30:27):
content here. I'm comfortable that my kid is not being
presented with that content.
They're not seeing what their kid is seeing.
I think that's the difference between traditional media, where if
you sit down and watch TV with your kids, you're
all seeing the same ads. It's a totally different environment
on that social media kind of landscape,
Michelle Jongenelis (30:44):
Yeah, which I think is sort of why we need a
more comprehensive approach to vaping control, just like we have
with tobacco control. You know there are going to be
some things that kids are exposed to that we can't
protect them from, and and nor should we. You know
there needs to be a certain level
of self moderation and resilience, so that's where you know
we can also use digital media for mass media campaigns
that present the harms of vaping or approach it in
(31:08):
a different way. Um, we've got the regulation. Of course.
I think policy is super important changing social norms. So, yes,
there are these issues in place that need to be addressed.
While they are being addressed, we can do other things
to help.
Nick Haslam (31:21):
When you started on this kind of work, did you
ever imagine that you would be so heavily engaged in
trying to change policy?
Michelle Jongenelis (31:27):
No, not in a million years. So every time I'm,
you know, sitting in a room and the Federal Minister
for Health is there and all the CEOs from health
agencies are there, I just sort of pinch myself. I'm like,
sneakily taking photos of, you know, my name on the
desk because I cannot believe that I'm at Parliament House,
you know, actually contributing to policy change. It's exciting.
Cassie Hayward (31:46):
What's the most important part of your research that you
think has had an impact on actually getting into this policy?
Michelle Jongenelis (31:53):
Well, I think it was the work that we're doing
at the moment around e-cigarette prevalence e-cigarette perceptions of use
reasons for use, but also what I've started doing with
all my work is creating infographics because you know, politicians,
decision makers, they don't have time to sift through a
5000 word document that's sitting behind a pay wall.
(32:15):
They want something that's bite size, that they can go
to the minister and say, You know, this is what
you should be doing. So translating that research, putting it
into infographics and then sending that out to everyone has
been really, really helpful, I've found.
Cassie Hayward (32:27):
Michelle, if anyone wants more information about themselves quitting or
helping their kids quit or teachers who want resources, where
could they go to get that?
Michelle Jongenelis (32:36):
Uh so I have a website drmichellejongenelis.com . I put
all resources up on that website, infographics etc. But if
you want information just broadly about health behaviour, change communications,
then there's also the Melbourne Centre for Behaviour Change, where
we have some resources there on you know what motivation is,
how to do anything really, smart goal setting if and planning,
(32:58):
self -monitoring. So if you're wanting to engage in behaviour,
change of any aspect, not just vaping, but increasing your
physical activity, then you can jump on to the Melbourne
Centre for Behaviour Change.
Cassie Hayward (33:07):
And I've seen on your website you have a great
simple tool that parents can use for helping their teens,
and probably younger than teens, quit vaping, which I think
would be a really useful tool for them as well.
So we'll put those links in the show notes.
Nick Haslam (33:19):
That was wonderful. Michelle, thank you so much for sharing
your expertise with us. And good luck with all of
your research endeavours and policy change.
Michelle Jongenelis (33:26):
Thank you for having me. This is fun.
Cassie Hayward (33:29):
Thanks for listening to psych talks with me, Cassie Hayward
and Nick Haslam. We were joined today by Associate Professor
Michelle Jongenelis . This episode was produced by Carly Godden
with production assistance from Louise Sheedy. Our sound engineer was
David Calf.
And of course, you can find links to all the
resources we've mentioned today in our show. Notes See you
(33:49):
next time on another episode of PsychTalks.
This podcast was made on the lands of the Wurrundjeri people,
the Woiurrung and the Boonwurrung, and we would like to pay respects
to their elders, past and present and emerging.
From the Melbourne School of Psychological Sciences at the University
of Melbourne, this is PsychTalks.
(00:23):
Hi there. I'm Professor Nick Haslam and you're joining us
for PsychTalks, a series that profiles pioneering research in psychology. Each
episode we pick the brains of one of our experts
here at the Melbourne School of Psychological Sciences. And to
help us do this, I'm joined by Associate Professor Cassie Hayward.
Cassie Hayward (00:37):
Hello again, Nick.
Nick Haslam (00:39):
So we're on the topic of e-cigarettes or vapes and
what's being done, or what the best research says ought
to be done to control their use and misuse.
Cassie Hayward (00:46):
Yeah, and it's just it's a bit of a mystery
to me as to how teenagers in particular can get
their hands on them so easily. I mean, you see
vapes for sale in shops almost everywhere. So we're keen
to explore the history of vaping and go over some
tips on how to talk to your kids about it.
Nick Haslam (01:00):
Mm, because simply saying, Oh, well, they're addictive. Perhaps isn't
going to work anymore. That's according to our guest Associate
Professor Michelle Jongenelis.
Michelle's research specialises in health related behaviours, including tobacco control,
and she's a regular advisor on this to not for
profits and importantly, the Australian Government.
Cassie Hayward (01:18):
Michelle, thank you for joining us today. We're fascinated to
get into this topic of vaping. But before we start
on the nitty gritty details, can you just give us
a little bit of an introduction about yourself and how
you came to be working in tobacco control?
Michelle Jongenelis (01:32):
Yeah, sure. So it was serendipity. Actually. I did a
master's and a PhD in clinical psychology and upon finishing
my PhD started working with a professor who was, uh,
doing some pro bono work for
Cancer Council WA and obviously Cancer Council WA and the Cancer Council
Federation deal broadly with what things cause cancer. And what
can we do to prevent that? And obviously, tobacco control
(01:53):
is a huge issue there. So that's how I found
myself getting into it in terms of the vaping, specifically
about 2016, I started working in this space, and here
I am now still working in it. Unfortunately, I wish
we had solved the problem?
Cassie Hayward (02:07):
Yes, and hopefully, maybe in five years, we won't be having
this podcast re aired. But let's see how we go.
But we hear a lot about vaping in the news
and in social media. But I think there are still
a lot of misperceptions about what vaping actually is, what
is allowed, what's not allowed. How have we got to
where we are? Can you just tell us a bit
of a quick history of vaping? If there is such
(02:28):
a quick history?
Michelle Jongenelis (02:29):
No thing there's a quick history with vaping. I guess it
started, y ou know, a few decades ago, the son of
two smokers who had died from smoking had decided to
create a a harm reduction product, I guess, in the
form of, uh, electronic cigarettes. So that's the original sort
of genesis of these products. And then, of course, as
you know what happens with most things, the industry sort
(02:51):
of started really diversifying and sort of seeing this as
an opportunity to get a new generation addicted to nicotine.
Obviously, their core consumers, being smokers, were dying. How do
we get more money through the door? How do we
appease our stakeholders and our shareholders. And so there was
a big investment in electronic cigarettes from the tobacco industry
that happened around 2013. And then since then we've just
(03:13):
seen obviously, the issue become increasingly more prevalent with particularly
among youth, because the industry then started marketing to that
age demographic.
Cassie Hayward (03:22):
And you talked about electronic cigarettes. I think there's also
some confusion about the terms. What's an electronic cigarette? What's
a vape? What is the difference?
Michelle Jongenelis (03:30):
There is no difference. That's another sort of industry tactic.
So they wanted to obviously move people away from thinking
that electronic cigarettes were bad. Let's create a new term
for it, so people don't actually know sort of think
that the two are related. And that's how the term
vape was coined. So vape, electronic cigarettes. They are exactly
the same thing.
Cassie Hayward (03:50):
Michelle. Just on this, the wording around vaping. We use vaping,
and it's very much different to the word smoking or cigarettes.
Has that been a conscious kind of word choice from
the industry to separate vaping from smoking, which, you know,
if you've grown up in Australia, you have very kind
of negative views about smoking. But then this thing vaping
(04:10):
is something very different.
Michelle Jongenelis (04:12):
I believe it is. So if you think of the
word vaping, it essentially sort of the connotation that you
get is vapour. Oh, it's just water vapour. And that's
something we hear a lot from kids and certainly, you know,
a couple of years ago there were some people in
some surveys that I conducted who said, 'Isn't it just
like putting your mouth over a kettle like, isn't that
just what it is?' And so I think definitely the
(04:32):
industry is using that term the vaping to separate it
from smoking and give the impression that it's actually OK.
And we've seen that as well. Where in the industry
has now obviously invested in what's called heated tobacco products,
which aren't available well, I'm sure you can get them
in Australia at some point, but they're not legally available
in Australia any means. But they are big over in
(04:53):
Europe in particular. So I was in Italy recently, and
certainly in Rome, 75% of the people who I saw
were smoking were using these new heated tobacco products, not cigarettes.
Now, heated tobacco products are essentially a cigarette that they've
put into a metal casing, but they're not calling them cigarettes.
They're calling them heat sticks. So the industry is really
playing around with a lot of language here to try
(05:16):
and sort of distract people from the fact that this
is just nicotine. This is just a harmful product. It
looks different. It looks flashy. It's in a colourful packaging,
but it is still just harmful.
Cassie Hayward (05:27):
Literally smoke and mirrors?
Michelle Jongenelis (05:28):
Exactly. Yes.
Cassie Hayward (05:32):
And then what about the regulations and laws? Again, I
think it's an area where there's a lot of confusion
and you see vapes being sold in toy shops and
milk bars and shopping centres, and you can see 12
year olds walk in and come out with vapes. So
what are the current regulations and how are they allowing
(05:53):
that kind of behaviour?
Michelle Jongenelis (05:55):
Yes, so in Australia at the moment we have, thankfully,
nicotine was always considered a poison by the Therapeutic Goods Administration.
So this means that Australia was able to classify nicotine
containing e-cigarettes or e-cigarette products as a prohibited good. So
it was always prohibited unless you had a prescription from
your GP to say that you were using it for
smoking cessation purposes or I guess, you know, quit smoking,
(06:17):
which is what most people would call it. Non nicotine products, though,
are available to those over 18. And so that's why
we're seeing these stores pop up that are selling supposedly
non nicotine. But we know when we take them back
to the lab, about 75% of them do contain nicotine.
Cassie Hayward (06:35):
And you say that that's available to over 18 consumers.
But we know that kids can walk into those shops
and buy them.
Michelle Jongenelis (06:41):
Absolutely, yeah, so there definitely needs to be some more enforcement,
particularly in Victoria. Victoria is now, I think, the only
state in Australia to not have a positive licensing scheme,
which means anyone can basically sell these products, they don't
have to register.
We don't know who's selling it or not. All the
other states do have a positive licensing scheme. So it
makes it tricky with enforcement because nobody can just go
(07:02):
into a store because we don't know what stores are
selling it. What stores aren't so we're hoping that the
Victorian Government makes some changes there very soon.
Cassie Hayward (07:09):
Hi, listeners. Just a quick qualifier here from Michelle. Like Victoria,
New South Wales, also doesn't have a positive licensing scheme, however,
it does have a negative licensing scheme. This means sellers
have to notify the New South Wales Government if they
plan on selling e-cigarettes. But they don't need a licence
per se, and they can be banned from selling vapes
if they're found to have breached the licensing conditions.
(07:31):
OK, let's get back to it.
Nick Haslam (07:33):
That's extraordinary. The idea that these things are being sold
as if they don't have nicotine, but they do. I mean,
do the purveyors, and do the purchasers have a sort
of nudge, nudge, wink, wink? They know it's got nicotine,
but they pretend it doesn't? Or is it just people
are generally mystified about?
Michelle Jongenelis (07:47):
No, it's generally for the retailers who are selling these products,
it's behind the counter. So there was a recent report
yesterday showing that these
products are being kept in pizza boxes to make it
look like it's actually pizza. But they open the pizza box,
and here you go a wide variety of nicotine vapes.
So often when you walk into the store, what you're
seeing is the non nicotine variety, the supposed non nicotine, and then
(08:09):
if you go to the counter and say, actually, you know,
I'm looking for a nicotine one. Here's the pizza box
full of the nicotine ones.
Yeah, and we certainly know that people aren't going out deliberately,
really to purchase non nicotine. So I ran some focus
groups earlier this year at random with adolescents, young adults
and adults. And I said, What do you think about
the fact that non nicotine products are available? And they
sort of looked at me blankly and went, what do
(08:30):
you mean? There are non nicotine products available? Why would
anyone want that? We want the heads spins that comes
from the nicotine. Why are you telling us this?
So they were really sort of. There was a lot
of negative sentiment around the non nicotine stuff being available. So
both retailers know they're selling it, and purchasers want actually
to buy the nicotine stuff.
Cassie Hayward (08:48):
I just think it's extraordinary, like if a corner shop
was selling a soft drink, but it turned out that 75%
of those drinks had alcohol in them. It wouldn't be allowed,
so it just seems crazy to me that these non
nicotine vapes that actually have nicotine in them are allowed
to be sold.
Nick Haslam (09:03):
But what would be wrong with having a non nicotine vape?
I mean, isn't it just smelly vapour?
Michelle Jongenelis (09:10):
Yes, well, that's what a lot of the certainly the
adolescents would say. Actually no. So what we know from
the research so far is that it's not just the
nicotine in these products that's harmful. It's actually a whole
bunch of other chemicals and the flavourings as well. So
there are certain flavourings, particularly the cherry flavouring uh, that
are particularly harmful.
And I think that's been a problem with Australia's focus
(09:31):
on nicotine. Nicotine is that it's giving this perception that
the non nicotine ones must be fine, which it's actually not,
which is why the government has now introduced or plans
to introduce reforms to make it so that both non
nicotine and nicotine varieties are prohibited from being used.
Nick Haslam (09:48):
Do you mean the recent reforms in May 2023?
Michelle Jongenelis (09:52):
Yes, I do.
Nick Haslam (09:53):
Right, so that's where I was going with this, the
drivers for these reforms. It sounded initially like you were
saying it was just to control the substance of nicotine
as you would, but it's obviously beyond that. It's also
health focus and it's, I mean, who are you marketing a
cherry flavour to? It's not people my age.
Michelle Jongenelis (10:09):
No, and it's not smokers either. I mean, very few
smokers say, Oh, look to quit, I absolutely need the
unicorn vomit flavoured e-liquid. How dare you take that away
from me? So while there is, you know there's some
evidence or certainly anecdotal evidence that smokers say, you know
the flavourings actually do help. Broadly when we look at
the systematic reviews and the matter analysis there, there is
no evidence that flavourings actually do contribute to more successful
(10:32):
quitting attempts. So that's what our recommendations has been to
government is, you know, we need to be restricting the flavourings,
just like we
been doing with tobacco cigarettes over the years. We need
to be putting these into similar to plain packaging as well.
So if you walk into a store, these things are
brightly coloured. There's cartoons on them. A smoker isn't wanting that.
It's really it is targeted toward youth. So a lot
(10:54):
of the recommendations we're making are about finding that balance
between how do we protect youth from potentially taking up
these products? And then how do we still provide access
to smokers who want to use these products to quit.
Nick Haslam (11:07):
So going back to your personal history, you said you
had a slightly strange path to get to where you
are now. And you started as a clinical psychologist. Do
you think that has had any influence on the way
in which you do this work? Or have you just
flipped over to the dark side and become a health psychologist?
What does being a clinician do to affect how you
approach this topic, if anything?
Michelle Jongenelis (11:29):
Yeah, I mean, I think when you work at the
public health level, you're working at the population level and
then when you're working clinically, you're working one on one.
So it's often me having to sort of balance how
I'm feeling across the board because obviously, you know, we
do hear stories of smokers saying, but hey, this is
helping me quit. Which is why I think the approach
that I'm taking is we can still have these products
(11:53):
be accessible to smokers at the individual level while controlling
access at the population level.
So I've sort of tried to merge both sides of
me together to create this viewpoint as opposed to being
very pro vaping or very anti vaping. I guess I
hate that dichotomy because it creates this sort of false debate,
but that's sort of how I've managed to deal with it.
Nick Haslam (12:15):
So what's actually in these e-cigarettes?
Michelle Jongenelis (12:18):
I mean, who knows? Right. These products are are being
imported from, you know, some developing countries. We don't know
where they're being made. They could be being made in
people's bathtubs. You know, we have actually have no clue.
So we do know that, you know, with the tests
that we've conducted in Australia, there are about 200 chemicals
in these vapes. Formaldehyde is a big one and then
(12:39):
others whose names I can't pronounce. Nicotine is often in
vapes as we know. Flavouring. So just a whole bunch of additives, chemicals.
And then, of course, the added element of vapes that's
different to smoking is the device itself. So the device
itself is often made of metal, so then you get
degradation so you get heavy metals like zinc that can
(12:59):
be ingested as well.
Nick Haslam (13:01):
So it sounds like there's a really good rationale for
these reforms, but you're clearly saying that it's not enough.
It hasn't gone far enough. So what more do we
need to do to deal with this problem in Australia,
in particular?
Michelle Jongenelis (13:13):
Yes. So the reforms that were announced by the government
back in May are a good next step. So back
in October 2021 they made it the prescription model, essentially,
which is, you know, the only country in the world
that has this prescription model. If you are wanting to
quit smoking using an e-cigarette, visit your GP get a prescription,
go to your pharmacist, fill that prescription. Now
the issue with that is obviously the fact that the
(13:37):
non nicotine ones are still available and there's fewer controls
at the border. People can still import these products. So
we've had a mass sort of importation of supposedly non nicotine
varieties that we know contain nicotine. And so the next
step of reforms which we are really excited about, is
the prohibition of both non nicotine and nicotine varieties unless
they are being used as a therapeutic product under medical supervision.
(14:01):
So that was the big ticket item. And then, on
top of that, there were what we call the more
demand side things. Restricting the flavourings so the current consultation
out at the moment is restricting flavourings to tobacco or menthol,
menthol mint, and then also pharmaceutical -like packaging. If these
products are to help people quit, then we're going to
put them in pharmaceutical-like packaging.
(14:22):
So no more bright colours. And there were also some
changes around reducing the nicotine concentration. So Australia had allowed
up to 100 milligrams per ml, which is five times
the legal limit in the European Union, the UK. So
the government is now suggesting we actually align with those
countries and only allow 20 milligrams per ml.
We're getting rid of the awful disposal e-cigarettes. So they
(14:43):
came onto the market in 2018 2019. And that's when
we really saw youth use skyrocket. So, apart from these products,
being just horrific for the environment, they also are based
with nicotine salt highly addictive, highly palatable. So the government
is making steps to completely prohibit the disposable products, too.
Nick Haslam (15:03):
So it sounds like we're ahead of the curve a
little bit in this country, or are we catching up?
What's the current overall judgement?
Michelle Jongenelis (15:10):
We're just taking a different approach to things. Obviously there
are other countries that have legalised these products the UK,
the US, New Zealand. The approach that we're adopting is
the precautionary approach which is consistent with The World Health Organization.
It always has been, so that's the idea that until
we get more information about how harmful or not harmful
a product is, we should be cautious about allowing that
(15:31):
product to be widely sold or available on the market.
I say we're ahead of the curve because what these
countries are seeing as a result of legalisation is skyrocketing
youth use. And so they allowed free for all and
now they're having to implement reforms to restrict those products.
I think certainly this will make Australia reclaim its position
(15:52):
as a world leader, not just in tobacco control but
also in vaping control.
But globally consumption is still going up. I believe. I
think I saw a stat somewhere that there's over 80
million users at present, 10 times up from 10 years
earlier when your history started. Is it any different here?
Is it flattened out or?
No. So use is also increasing here. Despite the sort of restrictions
(16:15):
that came in in October 21 we are hoping that
these new reforms will start flattening the curve there because
the increases that we're seeing in Australia are predominantly in
the adolescent young adult group. So what we would call
recreational vapers and not using it to quit, and these
reforms are directly targeting, you know, the recreational use.
Cassie Hayward (16:35):
It's devastating to hear about kids vaping and I think
also when we think about how young they are being
exposed to it. But is there good data on the
prevalence of vaping in young people? Do we know where
it's at? In terms of how many of them are
have tried it, regularly do it.
Michelle Jongenelis (16:51):
We know that if we communicate the message that these
things are being used widely, then it creates a social norm.
We don't have any good prevalence data because Covid threw
out all our monitoring. So the last sort of year
that we collected data on secondary school students was 2017.
We're hoping that the data from last year comes out
this year or next year, but we've got estimates of
(17:12):
you know, at least a third of adolescents and young
adults having ever used these products and about 14% being
regular users. So that's using monthly.
Nick Haslam (17:22):
So you said earlier that under the proposed or actual reforms,
you could still have vapes prescribed for certain medically appropriate uses.
I forget your exact wording there. So that is for
smoking cessation purposes. Is that a good use for vapes,
are vapes shown to be effective in reducing smoking?
Michelle Jongenelis (17:40):
I mean, the jury is still out there. The recent sort
of systematic review conducted by Emily Banks at ANU found
that there is limited evidence for the effectiveness of e-cigarettes
as a smoking cessation aid. And then even within that
there are certain types of e-cigarettes that are better than others. So,
like the disposable ones have not been found to be
(18:00):
effective or nicotine concentrations above 20 milligrams don't actually add
extra benefit.
So for those reasons, they haven't been approved by the
Therapeutic Goods Administration yet. But also, the vaping industry hasn't
actually put any product to the Therapeutic Goods Administration for approval.
And so that's why in Australia we really do need
(18:21):
to control access. If you are planning to use these products,
then you do need to use it under medical supervision
because they haven't been tested for quality safety efficacy. They
haven't gone onto the TGA's registry.
Cassie Hayward (18:33):
Well, I think the fact that you find that non
nicotine vapes have nicotine in them demonstrate the lack of
kind of regulation and oversight of the products in general.
Michelle Jongenelis (18:44):
Exactly, and the new reforms that are coming out as well.
There's a provision in there that even though these products
are being used for smoking cessation purposes with your doctor,
that doesn't mean that the product that you are using
can just be any product it needs to be approved.
Or it needs to meet the guidelines of what they
call the TGA's TGO 110 which is essentially a product standard.
(19:06):
So it needs to at least meet Australia's product standards.
You can't just be bringing in a random product and saying,
This is for smoking cessation and I have a prescription.
Nick Haslam (19:14):
So you said that a lot of young people are
using the vapes. So what are the drivers? Why are
kids going in for this? They are not obviously using
it for smoking cessation in most cases, why are they
doing it?
Michelle Jongenelis (19:25):
I mean, the most common answer that we get is
they're just curious right. And that curiosity' s obviously stemmed
from the very good marketing that the industry does and
the flavourings and I wonder what this would taste like. Um,
which is another common reason, you know, I use it
because I think they taste good in terms of, you know,
wanting to initiate. We do have some, um, reports that
(19:46):
kids are using it to make
moderate their anxiety or moderate the depression. Obviously, we know
from the research that e-cigarette use over the longer term
actually worsens depressive symptoms. So, you know, there's this emotion
regulation aspect to it that might be happening. The curiosity aspect.
Kids just wanting to experiment. And then, of course, social
(20:08):
norms not wanting to miss out peer pressure, all of
that sort of stuff.
Nick Haslam (20:12):
So they actually think it's good for them?
Michelle Jongenelis (20:14):
Uh, actually, no. So they do recognise that there are
health harms. So again, in the focus groups I conducted
earlier this year, I asked them, What do you guys
know about e-cigs? And they said, Oh, yeah, Look, we
know it's bad for you. We've seen the posters at school,
but we just ignore them. So there's this knowledge there
that these things aren't entirely harmless, but, hey, it's fun.
It tastes good. The flavourings are nice. Why not do it?
Cassie Hayward (20:37):
And it seems like that kind of curiosity in kids
is ever present in any generation. It's the smoking a
cigarette behind the, you know, the shed at school in
the seventies is now this kind of trying of vape.
But it seems like they are now more addictive, that
that curiosity could very quickly escalate into something more now,
compared to, say, in previous generations.
Michelle Jongenelis (20:59):
Yeah, I mean, the issue with vaping is that what
we know from the research is that you more likely
to then take up tobacco cigarettes after, so it doesn't
just have the potential to stop at vaping. It could
then escalate into tobacco cigarette use, which is something that
the Cancer Council recently found that for the first time
in three decades, we've seen an increase in smoking prevalence
among adolescents that coincides with the increase in vaping. So
(21:21):
we are really, really concerned about that. But yes, it
could just be experimentation. But then we know for a
lot of kids, it might not be, and it has
the potential to escalate.
Cassie Hayward (21:30):
What can parents do if they're worried about their kids
either starting to vape or know that their kids are
vaping and want to stop? Maybe starting with the prevention first,
how can a parent kind of prevent their kids from
or is it just inevitable that kids are going to experiment?
Is there anything parents can do to stop their kids
going down this vaping path?
Michelle Jongenelis (21:49):
I mean, I think in terms of prevention, it's about
having open conversations that don't involve lecturing.
So, you know, I've heard that there's this thing called vaping.
I've heard it's a thing at school. Is it coming
up at your school? How do you feel about it?
So just engaging in those sort of open ended questions
and and seeing how they feel, then if you were
to sort of sit them down and and tell them
(22:10):
about all the harms of vaping, probably not going to
make a difference. So that's where I would recommend to
stop just having those open conversations.
If you have a child who is using vapes, then
you know, finding out why they're using vape. So something
I always say is never tear down a wall before
first understanding why it's been built. And if this wall
(22:30):
has been built to cope with anxiety and you're suddenly
taking that away from your child, there are, you know,
there are consequences with that. So asking your child, why
are you vaping? If it is because of anxiety, do
they need to get some mental health support? Do they
need to learn other strategies to cope with anxiety? Is
it a social norm thing? Is it that it's happening
at school
and they're feeling pressured? Does that mean that as a parent,
(22:52):
you need to go to the school and sort of
talk through it? What else can we be doing here?
So I think finding out first why they're vaping will
then give you an idea of what to do and
how to cope with it. If they are addicted to nicotine,
then obviously going and seeing a medical professional or calling
the Quitline . And certainly the Quitline has reported an
increase in the number of children and parents calling the
(23:13):
Quitline because their kids are addicted to nicotine.
Cassie Hayward (23:16):
And when should parents start having those conversations? They're probably
one of those awkward conversations that parents don't want to have.
But what kind of age should they start? At least
broaching that topic of Hey, I've heard this thing. Is
it at your school?
Michelle Jongenelis (23:29):
Yeah, so I don't want to say primary school, but
we are getting reports that kids in late primary school
are starting to vape. So I would probably say late
primary school and you don't necessarily have to have indepth
conversations that,
you know, ask too many questions. It's it's more just Hey,
there's this thing. Is it a thing at your school?
And that could be the end of it. That could
be the end of it.
Cassie Hayward (23:49):
Yeah, and I presume some of those tactics around understanding
why the kids are vaping and trying to work on that,
that that could be used for adults who find themselves
vaping as well. Are those same tactics for quitting vaping
relevant to the adults who want to as well?
Michelle Jongenelis (24:05):
Yeah, absolutely so here we sort of talk about the
classic behaviour change techniques, what motivates you to vape and
then how can we sort of flip the script around that.
Setting goals, making it so that you are potentially using
other things to modify cravings. So a lot of the
stuff that is helpful in the smoking space actually comes
(24:26):
in helpful here. So chewing gum, getting out of the house,
getting out and about, doing something, distracting yourself. All of
those sort of techniques that have been found to work
for smokers could also work for vapers.
Cassie Hayward (24:37):
So, Michelle, in terms of these reforms, is there some
spending allocated in there for mass media communication to kids,
to parents, to teachers, to adults around the dangers of vaping?
Michelle Jongenelis (24:50):
Yes, so the government has recognised that there hasn't been
a national mass media campaign, even in the tobacco space,
for almost a decade I think. So they've committed 63
million to mass media campaigns not just for vaping but
also tobacco control. And I think what's going to be
really important with those
campaigns is making sure that we get the messaging right.
So there's a sort of sense, certainly with tobacco that
(25:13):
you know a lot of the ads over the years
have been focusing on the health harms because at the
moment it really is just adult smokers who are caring
about that.
With vaping, i t's a completely different approach because kids don't
care about cancer. Because they're not going to get cancer
for 40 years, and that's if they get cancer. We
don't know. So the traditional approach to campaigns needs to
(25:33):
sort of change. So, you know, at the Melbourne Centre
for Behaviour Change, we do a bit of communication work
as you know, and we sort of wanted to figure
out what messages could we look at for kids.
And in the focus groups we did earlier this year,
the messages that they seem to connect with the most
with vaping was around what chemicals are in there and
(25:54):
not just these contain formaldehyde. They were very clear that
they wanted to know what formaldehyde then does. So it's
not that they don't want to know the health harms.
It's just it has to be sort of with some
extra information, so you'll see a few campaigns that might
come out that will say it contains formaldehyde and this
is what formaldehyde does.
There's certainly some campaigns in New South Wales that talk about
(26:14):
nail polish remover and all of that sort of stuff,
So the chemicals one came up really strongly. Also, the
concept of dependence. Kids were really worried about becoming dependent
on these products. Interestingly, they weren't worried about addiction. They
sort of said, Oh, you can get addicted to anything.
It was the dependence and the consequences of dependence on
(26:36):
their life. So it means I might not be able
to play football as well as I used to, or
I might not be able to make out for as
long as I used to. That was another common one
we got in the focus groups. Um, so I think
dependence chemicals. They were the main sort of themes for consequences.
Cassie Hayward (26:52):
Fascinating, just like wording choices. And on your point in addiction.
I think kids are forever being told they're addicted to
social media. So I think that term has probably become
less scary to them because they don't see their social
media use as a problem.
Michelle Jongenelis (27:07):
Um, I completely agree. I was surprised with the focus
groups as well that the dependence word got a better
response than the addiction word. Um, and I think you're right.
I think kids have become desensitised to the word addiction,
and they're using it in everyday language. You know, I'm
addicted to this, I'm addicted to that, not realising what
addiction is, whereas dependence suddenly introduces this different concept. And
(27:27):
maybe in five years time they'll be desensitised to dependence,
and we'll have to pick a different word. But I
think that's really important because a lot of the stuff
we're talking about at the moment is around 'You will
become addicted'. That's just not resonating. So I think we
need to try a different approach.
Cassie Hayward (27:39):
I also love the focus on the short term harms,
as you say. They don't care about what happens in
40 years time, but they will care if they can't
keep playing footy or can't run as fast. And I
think that's probably tips that parents can keep in mind
as well, in terms of reasons why they might want
to try to quit. You know, not about the health harms,
but
(28:00):
you want to keep playing footy. You wanna keep playing netball,
You wanna keep playing soccer? For sure. This is gonna
stop your ability to do that.
Nick Haslam (28:06):
You want to keep making out.
Cassie Hayward (28:07):
Yeah, that's one of those awkward conversations that parents don't
want to have. I think they'll focus on the sport, but, yes,
really interesting to see that there are, and I think
we all have that kind of short term focus in
any kind of behaviour, change issue, but much more kind
of present for kids in terms of their age. When
you're talking about you know something that might happen when
they're 60 that's just absolutely, absolutely in the far, far
(28:29):
future for them. But but those short term risks are
are much more impactful for them.
Michelle Jongenelis (28:35):
For sure.
Cassie Hayward (28:35):
But another big part of it, in terms of how
especially young people are being exposed to this is advertising
and the visibility of vapes on social media, where there
are far fewer ways to regulate that type of exposure.
We can ban ads on TV. Not that kids these
days watch TV, but we can ban the ads on TV.
We can ban advertising in billboards and those other more
(28:57):
formal forms of advertising.
And there doesn't seem to be huge a huge amount
of regulation in terms of vape content that you know
you're seeing the same thing that you saw with cigarettes
in the seventies in terms of popular artists and singers
using vapes in their music videos, which is now just
all on social media. Is there any concern around that
side of things in terms of regulating that content?
Michelle Jongenelis (29:19):
I mean, definitely. I think social media has presented a
big issue not just for vaping but also in terms
of alcohol and gambling and all the harmful industries. You know,
we're not seeing the things that the kids are seeing because,
you know, kids are on TikTtok and we're not on
TikTok . Well, at least I'm not. I don't know
about you two. So you know, certainly that's something that
we have presented to the government as a particular issue.
(29:40):
And I do know that the reforms that are about
to become legislated for tobacco really knuckles down on some
of that advertising and specifically mentions that digital advertising.
How that looks like in terms of how it's enforced
is a different story. Because you're right. Kids are able to,
you know, buy products that hide their IP, and they
can just get access to stuff anywhere around the world.
(30:01):
So I think this is an issue that we're battling globally,
is how do we manage the digital marketing space?
Cassie Hayward (30:05):
And I think it's also even if we are on TikTok.
I am a little bit, but we're not seeing what
the kids are seeing. The algorithms are so smart that
I'm not getting the content that a 14 year old
kid is getting anyway. And if they're interested in vaping,
they're going to eventually get to vaping content and then
get fed more vaping content. So even if a parent
is on TikTok thinking, Oh, yeah, there's not much vaping
(30:27):
content here. I'm comfortable that my kid is not being
presented with that content.
They're not seeing what their kid is seeing.
I think that's the difference between traditional media, where if
you sit down and watch TV with your kids, you're
all seeing the same ads. It's a totally different environment
on that social media kind of landscape,
Michelle Jongenelis (30:44):
Yeah, which I think is sort of why we need a
more comprehensive approach to vaping control, just like we have
with tobacco control. You know there are going to be
some things that kids are exposed to that we can't
protect them from, and and nor should we. You know
there needs to be a certain level
of self moderation and resilience, so that's where you know
we can also use digital media for mass media campaigns
that present the harms of vaping or approach it in
(31:08):
a different way. Um, we've got the regulation. Of course.
I think policy is super important changing social norms. So, yes,
there are these issues in place that need to be addressed.
While they are being addressed, we can do other things
to help.
Nick Haslam (31:21):
When you started on this kind of work, did you
ever imagine that you would be so heavily engaged in
trying to change policy?
Michelle Jongenelis (31:27):
No, not in a million years. So every time I'm,
you know, sitting in a room and the Federal Minister
for Health is there and all the CEOs from health
agencies are there, I just sort of pinch myself. I'm like,
sneakily taking photos of, you know, my name on the
desk because I cannot believe that I'm at Parliament House,
you know, actually contributing to policy change. It's exciting.
Cassie Hayward (31:46):
What's the most important part of your research that you
think has had an impact on actually getting into this policy?
Michelle Jongenelis (31:53):
Well, I think it was the work that we're doing
at the moment around e-cigarette prevalence e-cigarette perceptions of use
reasons for use, but also what I've started doing with
all my work is creating infographics because you know, politicians,
decision makers, they don't have time to sift through a
5000 word document that's sitting behind a pay wall.
(32:15):
They want something that's bite size, that they can go
to the minister and say, You know, this is what
you should be doing. So translating that research, putting it
into infographics and then sending that out to everyone has
been really, really helpful, I've found.
Cassie Hayward (32:27):
Michelle, if anyone wants more information about themselves quitting or
helping their kids quit or teachers who want resources, where
could they go to get that?
Michelle Jongenelis (32:36):
Uh so I have a website drmichellejongenelis.com . I put
all resources up on that website, infographics etc. But if
you want information just broadly about health behaviour, change communications,
then there's also the Melbourne Centre for Behaviour Change, where
we have some resources there on you know what motivation is,
how to do anything really, smart goal setting if and planning,
(32:58):
self -monitoring. So if you're wanting to engage in behaviour,
change of any aspect, not just vaping, but increasing your
physical activity, then you can jump on to the Melbourne
Centre for Behaviour Change.
Cassie Hayward (33:07):
And I've seen on your website you have a great
simple tool that parents can use for helping their teens,
and probably younger than teens, quit vaping, which I think
would be a really useful tool for them as well.
So we'll put those links in the show notes.
Nick Haslam (33:19):
That was wonderful. Michelle, thank you so much for sharing
your expertise with us. And good luck with all of
your research endeavours and policy change.
Michelle Jongenelis (33:26):
Thank you for having me. This is fun.
Cassie Hayward (33:29):
Thanks for listening to psych talks with me, Cassie Hayward
and Nick Haslam. We were joined today by Associate Professor
Michelle Jongenelis . This episode was produced by Carly Godden
with production assistance from Louise Sheedy. Our sound engineer was
David Calf.
And of course, you can find links to all the
resources we've mentioned today in our show. Notes See you
(33:49):
next time on another episode of PsychTalks.
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