Meet the Solutionists, with Mark Scott

A new generation has become addicted to nicotine. 

Australia almost had smoking beaten. Thanks to decades of education, regulation and cultural change, smoking rates plummeted. And then: vaping. 

Lily started vaping at 17 and hasn't been able to stop. Social vaping quickly became a daily dependency, and now it affects every aspect of her life - from her health, sleep and appetite to her bank account.

Professor Becky Freeman from the University of Sydney School of Public Health has spent 25 years working in tobacco control. Now she's tackling vaping, and she says this disruption wasn't accidental.

Becky reveals how a loophole during the pandemic allowed vapes to flood Australian retail stores, why enforcement has been so difficult, and what's finally starting to work. The good news? School vaping rates are coming down thanks to targeted education programs and tighter regulations.

Learn more about Becky's work with Generation Vape and Our Futures.

Mark Scott 00:01

This podcast is recorded at the University of Sydney's Camperdown campus on the land of the Gadigal people of the Eora nation. They've been discovering and sharing knowledge here for 10s of 1000s of years. I pay my respects to elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people.

Lily 00:28

My name is Lily, and I started vaping when I was 17 years old. I've been vaping for five years. It started very minimal, very social. Whenever I would hang out with my friends, all of them were vaping. Vaping in cars that you're in and the rooms that you're in. There were no limitations to where everyone would do it. We would also as a hangout, go get vapes together, because at the time, it was a bit harder to get vapes, so we'd all kind of chip in and drive a long way to go get them. So, it was always a bit of like a thing we could do together. Everywhere you go, in the valley and parties, house parties, everyone's offering you a vape. If they see you have one, they'll ask for yours. It was just all around you. Ever since graduation I would say it's definitely been a constant in my life, constant every single day in my pocket at all times. I have a backup one for when the current one dies, so it's a constant thing that is thought about every single day, at least several times an hour.

Mark Scott 02:11

If you're around my age, you've seen Australia's smoking culture change dramatically across your lifetime. Maybe you remember the clouds of smoke choking up the back of airplanes or watching athletes on smoko at half time. Now you'll rarely see a cigarette anywhere but on the street or maybe a little closed off balcony out the back of a pub. Through a mixture of education, tax policies, cultural shifts and plain packaging initiatives, Australia has seriously reduced its smoking population. But you've probably noticed something new in the world of nicotine. Vapes. You've seen people puffing on brightly coloured little devices blowing great plumes of vapour into the sky and used in places where smoking had almost disappeared. Tobacconists are springing up everywhere on our high streets, and increasingly, so have vapes in schools. So how did we get here? Why, when we were so successful in curbing our smoking addictions, have we now become addicted to nicotine in a new way? How have so many young people been taken by this addiction, and what can we do about it?

Mark Scott 03:25

This is the Solutionists, and I'm Mark Scott. Becky Freeman is a professor in the University of Sydney School of Public Health, and she's a member of the Prevention Research Collaboration. Becky has over 25 years of experience in tobacco control, and now she's using that expertise to tackle the problem of vaping. Becky, welcome. We've made such great progress in cutting cigarette smoking, but vaping has complicated that picture. You've said that this disruption wasn't accidental. So, take us back into the history. Tell us about Juul. What was it and what was it designed to do?

Becky Freeman 04:03

Sure, I think that, you know, like you said in your opener here, we've made such great success, not even in Australia alone, globally, in reducing smoking rates, you know, really taking on the tobacco industry, making smoking not socially acceptable. But obviously, there's still people smoking. There's still people who have a lifelong addiction, who tried everything they can to quit. And so you had these two sort of IT graduates wanting to disrupt the space with their Juul product. That's J, u, u, l, Juul. And they thought, you know what if we could invent a product that could take on the tobacco industry, could disrupt their modus operandi of addicting young people and keeping people hooked for life. And so they came up with an electronic cigarette that was disposable and had a pod that you could replace. And this kind of revolutionized vaping, because up until that point, you had devices that were difficult to use. You had to refill them, you had to buy all kinds of like modifications to make them work. It was certainly not something your average 12 year old could pick up off the shelf and use. And along comes this Juul product that is supposedly going to disrupt the tobacco industry, and they add flavours to it, and they start marketing it on children's homework websites and children's entertainment websites, and lo and behold, they turn into the tobacco industry. Same tactics being used, and they're targeting their products to young people. They are not being used by older adults to quit smoking. And now you have this whole world of copycat devices popping up as well. So they see the success of this, that you can have a product that is discrete, easy to use, full of flavours, full of nicotine, and the nicotine in these products is what we call a nicotine salt. Essentially all that means is it goes down a little smoother. Anyone listening knows that first puff of a cigarette you ever take and you try, you've got to push through and try to keep on smoking. You kind of avoid all that with these nicotine salts. And this is kind of the perfect storm of a product that took countries like Australia by surprise, resting on our laurels, we've got smoking licked. Things are coming down, we're doing all this great work, and in comes this product that disrupts all that.

Mark Scott 06:06

So are you saying that the Juul founders were, you know, fairly high-minded in their original approach, that they were trying to reduce levels of smoking, but then a bigger industry came in behind that?

Becky Freeman 06:20

Well, the founders of Juul all their rhetoric, if I could say that, was helping smokers quit, disrupting the tobacco industry. And at the end of the day, that's not what their actions were. They were targeting kids, kids were taking up these products, they were designed to appeal to children, they were marketed to children. And I think it just goes to show that it's really attractive to have a tech solution to our problems. To be like oh! Look at the shiny new thing that can come in. We don't need public health and they're complicated systems thinking, and they're doing, you know, a comprehensive approach and, you know, making sure we engage with all levels of government and all levels of community. They're like, we have a tech solution that can fix it. Well their tech solution was to addict a whole new generation of children in nicotine.

Mark Scott 07:01

So vape started internationally before they came to Australia. What was then the Australian story? How did Australians and Australian children jump on this bandwagon?

Becky Freeman 07:13

So what happened in Australia is we had, again, these products are being developed overseas, proving very successful with young people. And then we had a pandemic hit, and everyone's eyes and public health shifted, rightly so. I'm not criticising that at all. This was a once in a, hopefully, lifetime experience. And this made it possible for retailers, manufacturers of these flavoured vaping devices, to sort of move into Australia and sell these products in broad daylight, in retail outlets to children everywhere. And point of clarification is that nicotine-containing vapes have never been legal to sell in Australia, in retail shops. You've always required a prescription for those products. So how did retailers get around this? They just said, “oh, well these are non-nicotine vapes. They're perfectly legal, we can sell these.” But I'm sure it doesn't take a genius to figure out that all of these vapes were riddled with nicotine. And the only way you can tell the difference between a non-nicotine vape and a nicotine vape is to test it in a lab. So if you're an enforcement officer, go into a shop, you see a vape on a shelf, you take a sample of that vape, send it to a lab, wait a few days. It comes back. Ah yes! It has nicotine in, therefore it's illegal. You go back to the shop to seize those products. They've got a new product on the shelf, a different disposable device. And you can see why this just wasn't working at all.

Mark Scott 08:29

So what was being promoted to children wasn't, you know, nicotine flavoured product branded in a way, but you know, bubble gum or other flavours targeting children. The assumption was, that people carried was, they didn't have nicotine, but testing showed they nearly all had nicotine.

Becky Freeman 08:47

Absolutely. And children who are naive to nicotine, who've never used it before, you know, try a vape device, and you can get quite head spin from nicotine. People don't understand that it does have quite an impact on you, especially if you've never smoked or vape before, and so this was sort of going around among kids as well as like, “oh, you have you tried vaping?” It not only smells good, it's you know, not your grandfather's cigarette, it's not disgusting and gross.

And you get this, like, wicked head spin when you use it as well. And that's the nicotine. And it goes from something fun and an experience out of curiosity, because all your peers are doing it, because it's being marketed to you so heavily on social media, to then you need it, and you wake up in the middle of the night and you don't ever feel right in yourself, and you keep one under your pillow. And you go from, oh, this is something fun I do on the weekends to I can't go anywhere without my vape.

Mark Scott 09:38

And it's the nicotine that's driving that, it's the nicotine that's the addictive.

Becky Freeman 09:43

Nicotine is incredibly addictive, and anyone who's ever smoked knows this as well. It is so fast acting when you inhale it into your mouth, it gets into your lungs and up to your brain in under 10 seconds, it's immediate relief. And if you are going through your day and we hear from a lot of young people. I lead a study called Generation Vape. We talk to lots of young people, we survey them, we interview them, and they'll talk about how vaping is really helpful for their anxiety. That I have a puff out of a vape and I instantly feel calmer and more relaxed, not understanding that that's a sign of their addiction, that they can't feel normal, can't function properly without nicotine. And in fact, nicotine, we know from studies, is more likely to drive mental health problems in young people, and one of the key public health issues facing young people in Australia right now is a mental health crisis, and nicotine vaping use is adding to that.

Lily 10:40

The first time I tried a vape was when my friend told me that she had too many, she didn't want them. So, she let me buy a $20 little puff bar off of her, and that's where it all started, I suppose. I felt a lot of head spins, a light sensation all over my body like tinkles. I wouldn't say there was any negative feelings I can associate with that first time. Definitely like it would cause more energy or produce more energy in my eyes. The first time I noticed that maybe it was getting a bit too much, was, or when I really needed it. It was when I was hanging out with my friends and, you know, for the whole day, and I didn't have my own vape at the time, and I was using theirs, and they went home and I did not have a vape still, so I started to get a bit, like, uncomfortable, a bit anxious, a bit fidgety. And I was already planning to, like, hang out with them the next day, so that I could use their vape. And that's when I was like, okay, maybe getting a bit much.

Mark Scott 12:15

In my previous role, I was secretary of the Department of Education in New South Wales, responsible for 2200 schools, and this time that you were speaking about, I mean, we were overwhelmed by response from school teachers, school principals that all of a sudden vaping was everywhere. How did this feel to you as a public health expert; you'd spent a career trying to drive down the take up rates of cigarettes, and now all of a sudden, vaping is ubiquitous, and you've got a new generation addicted?

Becky Freeman 12:48

Devastating, I guess, would be the short answer. And you know, I will say it was teachers who actually brought this to public's health attention. They were the ones, they are the eyes on the ground, they knew what was happening. And Cancer Council New South Wales, who I work really closely with on the Gen Vape study, they were hearing from teachers saying, “what is this? We're seeing it in kids backpacks, in their pencil cases, they're using it. What is it? We don't have any education resources. We have nothing is going on, there's no campaigns. Help, help, help.” And it was that impetus that Cancer Council New South Wales approached me and said, “we need to do more research. We need to show what is happening. We need actual data on this. We're hearing from the teachers, what can we do?” And that's what launched our Generation Vape study, which has now been going for five years, where we showed that, you know, a third of students had tried vaping. This was way back in 2021, and it just wasn't even on the radar outside of schools. And I really credit teachers with bringing this to public health's attention, to bringing it to the community's attention, and demanding action.

Mark Scott 13:47

Can you compare the health impacts of vaping to tobacco to smoking? I mean, you're not inhaling smoke, and so things that we'd have understood: the prevalence of lung cancer and other diseases linked to smoking. What do we think at this stage the health impacts of vaping are going to be?

Becky Freeman 14:08

If we want to talk immediate, we've had lots of explosions and burns. There's a reason why you can't charge them on airplanes, for example. These are not well-manufactured devices. They are known to overheat and explode. We also know that the mental health impacts on young people, those are immediate as well. Looking long-term, the picture is becoming clearer. These products have been around for 10 to 15 years now. It's not like smoking, where we have 60 years of history, where we understand, but just late last year, the Clinical Oncology Society of Australia did issue a qualitative report saying that they believe there is enough evidence now to suggest that there is an association between vaping and cancer. But that's very new, very fresh.

Mark Scott 14:52

But that dataset will grow over time?

Becky Freeman 14:55

We assume so, which is again, kind of depressing when you think about it, that we, we kind of go, well, we don't know the long-term impacts, so let's just pretend everything will be fine. And I really worry that that gives license to these companies to treat people like guinea pigs, like a big petri dish experiment, like well, this seems safer than smoking. There's no smoke in it, it doesn't burn, therefore it's not going to have all the tar and stuff. Man, let's just see what happens, and we'll report back in 30 years time.

Lily 15:28

I feel physically different in many aspects. I would say my chest and my back and surrounding that lung and rib area is very tight. It takes me weeks to recover from a simple cold, because I will either develop bronchitis or I will just have a very low immune defense because of it, because I also struggle to quit while I'm sick, so I kind of push myself when I have very low immune system and takes me a while to be able to recover, as well as just that constant kind of cough that will always be there. My sleep has definitely degraded over time. I wake up to hit it in the middle of the night, and sometimes that can wake me up and not allow me to go back to sleep for several hours. So, I'm very fatigued, very tired. It would affect my appetite as well. So instead of eating, I will sometimes just have a coffee and my vape, and that will kind of suppress my appetite for a while, and then with that, it can also make you feel very nauseous, nic-sick, I think.

Mark Scott 17:06

So cigarettes are legal in Australia, and we've seen reduction in smoking levels over time. Cigarettes aren't banned. Should vaping be legal and how regulated should vaping be?

Becky Freeman 17:21

Yeah look, I don't think anyone is saying like prohibition. This is why we've adopted a model in Australia where we're trying to find that balance between not making these products so accessible to children that we just repeat the mistakes of the past with that we did with tobacco, but that they are available to smokers who are getting the support of a health professional, either that's a pharmacist or their GP, and they're getting access to these products that are tightly regulated and controlled through pharmacies. And that's sort of the compromise position. And look, I get it. People say, “so I have to go to a pharmacy to get a vape, but I can just rock up to a petrol station and buy a cigarette? Like what, that doesn't make any sense.” I totally agree. I don't think that we should be selling cigarettes everywhere and anywhere. We've been leaders in, you know, where you can smoke, can't smoke, denormalising it. But for some reason, we've treated retailers like the sacred cow. It's like, “oh, we should be able to sell a product that kills people, is highly addictive and now, on top of all that, incredibly highly taxed as well, and just sell it everywhere to anybody.” It doesn't. There's no policy coherence to it at all.

Mark Scott 18:22

Let me try and deconstruct my understanding of this vaping market, because it's confusing to me.

Becky Freeman 18:28

It is confusing.

Mark Scott 18:29

We're saying that you can only get vaping products that contain nicotine through a pharmacy. We see vaping taking place everywhere, including so many school kids vaping. They're not all getting their vapes from the chemist, are they?

Becky Freeman 18:46

No, and so in 2024, we expose this ridiculous loophole at the very beginning of our study. Like this is the problem, like that we have this non-nicotine loophole that is absolutely undermining everything. And so then in 2024, the Australian Federal government, under Mark Butler, the health minister, recognised that this was a problem, and now there is no non-nicotine loophole anymore. So all vapes, regardless of nicotine or non-nicotine, you can only access through pharmacies. But no one wants a non-nicotine vape, so it's really not a thing, but we still have retailers who are selling these products, and that comes down to it's an enforcement issue. And because they were so, saturated the market so much, they were absolutely being sold everywhere under this non-nicotine loophole that it is taking time to clean that up. I know that health authorities, particularly in New South Wales, Queensland, are really trying to get enforcement under control. But I think one of the missing pieces of that is that we are still allowing these products because most people who sell tobacco products, illicit tobacco, tobacco products, illicit vaping, it's all concentrated in convenience stores and tobacconists. Why aren't we shutting those shops down? Why are we continuing to allow them to operate? Let's make enforcement a little bit easier and not have, I think it's something like 25,000, 20,000 tobacco retailers in the state of New South Wales, whereas for the whole country of Australia, we have about 7,000 community pharmacists, and they sell products that help people.

Mark Scott 20:13

And without wanting to put words in your mouth, this proliferation of convenience stores you're seeing in every high street, they are really fronts for tobacco and vaping in this era.

Becky Freeman 20:23

Yeah, I mean I live in Inner West Sydney, which is, you know, really close to the uni, really lovely, lovely suburbs, and I'm shocked that when I walk out my front door, it's easier for me to buy an illicit vape or an illicit pack of tobacco than it is to buy fresh fruit and vegetables. That, from a public health point of view, that just makes no sense at all.

Lily 20:49

Something that affects me quite a lot is money. So, you know, I get to the end of my pay cycle, and the first thing I think about is, okay, I have to get vapes, you know, pay rent, and I would think about that before food. So at the moment, for a one that lasts two weeks, which is what I usually get, it's about 45 to 50 dollars. And at the beginning of my pay cycle, I try to buy two to three. So that's 100 to 150 dollars every two weeks, which is quite a lot, as you can imagine it builds up a lot. And when I've looked back at how many I have smoked, I could have, you know, had a grand amount of savings, like an immense amount by now. I wish I had known before I started vaping slash when I started how easy it is, not only to do it everywhere you go, to hide them, to get them, and to get addicted is quite a fast process. It took me one vape to feel like I needed another one. So, I definitely wish I had known to slow down if I wanted to try it and only do it socially, I guess, never have my own, because then it's just a constant in that state.

Mark Scott 22:43

What's a parent meant to do?

Becky Freeman 22:45

I guess, for parents who have a child who's vaping and who's addicted, I think that can be probably one of the hardest things. And it's really important to maintain open dialog, to be supportive, to not be judgmental, and understand that it is addiction, and to offer supportive help. Young people tell us that they want their parents to help them, that they understand that they need to and I appreciate that it would just be easier if young people didn't vape at all. But unfortunately, that's not where we're at.

Mark Scott 23:12

You talked about how teachers were the one who really kind of blew the whistle and said something is happening here, what are you learning from teachers about how vaping is impacting their students and what should schools be doing around the vaping challenge?

Becky Freeman 23:27

Yeah, so the Generation Vape study we also include teachers in that. We have a national survey of teachers every six months, we also interview teachers in New South Wales, and because we've doing that over the course of five years, we've seen a real shift. When we began that study, teachers were telling us this is out of control, we don't know what's going on, we have no resources, help us. And I'm really pleased to report that, you know, health departments have heard that, and they've caught up. We now have great resources. Even here at the University of Sydney, the Matilda Centre, who I work closely with, put together this fantastic, really engaging program for young people, where they can self-direct, and it's, you know, tech, and they engage with avatars and scenarios, and they learn refusal skills. It's brilliant. All those things are really good. And teachers are telling us now that there's certainly less vaping at schools, and that's coming through in their numbers as well. So we've seen a decrease in teens vaping in New South Wales and nationally, a couple of percentage points has come down, which is very exciting. What we're doing is working for that teen audience. Unfortunately, I can't say the same for young adults. Young adult vaping seems to be stubbornly holding. We're not going any higher, but we're also not coming down.

Mark Scott 24:37

So the Matilda Centre's work, the OurFutures Vaping Prevention Program, that I think is now being rolled out nationally in Australian schools.

Becky Freeman 24:43

It is, absolutely, and for free, so schools do not have to pay any cost to access that program.

Mark Scott 24:47

But it’s a pretty intensive, well, well there are a number of structured programs where I suppose school students are really being educated about vaping in a way that goes way beyond the kind of education they'll be picking up online, an evidence based approach, and it shows, I think, a marked increase in students who'll never start vaping for the first time. Is that an important part of the strategy that it is so addictive and so easy to access that you've really got to try and stop the sampling.

Becky Freeman 25:20

Yeah, prevention is key. I work for the Prevention Research Collaboration, I am all about prevention and public health and prevention are synonymous with each other. And I just really want to stress that there's no magic bullet here. I think there's a real temptation to be like, especially in our online world. Do this one magic thing and all your belly fat will disappear in five days. Do this one magic thing and children will never vape again. And we need programs like the OurFutures Vaping, we need legislation, we need those mass media campaigns. I was really happy to see that New South Wales health campaigns, every vape is a hit to your health. They've moved from just online campaigns, which were highly targeted only to young people, to now they're in shopping centres and outdoor advertising, because we need those community conversations as well. We can't just hyper target young people and treat them like they're a separate entity from the rest of society. And then we need to take on these industries as well, holding them accountable for the harm they've caused, exposing that. So it's all these things working together.

Mark Scott 26:21

That's Professor Becky Freeman from the School of Public Health at the University of Sydney, and a member of the Prevention Research Collaboration. You also heard from Lily and our thanks to her for sharing her experience with us. If you want to know more about the important work Becky and her colleagues are doing, look for Generation Vape on the Cancer Council website, or look up OurFutures Vaping Prevention online. And if you want to better understand addiction itself, you'll want to hear our episode with Professor Michael Bowen, who's working on a drug that aims to treat cravings.

Michael Bowen 27:02

If it was just about doing a lot of something, then we'd all be addicted to toothpaste. So it's certainly not about that. It's about having a strong, often uncontrollable urge to use a substance or engage in a behaviour that's harmful despite negative consequences. And that's really the key component of it that someone with an addiction is continuing to drink alcohol despite the harms it's having on their health, on their relationships, on their professional life and so on.

Mark Scott 27:36

You can listen to that episode of The Solutionists right now. Make sure you're following the show, so you don't miss an episode. The Solutionists is a podcast from the University of Sydney, produced by Deadset Studios.

The Solutionists is a podcast from the University of Sydney, produced by Deadset Studios. Keep up to date with The Solutionists by following @sydney_uni on Facebook and Instagram, and @sydney.edu.au on Bluesky.

This episode was produced by Liam Riordan with sound design by Jeremy Wilmot. Supervising producer is Sarah Dabro. Executive editors are Kellie Riordan, Jen Peterson-Ward, and Mark Scott. Strategist is Ann Chesterman.

This podcast was recorded on the land of the Gadigal people of the Eora nation. For thousands of years, across innumerable generations, knowledge has been taught, shared and exchanged here. We pay respect to elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people.