Vaping has gained popularity among adolescents for various reasons, including that it is seen as a safer alternative to smoking.
This perception is misleading as both activities pose serious health risks, with vaping potentially being more harmful for young people.Adolescents are in a key developmental phase, making them particularly vulnerable to the harmful substances in vaping products.
While vaping devices do away with the tar and smoke of traditional cigarettes, they still deliver nicotine and toxic chemicals, including dangerous heavy metals like cadmium. What is equally worrying is that individuals frequently lack awareness regarding the contents of illicit vape liquids, which may include harmful solvents, heavy metals or psychoactive substances.
Inhaling these components can lead to:
- Serious lung damage (i.e. e-cigarette or vaping use-associated lung injury, or Evali)
- Loss of consciousness
- Addiction
- Organ damage.
Vapes are intended (by law) solely for use with nicotine or non-nicotine flavoured liquids. However, unregulated products may include illegal substances such as tetrahydrocannabinol (THC, an active component of cannabis, also known as ganja), methamphetamine (also known as meth or speed) or synthetic cannabinoids (components of cannabis), particularly those that are sold online or smuggled into the country.
Vape cartridges tainted with sedatives (especially etomidate) and opioids have also been reported – these formulations are illegal. The normalisation of vaping in social settings, fuelled by targeted marketing and peer influence, exacerbates the issue, often overshadowing the risks associated with vaping.
Health risks
While often seen as a safer alternative to smoking, vaping poses significant dangers, especially for developing young users. Key health concerns include:
> Respiratory issues
While marketed as cleaner than cigarettes, e-cigarette aerosols contain harmful ultrafine particles that can damage lungs. Evali is a serious respiratory condition caused by the use of e-cigarettes or vaping devices. Common symptoms include difficulty breathing, persistent cough and chest discomfort.
This illness is mainly associated with the presence of vitamin E acetate in certain THC-infused vaping products. Other potential diseases include chronic bronchitis, asthma exacerbations and bronchiolitis obliterans (popcorn lung) due to diacetyl exposure.
More immediately, inhaling these substances can irritate the airways, causing coughing, wheezing and shortness of breath. Some may also experience diarrhoea, nausea, vomiting, abdominal pain, fever, chills and a rapid heartbeat.
> Brain development
Adolescence is a critical period for brain development, affecting decision-making and impulse control. Nicotine exposure from vaping disrupts this process and can lead to lasting cognitive impairments. Early nicotine exposure also heightens the risk of future addiction to other substances.
> Addiction
Both vaping and smoking pose addiction risks, but vaping may have a higher potential for adolescents. Vaping products often contain higher nicotine concentrations than traditional cigarettes. The rapid absorption of nicotine can lead to quicker addiction due to frequent dopamine spikes.
Vaping devices, available in interesting designs with appealing liquid flavours, attract young users and encourage habitual use. The more adolescents vape, the more normalised it becomes among this group, thus encouraging even more adolescents to pick up the habit and be exposed to the risk of addiction.
Toxic substances
Cadmium is commonly found in vaping device components like batteries and coils, where it could potentially leach into aerosols when e-liquids are heated. Some flavoured e-liquids may also contain cadmium due to lack of safety measures during manufacturing or quality control of ingredients.
Cadmium exposure can severely impact adolescent health. It is a known carcinogen linked to kidney damage, bone fragility and cardiovascular (heart) issues. Even low exposure can disrupt the endocrine system, causing hormonal imbalances that affect growth and development.
Inhalation of cadmium aerosols intensifies these risks, leading to both acute and chronic health problems. The developing brain is vulnerable to neurotoxins like cadmium, potentially causing learning disabilities and behavioural issues. Chronic health conditions may arise from cumulative exposure through vaping, often only surfacing years later.
Social and psychological impacts
Adolescents face substantial peer pressure in a culture where vaping is glamourised via social media. Many view it as a socially acceptable alternative to smoking, leading to experimentation to fit in. This normalisation complicates their ability to recognise the potential dangers of vaping.
Vaping is also linked to increased rates of anxiety, depression and other mental health issues. The nicotine in vaping products can intensify these feelings, creating a cycle where individuals rely on vaping for emotional regulation.
This can hinder the development of healthier coping strategies, leaving adolescents vulnerable to mental health challenges. Marketing strategies by vaping companies significantly influence adolescent vaping.
Bright colours, enticing flavours and targeted ads create a brand image linking vaping to fun and rebellion. This marketing approach not only attracts youth, but also downplays the risks, leading to increased experimentation and potential addiction.
Prevention strategies
The dangers of vaping, especially compared to smoking, require urgent attention. Parents, educators and healthcare providers must engage in discussions about vaping risks. Awareness and education can combat the glamourised perception of vaping among peers, empowering youth with knowledge about addiction and health hazards.
Understanding the social and psychological factors driving adolescent vaping is crucial. Collaborative prevention strategies, including education and policy changes, are needed to reduce youth vaping rates. Many countries that once allowed vaping, like Thailand and India, have prohibited vaping after public health concerns grew.
Since 2014, Thailand has enforced a stringent prohibition on the importation, sale and possession of e-cigarettes and related items. The government has heightened its enforcement against illegal vaping activities, issuing specific advisories aimed at tourists.
India enacted a comprehensive ban on vaping through the Prohibition of Electronic Cigarettes Act of 2019. This legislation encompasses all facets of e-cigarette usage and is applicable to everyone, including international visitors. Meanwhile, Singapore took a “better safe than sorry” approach.
Their Health Ministry and Health Sciences Authority concluded that vapes do not serve as a safe substitute for traditional smoking; hence, vaping has been banned.
Taking vaping seriously
Malaysia should take the issue of vaping seriously because of:
> Rising youth uptake worldwide
Many countries report rapid increases in adolescent vaping, especially with multiple available liquid flavours and social media making these devices appealing.
> Unknown long-term harms
Vaping is newer than smoking, so long-term consequences (including respiratory, cardiovascular and neurodevelopmental) are still being studied.
> Gateway and dual-use risk
Some evidence shows that vaping can lead to nicotine addiction and possible transition to traditional cigarettes, or worse, dual use of vapes and cigarettes.
> Illicit market and adulteration risk
Banned or poorly regulated markets can produce contaminated cartridges (with illicit substances like THC and synthetic cannabinoids, as well as other adulterants) and unsafe hardware (e.g. batteries).
If Malaysia’s priority is youth protection and prevention of a new nicotine generation, then we need to move quickly with precautionary measures like flavour bans, age/advertising restrictions and online sales bans, while building suitable regulatory systems.
If regulated vaping is proven to reduce smoking without youth uptake, then we can consider a tightly-controlled medical/pharmacy pathway for adult smokers to help them transition to a less harmful method of nicotine intake.
In short, we mustn’t delay protective measures and out policies should be designed to be adaptive. Addressing vaping-related issues is vital for adolescent health. By promoting awareness and implementing effective prevention measures, we can ensure healthier futures for our young people.
By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 01 Dec 2025
