E-cigarettes

electronic cigarettes
e-cigs
vaping
vapes
vape pens
e-hookah
electronic nicotine delivery systems (ENDS) and puff bars

Are e-cigarettes a problem for you?

What are e-cigarettes?

E-cigarettes are battery operated devices that heat a liquid (also known as e-liquid) to produce a vapour that users inhale. Using an e-cigarette is called vaping.

E-liquids can come in a range of flavours, contain more than 200 chemicals, and frequently contain nicotine.

E-cigarettes come in many shapes and sizes and can be made to look like everyday items including highlighters, pens, or USB memory sticks.

Learn more

What's in an e-cigarette?

Many e-cigarettes and e-liquids contain nicotine (often in large quantities), even though they are not labelled as containing nicotine. Nicotine is a highly addictive chemical.

E-cigarettes also contain many other harmful substances which are again not always labelled correctly. E-cigarettes and e-liquids are usually imported from overseas and there are currently no safety or quality standards, meaning the labelling and contents are unregulated.

Physical effects can include

Mouth and airway irritation
Burns from e-cigarette overheating or exploding
Persistent cough
Chest pain

Substances which have been found in e-cigarettes include:

2-chlorophenol (used in pesticides and disinfectants)
Propylene glycol and glycerine (may be non-toxic when ingested orally, but researchers aren't sure how safe they are when vaporized and inhaled)
Diethylene glycol (found in industrial products such as antifreeze)
Acetone (a solvent in nail polish remover)
Acetaldehyde and formaldehyde (known to cause cancer)
Acrolein (a weed killer)
Heavy metals such as lead, chromium and nickel
Volatile organic compounds (common in paint and cleaning products)

Seizures
Throat irritation
Vomiting
Dizziness
Headache

See full list

How e-cigarettes affects your body

Tap a body part to learn more of the affects e-cigarettes places on your body.

Psychological effects can include

Increased stress and anxiety
Increased symptoms of depression

See full list

General information

Effects of vaping

The immediate and short terms effects are known to impact both the body and mind.

Physical effects

Mouth and airway - higher risk of developing tooth decay and gum disease, loss of taste (aka vape tongue), dry mouth, bad breath, stained teeth, irritation.
Burns from vapes overheating or exploding
Persistent cough
Chest pain
Dizziness
Headache
Nausea
Heart palpitations
Poison from vape liquid (if swallowed)
Shortness of breath
Seizures
Throat irritation
Vomiting

Vaping can result in a serious and sometimes fatal lung condition known as E-cigarette or Vaping Associated Lung Injury (EVALI).

Psychological effects

Increased stress and anxiety
Increased symptoms of depression

Long term effects

While the long-term impacts of tobacco use are well known, we are now also seeing evidence about the dangers of vaping. As vapes have not been around for long, more time and research is needed to entirely understand the long-term health impacts.

A lack of information does not mean that e-cigarettes are safe.

For more information see the 2022 NH&MRC CEO Statement on Electronic Cigarettes

Types of e-cigarettes

There are many types of e-cigarettes available that can look like metallic wands, pens, highlighters, USBs or other hand-held devices. They are available in thousands of flavours.

There are three main types of e-cigarettes:

Minis – These are disposable e-cigarettes and tend to be most popular with young people.
Closed pod e-cigs – These contain liquid pods that can be replaced when it runs out. These products tend to look like minis however are not disposable.
Refillable systems – For these devices, the e-liquid can be directly re-filled into the devices. They are also known as Mods, Tanks or APVs.

E-cigarettes and the law

It is illegal to sell e-cigarettes, vapes, accessories (and all other tobacco products) to a person under 18 years old. E-cigarettes that do not contain nicotine are legal for adults to purchase only.

E-cigarettes and e-liquids that do contain nicotine can only be prescribed by a GP for smoking cessation purposes and are a prescription only medicine. It is illegal for retailers (other than pharmacies) to sell e-cigarettes containing nicotine, including online sales.

The same smoke-free environment laws apply to e-cigarettes as they do to conventional cigarettes. E-cigarettes cannot be used in smoke-free areas and are banned in all enclosed public places such as shopping centres, pubs, clubs, cinemas and libraries. Vaping is also banned in a number of outdoor public places. These include:

within 10 metres of a children's playground equipment
public swimming pools
spectator areas of sporting grounds used for organised sporting events
public transport stops and platforms
within 4 metres of the entrance to a public building
in seated commercial outdoor dining areas where food is served

It is also against the law to smoke or use an e-cigarette in a car while a child under the age of 16 is present.

For more information on smoke free laws, visit 'Smoke free laws' on the NSW Health website.

E-cigarettes and young people

There has been a rapid rise of vaping in young people over recent years. Despite e-cigarettes being illegal for young people, it is still easy for young people to get a vape illegally at a shop or online.

The flavours (such as watermelon, grape, caramel, bubble-gum, vanilla and mint) and colourful packaging used for vapes make them appealing to young people. E-cigarettes also come in many shapes and sizes, including everyday items, making them easy to conceal. Many vapes contain nicotine, regardless of what the packaging says, which young people can become addicted to very quickly.

Nicotine is highly addictive for young brains and it can cause long-lasting negative effects on brain development. The impacts can include impaired attention, learning, memory, and changes in mood. Vapes can leave a young person at increased risk of depression and anxiety.

Vaping can be a gateway to conventional smoking, especially for young people. Non-smokers who use e-cigarettes are around three times as likely to take up conventional smoking compared to their peers who don't use e-cigarettes. It is known that tobacco companies have used many strategies, such as the promotion of e-cigarettes to get young people addicted to their products.

E-cigarettes used for cessation

Electronic cigarettes are often marketed as a method to assist smokers to quit, or as a 'safe alternative' to conventional cigarettes.

There is currently insufficient evidence to support these claims and no brand of e-cigarette has been approved by the Therapeutic Goods Administration (TGA) for this purpose.

Pregnancy and breastfeeding

E-cigarettes are not a safe alternative to smoking during pregnancy and breastfeeding. No amount of nicotine can be safe during pregnancy. E-cigarettes contain many harmful chemicals and can include nicotine, which can be harmful for pregnant women and the developing baby.

Fetal nicotine exposure can have adverse effects including:

preterm delivery
low birth weight
stillbirth
impaired lung and brain development
sudden infant death syndrome (SIDS)

There is also no evidence that e-cigarettes are an effective cessation aid for pregnant women.

When breastfeeding, the chemicals and nicotine can flow into milk supply and disrupt milk supply. If babies are exposed to nicotine through breast milk, they are prone to ear and lung infections, vomiting, diarrhoea, and increased irritability.

Environmental effects of e-cigarettes

E-cigarettes, especially disposable ones, are increasingly being littered into the environment.

E-cigarettes pose a threat to our environment for three reasons:

Disposable e-cigarettes and cartridges are made of single use plastic.
Vapes produce electronic waste as they contain lithium-ion batteries and a heating element.
They introduce hazardous and toxic chemicals like nicotine into the environment when used and discarded.

When e-cigarettes are littered into the environment, they can be choking hazards if eaten by animals - and they can puncture, explode, or burn. They could also be toxic and potentially deadly for animals due to the battery and chemicals.

There is currently no safe way of disposing of e-cigarettes.

Secondhand exposure

The secondhand exposure risks of vaping are not entirely known and the long-term impacts are still being researched. E-cigarettes do expose people to secondhand aerosol or "vapour" that can contain harmful substances.

There is evidence that non-smokers passively exposed to e-cigarettes absorb nicotine. Secondhand exposure to vaping can affect everyone, however some groups are at higher risk for negative health effects including:

Infants and children – lower body weight and developing respiratory systems put infants and children at higher risk in developing negative health outcomes from vapour.
Pregnant and breastfeeding women – any exposure of nicotine is harmful for developing babies.
People who have lung conditions - secondhand vapour exposure may cause asthma attacks and trigger other symptoms that will make their condition worse.

Addiction and withdrawal

E-cigarettes often contain nicotine making them very addictive. The more that someone vapes, the more the brain and body get used to nicotine and it is harder to go without it. Once someone is addicted to nicotine and they go without it, the nicotine in the blood stream drops, and they have strong urges to vape.

When someone quits vaping, they may have nicotine withdrawal and experience unpleasant physical and mental symptoms. The side effects of nicotine withdrawal can be uncomfortable. Some symptoms can include headaches, irritability, feeling sad and anxious, having trouble concentrating and feeling hungry.

Support available for quitting

Young people should see their General Practitioner, youth health service, or other health services for help to quit vaping.
Quitline counsellors are available to answer any questions about vapes on 13 7848 (13 QUIT). Quitline is a telephone-based service offering information and advice. Quitline counsellors provide tips and strategies, and help people to plan their quit attempts, based on their own needs and preferences. They can also help parents and carers think of ways to approach a conversation about vaping with young people.
The Aboriginal Quitline is also available on 13 7848. Run by Aboriginal counsellors, the Aboriginal Quitline is a telephone-based confidential advice and support service.
If you require assistance in a language other than English, Quitline has counsellors who speak Arabic, Cantonese, Mandarin and Vietnamese. You can ask to speak to one of these counsellors. For people who prefer to speak in a different language, Quitline uses the Telephone Interpreter Service (TIS).
The Cancer Institute NSW iCanQuit website provides information on quitting methods, links to support groups and top tips to help young people quit.
Too much nicotine from vapes can cause nicotine poisoning. If you think someone has been poisoned by liquid nicotine, please call the Poisons Centre on 13 11 26 immediately or 000 if it is an emergency. For more information see NSW Poisons Information Centre.

Resources available for young people, families, teachers and health professionals

NSW Health launched the 'Do you know what you're vaping?' campaign to raise awareness of the health risks of vaping in young people aged 14 to 17 years.

The social media campaign includes a Vaping Toolkit to support young people aged 14 to 17 years, parents, educators, health and other professionals, and community health organisation with information and strategies to educate and protect young people from the harms of e-cigarettes. All resources are on the NSW Health website: The facts about vaping.

The Lung Foundation Australia have also developed a suite of fact sheets for young people, young adults, parents and carers, and educators.

Are e-cigarettes a problem for you?

See full support list

Adolescence and emerging adulthood are periods of significant brain growth and development. Scientists call the adolescent brain highly 'neuroplastic' because it is a time of organising, construction and strengthening of connections in the brain. 3 different light globe animated characters

Respect Your Brain animated series
How do drugs affect the developing brain?
Areas of the brain in development
Alcohol and the developing brain
Cannabis and the developing brain
MDMA and the developing brain
Alcohol, antidepressants and the developing brain
Vaping and the developing brain
Getting help for drug and alcohol issues

Animated series

The Respect Your Brain animated video series focuses on the impact of five drugs commonly used in Australia and explores the way these drugs affect a young person’s developing brain.

How do drugs affect the developing brain?

The brain is highly neuroplastic (changing in response to experiences or exposure to chemicals), so during brain development (teens to 25 years) there is the risk of damage

The way a drug affects a person depends on which part of the brain it targets. Some drugs have far reaching effects, for example alcohol can reach three areas of the brain where important functions occur, whilst other drugs may be more localised and specific, for example MDMA is attracted to the limbic system and binds strongly to areas such as the hypothalamus. Often, it’s the amount of the drug taken (dose) that influences the risk of harm to the brain. Because we are all different, the effects can vary from person to person and be more harmful for some.

Areas of the brain in development

There are three significant areas where brain function occurs, they are:

	Hindbrain (pons, cerebellum and medulla oblongata), which is responsible for balance and coordination and basic automatic functions like breathing and heart rate.
	Subcortical midbrain (limbic system), which is responsible for our animal instincts, like our 'pleasure centre,' our flight or fight response and memory storage. It's also the home of the hypothalamus, which enables us to maintain internal balance and physical wellbeing despite changes or outside factors.
	Forebrain (cerebral cortex, including prefrontal cortex), which is responsible for our complex, high level thinking, like planning for the future and regulating our emotions.

Alcohol and the developing brain

Alcohol is a depressant which is rapidly absorbed into the bloodstream. It can affect the brain within five minutes of consumption (absorption may be slower if the person has recently eaten).

Drinking, particularly heavy drinking, at any time before, during and after brain development, can have a negative effect on the way the brain works.

Early alcohol use may interrupt cell growth in the frontal lobe of the brain, an area which does not reach full maturity until a person reaches their mid-twenties. The frontal lobe of the brain controls higher mental processes such as planning. Drinking alcohol interferes with brain development and harms can include poor attention, poor decision making and disrupts the ability to forward plan – impacting on mental health and educational performance and completion.

Little is known about whether excessive alcohol consumption in teenage years leads to permanent changes to the brain. However, there is evidence that excessive drinking (more than 4 standard drinks on a single occasion) can lead to young people taking risks and putting themselves in dangerous situations, such as drink driving and having unsafe sex.

Cannabis and the developing brain

Cannabis acts as a central nervous system depressant that also alters sensory perception.

THC (delta-9 tetrahydrocannabinol) is the active ingredient in cannabis which is responsible for the mood-altering effects which can make people feel high. Synthetic cannabis functions in a similar way to THC.

Cannabis can affect memory and attention, which can interfere with your ability to take in and remember new information. This can affect everyday life, particularly when learning something new or doing something difficult.

Using cannabis regularly when you are young and your body is still developing increases your body's exposure to the harms associated with cannabis use, such as a higher risk of respiratory illness.

Cannabis use can affect mental processing and if cannabis is used heavily over many years, persistent problems with memory, attention and the ability to handle complex information may be experienced.

Early and heavy cannabis use may affect your choices and options in life, leading to impact on social and physical wellbeing (Cannabis Facts for Young People. National Cannabis Prevention and Information Centre, October 2011).

MDMA and the developing brain

Methylene DioxyMethAmphetamine (MDMA) – also called ecstasy – is a derivative of amphetamine and has both stimulant and hallucinogenic properties. Stimulants speed up the central nervous system and brain, and hallucinogens can cause people to see, hear, feel or smell things that do not exist.

The effects of MDMA can start within an hour and typically last up to about six hours. Some effects may continue for up to 32 hours.

MDMA affects your brain by increasing the activity of neurotransmitters (the chemical messengers of brain cells): serotonin, dopamine, and norepinephrine.

Serotonin regulates mood, sleep, pain, appetite, and other behaviours. MDMA causes mood-elevating effects by releasing large amounts of serotonin. This release depletes the brain's supply of serotonin and some people can feel down or anxious the day after taking MDMA. Known as the 'come down', this may include sleep problems, feeling depressed and finding it hard to concentrate and can last for several days.

MDMA may cause an increase in body temperature (hyperthermia) and dehydration. A body temperature of 40 degrees Celsius or higher is life-threatening. Some symptoms of over-heating include confusion, nausea or vomiting and rapid breathing. MDMA can also cause fluid retention and water intoxication, which can also be life threatening.

Mixing MDMA with alcohol or other drugs is also dangerous, mixing drugs can cause people to feel unwell and put their health and life in danger. Some drug interactions are of particular concern, they are:

MDMA and some of painkillers or antidepressants can lead to serotonin toxicity which can be fatal
MDMA, methamphetamine (ice and speed) and cocaine are all stimulants so if either drug are taken together the effects can be very unpleasant or lead to an overdose
MDMA with alcohol raises blood pressure and body temperature and increases the chance of dehydration and confusion, which could lead to taking more MDMA and the increased risk of overdose

If someone shows the following signs of MDMA / ecstasy overdose an ambulance should be called immediately on Triple Zero (000).

Feeling really hot / overheating
Rigid muscles, tremors or spasms
Clenched jaw
Confusion or disorientation
Difficulty walking
Severe agitation or panic
Having difficulty breathing
Fast racing pulse / heart
Vomiting
Seizure
Unconsciousness

Alcohol, antidepressants and the developing brain

Antidepressants are prescribed to help treat mental health problems, like depression and anxiety. These medicines target neurotransmitters (chemical messengers) in the brain linked to low mood, such as serotonin, noradrenaline and dopamine.

Common antidepressants are 'selective serotonin reuptake inhibitors' (SSRIs), also known by brand names, like Lexapro, Cipramil and Prozac. SSRIs help increase the levels of serotonin in the brain by blocking the recycling of serotonin from the space between nerve cells (see image below).

Neurotransmitters such as serotonin in the synapse of a nerve cell

SSRIs block the re-uptake of serotonin, so it builds up in the synapse

This helps serotonin stay around for longer to help improve mood. Other antidepressants include 'serotonin and noradrenaline reuptake inhibitors' and 'tricyclic antidepressants', which have a similar effect on neurotransmitters.

It can take weeks for the medication to start having an effect, and regular and consistent use is very important.

Some types of antidepressants can interact with alcohol in the body with side-effects such as drowsiness, reduced attention and insomnia. Antidepressants when combined with alcohol (a depressant) can cause enhanced sedation – slow down reaction-time, affect co-ordination, decision making, lead to greater levels of drowsiness than taking either drug alone. This increases the chance of injury and other negative experiences associated with drinking, such as vomiting, fights and unwanted sexual experiences.

Alcohol slows down brain activity in the frontal lobe of the brain, making it harder to regulate stress and other emotions. Drinking alcohol can also intensify negative emotions and worsen underlying mood. There is also a strong link between frequent heavy drinking and symptoms of poor mental health where one disorder serves to maintain and worsen the other.

The safest thing during brain development (which continues until about age 25), is not to use alcohol at all particularly if also prescribed antidepressant medication.

For more information, refer to the fact sheet.

Vaping and the developing brain

Vapes (also known as electronic cigarettes, e-cigarettes, vape pens, pods or stigs) come in many different types. All have the same basic parts, as shown in the picture below: a battery, coil and cartridge. When the battery is switched on, the coil heats up the e-liquid, which is vapourised and inhaled.

vape ryb page.png

Many disposable vapes are one piece with no removable parts, and the e-liquid is stored inside a small pod. Other vapes may be refillable with parts that can be changed.

Vapes can contain over 200 chemicals. In the short-term, vaping can cause damage to the lungs and throat, and lead to nicotine overdose. Vapes haven't been around for very long, so the long-term effects aren't well known.

Nicotine is incredibly addictive. Using nicotine-containing vapes means you may develop nicotine dependence. Needing nicotine all the time to feel normal, otherwise you experience withdrawal symptoms like irritability, low mood, and even tremors. Vapes can deliver nicotine at higher doses – some as much as 50 cigarettes (often much more!)

Exposing young brains to nicotine early can wire your brain to be more addicted to substances into adulthood.

Vaping can lead to worse mental health, both in the short and long term, causing symptoms of depression within 12 months of starting. In the long term, it can lead to developing depression, anxiety and substance use disorders because of the way nicotine changes the brain.

It is illegal to sell vapes (and all other tobacco products) to anyone under 18 years old. It is illegal to sell nicotine vapes to anyone, unless they are prescribed by a doctor to someone over 18 years for smoking cessation purposes, and obtained with a prescription from a pharmacy.

For more information, check 'Do you know what you're vaping?'

Getting help for drug and alcohol issues

There are lots of services that young people can call or chat with online if they have concerns about themselves of others, including their family. All of the following services are free and confidential (unless there is a risk of harm to them or someone else) and can be accessed anonymously.

Alcohol and Drug Information Service (ADIS)
ADIS is 24 hours 7 days a week free, confidential and anonymous telephone service, providing counselling, support, referrals and information for those affected by alcohol or other drugs.

ADIS also provides Web Chat which is free, anonymous and confidential for people with concerns about alcohol or other drug use. Web Chat is available Monday to Friday 8.30am – 5pm (including public holidays).
T: 1800 250 015

Family Drug Support (FDS)
FDS provides 24 hours 7 days a week free telephone support line for families and friends affected by alcohol and drug use.
T: 1300 368 186

Kids Helpline
The Kids Helpline is a free, private, and confidential 24 hours, 7 days a week telephone and online counselling service for young people aged 5 to 25.
T: 1800 55 1800

ReachOut
ReachOut is Australia's leading online mental health organisation for young people and their parents. They have a supportive, safe and anonymous forum space where people care about what's happening to you, because they've been there too.

Lifeline
Lifeline is a 24-hours 7 days a week free crisis support and suicide prevention service.
T: 131 114

More information

Check out the A-Z of Drugs for more information.

#;Respect Your Brain

More about Drugs and the developing brain

The Aboriginal Quitline is run by Aboriginal Advisors, who are experts in helping people quit the smokes. Quitline is a telephone-based service, where Advisors give confidential advice and support to people who want to quit smoking.
Your Aboriginal Advisor can give you tips on how to quit smoking, and help you plan how you will quit. They can also give information about what medications and products could also help you quit.
Aboriginal Quitline Advisors will help you work out the best way to quit. They will listen and give advice that is suited to you.
Aboriginal Quitline offers a free call-back service, where an Aboriginal Advisor will call you to check in on how you are going as you quit the smokes.
Call Quitline on 13 7848 (13 QUIT) and ask to speak to an Aboriginal Advisor.
The cost is the same as a local call (can be higher from mobiles).
Or you can ask for an Aboriginal Advisor to call you by filling in a Request a NSW Quitline Call-Back form.

Monday to Friday 7.00am – 10.30pm Saturday, Sunday and Public Holidays 9.00am – 5.00pm
13 78 48
More about NSW/ACT Aboriginal Quitline
For the cost of a local call (except from mobiles), professional Quitline counsellors provide encouragement and support to help you cut down, quit smoking or stay quit. Quitline also offers bilingual services.
Call Quitline to:
- Request a free quit kit
- Talk to the professional counsellors
- Take part in the free Quitline programs, where counsellors ring back to support you while you are quitting
Counsellors can:
- Give you information and advice about quitting smoking
- Help you assess your level of nicotine dependence
- Provide strategies on preparing to quit and staying quit
- Provide information on products and services to help you quit
- Encourage and support you in your quit attempts
- Assist you to work with lapses or relapse
Call 13 7848 (13 QUIT) Monday to Friday 8am – 8pm, Saturday 9am – 5pm .
Outside these hours you can leave your phone number and a Quitline counsellor will call you back.
Calls from landlines and mobile phones are the cost of a standard call.
Monday to Friday 8am – 8pm, Saturday 9am – 5pm
13 78 48
More about NSW Quitline