Anna* started smoking cigarettes in eighth grade.

A college student at a university in Manila, she had her first cigarette stick when she was just 14 years old. For her, it was more than just a vice–it was social acceptance.

When she moved to Manila from Northern Luzon, she felt that she had to fit in and saw vaping as a “social thing” where she earned a sense of belongingness. Anna switched from cigarettes to vapes in the belief that these devices were a safer alternative.

More than being a “social thing,” she found smoking from a device stress relieving.

“Nagturn out siya na mas regular kasi kapag nasstress na ako yung response ng katawan ko ay maghanap ng yosi kasi mas mabigat na gung ginagawa sa school,” she said.

According to the Global Adult Tobacco Survey, the percentage of adults who smoked slid to 19.6 percent in 2021 from 29.5 percent in 2009. Meanwhile, the Global Youth Tobacco Survey found that the percentage of youths aged 13 to 15 who smoked cigarettes declined from a record high of 27.3 percent in 2007 to 12.5 percent in 2019. The National Nutrition Survey in the same year indicated that 44 percent of vapers are nonsmokers.

In a report by the PhilippineSTAR Dr. Rizalina Gonzalez, chairperson of the Philippine Pediatrics Society (PPS) Tobacco and Nicotine Control Advocacy Group, said that about 14.1 percent of school-aged children, or one in every seven students, smoke electronic cigarettes or vape devices.

Assoc. Prof. Maria Vida Caparas from the Department of Behavioral Science of the University of Santo Tomas and head of office for Human Resources Services of the Senate noted in an exclusive interview that nicotine products offer “sort of a reward system” for the brain.

“The brain gets rewarded because of the increased dopamine levels. You may also become more excited as you use this [vape],” she said.

Caparas also emphasized that young people usually take up smoking or vaping at a stage in life where they explore and seek belongingness in society.

“It enhances their self-esteem if they think they belong to a wider group of youngsters like them. There’s this social acceptance that encourages people to use this [vape],” she added.

Inside the device

(Photo from E-cigarette, or Vaping Products Visual Dictionary of US Department of Health and Human Services)

Disposable vapes are becoming greatly popular because of their portability and accessibility, offering a wide range of flavors and adjustable nicotine levels that entice curious young minds.

These devices usually have a cartridge, more commonly known as the pod— where the e-liquid is stored; an atomizer that heats the e-liquid; a mouthpiece for inhaling; and a small battery that powers the device. It is a convenient choice for smokers who want to escape the hassle of refilling.

Dr. Leonora Fernandez, professor at the UP College of Medicine and pulmonologist at the UP-Philippine General Hospital, said during a health update webinar that while many people think vape emissions are liquid or gas, these are actually aerosols because they contain solid particles and chemicals similar to tobacco smoke.

“Heated tobacco products and electronic smoking devices operate on a principle similar to traditional cigarettes— hindi nga lang sinisindihan, but they are being heated to a temperature wherein toxic chemicals are generated and that is exactly what the smoker or vaper will be able to inhale and exhale in the form of an aerosol,” she said.

Causes

((Various flavors and types of vape pods) )

The top three factors that have driven the increase in the number of vape users among young people are online accessibility, varied flavors, and the belief that e-cigarettes are safer than tobacco, the Philippine News Agency reported according to the PPS.

These devices come in attractive colors and different flavors, offered at affordable prices that can even be bought from known online shopping platforms in the country. Offered flavors range from sweet flavors to menthol flavors.

“There’s also an aggressive marketing strategy. It becomes readily available in the market. It’s a fashion, and [it’s] trendy among the youngsters,” she said.

Vape stores are spread out around the University of Santo Tomas. There is even a roving store powered by an e-tricycle in P. Campa St., while a sari-sari store in Antonio St. also offered vape pods. There are also more stores stationed along Lacson Ave. with bright and huge signboards.

Fernandez also said that the younger generation has a strong motivator for why they continue smoking.

“There is this kind of reasoning now in the younger ones–that passionate defiance. ‘Kung ito yung mas uso at mas cool ako pag ginagawa ko ito, nobody can tell me what to do. This is my option, this is my personal choice so I will continue to do it.’ That is a strong motivator for them to continue to smoke,” she said.

Health risks

Health experts warn vape users of its harmful effects on the body. As opposed to the belief that vaping reduces harm, Dr. Maria Encarnita ‘Maricar’ Limpin, a tobacco cessation expert and executive director of Action on Smoking and Health Philippines, said that it increases the risk of diseases, including cancer and cardiovascular issues.

Limpin highlighted cases of electronic vape-associated lung injury (EVALI), discussing studies showing DNA and genomic changes among vape users. Sweet-flavored vapes are recorded to have high levels of DNA damage, followed by menthol-flavored ones, then fruit-flavored vapes.

The tobacco cessation expert also said that “vaping is not just a habit nowadays.”

“Ito yung gusto nating paradigm shift: [that] we think of smoking not as a risk factor, but it is a disease and an illness by itself. It is a medical disorder. It is a chronic relapsing disorder called nicotine dependence syndrome,” she said.

In a reported case from Philippine General Hospital, a 22-year-old Filipino male died of a heart attack following a severe lung injury associated with his two years of daily vaping. The patient has no history of cigarette smoking nor an alcohol or illegal drug case.

This was the first reported vape casualty in the Philippines, along with the seven other documented victims of EVALI since 2019.

Continuous call for action

SafeVape PH has slammed vape manufacturers and stakeholders and urged them to comply with government registration requirements and pay their duties and taxesThe government has initiated action to regulate the vaping industry through the Department of Trade and Industry’s Office for the Special Mandate on Vaporized Nicotine and Non-Nicotine Products (OSMV).

Gonzalez said that easily being lured into vaping would make younger people vulnerable to different kinds of diseases.

“It can produce clouds and tricks, but upon checking on these children engaged in vaping, we observed that most suffer from tonsillar abscess,” said Gonzalez.

Department of Health Secretary Teodoro Herbosa asked for the improved enforcement of regulations on prohibiting minors from buying tobacco products such as vape.

The health secretary said minors are not legally allowed to purchase tobacco products, but many of them can still be using them.

“Technically, by law, 18 years old and above lang ang pwede mag vape legally, pero pag pumunta kayo sa mall, pag tumingin kayo sa labas, naka-uniform ng high school nage-e-cigarette. Tsaka binebenta yun openly,” he said in a media briefing.

Crackdown on illegal vape products

The Philippine government has been ramping up enforcement of the Vaporized Nicotine and Non-Nicotine Products Regulation Act.

The law mandates strict rules in e-cigarettes and Heated Tobacco Products, from its importation, sales, packaging, distribution, and advertising. Republic Act No. 9211 and Executive Order No. 106 add stricter measures in the sales of tobacco products near schools.

The Bureau of Customs has seized P6.5 billion worth of smuggled vape products in 36 operations from October 2023 until August 2024 in which the majority of products came from China, while the Bureau of Internal Revenue and Illicit Trade Task Force confiscated 5,385 vape products in Aug. 18 during the “Philippine Vape Festival.”

The road ahead for young vapers

Anna has been trying to quit smoking and vaping, which she succeeded doing for a month but eventually came back to her vice and “stress reliever” after one of her friends died. She also said that it has become part of her system ever since.

“Hinahanap-hanap na siya ng katawan ko eh, every after meal ganun. Minsan pag gising ko sa umaga, nagyoyosi na agad ako kaya naisip ko na baka it’s time to stop,” Anna said.

For someone who came from the province and moved to Manila, she found belongingness and felt acceptance in a group of people with sticks of cigarette in their hands or flavored-smoke devices in their pockets.

“Mas naging regular siya [smoking and vaping] kasi ganun din yung group of friends ko, parang nai-invite ka ring magyosi dahil nagyoyosi rin sila.”

Anna’s real name has been withheld upon request.