A recent article claims South Africa has “The nicotine Wild West: How SA birthed the next generation of nicotine addicts”.
It is a powerful headline.
It is also exactly the kind of claim that demands careful scrutiny.
Nobody should misunderstand my position.
I support evidence-based regulation of nicotine products. I support strict enforcement against sales to minors. I believe nicotine products should not be sold to anyone under the age of 18. I support meaningful penalties for retailers who break the law.
Protecting young people should never be controversial.
But protecting young people should not require abandoning critical thinking.
The article’s central argument rests on a study of approximately 25,000 learners from 52 South African schools. Readers are told that almost 17% of learners currently vape and that 61% of young vapers show signs of nicotine dependence.
Those numbers sound alarming.
Yet there is a crucial question that receives surprisingly little attention:
Do these findings actually tell us what is happening among South African youth? Or do they tell us what is happening among a very specific group of learners?
The distinction matters.
The study did not survey the next generation in South Africa as a whole. It surveyed learners attending fee-paying schools. Around 60% of participants came from single-sex schools, institutions that represent a tiny fraction of South Africa’s education system and which are disproportionately concentrated among historically advantaged, urban and better-resourced communities.
This is not a criticism of the researchers. Researchers can only study the populations they can access.
But it becomes a problem when findings from a highly selective cohort are presented as though they describe an entire nation. Let's be reminded that during the 2021 South African Global Adult Tobacco Survey (GATS-SA), only 26 individuals aged 15 to 17 participated.
South Africa remains one of the most unequal countries in the world. Most learners attend public schools. Most do not attend prestigious fee-paying institutions. Many learn in communities facing poverty, unemployment, overcrowded classrooms, poor infrastructure and limited access to technology. Not to mention the significant number of children who drop out of the education system.
During the period of the study, internet access for educational purposes remained limited in large parts of the school system. According to the Independent Communications Authority of South Africa, an estimated 24% of all public schools had access to the internet and ICT labs for educational purposes at the time. The researchers themselves acknowledged that non-fee-paying schools were not represented because of logistical challenges.
That omission matters.
Because a study cannot tell us what is happening among populations that were largely excluded from participation.
Yet the article asks readers to accept a conclusion about South Africa’s youth as a whole.
The further one examines the data, the more questions emerge.
The article repeatedly highlights findings about dependence and addiction. What receives far less attention is the extraordinary amount of missing data contained within the supplementary material.
Among current vapers, nearly half did not provide information on whether they were using nicotine-containing or nicotine-free products. More than half did not answer questions relating to whether they could get through a school day without vaping. More than 60% did not answer questions regarding anxiety or irritability when unable to vape. More than 70% did not provide sufficient information for one of the dependence assessments, while more than 80% were missing from another dependence calculation entirely.
These are not small gaps.
They are substantial portions of the vaping cohort. Missing data does not automatically invalidate research. Every researcher deals with non-response. However, when findings are presented to the public, the level of uncertainty created by that missing data should be openly discussed.
Instead, readers are left with the impression of certainty.
The study becomes even more difficult to interpret when placed within South Africa’s broader social and public health reality.
The article portrays vaping as a defining nicotine crisis. Yet the country’s largest nicotine problem remains combustible cigarettes.
Millions of South Africans continue to smoke. Smoking remains responsible for the overwhelming majority of tobacco-related disease and death.
At the same time, South Africa faces one of the largest illicit cigarette markets in the world. Cheap illegal cigarettes remain readily available in many communities. Age restrictions are frequently ignored. Enforcement remains inconsistent. Single-stick sales continue despite long-standing concerns.
In many poorer communities, illicit cigarettes are more visible, more accessible and more entrenched than vaping products.
This is not an argument for ignoring youth vaping. It is an argument that public health priorities should reflect reality. When discussing nicotine use among young people, context matters. The lived experience of a learner at a well-resourced urban fee-paying school is not necessarily the lived experience of a learner in a rural village, township or under-resourced public school, and again, not to mention the large number of children who have dropped out of the schooling system. The challenges facing a teenager experimenting with disposable vapes are not identical to those facing a community where illicit products are sold openly, and enforcement is virtually absent, gripped by poverty, unemployment, and lack of basic services.
Yet one issue dominates headlines while the other often receives only passing mention.
Perhaps most importantly, millions of South Africans (11.1 million) who already smoke appear almost entirely absent from the conversation, including the 23,9% of youth (aged 15-24) reported in the GATS-SA.
Where is the urgency around helping them quit?
Where is the discussion around smoking cessation support?
Where is the debate around risk-proportionate regulation that recognises the difference between combustible and non-combustible nicotine products?
Where is the concern for smokers who remain trapped between addiction, poverty, illicit markets and limited access to effective alternatives?
Public health should be capable of addressing multiple problems at once.
Protecting youth matters.
Reducing smoking-related disease matters.
Combating illicit trade matters.
Enforcing existing laws matters.
Helping smokers quit matters.
The danger is not that we are talking about youth vaping. The danger is that we are talking about youth vaping as though it exists in isolation from every other nicotine-related challenge facing South Africa.
The article asks readers to accept that South Africa has created a new generation of nicotine addicts.
Perhaps.
But before accepting such a sweeping conclusion, readers deserve a fuller understanding of who was surveyed, who was not surveyed, how much data was missing, and how these findings fit into the broader realities of smoking, illicit trade, enforcement failures, poverty, unemployment, and public health in South Africa.
After all, scrutiny (Bhekisisa) should not end with the headline.
It should begin there.