CHAPTER II
REVIEW OF RELATED LITERATURE
Vaping has become increasingly prevalent among Senior High School (SHS)
students, raising concerns about its impact on academic performance. This chapter
reviews literature and studies related to the academic consequences of vaping among
students. A number of literature and studies will reveal concepts and information
connected to the study.
Foreign Literature
Numerous studies have demonstrated vaping's detrimental effects on cognitive
function. Nicotine, the primary psychoactive substance in e-liquids, impairs attention
span, memory consolidation and decision-making abilities (Hukkanen et al., 2017;Dwyer
et al., 2018). Barrington-Trimis et al. (2018) found significant declines in GPA among
vaping students, attributing this to cognitive impairment.
Vaping has been linked to increased anxiety, depression and stress levels among
SHS students (Primack et al., 2018; Miech et al., 2019). Lechner et al. (2019) reported
anxiety symptoms among e-cigarette users, while Wang et al. (2019) found exacerbated
stress levels. Psychological distress undermines academic motivation and performance.
Empirical evidence suggests vaping negatively impacts academic achievement.
Huang et al.(2020) reported lower standardized test scores among vaping students.
Kandel et al. (2018) found vaping students were more likely to fail courses and exhibit
decreased academic engagement. GPA declines and attendance issues are also prevalent
(Barrington-Trimis et al., 2018).
The World Health Organization has emphasized the dangers of e-cigarettes, but
the Philippines is facing a vaping epidemic. A 2019 Global Youth Tobacco Survey
revealed that 1 in 7 students aged 13-15 are already using e-cigarettes, far below the age
limit allowed by existing laws. The easy accessibility of tobacco products, including e-
cigarettes, is also a concern. Health professionals play a crucial role in tobacco control
activities, but nursing students often lack knowledge about e-cigarettes but hold favorable
stance. Social media, particularly Facebook, is a major source of misinformation, making
it difficult for Filipinos to understand the dangers of e-cigarettes. The Vaporized Nicotine
and Non-Nicotine Products Regulation Act, passed in July 2022, legitimizes vaping but
lowers access to them from 21 to 18. This raises concerns about political decisions
affecting health choices in the future. Actions should include tailoring national policies,
funding research, and improving health education in the youth. (Lance Vincent C. Sese
and Ma. Celina L. Guillermo, 2023)
The most important part of changing their minds about e-cigarette use is to
educate them. Research shows that adolescents need to understand the risks of addiction
so that they believe in the risks, both short and long term, associated with smoking. If
they are not able to conceptualize addiction, then they have a lower chance of believing
in the consequences of smoking (Roditis et al., 2015). A focus group in Kansas found that
when adolescents learned the harmful effects of e-cigarettes on their health that they were
more likely to stop using them (Hedger, 2021).
While educating students about the negative effects of vaping is important, it is
equally important to also educate the parents. Schools sometimes provide flyers, fact
sheets or other resources to students, but this does not impact the parents of students.
Data shows that parents prefer their children use an e-cigarette over a cigarette (Hedger,
2021)
Local Literature
Nursing students play a crucial role in health promotion and disease prevention,
as they are. expected to counsel, advocate for, and model a smoke-free lifestyle. They
also need to develop proper coping skills and attitudes to manage stress. However,
smoking and vaping are prevalent among nursing students, with studies suggesting they
have engaged in these behaviors in the Philippines. Adolescent substance use has been
associated with psychosocial distress, and mental health services in the country are
limited. Nurses who have smoked are less likely to encourage smoking cessation and
arrange follow- up interventions. Nicotine intake and stress have a bidirectional
relationship, increasing psychological. distress and vice versa. Smoking facilitates
ineffective coping responses and is a causal factor in the onset of common and severe
mental illnesses, including major depression and bipolar disorder There is a growing
body of knowledge that smoking and vaping can be barriers to optimal health and
predispose individuals to various physical and mental health disturbances. This study
examined the association between cigarette and electronic cigarette use and perceived
stress levels in nursing students in a private university in Metro Manila, Philippines.
(Joseph Emmanuel P. Resano, Zypher Jude G. Regencia, and Emmanuel 5. Baja, 2022)
Many retailers are not adhering to laws that forbid the sale and distribution of
tobacco products near or within schools, according to a study conducted in the
Philippines. Eleven percent of students use tobacco, ten percent smoke cigarettes, and
fourteen percent use electronic cigarettes, according to the 2019 Global Youth Tobacco
Survey. Online accessibility, taste, and confidence in the safety of e-cigarettes are among
the factors driving the vaping community. (Cristina Eloisa Bnclig, 2023)
The Philippines may be facing an uphill struggle in the vaping epidemic. The
Global Youth Tobacco Survey (GYTS) which was done last 2019 showed that the
country is facing an alarming prevalence of using ENDS among the youth. 1 in every 7
students, aged 13-15 years old, is already using e-cigarettes- an age group far less than
what is allowed by existing laws. In addition, the survey highlights that there is an easy
accessibility for tobacco products as a whole, with 37.1% of the youth not being
prevented from buying these products regardless of their age, both from stores or street
vendors and as advertised in social media. Health professionals on the frontlines in the
country also play a crucial role in tobacco control activities. (Lance Vincent C.
Sese,2023)
Social media, particularly Facebook, is a major source of misinformation, making
it difficult for Filipinos to understand the dangers of e-cigarettes. The Vaporized Nicotine
and Non-NicotineProducts Regulation Act, passed in July 2022, legitimizes vaping but
lowers access to them from 21 to 18.This raises concerns about political decisions
affecting health choices in the future. Actions should include tailoring national
policies, funding research, and improving health education in the youth. (LanceVincent
C. Sese and Ma. Celina L. Guillermo, 2023)
New findings on the detrimental health effects of electronic nicotine delivery
system (ENDS)/ electronic non-nicotine delivery system (ENNDS) confounds the “harm
reduction” perspective of using it as an alternative to conventional cigarettes. In the
Philippines, the pressing debate on its safety and efficacy had initiated actions from
policy makers on legislative issues such as draft DOH Administrative Order, House Bill
4325 and House Bill 532. ( Hylton Y. Lam, 2018)
De Guzman (2020) at the University of Santo Tomas revealed a significant
correlation between vaping and poor academic performance among SHS students. In the
Philippine Journal of Psychology found that peer influence, family factors, and stress
contribute to vaping initiation (Sarte et al. 2020) and Santos et al. (2019) in the Philippine
Journal of Neurology linked vaping to cognitive impairment, particularly in attention and
memory, among Filipino adolescents. Additionally, vaping has been associated with
increased stress, anxiety, and depression (Sarte et al., 2020).
Margarita Isabel Fernandez (2024) presented the vaping‐use associated lung
injury in a young Filipino vape user, the presence of simultaneous acute myocardial
infarction and respiratory failure in our patient with no underlying risk factors or
comorbid diseases suggests that his e‐cigarette use caused both chronic total obstruction
of two large vessel coronary arteries and direct lung injury, though acute myocardial
infarction related ARDS and cardiogenic pulmonary edema cannot be completely
excluded without pulmonary capillary wedge pressure or left atrial pressure
measurement. This case report is the first in the Philippines that links vape use to the
development of both acute lung injury and myocardial infarction. The limitation of this
study includes the lack of vape liquid analysis for further biochemical study and its
qualitative nature.
Foreign Study
Vaping among senior high school students is a growing concern due to potential
health risks and the potential for future smoking. Despite FDA regulations, over 9,000 e-
cigarettes have been sold since 2020. The number of college students vaping nicotine
increased 16 percentage points between 2017 and 2019. (Ashley Mowreader, 2023)
Barrington-Trimis's study (2018) revealed vaping students were more likely to
exhibit decreased academic engagement, fail courses and experience lower standardized
test scores. These findings underscore vaping's negative impact on academic
achievement. Barrington-Trimis et al. (2019) examined nicotine dependence among
adolescent vapers, highlighting the addictive nature of e-cigarettes. Jessica Barrington-
Trimis's research provides critical insights into vaping's academic consequences among
adolescents. Her findings inform evidence-based interventions, policy discussions and
public health initiatives aimed at mitigating vaping's risks.
On Dwyer et al. (2018), demonstrated that nicotine exposure during adolescence
impairs cognitive function, particularly attention and memory consolidation. Dwyer's
study (2018) revealed that nicotine alters brain development, affecting regions
responsible for attention, learning and memory. These changes may lead to long-term
cognitive and behavioral deficits. Dwyer's research highlights the risks associated with
vaping, particularly among adolescents. E-cigarette use has been linked to increased
nicotine dependence, respiratory issues and other health problems. He provides critical
insights into the effects of nicotine and vaping on adolescent brain development. His
findings inform evidence-based interventions, policy discussions and public health
initiatives aimed at mitigating vaping's risks.
Another related study from Primack et al. (2018) demonstrated a significant link
between vaping and depression among adolescents. Primack's research revealed vaping's
negative impact on academic performance. Vaping adolescents exhibited lower GPAs,
decreased academic engagement and increased absenteeism. His findings inform
evidence-based interventions, policy discussions and public health initiatives.
A study by Owotoma found that e-cigarette users are more likely than those who
do not use tobacco to underestimate the addictiveness of cigarette smoking (p. 92). The
study suggests that more longitudinal research is needed in the development of a course
of action that assesses perceived risks of nicotine addiction for all tobacco products,
including e-cigarettes. Likewise, it is recommended that anti-smoking messages include
the potential risks of addiction in all tobacco products, not just cigarettes (Owotoma et
al., 2018). One of the reasons why adolescents use e-cigarettes rather than cigarettes is
the stigma that is associated with smoking cigarettes (Donaldson et al., 2021).
Despite the increased prevalence of youth e-cigarette use, no longitudinal studies
have examined the association of e-cigarette use initiation on subsequent academic
achievement. Findings from one cross-sectional study of a U.S. nationally representative
sample of high school seniors indicated that exclusive e-cigarette users had lower
academic achievement and were less likely to plan to go to college compared with
nonusers, but had higher academic achievement and were more likely to plan to go to
college than those who exclusively use conventional cigarettes (McCabe et al., 2017). A
longitudinal study of 7th graders in Helsinki, Finland found that poor academic
achievement in 7th grade predicted e-cigarette experimentation by 9th grade, but did not
report the association between e-cigarette experimentation in 7th grade on academic
achievement at 9th grade (Kinnunen et al., 2018).
Vaping among adults aged 18-24 years has increased globally, with a study
revealing that 25.8% of 18-24 year olds ever vaped and 0.2% currently do so. In New
Zealand, adolescents and young adults are more likely to try e-cigarettes than older
adults. This study aims to estimate the prevalence and reasons for vaping among
university students aged 18-24 years in NZ, contributing to understanding the uptake of
e-cigarettes and potentially promoting public health. (Ben Wamamili, Mark Wallace-
Bell, Ann Richardson, Randolph C Grace, and Pat Coope,2020)
Local Study
The Philippines has one of the highest cigarette smoking rates in Southeast Asia,
with 13.1 million adults aged 15-34 engaging in tobacco smoking daily. Tobacco
cigarettes are the only product that can destroy and deteriorate the human body when
used directly. The United States top cause of preventable death is tobacco cigarettes,
killing 480,000 people annually. Smoking increases the risk of neurovascular,
cardiovascular, neurovascular, oncologic, and endocrine diseases, and the average life
span decreases at least 10 years. To address this health problem, smoking cessation
programs are being implemented, but tobacco prevention and control efforts should not
be a one-size-fits-all approach. E-cigarettes, or vaping, have gained popularity among
adults but may have potential harmful effects. The U.S. Food and Drug Administration
(FDA) has initiated control of marketing sales and electronic cigarette production rules in
2016. Further research is needed to understand the factors affecting health behavior of
people using e cigarettes, as most studies focus on factors influencing tobacco or cigarette
smoking. (Fahad Khamis D. Aljaberi, Johnny J. Yao J. 2021)
Over 80% of tobacco users worldwide live in low- and middle-income countries,
including the Philippines, where smoking-related preventable illnesses remain the leading
cause of death. Despite a significant decline in tobacco use among adults, 22.5% still
smoke cigarettes. Emerging nicotine and tobacco products, such as e-cigarettes (ECs),
have been associated with health risks and can be a gateway to substance use among non-
smokers (Joseph Emmanuel P. Resano, Maria Nicola, 2021). Adolescents and young
adults are mainly vulnerable to cigarette and EC use, with nursing students worldwide
having up to 40% prevalence for smoking and 12% for vaping (Zamantha Z. Manicio
2021). The smoking experience of nurses can negatively impact their engagement and
credibility in implementing smoking cessation interventions. Nursing students'
knowledge and attitude towards smoking and vaping should be analyzed to inform
nursing research and education. The role of nurses and other health professionals is
crucial in addressing the global tobacco epidemic (Zypher Jude G. Regencia, and
Emmanuel S. Baja, 2021)
The Philippines has one of the highest cigarette smoking rates in Southeast Asia,
with 13.1 million adults aged 15-34 engaging in tobacco smoking daily. Tobacco
cigarettes are the only product that can destroy and deteriorate the human body when
used directly. The United States top cause of preventable death is tobacco cigarettes,
killing 480,000 people annually. Smoking increases the risk of neurovascular,
cardiovascular, neurovascular, oncologic, and endocrine diseases, and the average life
span decreases at least 10 years. To address this health problem, smoking cessation
programs are being implemented, but tobacco prevention and control efforts should not
be a one-size-fits-all approach. E-cigarettes, or vaping, have gained popularity among
adults but may have potential harmful effects. The U.S. Food and Drug Administration
(FDA) has initiated control of marketing sales and electronic cigarette production rules in
2016. Further research is needed to understand the factors affecting health behavior of
people using e-cigarettes, as most studies focus on factors influencing tobacco or
cigarette smoking. (Fahad Khamis D. Aljaberi, Johnny J. Yao J, 2021)
The rise of electronic cigarettes (EC) has led to a global market estimated at $10
billion in 2015,with the majority of sales in the US, UK, China, France, Germany, and
Italy. However, the safety and efficacyof EC have been a topic of debate in the
Philippines, with the FDA warning that the benefits and healthconsequences of EC have
not been established. The Philippine E-cigarette Industry Association (PECIA)has been
working to set best practice standards and regulate the EC market. The Department of
Healthhas drafted guidelines for regulating EC, and in 2017, a nationwide ban on
smoking was imposed, but ECwas excluded. (Hilton Y. Lam, Carlo Irwin A. Panelo,
Ofelia P. Saniel, Carmelita C. Canila, Jonathan P.Guevarra, Ma-Ann M. Zarsuelo and
Ma. Angelica Q. Castro, 2019)
This chapter highlighted vaping's detrimental effects on SHS students' cognitive
function, psychological well-being, and academic performance. Educators, policymakers,
and healthcare professionals must collaborate to develop effective interventions and
prevention strategies. Preventing academic consequences of vaping among SHS students
requires a multifaceted approach by implementing school-based interventions, engaging
families and communities, promoting health-focused initiatives, advocating for policy
support and leveraging technological solutions, we can mitigate vaping's harmful effects
and foster a healthier, more productive learning environment.
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