Review Links Youth Vaping to Health Concerns and Later Smoking

A systematic review reported by Nature links vaping among children and young people with nicotine dependence, a range of health concerns and a greater likelihood of later smoking cigarettes. The review’s authors say the findings should be considered alongside the potential role of e-cigarettes in helping established adult smokers quit.

Published in August and co-authored by respiratory paediatricians, the review examined available evidence on vaping-related health outcomes in children and young people. Its authors said the range of potential harms was wider than they had expected and increasingly apparent in clinical practice.

Nicotine exposure and product features

E-cigarettes were introduced in the 2000s as a possible way to help people who already smoked stop using tobacco. The review cited a meta-analysis that found e-cigarettes more effective for smoking cessation than other nicotine-replacement therapies. But the authors emphasised that a possible benefit for established adult smokers does not mean vaping is risk-free, particularly for people who have never smoked.

Nicotine is addictive, and research on tobacco use has established that exposure can affect fetal and adolescent brain development. The review says even intermittent, relatively low-level exposure can lead to dependence symptoms, and that adolescents may experience cravings and withdrawal after occasional use.

Some modern devices use nicotine salts, which can make vapour feel smoother and taste sweeter. In some products, they can also produce faster and higher peaks of nicotine in the bloodstream. Sweet and fruity flavours and colourful packaging may make these products particularly appealing to younger people, the review’s authors said.

E-cigarette aerosols can contain substances such as lead and other heavy metals, toxic carbonyl compounds and nanoparticles. Some products may also contain unregulated substances, including synthetic cannabinoids. The long-term effects of exposure are not fully understood. The review notes that some of these substances have inflammatory, immunosuppressive, carcinogenic or addictive properties.

Health concerns reported in the review

Studies reviewed linked youth vaping with respiratory symptoms including coughing, chest discomfort, wheezing and wet coughs. They also reported associations with oral and dental problems, including gum inflammation, ulcers and dry mouth, and with eye symptoms such as irritation, redness, dryness, blurred vision and pain. The review also identified associations with allergic conditions including atopic dermatitis and allergic rhinitis.

The authors raised concerns about reports of poorer mental health among young people who vape. Depression, panic disorder, anhedonia and suicidal thoughts were reported more often in this group. According to the review, young e-cigarette users were almost twice as likely as non-users to report suicidal thoughts or plans, or suicide attempts. The authors described this as a serious concern, while noting that associations in these studies do not by themselves show that vaping directly causes the mental-health outcomes.

The review also considered maternal vaping. It reported associations with higher rates of preterm birth, low birth weight relative to gestational age, abnormal reflexes and motor immaturity among infants. The authors said these findings added to concerns about nicotine exposure during pregnancy.

Links with later cigarette smoking

Among children and young people who had never smoked, those who used e-cigarettes were typically between two and 12 times more likely than non-users to subsequently begin smoking conventional cigarettes, the review found.

The review discussed this finding against a backdrop of changing youth smoking patterns. Figures cited by Nature showed that in the United Kingdom, the proportion of 11–17-year-olds who had ever smoked fell to about one in eight by 2021. The review authors said that trend has since reversed, with vaping and cigarette smoking both increasing among young people.

Regulation and prevention

The authors argue that governments should strengthen regulation and enforcement while distinguishing between vaping as a possible cessation tool for established adult smokers and vaping by people who have never smoked.

The review notes that China, Denmark, Finland and the Netherlands have introduced bans on flavoured vapes. In the United Kingdom, the Tobacco and Vapes Act introduced tighter restrictions on tobacco and vape advertising and promotion. The article also says legislation prohibits the sale of tobacco products to people born on or after 1 January 2009, and that Britain separately banned single-use vapes in 2025.

The authors say enforcement will be important. They also call for stronger educational programmes for children, clearer health warnings and further research into ways to help young people stop vaping.

The review’s central distinction is that vaping may help some established smokers move away from cigarettes, while exposing non-smoking children and adolescents to nicotine dependence and potentially increasing their likelihood of taking up smoking.