Youth vaping consistently linked to subsequent smoking, marijuana and alcohol use

Vaping among teens and young people is consistently linked to subsequent smoking, marijuana and alcohol use, finds an overarching (umbrella) review of systematic reviews of the evidence, published online in the journal Tobacco Control.

And it’s associated with other harmful consequences, including heightened risks of asthma, cough, injuries and mental ill health as well as possibly pneumonia, bronchitis, headaches, migraine, dizziness/lightheadedness, low sperm count, and poor mouth health.

The findings reinforce policy measures to restrict sales and marketing of vapes to young people, conclude the researchers.

The World Health Organization (WHO) has described the rise in the prevalence of children who vape around the world as "alarming." The proportion of 15–16 year olds who vape ranges from 5.5% to 41% in WHO Europe region countries alone, note the researchers. And concerns persist about the harms of vaping in young people, in particular whether vaping leads to smoking. 

Although four umbrella reviews on the topic have been published, these don’t focus exclusively on young people or do so only for a narrow set of outcomes, such as smoking initiation, they add.

To strengthen the evidence base and uncover the extent of physical and mental harms associated with vaping among young people, the researchers carried out an overarching review of existing systematic (and umbrella) reviews after scouring research databases.

The 56 reviews (52 systematic reviews and 4 umbrella reviews) included pooled data analyses and health technology assessment reports, published between 2016 and 2024, with most (47) published after 2020.

Synthesis of the data from 21 systematic reviews revealed a consistent and significant association between vaping and starting smoking, ranging from a 50% to 26-fold higher risk, and suggesting a causal relationship, say the researchers.

Most of these reviews suggested that young people who vape are about 3 times as likely to start smoking as those who don’t vape. 

Pooled data analysis of the results of 5 systematic reviews showed a strong link between vaping and substance use, ranging from a near tripling to 6-fold heightened risks for marijuana, a 4.5 to more than 6-fold increased risk for alcohol, and a 4.5 to a nearly 7-fold increased risk for binge drinking. 

Asthma was the most common respiratory health outcome, with consistent associations of between 20% and 36% heightened risks of being diagnosed with the condition, and a 44% heightened risk of worsening symptoms. 

Synthesis of the findings from 3 systematic reviews showed associations between vaping and suicidal outcomes, and 6 others suggested associations between burn injuries or similar. 

Significant associations emerged between vaping and other harmful health outcomes, including pneumonia, bronchitis, lower total sperm counts, dizziness, headaches, migraines and poor mouth health, although this evidence was largely derived from limited surveys or case series/reports, note the researchers.

They acknowledge that the quality of umbrella reviews depends on the quality of the included systematic reviews. And much of the evidence on outcomes was observational. Inferring causality therefore remains difficult, say the researchers. 

“None the less, given the consistent associations we observed with increased smoking and multiple possible harms to health and wellbeing in this age group, which are consistent with possible causal effects, the evidence supports policy measures to protect young people who do not smoke from the potential risks associated with vaping,” they emphasise.

These measures include restricting the sales and marketing of vapes to young people, and curbs on advertising design features that are likely to appeal to them. 

“Such efforts may form part of a wider set of measures to restrict harms, including raising the public’s and young people’s awareness of these harms, and counter-marketing to raise public and policy awareness of the marketing and strategies that e-cigarette companies have targeted at children and young people,” they add.