Young people who use e-cigarettes are more likely to take up smoking and face wider health risks, according to a major review by researchers at the University of York and the London School of Hygiene and Tropical Medicine (LSHTM).
The study, described as a “review of reviews,” found consistent evidence linking vaping with later cigarette smoking, as well as possible associations with asthma, coughing, airway irritation, mental health problems, and substance use.
While researchers emphasised the need for further research to establish cause and effect, they noted that the weight of evidence supports precautionary policies, including stricter restrictions on youth access to e-cigarettes and more robust public education campaigns.
Regular vaping carries greater risks
Dr Su Golder, Associate Professor in Health Sciences at York, said earlier reviews had already shown that marketing e-cigarettes on social media encouraged young people to start vaping.
The latest review, she said, paints a worrying picture of what happens when vaping becomes a regular habit.
“The consistency in the evidence is striking,” Golder said. “Across multiple studies, young people who use e-cigarettes are more likely to smoke in the future.”
“These findings support stronger public health measures to protect teens from the risks associated with vaping,” she added.
The analysis showed that young people who start vaping not only have a higher likelihood of moving on to cigarettes, but may also smoke more frequently and heavily. Vaping was also found to be followed by alcohol and marijuana use among many teenagers.
Mental health concerns
The review highlighted links between vaping and respiratory issues such as asthma and airway irritation. It also found a concerning association between e-cigarette use and depression or suicidal thoughts in adolescents — though experts cautioned that more research is needed to fully understand the mental health risks.
Many young people report nicotine dependence, including cravings and difficulty quitting. Yet despite concerns about nicotine’s impact on the developing brain, few studies have examined this in detail.
Dr Greg Hartwell, Clinical Assistant Professor at LSHTM, said: “Our review provides the most comprehensive picture to date on the range of risks vaping poses to young people.”
“In particular, we found consistent evidence around transitions to smoking which, of course, opens the door to the multitude of harms that conventional cigarettes bring,” he said.
Call for urgent research and sales ban
The researchers urged further longitudinal studies into how e-cigarettes affect brain development, cardiovascular health, oral health, and the combined use of tobacco and e-cigarettes.
They argue that until these gaps are filled, public health measures should err on the side of caution to shield young people from the potentially long-term harms of vaping.
According to a 2023 World Health Organization report, 121 countries and territories have introduced regulations on electronic nicotine delivery systems. Among them, 33 have imposed outright sales bans, while 87 have adopted measures such as age limits, advertising restrictions, and bans on vaping in indoor public spaces.
But regulation remains uneven. The report found that 74 countries — home to more than two billion people — have no rules at all governing e-cigarettes. This includes 40 percent of middle-income countries and nearly 80 percent of low-income countries, where authorities have yet to take regulatory action.
