Introduction
Youth vaping has significantly increased in recent years. The World Health Organization (WHO) has described the rise in vaping among children worldwide as “alarming.” The percentage of 15–16-year-olds who vape ranges from 5.5% to 41% in countries within the WHO Europe region alone. Moreover, the WHO is concerned about the aggressive marketing of vapes to young people and has urged governments globally to strengthen their vaping regulations.
There are ongoing concerns regarding the harms of vaping among young people, particularly the extent to which e-cigarettes may increase the risk of smoking initiation. To date, no umbrella review has specifically focused on young people and assessed a full range of potential physical and mental health impacts in this age group.
Objective
This paper evaluated and synthesized the short-term and long-term harms of vaping among youth.
Methods
The researchers conducted an overarching review of existing systematic and umbrella reviews from several databases. The 56 reviews included pooled data analyses and health technology assessment reports, published between 2016 and 2024, with most (47) published after 2020.
Results
Synthesis of the data from 21 systematic reviews found a consistent, significant association between vaping and starting smoking, ranging from 50% to 26 times higher risk, and suggesting a causal relationship. Most of these reviews suggested that young people who vape are about three times as likely to start smoking as those who do not vape.
A pooled data analysis from five systematic reviews revealed a strong association between vaping and substance use. The risks associated with cannabis use were found to be nearly tripled to six times higher, while the risk for alcohol consumption increased by 4.5 to over six times, and the risk of binge drinking rose by 4.5 to nearly seven times.
Asthma was identified as the most prevalent respiratory health issue, with consistent findings showing a 20% to 36% increased risk of being diagnosed with the condition, and a 44% heightened risk of experiencing worsening symptoms.
Synthesis of the findings from three systematic reviews showed associations between vaping and suicidal outcomes, and six others suggested associations between burns and other injuries.
Significant associations emerged between vaping and other harmful health outcomes, including pneumonia, bronchitis, lower total sperm counts, dizziness, headaches, migraines and poor oral health. However, this evidence was largely from limited surveys or case series/reports.
Conclusions
Systematic reviews showed consistent evidence that higher risks of smoking initiation, substance use (cannabis, alcohol, and stimulants), asthma, coughing, injuries, and adverse mental health outcomes are associated with e-cigarette use in young people. Other harms such as pneumonia, bronchitis, headaches, migraines, lightheadedness, dizziness, low sperm count and oral health harms are possibly associated with e-cigarette use in young people but require further research. The findings reinforce policy measures to restrict sales and marketing of e-cigarettes to youth.
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