Vaping during childhood and adolescence may carry a broader range of health risks than previously recognised, with evidence linking e-cigarette use among young people to nicotine dependence, respiratory and oral-health problems, poorer mental health and subsequent cigarette smoking, according to a systematic review reported by Nature.
The review, published in August and co-authored by respiratory paediatricians, examined the available evidence on the health consequences of vaping among children and young people. The authors said the range of potential harms was wider than anticipated and increasingly apparent in clinical practice.
E-cigarettes were originally introduced in the 2000s as a potential tool to help established smokers stop using tobacco. Their ability to deliver nicotine efficiently has contributed to their use in smoking-cessation programmes. A meta-analysis cited by the authors found e-cigarettes to be more effective than other nicotine-replacement therapies for smoking cessation.
But the authors stressed that this potential benefit for adult smokers does not mean vaping is without risk, particularly for people who have never smoked.
Nicotine is highly addictive and decades of research on tobacco use have established that exposure can affect fetal and adolescent brain development. Even intermittent, relatively low-level exposure can lead to symptoms of dependence, while adolescents can experience cravings and withdrawal after occasional use.
The composition and design of modern vaping products have also increased concerns about nicotine exposure. Some devices use nicotine salts, which can produce smoother and sweeter-tasting vapour and, in some products, faster and higher peaks of nicotine in the bloodstream. Manufacturers have also used sweet and fruity flavours and colourful packaging, features that the review’s authors say can make the products particularly attractive to younger people.
E-cigarette aerosols can contain substances including heavy metals such as lead, toxic carbonyl compounds, nanoparticles and, in some products, unregulated substances such as synthetic cannabinoids. The long-term consequences of exposure to these substances remain incompletely understood, although some are known to have inflammatory, immunosuppressive, carcinogenic or addictive properties.
Respiratory effects were among the health problems identified in the review. Young people who vape were consistently associated with symptoms including coughing, chest discomfort, wheezing and wet coughs. Studies also reported associations with oral and dental problems, including gum inflammation, ulcers and dry mouth, as well as eye symptoms such as irritation, redness, dryness, blurred vision and pain.
The review also identified associations between youth vaping and allergic conditions including atopic dermatitis and allergic rhinitis.
The authors said they were particularly concerned by evidence connecting vaping with poorer mental health. Depression, panic disorder, anhedonia and suicidal thoughts were reported more frequently among young people who vape. 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 noted the finding as a serious concern, although associations observed in such studies do not by themselves establish that vaping directly causes these mental-health outcomes.
The review also examined potential effects on unborn children. Maternal vaping was associated 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.
One of the strongest findings identified by the researchers concerned the relationship between vaping and 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 finding is particularly significant because vaping had emerged alongside a long-term decline in cigarette use among young people in several countries. In the United Kingdom, the proportion of 11–17-year-olds who had ever smoked fell to about one in eight by 2021, according to figures cited by Nature. The review authors said that trend has since reversed, with both vaping and cigarette smoking increasing among young people.
They argue that the evidence requires governments to strengthen regulation and enforcement while maintaining the distinction between vaping as a possible smoking-cessation tool for established adult smokers and its use by people who have never smoked.
Several countries, including 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, while legislation also prohibits the sale of tobacco products to people born on or after 1 January 2009. Britain separately banned single-use vapes in 2025.
The authors said enforcement would be critical and called for stronger educational programmes for children, clearer health warnings and further research into effective methods of helping young people stop vaping.
Their central distinction is that vaping may serve as an exit from cigarette smoking for some established smokers while exposing non-smoking children and adolescents to nicotine dependence and potentially increasing their likelihood of taking up cigarettes.
