There is evidence that young people who vape are more likely to start smoking, drink alcohol and use marijuana. — Filepic posed by models
Vaping among teenagers and young adults is consistently linked to subsequent smoking, marijuana and alcohol use.
This is according to an overarching (umbrella) review of systematic reviews of the evidence, published online Aug 19 (2025) 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 number 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 four umbrella reviews) included pooled data analyses and health technology assessment reports, published between 2016 and 2024, with most published after 2020.
Harmful effects
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 three times as likely to start smoking as those who don’t vape.
Pooled data analysis of the results of five systematic reviews showed a strong link between vaping and substance use.
This ranged from a near tripling to six-fold heightened risk for marijuana use, a 4.5 to more than six-fold increased risk for alcohol consumption, and a 4.5 to a nearly seven-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 three systematic reviews showed associations between vaping and suicidal outcomes, and six 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.
However, the researchers note that this evidence was largely derived from limited surveys or case series/reports.
Policy measures needed
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.
“Nonetheless, given the consistent associations we observ-ed with increased smoking and multiple possible harms to health and well-being 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.
