E-cigarette use may act as a gateway to cigarette smoking and health issues in young people

Researchers have shown that there is strong evidence that e-cigarette use may act as a gateway to cigarette smoking and other health issues in young people.

A review of reviews has revealed that there is a consistent link between e-cigarette use and later cigarette smoking, as well as potential links between vaping and a range of health issues, including asthma, mental health concerns, and drug use.

Researchers, from the University of York and the London School of Hygiene and Tropical Medicine (LSHTM), argue that more research is needed to determine whether there is a direct cause and effect, but the consistency of the findings between the studies conducted so far provide a strong case for precautionary policies, such as restricting youth access to e-cigarettes and strengthening public education efforts.

Our previous reviews have shown that commonly used marketing strategies for e-cigarettes on social media networks resulted in more young people vaping, and this new review looks at what happens when vaping is a regular practice. 

The consistency in the evidence is striking. 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."

Su Golder, Associate Professor in Health Science, University of York

Researchers not only showed an increased smoking risk, but that young people who once vaped, may go on to smoke more frequently and intensely. The review also found that vaping in young people often is followed by alcohol and marijuana use.

A number of studies showed links between e-cigarette use and asthma, coughing, and airway irritation, and experts highlighted that the associated risk of depression and suicidal thoughts in teens, needed more research to better inform on the mental health risks of vaping.

Many young people report signs of nicotine dependence, including cravings and difficulty quitting, but despite concerns about nicotine's effects on the adolescent brain, very few reviews have examined this issue.

Dr Greg Hartwell, Clinical Assistant Professor at the London School of Hygiene Tropical Medicine, 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, in turn, opens the door to the multitude of harms that conventional cigarettes bring."

Researchers are also calling for urgent, longitudinal research into e-cigarettes and areas such as brain development, cardiovascular impacts, oral health, and dual use of e-cigarettes and tobacco.

The research is published in the journal Tobacco Control.