Researchers led by the University of Massachusetts Amherst and the University of Oxford have found low-certainty evidence that vaping among youth leads to future smoking. This significant finding could reshape public health policies.
Public health researchers have unveiled a significant finding that challenges a widely held perception: the belief that youth vaping inevitably leads to cigarette smoking. In a comprehensive review published in the journal Addiction, the researchers discovered “very low-certainty evidence” supporting the claim that nicotine vaping acts as a gateway to smoking for young people.
The study, which reviewed 123 studies encompassing around 4 million participants under the age of 29 from the United States, Canada and Western Europe, offers a nuanced perspective on the complicated issue of youth vaping and smoking.
“One of the substantial concerns from some members of the public health community about vaping is that it might cause more young people to smoke,” senior author Jamie Hartmann-Boyce, an assistant professor of health policy and management at the University of Massachusetts Amherst, said in a news release. “Some – but not all – evidence from our study possibly suggests the opposite – that vaping may contribute to declines in youth smoking, particularly in the US.”
Despite the extensive data, definitive conclusions remain elusive.
“We need more studies to establish any causal links,” added Monserrat Conde, one of the lead authors from the University of Oxford.
The researchers face methodological challenges in examining this issue.
“The studies themselves are not straightforward study designs, because you can’t randomize kids to vape or not vape – it just wouldn’t be ethical,” Hartmann-Boyce added. “But it means that there are so many different ways to interpret the findings of these studies.”
While data from the larger studies reviewed showed mixed results, there was a trend suggesting that increased vaping among youth correlated with decreased smoking rates. Conversely, when vaping was restricted, smoking rates tended to rise.
However, not all studies supported this trend, and some indicated the opposite effect.
On an individual level, the study found that young people who vape are more likely to start smoking compared to those who do not vape. However, it remains unclear whether vaping directly causes them to smoke, as some youths who vape might have become smokers regardless, Hartmann-Boyce pointed out.
“There’s enough non-smoking kids who start vaping in the US that if vaping was in a consistent and widespread way causing kids to start smoking, we would start seeing that in our population-level smoking data,” she added. “And we haven’t seen that at all.”
Statistics from the U.S. Centers for Disease Control and Prevention (CDC) back up this observation, showing a steady decline in youth smoking rates: from 15.8% of high school students in 2011 to just 1.7% in 2024.
“The smoking rates among kids have declined steeply, and whether or not that’s due to vaping or something else is up in the air,” Hartmann-Boyce concluded. “But it’s difficult to argue that – in the US population – youth vaping is en masse causing kids to smoke. The data doesn’t support that so far.”
This review’s implications are profound for public health policy. Previous research from Hartmann-Boyce and her team indicates that nicotine e-cigarettes can assist adults in ceasing smoking. However, if vaping were proven to cause youth smoking, it would strongly justify restrictions on e-cigarettes.
The study underscores the necessity for more nuanced and extensive research to clarify the relationship between youth vaping and smoking. Until such evidence is available, public health policies must balance the potential benefits of vaping for adults with the uncertain risks for youth.