Underage vaping continues to dominate discourse and drive public policy. Daily, alarmist media headlines feed the anxieties of parents, teachers and public health officials and have created a full-blown moral panic. However, the fear of youth vaping greatly exceeds the objective threat it poses—and benefits are almost universally overlooked.
In fact, vaping may be beneficial overall to young people.
That statement will undoubtedly spark angry reactions. I hasten to add that in an ideal world, it is generally best for young people’s health not to vape (nor, of course, smoke). But the real world is different, and youth will always experiment with pleasurable activities, especially if we tell them not to.
Vaping opponents have weaponized fears about youth use to demonize vaping. “Think of the children” is a compelling emotive tactic—reminiscent of the 1930s Reefer Madness debacle, and long used as justification for the global drug war. This argument is often used as a screen, when the real concerns are underlying ideological, moral or political objections to harm reduction that are less socially acceptable to express.
Public health policy should be based on evidence rather than emotion, moral panic and misinformation. So, what is the evidence about youth vaping? How harmful is it really, and how can it be beneficial? Importantly, what is the net impact of vaping on youth health and wellbeing?
The young people who are most at-risk of harm from vaping are those who have never smoked, as vaping can expose them to new and unnecessary health risks. However, most vaping by never-smokers is experimental and short-term. Exposure to toxicants and the risk of harm are low with this pattern of vaping.
For example, in England in 2021, only 1 percent of 11-15-year-olds who had never smoked cigarettes vaped once or more weekly.
In the United States, where a “youth vaping epidemic” has frequently been claimed, only 2.1 percent of 14–18-year-olds, in 2019, had vaped on 20 or more days in the past month.
Vaping can cause nicotine dependence in some young people who are not already smoking. However, this is a minority of cases—not, as the media and policymakers often claim, a “whole new generation addicted to nicotine.” And when it occurs, we must ask what harm it actually poses beyond the expense of regular purchases.
Nicotine itself is relatively benign in the doses used in vaping. It does not cause cancer or lung disease. However, it does have minor cardiovascular effects. And if you use it frequently and then stop, you may experience unpleasant withdrawal symptoms and cravings.
Monitoring and long-term studies are essential to detect any emerging problems. However, serious harm is likely to be very uncommon even after decades of vaping.
Vaping involves inhalation of trace amounts of other chemicals besides nicotine. It has effects on the lungs in cell and laboratory tests, but studies have so far identified no clinically-important respiratory symptoms from vaping in young people.
There is also no evidence that nicotine harms the human adolescent brain, although high doses can cause harm to adolescent rodents. Studies have not found differences in IQ, educational achievement or cognitive abilities in adults who smoked in the past compared to those who never smoked, so vaping is very unlikely to have these effects.
And there is certainly no evidence that vaping nicotine causes the misnamed serious lung disease “E-cigarette or Vaping Associated Lung Injury” (EVALI), when a completely different culprit has been identified. Neither does it cause seizures or spontaneous pneumothorax, as is often claimed. There is a rare risk of burns and injuries from lithium-battery explosions.
Long-term vaping may cause cardiovascular and respiratory effects, and ongoing monitoring and long-term studies are essential to detect any emerging problems.
However, as vaping is far less harmful than smoking, serious harm is likely to be very uncommon even after decades of vaping. People who smoke cigarettes but quit by the age of 35 have a full recovery and a normal life expectancy.
Most frequent youth vaping is by those who have previously smoked, or currently do. Vaping by young people who already smoke is beneficial if it diverts them completely or partly away from cigarette smoking, and many vape for this purpose.
It cannot be overemphasized that vaping, overall, is diverting young people away from deadly smoking.
Some young people who would have smoked have never started because nicotine vapes were available as an alternative. Other research has found that restrictions on vaping are associated with increased youth smoking.
It cannot be overemphasized that vaping, overall, is diverting young people away from deadly smoking. Increases in youth vaping have been accompanied by accelerated declines in smoking in the United States, the United Kingdom and New Zealand.
Young people who try vaping are more likely to try smoking. But this simply tells us that people who are more likely to try nicotine products are also more likely to try other nicotine products. There is no evidence that vaping causes people to smoke if they would not otherwise have done so (the “gateway theory”).
Young people who vape exhibit the same genetic, psychological and social factors (such as peer-group pressure, or parental smoking) that are also shown to predispose people to smoking—i.e., they have a “common liability” to both vaping and smoking.
If there is a small “gateway effect” for some youth, it is certainly outweighed by a much larger number moving from smoking to vaping.
There is also growing evidence that those who vape first (before smoking) are less likely to smoke later, compared to those who smoke first.
Many people also experience positive effects from vaping nicotine on mental health. Nicotine has been shown to create pleasure, reduce anxiety and relieve depression. And just like adults, young people often vape for these benefits.
The 2021 Canadian Student Tobacco Alcohol and Drugs Survey, for example, reported that the most common reason for vaping was to relax and relieve tension. Vaping is more common in teens with depression, and is likely being used by some to self-medicate.
Young people benefit immeasurably when their parents quit smoking.
Nicotine also improves attention, working memory and cognitive function and is beneficial for young people with attention deficit hyperactivity disorder and schizophrenia. Vaping nicotine can assist with weight control and is used by some for this purpose. Other benefits are social acceptance and enjoyment.
Another critical factor is vaping’s role as an effective quitting aid for adults who smoke. Young people benefit immeasurably when their parents quit smoking.
Adults who quit with vaping have improved health and live longer, removing the trauma and grief of losing a parent to a smoking-related disease. As vaping is less costly than smoking, there is more money for the family budget and reduced financial stress. Kids grow up without secondhand smoke. And parents who switch to vaping are also no longer smoking role models, meaning their children are less likely to start smoking.
Even if you deny some of these benefits, the panic about youth vaping is grossly out of proportion to the harm it causes.
A recent assessment of youth drug harms in New Zealand ranked vaping as just about the least harmful form of drug use among young people.
No young person or adult has ever died from vaping nicotine.
There are far, far bigger issues that should concern us regarding young people’s health. In the US high school population in 2021-22, 41 percent reported poor mental health, and 22 percent had considered attempting suicide. Many others used drugs with more concerning risk profiles than nicotine, or engaged in unprotected sex.
The biggest danger of the youth vaping panic is that it discourages adults who smoke from switching.
Again, young people who do not smoke should generally be advised not to start vaping, due to its small potential health risks. But at a population level, the benefits of youth vaping, particularly in reducing smoking rates, outweigh the harms.
The biggest danger of the youth vaping panic, however, is that it drives counterproductive policies and discourages adults who smoke from switching to a far safer alternative.
These adults are dying prematurely at a rate of over 8 million a year—a real, devastating harm that should be at the top of the public health agenda. For many, vaping nicotine is the only way to save their lives.
Photograph via Pxfuel
The author recently published, with Wayne Hall, the commentary “What are the harms of vaping in young people who have never smoked?” in the International Journal of Drug Policy.