Young people who vape face a heightened risk of asthma, cough and injuries as well as possibly pneumonia, bronchitis, headaches, and dizziness/lightheadedness.

That is the conclusion of an overarching (umbrella) review of systematic reviews of the evidence, which is published online today (20 August) in the journal Tobacco Control.

The article’s first author is Su Golder, an associate professor at the University of York’s Department of Health Sciences. Dr Golder and her colleagues suggest that their findings reinforce policy measures aimed at restricting the sales and marketing of vapes to young people.

Vaping among teens and young people is consistently linked to subsequent smoking, marijuana and alcohol use. Although four umbrella reviews on the topic have been published, they did not focus exclusively on young people or do so only for a narrow set of outcomes, such as smoking initiation, the authors note.

To strengthen the evidence base and uncover the extent of physical and mental harms associated with vaping among young people, they carried out an overarching review of existing systematic (and umbrella) reviews after scouring research databases.

The 56 reviews (52 systematic reviews and 4 umbrella reviews) included pooled data analyses and health technology assessment reports, published from 2016 to 2024, with most (47) published after 2020.

Key findings

A synthesis of the data from 21 systematic reviews revealed a consistent and significant association between vaping and starting smoking, ranging from a 50 per cent 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. 

[Efforts could include] ‘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’ [Sue Golder et al]

Pooled data analysis of the results of five systematic reviews showed a strong link between vaping and substance use, ranging from a near tripling to six-fold heightened risks for marijuana, a four and a half to more than six-fold increased risk for alcohol, and a four and a half to a nearly seven-fold increased risk for binge drinking. 

Asthma was the most common respiratory health outcome, with consistent associations of between 20 per cent and 36 per cent heightened risks of being diagnosed with the condition, and a 44 per cent 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, although this evidence was largely derived from limited surveys or case series/reports, note the researchers.

Caveats and conclusions

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 Dr Golder and her fellow researchers. 

‘None the less, given the consistent associations we observed with increased smoking and multiple possible harms to health and wellbeing 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,’ Dr Golder and her co-writers 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. 

Fact file

• the World Health Organization (WHO) described the rise in the prevalence of children who vape around the world as ‘alarming’

• the proportion of 15-16-year-olds who vape ranges from 5.5 per cent to 41 per cent in WHO Europe region countries alone, note the researchers

To access the full version of the article – titled Vaping and harm in young people: umbrella review Doi:10.1136//tc-2024-059219 – see: https://tobaccocontrol.bmj.com/lookup/doi/10.1136//tc-2024-059219

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