According to a longitudinal study published in Tobacco Control, electronic cigarettes (e-cigarettes) may erase five decades of progress against smoking.

Researchers found that young people who vape are just as likely to take up traditional cigarettes as teens were half a century ago.

Rather than offering a safe substitute, e-cigarettes pose health risks of their own and may normalise smoking behaviours, making the transition to regular cigarettes more likely.

The hypothesis that e-cigarettes can help individuals quit smoking remains controversial.

Studies have shown that dual use is common, and switching from e-cigarettes to traditional cigarettes is easier than switching from traditional cigarettes to e-cigarettes, raising questions about their role as a risk factor for smoking.

In fact, switching from e-cigarettes to traditional cigarettes is easier than switching from traditional cigarettes to e-cigarettes. Therefore, it is reasonable to question whether e-cigarettes are a risk factor for traditional smoking.

Study Findings

The study analysed data from three UK cohort studies: the National Child Development Study (NCDS), which tracked 11,969 individuals born in 1958; the British Cohort Study (BCS), which tracked 6222 participants born in 1970; and the Millennium Cohort Study (MCS), including 9733 individuals born between 2000 and 2002.

Researchers assessed smoking rates among 16- and 17-year-olds in 1974, 1986, and 2018.

They examined individual risk factors such as alcohol consumption, school engagement, verbal ability, and parent-reported externalising behaviours.

Family factors included paternal occupation status such as unemployed or self-employed, the age at which the mother left education, and parental tobacco use, including maternal smoking during pregnancy. The MCS also collected data on e-cigarette use (never, past/experimental, and current).

Adolescent smoking has declined by two thirds over the past 50 years, from 33% in 1974 to 12% in 2018.

Key risk factors have remained consistent: Alcohol use increased the odds of smoking by 2.87-fold in the NCDS, 4.37-fold in the BCS, and 3.15-fold in the MCS.

Meanwhile, many risk factors have decreased over time: Teen alcohol use fell from 94% to 83%, mothers’ average school-leaving age rose from 15.5 to 17.7 years, and parental smoking dropped from 72% to 27%.

In the most recent cohort, 11% of the youth reported current e-cigarette use, 41% reported past or experimental use, and 48% had never vaped.

Young individuals who have never used e-cigarettes have a very low chance of starting to smoke (approximately 1.4%).

In contrast, individuals who currently use e-cigarettes face a much higher risk of around 32.6% comparable to smoking rates in the general population in 1974. In practice, nonusers are extremely unlikely to start smoking, while current users face a risk similar to that of adolescents over 50 years ago.

Implications

The data do not prove causation but suggest that vaping may act as a gateway to tobacco, or that shared risk factors may predispose some youth to both behaviours.

Researchers have warned that long-standing reductions in youth smoking could be reversed by increasing the use of e-cigarettes. The number of youth using e-cigarettes is even more striking. “Indeed, it may be that youth who would have historically been considered ‘low risk’ for combustible cigarette use become ‘at risk’ through their nicotine exposure by experimenting with or using e-cigarettes,” the authors wrote.

In 2024, Italy’s National Institute of Health (ISS) reported that one third of adolescents smoke or vape, with 60% using multiple nicotine products, including tobacco, heated tobacco, and e-cigarettes.

European School Survey Project on Alcohol and Other Drugs

The European School Survey Project on Alcohol and Other Drugs (ESPAD) data show that 23.6% of 15- to 16-year-olds smoked cigarettes in 2024, a declining but still common rate of cigarette smoking.

“The increasingly aggressive marketing of nicotine products towards this age group, which moves from tools such as packaging and the increasingly ‘attractive’ appearance of the devices to the creation of ‘fruity’ flavours closer to the tastes of young people, is causing their use to become increasingly widespread,” emphasised Simona Pichini, director of the National Centre for Addiction and Doping at the ISS.

Social media platforms, such as Instagram, and large networks of influencers extensively promote these products.

Italy is facing rising concerns regarding nicotine use among the youth. ESPAD data show that nearly 15% of 16-year-olds still smoke, more than 20% use tobacco, and 40% of e-cigarette users begin smoking before the age of 15 years. In the past month, e-cigarette use surged to 20%, up from 7% in 2018.

This story was translated from Univadis Italy.