NEWPORT, Wales — Family doctors across the UK are facing an escalating youth vaping crisis and need clear national guidance and training to manage the issue, according to new study data presented here at the Royal College of General Practitioners (RCGP) Annual Conference 2025 .

“Vaping has outpaced policy and guidance,” said Yasmin Baker, a final year medical student at Imperial College London, who presented the findings alongside fellow final year medical student, Maneth Warnapala, from the same university.

“GP education and established organisations need to release guidance on how to deal with the vaping epidemic, especially in those who do not smoke, and in particular, on vaping cessation,” Baker said.

“One in five UK adolescents have tried e-cigarettes, and almost half of them never smoked traditional cigarettes,” added Warnapala, “Yet GPs don’t have the tools, data, or guidance to address it proactively.”

The study entitled From Puffs to Prevention: Battling the Vaping Epidemic in UK Primary Care, highlights the widening gap between the scale of adolescent e-cigarette use and the readiness of general practice to respond.

Lack of Guidance for Never-Smokers

Speaking to Medscape News UK after their presentation, the researchers said most healthcare professionals feel confident in the evidence that supports vaping as a positive step towards tobacco use cessation, but its role among youth is entirely different. 

“What we're focusing on is the youth who have never smoked a cigarette,” said Warnapala. “We were the generation that were never meant to smoke, and now we're picking up e-cigarettes.”

The researchers combined a systematic review of 16 studies (2000-2024) with a national survey of 284 UK GPs and qualitative interviews with 11 clinicians to map knowledge, attitudes, and practice in primary care. 

Findings revealed that, while 86% of GPs believe vaping should be routinely discussed in consultations with young people, only 1 in 4 GPs regularly ask ‘do you, vape?’. Almost all (95%) reported being unsure how to quantify vaping, and just 12% felt confident counselling patients about associated risks.

“These are not reluctant clinicians, they’re clinicians without a framework,” said Warnapala. “Most GPs recognise vaping as a public health issue, but they lack evidence-based materials, documentation fields in electronic records, and standardised referral pathways. It’s like being asked to tackle smoking before the anti-tobacco guidelines existed.”

Barriers and Drivers for Change 

The series of qualitative interviews revealed several consistent barriers: time pressure in consultations, absence of coding fields in electronic health records, and lack of clarity about whether vaping should be treated as harm reduction or a behavioural risk factor.

GPs felt caught between mixed messages of whether to discourage vaping entirely or support it as a harm-reduction tool for adult smokers. 

Baker explained that when advising on how to stop cigarette smoking, GPs have quantitative tools to refer to. “By knowing how many cigarettes a patient smokes per day and for how long, clinicians can estimate their level of nicotine dependence and tailor nicotine replacement therapy accordingly,” she said. But “with e-cigarettes, there’s no standardization — different brands and devices contain widely varying nicotine concentrations. As a result, GPs often lack the knowledge and tools to determine appropriate nicotine replacement therapy or even how best to counsel these patients.”

However, the study also identified strong drivers for change. Education, resources, and a change towards structured training at all levels were seen as priorities. Updated NHS resources including leaflets, Ardens guidance, and Continuing Professional Development modules, as well as better documentation within electronic health records, were also recommended. 

“There are no updated guidelines on this from, for example, the RCGP or from [National Institute for Health and Care Excellence] that talk about vaping cessation in absence of smoking,” said Warnapala. “GPs have nothing to rely on. It's a massive gap.”

“There’s an urgent need for a national strategy,” Baker added. “That means alignment between RCGP, [Department of Health and Social Care], and public health agencies, updated training resources, and better documentation systems within GP software. Otherwise, we’re leaving an entire generation exposed.”

Public Health Messaging Under Scrutiny

Commenting on the data, session moderator, GP, and member of Birmingham and Solihull Integrated Care Board, Dr Onyinye Okonkwo, remarked that this was a pressing and huge issue. “Recently our public health message has been if you smoke, then move to vaping, and if you don’t smoke than don’t vape. Unfortunately, young people interpret this as ‘it’s okay to vape’ and we as GPs just don’t have the skills with vaping as we do with smoking. Now we have adolescents that need help and they are turning to us as the people to help them, but there’s a paucity of knowledge and information for us as GPs.”

Okonkwo also drew parallels between the marketing of e-cigarettes and cigarette advertising in the 1940s. “We see manufacturers returning to this and attracting young people who are led to believe vaping is ‘cool.’ We as professionals need to start pushing back and say, ‘if you smoke, vape; but if you don’t smoke, please don’t vape.’”

Findings related to the study have been published in BJGP Open .

Baker and Warnapala report no relevant financial relationships. Okonkwo also reported no financial relationships. The project was supported by Imperial College London Business School.