This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Vaping is increasingly common among young people. It is less harmful than smoking, but not without risk, particularly for people who have never smoked. Researchers surveyed 39,214 young people and found that:
- those who vaped were more likely to have breathing issues than those who did not
- the more they vaped, the higher their chance of breathing issues.
More information on quitting smoking and vaping can be found on the NHS website.
The issue: is vaping harmful for young people?
It is unclear whether vaping itself, or specific vape flavours, devices, or vape liquids are linked with breathing issues. This study explored these potential links in young people.
What’s new?
Researchers surveyed 39,214 young people (aged 16 to 19) from the US, Canada, and England about vaping and smoking. Surveys were carried out in 2020 and 2021 as part of the International Tobacco Control Policy Evaluation Project. Young people with asthma were excluded from the analysis. Half the participants were male (52%), most (65%) were white, and almost a quarter (23%) came from a deprived background.
Most had never vaped (64%) nor smoked (70%). Few vaped regularly (10% vaped at least once in the past 30 days) or were former vape users (6%). Several (20%) had experimented with vaping (up to 10 times).
The researchers asked young people if they had breathing issues (breathlessness, wheezing, chest pain, phlegm, cough) in the past week. Overall, more than a quarter (28%) reported experiencing a breathing issue.
Results were adjusted for factors such as age, sex, ethnicity and socio-economic status. The researchers found that those who had vaped (but not smoked) in the past month:
- had more chance of breathing issues than those who neither smoked nor vaped
- had a similar chance of breathing issues to those who had smoked (but not vaped)
- had less chance of breathing issues than those who smoked and vaped.
A second analysis found that, compared to those who had never vaped:
- those who had ever used vapes (former users and those who had experimented) reported more breathing issues
- current users were more likely to report breathing issues.
The more often people vaped, the more likely they were to report breathing issues. Those who had vaped more than 20 days in the past month were about twice as likely as never-users to report breathing problems.
On types of vape, the researchers found that nicotine salts (rather than free-base) may be associated with more breathing issues, though many respondents did not know which they used. Disposable vapes were associated with an increased risk of some symptoms. More young people who usually used multiple flavours reported symptoms (51%) than those who usually used tobacco flavours (34%).
Associations between vaping and breathing issues were generally similar across countries.
How robust are the findings?
The study found links between vaping and breathing issues. Overall, breathing issues were relatively common, even among those who had never smoked or vaped. The study captured breathing issues but not their severity, therefore some of the breathing issues reported may not be concerning. The survey took place during the pandemic when people may have been more aware of breathing issues; those with COVID-19 were excluded from some analyses.
The study could not account for the strength of nicotine in the vapes people used, poor air quality or being exposed to other people’s smoke or vapes. Cannabis use, which may explain some of the breathing problems, was accounted for, but it is likely that some young people did not report their use.
What’s next?
The UK Government is consulting on its Tobacco and Vapes Bill, introduced in November 2024. Its headline intervention is to incrementally increase the age at which people in the UK can buy cigarettes. The Bill also proposes restrictions on vaping, including banning marketing and sponsorship of vapes. It includes powers to regulate flavours and packaging so that they do not appeal to children, and to ban vaping in smoke-free public places and workplaces.
The researchers call for more research on the overall safety of vaping in young people, and on the effects of different types of nicotine and vapes and the various flavours. They say that improved labelling would allow thorough investigation of ingredients.
You may be interested to read
This is a summary of: Brose LS, and others. Associations between vaping and self‑reported respiratory symptoms in young people in Canada, England and the US. BMC Medicine 2024; 22. DOI: 10.1186/s12916-024-03428-6.
Information about vaping from Action on Smoking and Health (ASH).
An article about vaping and young people by the NHS.
Information on taking part in NIHR research on vaping and smoking.
Funding: NIHR Public Health Research Commissioned Call.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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