Vaping may not lead to future cigarette smoking, study finds

Tobacco use remains one of the leading causes of preventable deaths worldwide, responsible for over 8 million deaths annually. As alternatives to combustible tobacco, electronic cigarettes (ECs) have gained significant attention.

These handheld devices heat a liquid to create an aerosol for inhalation, offering an alternative to traditional smoking. However, regulatory approaches to ECs vary widely, ranging from complete bans to partial restrictions, with most policies limiting sales to adults.

Despite the widespread adoption of ECs, debates persist about their influence on youth smoking behaviors. Some theories suggest vaping serves as a "gateway" to cigarette use, while others propose that it acts as a "diversion" that reduces smoking rates among young people.

A third possibility suggests that vaping and smoking share common risk factors without a direct causal relationship. However, there is still limited empirical evidence to support any of these hypotheses conclusively.

A team of public health researchers recently conducted a large-scale review of 123 studies, analyzing data from approximately 4 million participants under the age of 29 across the U.S., Canada, and Western Europe.

Their findings, published in the journal Addiction, provide valuable insights—but no definitive answers—regarding the relationship between vaping and cigarette smoking among youth.

“One of the substantial concerns from some members of the public health community about vaping is that it might cause more young people to smoke,” explains Jamie Hartmann-Boyce, assistant professor of health policy and management at the University of Massachusetts Amherst and senior author of the review. “Some—but not all—evidence from our study possibly suggests the opposite—that vaping may contribute to declines in youth smoking, particularly in the U.S.”

The researchers emphasize that the data can be interpreted in multiple ways. Some studies suggest an association between increased vaping rates and declining cigarette smoking rates, while others show conflicting results. “We need more studies to establish any causal links,” says Monserrat Conde, lead author from the University of Oxford.

Determining whether vaping causes youth to smoke presents a significant challenge due to the nature of study designs. Unlike controlled experiments, where participants can be randomly assigned to behaviors, researchers cannot ethically assign adolescents to start vaping or smoking.

“The studies themselves are not straightforward study designs, because you can’t randomize kids to vape or not vape—it just wouldn’t be ethical,” Hartmann-Boyce explains. “But it means that there are so many different ways to interpret the findings of these studies.”

Among the larger studies reviewed, data indicated that when vaping rates increased among youth, smoking rates tended to decrease. Conversely, when vaping access was restricted, smoking rates appeared to rise. However, not all studies supported this trend, and some even reported the opposite effect.

At the individual level, young people who vape are more likely to smoke cigarettes later compared to those who never vaped. However, it remains unclear whether vaping causes this transition or if these individuals would have become smokers regardless. Hartmann-Boyce suggests that some youth who vape may have otherwise turned to smoking if vaping were not an option.

“There’s enough non-smoking kids who start vaping in the U.S. that if vaping was in a consistent and widespread way causing kids to start smoking, we would start seeing that in our population-level smoking data,” she says. “And we haven’t seen that at all.”

Despite ongoing concerns about youth vaping, cigarette smoking among young people has been steadily declining for years. Data from the U.S. Centers for Disease Control and Prevention (CDC) shows a sharp drop in high school students who reported smoking in the past 30 days—from 15.8% in 2011 to 4.6% in 2020 and just 1.7% in 2024.

“The smoking rates among kids have declined steeply, and whether or not that’s due to vaping or something else is up in the air,” Hartmann-Boyce says. “But it’s difficult to argue that—in the U.S. population—youth vaping is en masse causing kids to smoke. The data doesn’t support that so far.”

The implications of these findings extend beyond academic debate. If vaping were proven to encourage smoking among young people, it would be a strong argument for tighter e-cigarette regulations. However, previous research from Hartmann-Boyce’s team indicates that nicotine e-cigarettes can help adults quit smoking.

Striking a balance between reducing youth vaping while preserving access for adult smokers remains a critical challenge for public health policymakers.

While the long-term effects of vaping remain unclear, current evidence does not conclusively support the idea that youth vaping drives cigarette smoking.

More research is needed to determine whether vaping is truly a gateway to smoking or a safer alternative that helps keep young people away from cigarettes.

Note: Materials provided above by The Brighter Side of News. Content may be edited for style and length.

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