Vaping among children and young people is consistently associated with poorer respiratory health and an increased likelihood of subsequently smoking cigarettes, according to a major new review by the Royal College of Paediatrics and Child Health (RCPCH).
The systematic review, published today (20 August) in the Archives of Disease in Childhood, examined more than 14,000 published articles before assessing 325 full-text studies and synthesising evidence from 81 studies covering eight health and social domains.
The RCPCH said the findings provide “significant evidence” of the short- and medium-term impacts of vaping among those aged 0-19.
The review found consistent evidence linking youth vaping with respiratory symptoms including cough, wheeze, bronchitis symptoms and asthma exacerbations. Long-term studies also provided strong evidence of an association between vaping and subsequent cigarette smoking.
The review also identified evidence of wider health impacts, including associations with oral and dental health and poorer mental health outcomes such as anxiety, depression and suicidal ideation. Emerging evidence points to potential impacts on sleep, eye health and allergies, as well as adverse outcomes associated with infants exposed to nicotine during pregnancy.
However, an expert reaction to the study has stressed that the findings do not establish that vaping itself causes the health harms identified.
Dr Nicola Lindson, associate professor at the Nuffield Department of Primary Care Health Sciences at the University of Oxford, said many of the studies included in the review were surveys, which she said “do not provide the strongest evidence on health harms”.
She also said the review did not establish whether regulated nicotine vapes are associated with the same health harms as non-regulated nicotine vapes.
“It is important to consider this review alongside the wider evidence base which has found that nicotine vaping can help people who smoke to stop smoking and that smoking tobacco is much more harmful than vaping nicotine,” Lindson said.
The distinction between vaping by young people and its use by adult smokers is likely to remain important for the vape sector as the government moves ahead with further regulation under the Tobacco and Vapes Act.
Professor Will Carroll, co-author of the RCPCH review, said vaping should not be viewed as “a harmless part of growing up”, pointing to the evidence around respiratory symptoms, nicotine dependence and subsequent cigarette smoking.
He welcomed recently announced government measures but called for further restrictions, including limits on the types of flavours available rather than simply restricting flavour descriptions.
Current proposals would move away from names inspired by sweets, desserts and alcohol towards more factual descriptions such as “apple”.
“If vaping is to remain a viable smoking cessation tool without attracting new users, [the] government must go further. As paediatricians, we call on the government to limit the types of flavours available, as opposed to just their descriptions,” he said.
RCPCH vice president for policy Dr Mike McKean said the evidence around vaping’s long-term impact on young people remained incomplete, but that a “clear and concerning picture is emerging”.
“The Tobacco and Vapes Act is an important step towards protecting children from nicotine addiction, but it must not be seen as a one-and-done solution,” he said.
“We need to keep pace with a rapidly evolving market and continue to take action to protect children from nicotine products that are deliberately made and marketed to appeal to them.”
The findings also come against a wider evidence base showing that nicotine vaping can assist adults who smoke to quit. The latest Cochrane evidence review, for example, has found evidence supporting the effectiveness of nicotine e-cigarettes for smoking cessation, underlining the different considerations around youth vaping and adult smoking cessation.
A working group of 24 tobacco treatment and addiction experts convened by the Society for Research on Nicotine and Tobacco (SRNT) recently recommended US-based clinicians to discuss nicotine-containing e-cigarettes alongside other evidence-based options when advising adult patients who smoke.