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A new review by a team of public health researchers has found “very low-certainty evidence” to support the widely held belief that nicotine vaping acts as a gateway to cigarette smoking for young people. The study, published in the journal Addiction, challenges a long-standing concern in the public health community regarding youth vaping.
Unclear Causal Link Between Vaping and Smoking
“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,” said Jamie Hartmann-Boyce, assistant professor of health policy and management at the University of Massachusetts Amherst and senior author of the study. However, Hartmann-Boyce notes that some findings suggest the opposite—that vaping may actually contribute to declines in youth smoking, particularly in the U.S.
The study reviewed 123 research papers involving approximately four million participants under the age of 29 in the U.S., Canada, and Western Europe. The researchers emphasize that their main conclusion is that no definitive link between vaping and smoking has been established.
“We need more studies to establish any causal links,” said Monserrat Conde, one of the lead authors from the University of Oxford in the United Kingdom.
Interpreting the Data
According to Hartmann-Boyce, the research is complicated by the ethical constraints of studying youth behavior, making it impossible to conduct randomized controlled trials on vaping and smoking initiation.
Some data from 21 larger studies suggested that as vaping rates among young people increased, smoking rates declined. In contrast, when vaping was restricted, smoking rates rose. However, not all studies supported this trend, with some indicating the opposite effect.
At an individual level, the study found that young people who vape are more likely to later smoke compared to those who do not vape. However, the researchers stress that this does not necessarily mean vaping causes smoking—many of these young people might have become smokers regardless of vaping.
“There’s enough non-smoking kids who start vaping in the U.S. that if vaping was consistently and widely causing kids to start smoking, we would see that reflected in population-level smoking data,” Hartmann-Boyce said. “And we haven’t seen that at all.”
Youth Smoking Declines Despite Rise in Vaping
Data from the U.S. Centers for Disease Control and Prevention (CDC) support the declining trend of youth smoking. The percentage of high school students who reported smoking cigarettes in the past 30 days has dropped from 15.8% in 2011 to 4.6% in 2020, and further down to 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,” said Hartmann-Boyce. “But it’s difficult to argue that youth vaping is, on a large scale, causing kids to smoke. The data doesn’t support that so far.”
Implications for Public Health Policy
The study’s findings have important public health policy implications. Previous research has shown that nicotine e-cigarettes can help adults quit smoking. If vaping were proven to cause young people to start smoking, it would be a strong argument for stricter regulation of e-cigarettes. However, given the mixed evidence, the researchers emphasize the need for further studies to draw firmer conclusions.
More Information: Rachna Begh et al., Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review, Addiction (2025). DOI: 10.1111/add.16773
Disclaimer: This article presents research findings that are subject to further validation and debate within the scientific community. The study does not establish a definitive causal link between vaping and smoking among youth. Readers should consult health professionals and official public health guidance for more information on vaping and smoking risks.
