Summary
A systematic review discussed by two paediatric respiratory physicians links vaping among children and young people with respiratory symptoms, mental-health concerns and later cigarette smoking. The authors call for governments to legislate and enforce protections.
A systematic review of research on vaping in children and young people found links with respiratory symptoms, mental-health concerns and later cigarette smoking, according to a Nature Comment published on 28 September 2026. The Comment’s authors, paediatric respiratory physicians William D. Carroll and Francis J. Gilchrist, co-authored the review and argue that governments should legislate to protect young people and enforce those laws.
The review considered vaping as an exposure and examined a range of health outcomes. Its findings extend beyond the immediate lung symptoms that early research often focused on. The results described in the Comment are associations reported across studies; they should not be read as showing that vaping alone caused every outcome.
Health effects reported in young people
The authors say studies in the review consistently associated vaping with cough, chest discomfort, wheezing and a wet cough. Other reported links included oral and dental problems, such as gum inflammation, ulcers and dry mouth; eye symptoms; and allergic conditions including atopic dermatitis and allergic rhinitis.
Mental-health findings also stood out to the authors. Depression, panic disorder, anhedonia — reduced ability to experience pleasure — and suicidal thoughts were more commonly reported among young people who vaped. The Comment reports that young e-cigarette users were almost twice as likely as non-users to have suicidal thoughts or plans, or to have attempted suicide.
The review also highlighted higher rates of preterm birth, small-for-gestational-age birth weight, abnormal reflexes and motor immaturity among infants born to mothers who vaped. These are reported associations in the review, not evidence that establishes the cause of an individual pregnancy or infant outcome.
For young people who had never smoked, the authors describe subsequent cigarette smoking as the review’s most alarming finding. They report that e-cigarette users were typically 2–12 times more likely than non-users to go on to smoke conventional cigarettes. The range reflects findings across the studies discussed, rather than one estimate that applies uniformly to every young person.
Nicotine delivery and the policy concern
Vapes are designed to deliver nicotine efficiently. Nicotine is addictive, and research on smoking has linked exposure during adolescence with effects on brain development. The Comment notes that even occasional, low-level nicotine use can lead to dependence symptoms, including cravings and withdrawal.
Nicotine salts have also made vaping products smoother and sweeter to inhale. Studies cited in the Comment found that some salt-based products can produce higher and faster peaks in blood nicotine than other forms. The authors say sweet flavours and colourful packaging have helped make these products appealing to younger users.
The authors distinguish this concern from vaping as an aid for adults trying to stop smoking: they acknowledge its use in smoking-cessation programmes while warning against presenting vaping as a safe choice for non-smoking children. Their policy argument is that preventing youth uptake requires both suitable laws and effective enforcement.