Vaping and harm in young people: umbrella review.

Objective: To appraise and synthesise the evidence on short and longer term harms of vaping in young people.

Data sources: KSR Evidence (systematic reviews); Medline, Embase, and PsycInfo (umbrella reviews); and reference screening.

Study selection: Systematic and umbrella reviews evaluating any potential harms from e-cigarettes in young people.

Data synthesis: Searches identified 56 reviews for inclusion from 384 unique articles. A consistent significant association between vaping and smoking initiation was found, supporting a causal relationship, with pooled ORs of 1.50-26.01 (21 systematic reviews), most of which suggested that young people using e-cigarettes are about three times more likely than those not using them to initiate smoking. Five systematic reviews demonstrated a substantial association between e-cigarettes and substance use, with pooled ORs of 2.72-6.04 for marijuana, 4.50-6.67 for alcohol and 4.51-6.73 for binge drinking. Asthma was the most common respiratory outcome, with consistent associations (ORs: 1.20-1.36 for diagnosis and 1.44 for exacerbation). Three systematic reviews found associations between vaping and suicidal outcomes, and six included investigation of injuries, predominantly documenting explosion incidents. Significant associations between vaping and other harmful outcomes included pneumonia, bronchitis, lower total sperm counts, dizziness, headaches, migraines and oral health harms, but this evidence was largely derived from limited surveys or case series/reports.

Conclusions: This study found that there were consistent associations between vaping and subsequent smoking, marijuana use, alcohol use, asthma, cough, injuries and mental health outcomes. The findings support the implementation of policy measures to restrict sales and marketing of e-cigarettes to young people.

Trial registration number: PROSPERO CRD42024569728.