The brain undergoes substantial growth and development during adolescence. For example, the prefrontal cortex—responsible for executive functions, decision-making, attention, working memory, and self-regulation—continues to develop throughout adolescence and young adulthood. 1 Neuroplasticity (also known as brain plasticity) is the ability of the brain to undergo structural and neurochemical changes in response to learning and experience. 2 Due to adolescence being a critical phase of brain development, adolescents are particularly vulnerable to environmental triggers (such as tobacco/nicotine use) that can cause major and lasting plasticity, especially in the prefrontal cortex. 3
Vaping can expose young people to very high levels of nicotine. 4 Evidence suggests that nicotine exposure during adolescence, a time during which the brain undergoes rapid development, may have a long-term negative impact on higher cognitive function 5-7 and emotional regulation. 3 Although much of the research on nicotine comes from animal studies (as experimental studies cannot be conducted in humans for ethical reasons), observational studies in humans show behavioural effects similar to those found in animal studies. 8 Human studies have demonstrated that nicotine/tobacco exposure during adolescence increases the risk of developing psychiatric disorders, cognitive impairment and attention deficits. 9-11
There is evidence that adolescents who are exposed to nicotine may become addicted more rapidly, and at lower or more intermittent levels of consumption than adults. 12-14 Compared with adults, adolescents are more sensitive to the rewarding effects of nicotine, and may also be especially sensitive to withdrawal. 8 Recent research in the US shows concerning increases in the frequency of e-cigarette use and symptoms of nicotine dependence among adolescents and young adults. 15-17 Australian data similarly shows substantial increases in daily use of e-cigarettes among young people. 18 Younger adolescents who vape appear to be more likely to progress to daily vaping, compared with older adolescents and young adults. 15 , 16 Studies in Canada, England, and the US suggest that levels of dependence among adolescent e-cigarette users now appear to be comparable to those of daily smokers. 16 , 19 , 20
Studies have also found an association between vaping and mental illness among adolescents, 21-27 including increased depressive symptoms, perceived stress, anxiety disorder symptoms and suicide‑related behaviours. 28 As these studies are largely cross-sectional, it is yet to be determined whether vaping is more common among young people with mental illness, whether vaping causes mental illness, or both. 25 If causal, this relationship may be attributable to nicotine as well as exposure to trace metals in e-cigarettes. 21 Additional risks of nicotine e-cigarettes and e-liquids include respiratory distress/lung injury, oral or dermal poisonings, and acute nicotine toxicity, including seizures. 29-31 The US Surgeon General’s 2014 report on the health consequences of smoking noted that “the evidence is already sufficient to provide appropriately cautious messages to […] adolescents about the use of nicotine-containing products such as smokeless tobacco and electronic cigarettes, and newer forms of nicotine-containing tobacco products, as alternatives to smoking”. 5 The 2016 report similarly concluded that “nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain”. 32
Aside from nicotine, research has examined the potential health risks of other constituents of e-liquids and e-cigarette aerosol. Adolescents who vape are exposed to greater levels of particular toxicants and carcinogens compared with non-users. 33 The use of sweet/fruit flavoured vapes is particularly common among young people, and flavouring chemicals that are generally safe in food may not be safe when inhaled—see Section 18.5. Cross-sectional studies have shown a relationship between vaping and poorer respiratory health among adolescents, 25 , 34-44 and a prospective study found associations between e-cigarette use and wheeze, bronchitic symptoms and shortness of breath among adolescents and young adults. 45 A longitudinal study in the US also found that young people who vape had a higher risk of diagnosed bronchitis, pneumonia, or chronic cough. 46 However, others have not found evidence of a relationship between exclusive vaping and asthma 47 , 48 or respiratory symptoms 49 , < a href="#_ENREF_50"> 50 or disease. 51 Further longitudinal studies are needed to examine whether vaping can cause respiratory symptoms and illness. Lung development continues into early adulthood, and experts have raised concerns about the potential long-term impacts on lung development and function of vaping during adolescence. 52 There are also reports of traumatic injuries among youth from malfunctioning/exploding devices. 53 The health effects of e-cigarette use among users more broadly are discussed in the remainder of Section 18.6.
Beyond the health effects of e-cigarette use, there are also broader potential consequences of e-cigarette use among young people that should be considered. 54 Studies have found an association between vaping and insufficient sleep 55 as well as poorer academic achievement, particularly poor school grades. 56 Uptake of a highly addictive substance at an age typified by a poor understanding of health risks and addiction 57 undermines adolescents’ freedom and autonomy 58 and may have lifelong consequences for social and economic disadvantage similar to tobacco and other substance use. E-cigarette use among never smokers increases harm compared to no nicotine use at all. 58
There is also robust evidence of an association between e-cigarette use and smoking uptake. Never smokers who use e-cigarettes appear to have about three times the odds of smoking uptake compared with non-e-cigarette users 59 —see Section 18.7 for a detailed discussion. The causal nature and public health implications of this relationship continue to be debated, but regardless, the potential health and addiction risks of vaping warrant strong regulatory efforts that prevent the uptake of all tobacco and nicotine products among youth. In Australia, regulatory loopholes have allowed widespread illegal sales of e-cigarettes to young people, 60 including products and e-liquids that fail to disclose the amount or presence of nicotine. 61 Australia’s vaping reforms, 62 set to be introduced over the course of 2024, aim to close these loopholes, while still allowing access to vapes for those who decide to use them for smoking cessation or management of nicotine addiction—see Section 18.13.
Relevant news and research
For recent news items and research on this topic, click here. ( Last updated December 2024)
References
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