The new nicotine epidemic: understanding the systemic harms of e-cigarettes in the adolescent population

The growing use of electronic cigarettes (e-cigarettes) among adolescents represents a serious public health concern. Initially marketed as safer alternatives to traditional cigarettes, e-cigarettes are now the most prevalent nicotine products among youth. This narrative review summarizes evidence published up to May 2025 on the epidemiology, health effects, and prevention of e-cigarette use in children and adolescents. Recent surveys indicate a decline in traditional smoking among adolescents but a sharp increase in e-cigarette use, with up to one-third of youth reporting having tried vaping at least once. The widespread appeal of e-cigarettes is driven by flavour variety, social influence, and perceptions of reduced harm. However, evidence shows that vaping aerosols contain toxic substances capable of inducing oxidative stress, inflammation, and cellular injury. Adolescents are especially vulnerable: vaping has been associated with respiratory diseases such as asthma and bronchitis, endothelial dysfunction, immune suppression, and neurodevelopmental alterations linked to nicotine exposure. Moreover, e-cigarette use increases the likelihood of transitioning to conventional smoking and other risky behaviours, while ‘dual use’ of cigarettes and e-cigarettes further amplifies health risks. Effective prevention requires a comprehensive approach combining school-based education, parental and healthcare engagement, behavioural support, and public policies that restrict marketing and flavour availability. In conclusion, e-cigarette use poses significant health threats to adolescents, undermining decades of tobacco control progress. Coordinated public health interventions, regulatory enforcement, and continued research are essential to prevent nicotine dependence and protect the wellbeing of future generations.