A Global Picture of Vaping: Youth, Regulation, and the Cancer Debate

Key findings indicate both potential benefits for smoking cessation in specific populations and documented health risks, alongside criticism of the methodologies used in some studies linking vaping to cancer.

Vaping Trends and Demographics

Australia: Youth Uptake and Quit Programs

The number of Australians aged 16 to 24 who have tried a vape has nearly tripled since 2018, according to the 2024 ACT General Health Survey. Among those aged 16 to 44, the most common reasons for starting are curiosity and perceived better taste. For smokers aged 45 to 64 in Canberra, 65.7% reported vaping to help quit tobacco.

In response, a youth vaping support program called Nicotine Knockout opened in Canberra in March 2024. Operated through Anglicare's The Junction Youth Health Service, it provides support from nurses and youth workers for individuals under 25.

Nurse practitioner Diane Bowden stated that some young people have expressed motivation to quit, though some have tried and resumed use previously.

Reasons for starting vaping cited by Bowden include peer pressure, addiction, and use for stress management, anxiety, or depression.

One 28-year-old Canberra resident reported using vaping products for nearly a decade, experiencing a persistent cough and chest pain, which prompted him to stop. He stated that vaping was more accessible than cigarettes and described switching to a prescription vape, which caused less lung pain than unregulated vapes.

United Kingdom: Vaping Population Exceeds Smokers

Data released by the UK's Office for National Statistics indicates that the number of adults aged 16 and over in Great Britain who use vapes has surpassed those who smoke cigarettes for the first time. Currently, 5.4 million adults report daily or occasional vaping, while 4.9 million adults smoke.

Some individuals who vape have expressed a desire to cease or reduce their usage, citing difficulties in doing so. Concerns have also been noted regarding some individuals considering a return to cigarette smoking.

Regulatory Frameworks and Enforcement

Australia

Since July 2024, vapes in Australia can only be legally sold in pharmacies to help people quit smoking or manage nicotine dependence. Despite these regulations:

• The Australian Border Force has seized 19.4 million vaping products since January 2024, with an estimated street value of $974 million.
• The Therapeutic Goods Administration (TGA) removed 2.2 million unlawful vaping products from the community, valued at $110.5 million.
• Total seizures amount to over 20 million products worth more than $1 billion.
• A report found that approximately 95.7% of vapes purchased in Australia were illegal, representing an illicit market value of about $1.6 billion.
• The TGA issued 8,706 online ad removal requests in 2024-25, a 300-fold increase from the previous financial year.
• Reports indicate that some pharmacies have limited stock of vapes, and there are approximately 3,000 authorized prescribers out of 39,000 Australian doctors.
• An individual reported that illegal vapes remain accessible despite government crackdowns.

A Senate inquiry is currently examining illegal vapes and cigarettes in Australia. Concerns remain about loopholes in advertising bans, including international tobacco companies maintaining social media accounts.

United Kingdom

The UK's regulatory approach differs from Australia's. Some researchers, including Professor Wayne Hall of the University of Queensland, have suggested a regulated market similar to New Zealand and the UK as an alternative to the prescription-only model, which he stated is not working.

Scientific Evidence and Health Impacts

Potential Benefits: Smoking Cessation

A clinical trial conducted in Australia examined vaping as a smoking cessation aid for individuals experiencing socio-economic hardship. The trial evaluated newer nicotine "pod" devices using nicotine e-liquid salts.

Key findings include:

• Participants in the vaping group were three times more likely to achieve continuous six-month abstinence (28.4%) compared to the nicotine replacement therapy (NRT) group (9.6%).
• Comparable quit rates were observed across sub-group analyses for sex, age, and mental illness.
• Adverse events reported by treatment users were less frequent in the vaping group.
• At the 7-month follow-up, 56% of the vaping group continued allocated product use, compared to 31% in the NRT group.

However, researchers noted that vaping for quitting smoking may lead to longer-term use compared to NRT, and an eventual goal for vapers should be to stop vaping to mitigate unknown long-term risks.

Potential Health Risks: Cancer and Other Effects

Cancer Research

A review published in the journal Carcinogenesis by researchers from the University of New South Wales (UNSW) and other Australian institutions concluded that nicotine-based e-cigarettes are "likely to be carcinogenic to humans." The review, led by Adjunct Professor Bernard Stewart, analyzed evidence from animal studies, human case reports, and laboratory research published between 2017 and 2025.

Key findings from this review include:

• Evidence of DNA damage, oxidative stress, and inflammation linked to e-cigarette use.
• Case reports of oral cancer in individuals who exclusively vaped and had no smoking history.
• A mouse study showing exposure to e-cigarette vapor was associated with higher rates of lung tumors.
• The presence of carcinogens in vape liquids, including volatile organic compounds (formaldehyde, acrolein), metals (nickel, chromium), and cytotoxic flavoring chemicals.

The researchers acknowledged that there is no current epidemiological link between vaping and cancer, but argued this is not unexpected given vapes have been available for about 20 years, whereas proving smoking caused cancer took a century.

Other Health Effects

Dr. Kerrie Aust, outgoing ACT Australian Medical Association President, reported short-term effects like anxiety and cravings, and longer-term reports of persistent cough and reduced exercise tolerance among users. She stated that, in her experience, traditional nicotine replacement therapies have been more effective for quitting than vaping. A single device can contain nicotine equivalent to 50 cigarettes, she stated.

Nicotine-Free Vapes

Experts warned that nicotine-free vapes are not necessarily safe. Research has identified harmful substances in common vape liquids, including the same carcinogens and other detrimental chemicals found in nicotine-containing products.

Scientific Controversy and Methodological Criticisms

Several studies purporting to link vaping to cancer have faced significant criticism for methodological flaws, resulting in the retraction of one study.

Retracted Study

A study titled "Evidence on vaping e-cigarettes as a risk factor for cancer: A systematic review," published in the Journal of Cancer Policy in 2025, was retracted on March 19.

The journal's retraction notice cited "substantial concerns regarding the methodological integrity, accuracy, and scientific validity," including:

• Undisclosed deviations from the registered protocol.
• Methodological inconsistencies and misclassification of study designs.
• Inclusion of a previously retracted study.
• Internal contradictions and numerical discrepancies.
• Conclusions not supported by the presented evidence.

Dr. Arielle Selya, a behavioral scientist, noted that the original protocol specified reviewing only human studies with clinical health outcomes, but the published study broadened its criteria to include biomarker studies, animal studies, and non-peer-reviewed conference abstracts, potentially introducing bias.

Frontiers in Oncology Study

A case-control study published in Frontiers in Oncology in January concluded that "the odds ratio for those who both vaped and smoked was 2.8 times higher than for smoking alone."

Dr. Michael Siegel, a professor of public health at Tufts University, criticized the study for a "reverse causation" flaw, suggesting that smokers who develop lung cancer symptoms might be more likely to try e-cigarettes, making dual use a reflection of symptoms rather than a cause of cancer. This study also referenced a previously retracted paper.

Carcinogenesis Review Criticisms

The Carcinogenesis review by Stewart et al. also drew criticism from other scientists:

• Dr. Peter Hajek, professor of clinical psychology at Queen Mary University of London, stated the review did not compare vapers and smokers, allowing any detected level of a suspect chemical to be presented as "carcinogenic" without considering dosage.
• Dr. Lion Shahab, professor of health psychology at University College London, described "extraordinary claims that are not borne out by the data" and a "tendency to overclaim certainty."
• Professor Stephen Duffy noted that equating vaping to smoking in terms of harm would be an "overinterpretation," as vaping lacks the combustion products responsible for significant carcinogenic effects in smoking.

Expert Consensus Points

Despite disagreements on specific studies, experts generally agreed on several points:

• E-cigarettes are not entirely risk-free and involve exposure to various chemicals.
• Vaping is considerably less harmful than traditional combustion smoking.
• E-cigarettes can serve as an effective cessation tool for individuals seeking to quit smoking.
• Vaping is not recommended for individuals who have never used tobacco products.

Perspectives on Policy and Future Directions

Access and Enforcement

• Professor Becky Freeman praised Australia's vape sales laws but noted a lack of enforcement. She argued that full enforcement would make Australia's laws among the best globally.
• Professor Richard Edwards of Flinders University commented that inhaling anything other than fresh air is likely to be harmful, and advised non-smokers not to start vaping.
• The Australian government plans to spend $350 million through the National Disruption Group to enforce measures against illicit vape and cigarette markets.

Regulatory Approaches

• Dr. Kerrie Aust called for more investment in research, education about the harms of vaping, and support services for nicotine replacement therapy.
• Some researchers advocate for stricter interventions against the illicit vape market.
• Others suggest a regulated market model similar to the UK as an alternative to the prescription-only approach.

Prevention Messaging

"Regulators should protect individuals, particularly children, from harm, and vapes are not a safer alternative to smoking." — Dr. Freddy Sitas, lead author of the UNSW review

Public health experts in the UK expressed concern that perceived risks of vaping may be overstated, potentially influencing smoking initiation. Data indicated that 63% of young people believe vaping to be as harmful as, or more harmful than, smoking, which contrasts with evidence indicating cigarettes pose significantly greater health risks.

Conflict of Interest Disclosures

In reporting on scientific controversies, it was noted that Dr. Arielle Selya is employed by Pinney Associates, Inc., which consults for Juul Labs and Philip Morris International on non-combustible nicotine products. The Influence Foundation, which operates the publication Filter, has received unrestricted grants from Juul Labs, Inc, Philip Morris International, and Global Action to End Smoking.