Vaping: an emerging multi-systemic public health crisis

Abstract

Walking down a high street anywhere across Scotland, it would be difficult not to notice the bright and attractive vape shops that have quickly sprouted up into business. Developing as an all-round alternative to traditional cigarette smoking, e-cigarettes (or vapes) has been popularised globally since the 2010s, as a cost-effective and innovative substitute. Results from the Office for National Statistics has now estimated that people who use e-cigarettes have outnumbered smokers in the UK; a result driven by using vaping as a smoking cessation tool, alongside lucrative flavours and advertising strategies.⁽¹⁾

While this might not seem concerning, data from the World Health Organization estimates these results to be replicated globally, with around 100 million people worldwide using e-cigarettes.⁽²⁾ Unsurprisingly, poor initial efforts to tackle the addictive element of vapes, accompanied by its increased reliance as a smoking alternative has expanded the role of vaping beyond its harm reduction benefits. Historically, there was always a consensus among the scientific community that e-cigarettes posed a lower risk than traditional smoking, however, this perspective has now been challenged.^(3-5)

Vaping has been researched to pose a multi-systemic risk to human health affecting the respiratory, cardiovascular and nervous system. Several studies have demonstrated that the use of e-cigarettes is linked to an increases in airway irritation, epithelial injury, and arterial stiffness.⁽⁵⁾ Interestingly, a recurring finding across research in this field is that the mechanisms through which e-cigarettes impact human health differs significantly from those associated with traditional cigarette smoking.

Evaluating the risk of e-cigarette use in conditions which require a longer latency period, such as cancer, has shown substantial evidence vaping could be linked to an elevation in biomarkers involved in cancer development.⁽⁶⁾ Other studies have also demonstrated that the rapid nicotine consumption from e-cigarettes can hamper efforts to quit vaping, inducing a difficult cycle of dependency that has multi-systemic effects from increased anxiety to suicidal tendencies.^{(7, 8)}

When comparing the risks and adverse events linked with smoking, it might still be accepted that vaping as a smoking cessation tool would render less harm to the user. However, the long-term effects of vaping and the addiction associated with nicotine consumption have not been holistically considered when advancing this argument.

Nevertheless, we need to be proactive – awaiting results from long-term studies on e-cigarette use would hamper any public health benefits that early interventions could offer. If the government wants to reduce the long-term impacts that e-cigarettes can have on public health, immediate action is needed to enforce the recently passed Tobacco and Vapes Bill (2026). Moreover, stricter controls need to be balanced with further regulations that could reduce and limit the use of e-cigarettes across the country.

As a future doctor, my concerns are particularly with the younger e-cigarette users, especially those who live in areas with increased socioeconomic deprivation, have easier access to e-cigarettes and are more likely to suffer the multifactorial impacts of chronic use. Recent evidence from systematic and umbrella reviews indicates that e-cigarette use among young people is associated with a range of adverse outcomes, including later cigarette smoking, alcohol consumption, respiratory issues such as asthma and cough, and poorer mental health.⁽⁹⁾

My fears are not limited to Scotland and the United Kingdom; as similar to smoking, I am worried about the impact e-cigarettes can have on people in other countries, particularly those with lax public health polices or fewer government regulations. Educating our future generations and a global call to action are the way forward in our fight against the rise in e-cigarettes.

Globally, universities need to urgently address gaps in knowledge among medical students on the harmful effects of e-cigarettes, the risk of long-term nicotine addiction and the wider health consequences it poses. Education on the rise of e-cigarette or vaping associated-lung injury (EVALI) needs to be further advanced, alongside counselling strategies for patients who are chronic vapers. Providing the next generation of doctors with this training is essential, as new research on the health impacts of vaping continues to emerge.⁽¹⁰⁾

References

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