Vaping and Public Health: Scientific Evidence, Therapeutic Controversies, and Regulatory Challenges in Adolescents
Main Article Content
Abstract
Several types of electronic cigarettes or vapes are currently available on the market. The World Health Organization (WHO) classifies them into two categories: electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) (WHO, 2016). Both have health implications, as they operate in a comparable way (WHO, 2020). Moreover, health alerts have been issued because some products labeled as ENNDS contain nicotine despite their packaging indicating otherwise (Guraka et al., 2024; Miller et al., 2021; Omaiye et al., 2017). These devices operate using a battery and a metal heating element that vaporizes a mixture of substances known as electronic liquids (e-liquids), producing aerosols that are inhaled and exhaled by the user, a practice known as vaping (Baldassarri, 2020).
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Abdulhay, N., Wiener, R. C., Wen, S., Gibbs, B. B., & Bhandari, R. (2025). Mental health outcomes associated with electronic cigarette use, combustible tobacco use, and dual use among U.S. adolescents: Insights from the National Youth Tobacco Survey. PLOS Mental Health, 2(7), e0000370. https://doi.org/10.1371/journal.pmen.0000370
Allbright, K., Villandre, J., Alexander, L. E. C., Zhang, M., Benam, K. H., Evankovich, J., Königshoff, M., & Chandra, D. (2024). The paradox of the safer cigarette: understanding the pulmonary effects of electronic cigarettes. European Respiratory Journal, 63(6), 2301494. https://doi.org/10.1183/13993003.01494-2023
Baldassarri, S. R. (2020). Electronic Cigarettes: Past, Present, and Future: What Clinicians Need to Know. Clinics in Chest Medicine, 41(4), 797–807. https://doi.org/10.1016/j.ccm.2020.08.018
Barrera-Núñez, D. A., Zavala-Arciniega, L., Austria-Corrales, F., Romero, M., Barrientos-Gutiérrez, I., Tenorio-Bello, A., & Reynales-Shigematsu, L. M. (2025). Tendencias de uso exclusivo y dual de tabaco combustible y cigarro electrónico en población mexicana. Salud Pública de México, 67(3), 276-281. https://doi.org/10.21149/16293
Centros de Integración Juvenil (CIJ). (2025a). Reporte de Información Epidemiológica del Consumo de Drogas. Consumo de drogas en solicitantes de tratamiento en Centros de Integración Juvenil. Usuarios de drogas Ilícitas. Primer semestre del 2025. CIJ. http://www.cij.gob.mx/programas/Investigacion/Epidemiologica.asp
Centros de Integración Juvenil. (CIJ) (2025b). Sondeo de factores de riesgo del uso de drogas con estudiantes de escuelas de nivel medio y medio superior en México. [Comunicación oficial]
Czaplicki, L., Kostygina, G., Kim, Y., Perks, S. N., Szczypka, G., Emery, S. L., Vallone, D., & Hair, E. C. (2020). Characterising JUUL-related posts on Instagram. Tobacco Control, 29(6), 612-617. https://doi.org/10.1136/tobaccocontrol-2018-054824
Diaz, M. C., Silver, N. A., Bertrand, A., & Schillo, B. A. (2025). Bigger, stronger, and cheaper: growth in e-cigarette market driven by disposable devices with more e-liquid, higher nicotine concentration and declining prices. Tobacco Control, 34(1), 65-70. https://doi.org/10.1136/tc-2023-058033
Feeney, S., Rossetti, V., & Terrien, J. (2022). E-Cigarettes—a review of the evidence—harm versus harm reduction. Tobacco Use Insights, 15. https://doi.org/10.1177/1179173X221087524
Gaiha, S. M., Lempert, L. K., Lung, H., Vescia, F., & Halpern-Felsher, B. (2024). Appealing characteristics of E-cigarette marketing in the retail environment among adolescents. Preventive Medicine Reports, 43, 102769. https://doi.org/10.1016/j.pmedr.2024.102769
Glantz, S. A., Nguyen, N., & Oliveira, A. L. (2024). Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes. NEJM Evidence, 3(3). https://doi.org/10.1056/EVIDoa2300229
Golder, S., Hartwell, G., Barnett, L. M., Nash, S. G., Petticrew, M., & Glover, R. E. (2025). Vaping and harm in young people: umbrella review. Tobacco Control. https://doi.org/10.1136/tc-2024-059219
Guraka, A., Mierlea, S., Drake, S. J., Shawa, I. T., Waldron, J., Corcoran, M., Dowse, D., Walkman, D., Burn, L., Sivasubramaniam, S., & Kermanizadeh, A. (2024). A comprehensive toxicological analysis of panel of unregulated e-cigarettes to human health. Toxicology, 509, 153964. https://doi.org/10.1016/j.tox.2024.153964
Hariri, L. P., Flashner, B. M., Kanarek, D. J., O’Donnell, W. J., Soskis, A., Ziehr, D. R., Frank, A., Nandy, S., Berigei, S. R., Sharma, A., Mathisen, D., Keyes, C. M., Lanuti, M., Muniappan, A., Shepard, J. O., Mino-Kenudson, M., Ly, A., Hung, Y. P., Castelino, F. V., (…) & Christiani, D. C. (2022). E-cigarette use, small airway fibrosis, and constrictive bronchiolitis. The New England Journal of Medicine Evidence, 1(6). https://doi.org/10.1056/EVIDoa2100051
Harris, T. (2024). Physical and Chemical Characterization of Aerosols Produced from Experimentally Designed Nicotine Salt-Based E-Liquids. Chemical Research in Toxicology, 37(8), 1315-1328. https://doi.org/10.1021/acs.chemrestox.4c00073
Hatsukami, D. K., & Carroll, D. M. (2020). Tobacco harm reduction: Past history, current controversies, and a proposed approach for the future. Preventive Medicine, 140, 106099. https://doi.org/10.1016/j.ypmed.2020.106099
Izquierdo-Condoy, J. S., Ruiz, K., Salazar-Santoliva, C., Restrepo, N., Olaya-Villareal, G., Castillo-Concha, J. S., Loaiza-Guevara, V., & Ortiz-Prado, E. (2024). E-cigarette use among adolescents in Latin America: A systematic review of prevalence and associated factors. Preventive Medicine Reports, 49, 102952. https://doi.org/10.1016/j.pmedr.2024.102952
Jackler, R. K., Chau, C., Getachew, B. D., Whitcomb, M. M., Lee-Heidenreich, J., Bhatt, A. M., Kim-O’Sullivan, S. H. S., Hoffman, Z. A., Jackler, L. M., & Ramamurthi, D. (2019). JUUL Advertising Over its First Three Years on the Market. Stanford University School of Medicine. https://tobacco-img.stanford.edu/wp-content/uploads/2021/07/21231836/JUUL_Marketing_Stanford.pdf
Javed, S., Usmani, S., Sarfraz, Z., Sarfraz, A., Hanif, A., Firoz, A., Baig, R., Sharath M., Walia, N., Chérrez-Ojeda, I., & Ahmed, S. (2022). A Scoping Review of Vaping, E-Cigarettes, and Mental Health Impact: Depression and Suicidality. Journal of Community Hospital Internal Medicine Perspectives, 12(3), 33-39. https://doi.org/10.55729/2000-9666.1053
Levett, J. Y., Filion, K. B., Reynier, P., Prell, C., & Eisenberg, M. J. (2023). Efficacy and Safety of E-Cigarette Use for Smoking Cessation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The American Journal of Medicine, 136(8), 804-813. https://doi.org/10.1016/j.amjmed.2023.04.014
Meehan, J., Heffron, M., Mc Avoy, H., Reynolds, C., Kyne, L., & Cox, D. W. (2024). The adverse effects of vaping in young people. Global Pediatrics, 9, 100190. https://doi.org/10.1016/j.gpeds.2024.100190
Miller, D. R., Buettner-Schmidt, K., Orr, M., Rykal, K., & Niewojna, E. (2021). A systematic review of refillable e-liquid nicotine content accuracy. Journal of the American Pharmacists Association, 61(1), 20-26. https://doi.org/10.1016/j.japh.2020.09.006
Novak, M. L., & Wang, G. Y. (2024). The effect of e-cigarettes on cognitive function: a scoping review. Psychopharmacology, 241(7), 1287-1297. https://doi.org/10.1007/s00213-024-06607-8
Omaiye, E. E., Cordova, I., Davis, B., & Talbot, P. (2017). Counterfeit Electronic Cigarette Products with Mislabeled Nicotine Concentrations. Tobacco Regulatory Science, 3(3), 347–357. https://doi.org/10.18001/TRS.3.3.10
Organización Mundial de la Salud (OMS). (2016). Sistemas electrónicos de administración de nicotina y sistemas similares sin nicotina (Informe FCTC/COP/7/11). OMS. https://fctc.who.int/docs/librariesprovider12/meeting-reports/fctc-cop-7-11-es.pdf
Organización Mundial de la Salud (OMS). (2020). Electronic nicotine and non-nicotine delivery systems: a brief. OMS. https://iris.who.int/server/api/core/bitstreams/ae5bfd99-3a25-4fc3-ac12-7f2e24c60ac5/content
Organización Mundial de la Salud (OMS). (2023). Hay que actuar con urgencia para evitar que los niños y los jóvenes consuman cigarrillos electrónicos [Comunicado de Prensa]. OMS. https://www.who.int/es/news/item/14-12-2023-urgent-action-needed-to-protect-children-and-prevent-the-uptake-of-e-cigarettes
Organización Mundial de la Salud (OMS). (2024a). Electronic cigarettes: Call to action. OMS. https://cdn.who.int/media/docs/default-source/tobacco-hq/regulating-tobacco-products/ends-call-to-action.pdf
Organización Mundial de la Salud (OMS). (2024b). Enganchando a la próxima generación: cómo capta la industria tabacalera a los clientes jóvenes. OMS. https://iris.who.int/handle/10665/378116
Organización Mundial de la Salud (OMS). (2025). WHO global report on trends in prevalence of tobacco use 2000–2024 and projections 2025–2030. OMS. https://www.who.int/publications/i/item/9789240116276
Pennington, C., & Hernandez, S. (2025). Disposable electronic cigarettes: Chemical composition in new and used devices. Journal of Chromatography A, 1758, 466178. https://doi.org/10.1016/j.chroma.2025.466178
Peri, K., & Eisenberg, M. J. (2024). Feasibility of restricting e-cigarettes to prescription only for smoking cessation. Respiratory Research, 25(1). https://doi.org/10.1186/s12931-024-02792-4
Przulj, D., Pesola, F., Myers Smith, K., McRobbie, H., Coleman, T., Lewis, S., Griffith, C., Walton, R., Whitemore, R., Clark, M., Ussher, M., Sinclair, L., Seager, E., Cooper, S., Bauld, L., Naughton, F., Sasieni, P., Manyonda, I., & Hajek, P. (2023). Helping pregnant smokers quit: a multi-centre randomised controlled trial of electronic cigarettes versus nicotine replacement therapy. Health Technology Assessment 27(13), 1–53. https://doi.org/10.3310/AGTH6901
Reynolds, L. M., Faure, P., & Barik, J. (2025). Adolescent nicotine exposure and persistent neurocircuitry changes: unveiling lifelong psychiatric risks. Molecular Psychiatry, 30. https://doi.org/10.1038/s41380-025-03110-0
Schmidt, C. (2024). Nicotine, Flavor, and More: E-Cigarette Aerosols Deliver Toxic Metals. Environmental Health Perspectives, 132(2). https://doi.org/10.1289/EHP14425
Starnini, J. G., Natalello, G., Nigroli, F., Diana, C., Bargagli, E., & Melani, A. S. (2025). Electronic Nicotine Delivery Systems (ENDS): Implications for the Clinician. Pulmonary Therapy, 11, 387–404. https://doi.org/10.1007/s41030-025-00305-2
Wakefield, T., Bialous, S., Ling, P., & Apollonio, D. E. (2025). Efforts to Secure Nicotine and Cannabis Product Placements in Popular Media by Ploom, Pax, and Juul: An Analysis of Tobacco Industry Documents. Nicotine & Tobacco Research. https://doi.org/10.1093/ntr/ntaf180
Williams, M., & Talbot, P. (2019). Design Features in Multiple Generations of Electronic Cigarette Atomizers. International Journal of Environmental Research and Public Health, 16(16), 2904. https://doi.org/10.3390/ijerph16162904