Vaping will help individuals stop smoking while considerably lowering their publicity to lethal toxins and bettering their well being outcomes (Lindson et al., 2025; Royal Faculty of Physicians 2024). Nonetheless, with an increase in teen vaping amongst those that have by no means usually smoked, persons are questioning whether or not vaping might result in a rise in subsequent teen smoking. This concept is often known as “the gateway speculation”. The speculation originated virtually 100 years in the past and has been famously utilized to hashish use being a “gateway” to different, “tougher”, medicine. In a latest umbrella evaluation, Golder et al. (2025) explored the gateway speculation in relation to vaping and subsequent smoking and different dangerous behaviours—right here, we unpack this.
The gateway speculation has been broadly contested, for a lot of causes. The central argument towards the gateway speculation is that we can not actually, ethically, check whether or not youth use of 1 product (e.g., vapes) is related to use of one other (e.g., smoking) amongst younger individuals. To do that, we would want a trial the place younger persons are randomised to vape or not and are then adopted as much as see if they’ve began smoking. That is extremely unlikely to go via any analysis ethics committees.
One of the best out there, moral, strategies we have now to check the gateway speculation are inhabitants surveys. Nonetheless, whereas inhabitants surveys would possibly discover that individuals who vape at age 12 usually tend to smoke at age 18, can this ever actually present enough proof of a “gateway” impact? Younger individuals being surveyed might need gone onto smoke anyway, no matter whether or not they used vapes. There are additionally different components like adjustments out there, in style merchandise, or the likelihood that youth are merely getting older or “rising out” of vapes.
The contender to the gateway speculation is the frequent legal responsibility idea. The frequent legal responsibility idea proposes that individuals who vape and smoke have the identical underlying traits, like genetics, constructive attitudes/tradition in the direction of nicotine use, and being extra more likely to take dangers. Certainly, proof within the discipline of vaping and smoking means that there are robust genetic vulnerabilities to each behaviours (Khouja et al., 2021), and likewise that the affiliation goes each methods (i.e., vaping being related to subsequent smoking, and smoking being related to subsequent vaping; East et al., 2018). With longitudinal surveys, it’s nearly unattainable to manage for all of the potential underlying traits (i.e., confounders) of smoking and vaping, so it’s troublesome to inform whether or not the associations are real or brought on by these confounding components. A meta-analysis of “gateway” research in 2021 (Chan et al., 2021) addressed this via calculating one thing referred to as an “E worth”, which permits us to judge the sufficiency of adjustment for confounding. Unsurprisingly, this examine discovered a comparatively excessive E-value, indicating that estimates in vaping-smoking “gateway” research will not be sturdy towards unmeasured confounding. Total, this proof factors extra in the direction of a standard legal responsibility for each behaviours slightly than vaping being a “gateway” to smoking.
Can vaping actually result in smoking amongst teenagers — or can the ‘gateway’ impact be defined by frequent threat components?
Strategies
The umbrella evaluation by Golder et al. (2025) synthesises proof of 56 opinions that assessed the associations between youth vaping (publicity) and any bodily or psychological well being harms (consequence; together with uptake of smoking or different addictive behaviours). Research assessing quitting smoking as an consequence or different constructive advantages (e.g., diminished stress) have been excluded—that is vital for causes we’ll point out later. The examine critically appraised the included opinions utilizing a validated risk-of-bias device, scoring the opinions from critically low to excessive. A youth advisory panel offered enter on the rising outcomes, implications, and dissemination, which is nice to see and uncommon for systematic opinions.
Outcomes
Most opinions assessed the associations between vaping and smoking uptake (n = 25), though most of the opinions reported on the identical research. 5 opinions assessed the associations between vaping and subsequent hashish, alcohol, and/or non-prescribed Ritalin/Adderal. Most of those opinions included longitudinal cohort research, thus permitting for evaluation of whether or not vaping is related to subsequent smoking or use of different substances.
The meta-analyses included discovered that odds ratios for the affiliation between vaping and smoking initiation ranged from 1.50 to 26.01, with most research reporting that younger individuals who vape are round thrice extra doubtless than these not utilizing them to provoke smoking. For different substances, the chances for associations with vaping ranged from 2.13 to six.67.
The opposite opinions focussed on associations between vaping and respiratory outcomes (e.g., bronchial asthma; 16 opinions), burns/accidents (7 opinions), psychological well being (9 opinions), and cardiovascular issues (4 opinions). These discovered that vaping amongst youth was related to poorer respiratory outcomes (e.g., bronchial asthma, wheezing, bronchitis) and poorer psychological well being. A lot of the research included within the opinions, nonetheless, have been cross-sectional which is especially vital for the affiliation between psychological well being and vaping as a result of some research have discovered that youth use nicotine to deal with psychological well being signs, slightly than vaping inflicting poor psychological well being. Some opinions additionally discovered that vaping was related to burns/accidents, though the vast majority of these have been primarily based on case studies and so won’t be generalisable, and plenty of electrical gadgets may cause burns if used or manufactured inappropriately.
Importantly, the standard of the overwhelming majority of the included opinions have been all rated as critically low on account of vital methodological limitations, together with a scarcity of a-priori strategies, not itemizing excluding research, and insufficient reporting on threat of bias impacts.
Youth who vape seem extra more likely to smoke later, however poor examine high quality clouds the interpretation of the findings.
Conclusions
The conclusions of the Golder et al. (2025) umbrella evaluation have been that there have been constant associations between vaping and subsequent smoking, marijuana use, alcohol use, bronchial asthma, cough, accidents and psychological well being outcomes. Additionally they declare that the “robust associations in potential cohort research are in step with a causal relationship between vaping and subsequent smoking”.
The umbrella evaluation indicated constant associations between vaping and subsequent smoking, marijuana use, alcohol use, bronchial asthma, cough, accidents and psychological well being outcomes.
Strengths and limitations
As Golder et al. (2025) establish, key strengths of their evaluation embrace being probably the most complete evaluation of vaping-associated dangers up to now and the inclusion of a public involvement group of younger individuals (which is uncommon with opinions). They thought-about an unlimited variety of opinions (56 opinions), with most being systematic opinions. Screening was undertaken by two reviewers, enhancing the reliability of the evaluation.
Nonetheless, there are a number of limitations of this work. As Golder et al. (2025) point out, moreover the outcomes of smoking initiation, many of the associations assessed are cross-sectional and, for burns/accidents and cardiovascular outcomes, have been primarily restricted to case studies, which rank low on the “hierarchy of proof”. Additionally they spotlight that high quality of the included opinions was typically low; nonetheless, the authors don’t account for this of their conclusions. Due to this fact, the findings from this evaluation have to be handled with warning.
Extra broadly, the authors don’t bear in mind the likelihood that their findings may very well be defined by a standard legal responsibility. They point out this competing idea of their dialogue however place extra emphasis on the gateway speculation. One of many opinions (Chan et al.) that was included within the umbrella evaluation discovered that estimates in vaping-smoking “gateway” research will not be sturdy towards unmeasured confounding, as talked about earlier on this weblog; nonetheless, the nuance of this examine isn’t described by Golder et al. It is a main limitation of the evaluation.
Lastly, we even have the problem of what we’re focussing our consideration on: if researchers are on the lookout for an affiliation between vaping and smoking, that’s what they may discover. A latest proof and hole map by Conde et al. (2024) discovered that the overwhelming majority of research assessing vaping and smoking amongst youth deal with vaping and subsequent associations with smoking, with only a few contemplating whether or not vaping may very well be a “gateway” away from smoking—that’s, whether or not youth who smoke are utilizing vapes to get themselves off of smoking. It’s well-established that vapes are a lot much less dangerous than smoking and will help adults to stop smoking. Due to this fact, slightly than repeatedly synthesising proof of poor high quality “gateway” research, researchers could be finest to focus their efforts on under-researched areas. This might embrace analysis into whether or not vaping is a manner out of smoking amongst younger individuals, in addition to particular coverage choices that steadiness the necessity to forestall individuals who have by no means smoked from vaping with guaranteeing they’re out there to help adults who smoke to stop.
The evaluation brings collectively a formidable physique of analysis, however poor high quality research and lacking nuance prevents any agency conclusions on the affiliation between vaping and subsequent well being outcomes.
Implications for observe
It vital to do not forget that vaping is a vital gateway out of smoking for a lot of, and the arguments about youth vaping shouldn’t cloud this focus. Tobacco smoking is the main reason behind preventable loss of life and incapacity globally, killing as much as two thirds of people that smoke in the long run (World Well being Group, 2025). Vaping is considerably much less dangerous than smoking and there’s high-certainty proof that vaping will help individuals stop smoking (Lindson et al., 2025; Royal Faculty of Physicians, 2024). NICE scientific tips suggest e-cigarettes to assist individuals stop smoking, encouraging a full swap to cut back the harms from tobacco use. It’s estimated that round 2.7 million individuals in Nice Britain have stop smoking with a vape within the final 5 years (Motion on Smoking and Well being, 2024).
Though the help for the gateway idea of vaping is questionable, we should nonetheless acknowledge that vaping carries dangers and younger individuals and people who have by no means smoked shouldn’t vape (Royal Faculty of Physicians, 2024). It’s due to this fact vital that tips and coverage approaches steadiness the necessity to make sure that vaping doesn’t enchantment to younger individuals with guaranteeing that vapes can be found to adults for the needs of quitting smoking. This might embrace insurance policies to make vapes much less interesting to youth and younger adults, equivalent to standardising packaging and point-of-sale restrictions mixed with initiatives to make them accessible to adults who smoke, equivalent to Swap to Cease, a authorities scheme that gives free vape kits and help to adults who smoke in England.
Vaping will help individuals who smoke to stop, however defending younger individuals with out denying adults this device stays a fragile steadiness.
Assertion of pursuits
The authors of this weblog had no private involvement within the examine. KE led the primary examine in Nice Britain to evaluate the longitudinal associations between vaping and smoking amongst younger individuals and this examine was included in most of the opinions within the Golder et al. umbrella evaluation. Each KE and ET have labored within the discipline of tobacco and nicotine analysis for a few years, finishing their PhDs on vaping and smoking norms (KE) and toxicants from vaping (ET). KE and ET are employed by the Brighton and Sussex Medical Faculty and College Faculty London, respectively. They’ve each co-authored studies on well being dangers and perceptions of vaping for the Workplace for Well being Enchancment and Disparities (OHID) and Royal Faculty of Physicians.
Hyperlinks
Major paper
Golder S, Hartwell G, Barnett LM, Nash SG, Petticrew M, Glover RE. Vaping and hurt in younger individuals: umbrella evaluation. Tobacco Management. 2025.
Different references
Motion on Smoking and Well being (2024). Practically 3 million individuals in Britain have stop smoking with a vape within the final 5 years.
Chan GC, Stjepanović D, Lim C, Solar T, Shanmuga Anandan A, Connor JP, Gartner C, Corridor WD, Leung J (2021). Gateway or frequent legal responsibility? A scientific evaluation and meta‐evaluation of research of adolescent e‐cigarette use and future smoking initiation. Habit. 116(4):743-56.
Conde M, Tudor Okay, Begh R, Nolan R, Zhu S, Kale D, Jackson S, Livingstone‐Banks J, Lindson N, Notley C, Hastings J (2024). Digital cigarettes and subsequent use of cigarettes in younger individuals: An proof and hole map. Habit. 119(10):1698-708.
East Okay, Hitchman SC, Bakolis I, Williams S, Cheeseman H, Arnott D, McNeill A (2018). The affiliation between smoking and digital cigarette use in a cohort of younger individuals. Journal of Adolescent Well being. 62(5):539-47.
Khouja JN, Wootton RE, Taylor AE, Davey Smith G, Munafò MR (2021). Affiliation of genetic legal responsibility to smoking initiation with e-cigarette use in younger adults: a cohort examine. PLoS medication.18(3):e1003555.
Lindson N, Butler AR, McRobbie H, Bullen C, Hajek P, Wu AD, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J (2025). Digital cigarettes for smoking cessation. Cochrane Database of Systematic Critiques, Challenge 1. Artwork. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub9.
Nationwide Centre for Smoking Cessation and Coaching (2025). Supporting shoppers who need to cease vaping.
Royal Faculty of Physicians (2025). E-cigarettes and hurt discount: An proof evaluation.
World Well being Group (2025). Tobacco Truth Sheet.
