Youth Shift to Vaping: E-Cigarette Use at Age 25 Hits 38%, Exceeds Traditional Smoking

At the European Respiratory Society (ERS) Congress in Barcelona, a series of studies revealed an unprecedented shift: while traditional cigarette smoking rates among young people are declining, e-cigarette use is surging, becoming the main risk factor for the health of the new generation.

According to a longitudinal cohort study from Northern Ireland, 38% of 25-year-olds had used e-cigarettes, compared to 25% who smoked traditional cigarettes. The data show that vaping is not only replacing conventional cigarettes but also acting as a 'gateway' to later smoking. Our analysis suggests that more important than the percentages is understanding that the 'smoking prevalence' metric, which has been used for decades, is no longer an accurate proxy for nicotine exposure among young people.

This article will delve into the studies presented at ERS 2026, emphasizing measurement, physiological mechanisms, and the impact of dual use of multiple nicotine products. We will not only examine the statistical figures but also explore hidden findings, gaps in current evidence, and public health implications for countries like Vietnam, where youth are beginning to access new nicotine products.

Three Studies, One Shared Conclusion: Vaping Leads

ERS 2026 featured three studies of different designs, all converging on the same direction: young people are increasingly using e-cigarettes, and this comes with respiratory and physical issues.

The first study is a longitudinal cohort following 3,380 Irish youths aged 13–25. Results show that at age 25, e-cigarette use reaches 38%, while traditional smoking is only 25%. Those who never vaped have the lowest probability of starting smoking.

The second study is a large-scale evidence synthesis by the Royal College of Paediatrics and Child Health (RCPCH) in the UK. They screened over 14,000 articles and analyzed 81 studies in depth. Conclusion: vaping is associated with cough, wheeze, bronchitis, asthma, and nicotine dependence in young people. Notably, those who vape have a higher probability of starting traditional smoking later.

The third study, published in ERJ Open Research, focuses on physiology. Results from a group of adults who vape or smoke showed a 15% reduction in exercise capacity compared with non-users, along with decreased blood oxygen retention, less efficient CO2 elimination, early fatigue, and vascular inflammation.

Strikingly, all three studies do not merely measure 'smoking' but measure 'nicotine exposure' as a composite. This suggests that previous smoking prevalence data no longer fully reflect the health burden caused by nicotine in young populations.

The Rise of Novel Nicotine Products: A Market Reshaping Itself

'Numbers never lie,' but they can conceal. When we look at the 38% vaping rate at age 25, this figure paints a picture of a profound behavioral shift. But if we only look at declining smoking rates, we miss the bigger picture: nicotine is entering the young generation through multiple routes, not just e-cigarettes.

Nicotine products include e-cigarettes, heated tobacco, nicotine pouches, and shisha. The pharmacokinetics of nicotine from each product are very different. Young people today often use multiple products simultaneously, making total nicotine load potentially much higher than any single product indicator suggests. The Irish cohort study, while not publishing details on 'poly-use,' has mentioned this phenomenon.

Another blind spot: Are there differences by ethnicity or region? For example, in Vietnam, the rate of e-cigarette use among high school students increased from 2.6% in 2026 to 8.1% in 2026 (according to WHO). Specific research is needed to determine whether European results can be directly applied in Southeast Asia.

Physiological Mechanism: Vaping Reduces Exercise Capacity by 15%

The ERJ Open Research study reveals the physiological mechanism for why vaping is harmful. When users vape or smoke, exercise capacity decreases by 15%. The mechanism includes reduced oxygen retention in the blood, leading to insufficient oxygen supply to muscles during exercise. The consequence is sudden fatigue and decreased performance.

What is concerning: the researchers emphasize that these changes can appear in young people with an active lifestyle and healthy lungs at rest. In other words, despite normal routine checkups, there is still subclinical damage. This means a 'hidden burden' that public health might be missing.

15% reduction in exercise capacity is a significant number. In football or any sport, losing 15% physical capacity can mean losing a starting position, or being unable to compete at a high level. For a country like Vietnam that values sports, if young people are affected, the country's athletic future could be threatened.

Largest Evidence Synthesis: 81 Studies Confirm Links to Asthma and Bronchitis

The RCPCH conducted a comprehensive synthesis to reach a firm conclusion: vaping is associated with a range of respiratory symptoms. Specifically, vapers aged 10–24 have higher risks of cough, wheeze, bronchitis, and asthma flare-ups compared with non-vapers. They also have a higher risk of nicotine dependence.

Notably, the synthesis also found that vaping increases the probability of starting traditional smoking. If previously it was thought that vaping was only a less harmful alternative for adult smokers, for youth it is a gateway to actual smoking.

In my analysis, the slow response of public health bodies to this evidence is serious. When there is suspicion, following the precautionary principle, immediate action is needed, similar to when a player is suspected of injury.

Contrarian View: Vaping Reduces Smoking But Brings More Young People to Nicotine

A common narrative holds that vaping helps quit smoking. For adult smokers, that might be true. But for young people, data suggest the opposite. They do not start with cigarettes and then switch to vaping; they start with vaping, and then switch to smoking.

This creates a problem for policymakers: they might mistakenly think that declining traditional smoking rates are a success. But in reality, the total number of young people exposed to nicotine is still increasing. E-cigarettes do not reduce harm in this population; they simply 'take over' as a new exposure pathway.

The new tobacco market acts like a 'propaganda machine,' continuously promoting products through social media targeting youth. If current regulations consider e-cigarettes as less harmful products, they must be reconsidered in light of new evidence.

What Does This Mean for Vietnam?

In my field trips, I have seen how quickly e-cigarettes have spread in major cities like Hanoi and Ho Chi Minh City. At convenience stores, these products are openly displayed with attractive flavors like bubble gum and fruits.

In 2026, the National Assembly of Vietnam officially banned the production, sale, import, and advertising of e-cigarettes and heated tobacco products effective January 1, 2026. This is a timely and correct step. However, enforcement at the local level will be a major challenge, especially eliminating clandestine online sales channels.

Schools have reported students using e-cigarettes in restrooms. Many parents still do not understand the difference between traditional and e-cigarettes, leading to a lack of necessary supervision.

Another aspect is price: e-cigarettes are often cheaper and more accessible to students than traditional cigarettes. Thus, they become a 'gateway' to nicotine.

Conclusion

From the studies at ERS 2026, a clear message is sent to policymakers: youth vaping is a real problem, no longer a hypothesis. The convergence of three different types of studies shows the urgency of action.

The 38% rate of 25-year-olds using e-cigarettes compared with 25% smoking traditional cigarettes shows that this generation is not quitting nicotine; they are simply switching from one product to another. With a 15% reduction in exercise capacity, that is a warning about the physical health of a generation.

The question is no longer 'whether to intervene,' but 'how to intervene most effectively' before the damage becomes irreversible.

Lessons from countries like the UK and Ireland should be carefully studied for application in the Vietnamese context. Vietnam has had a ban since 2026, but enforcement is the key. Coordination between families, schools, and regulatory bodies is essential to protect the future generation.