Three large studies together show that, although the number of people who smoke is declining, people are taking up smoking at a younger age and vaping has increased, particularly among children and younger people. The research, examining trends in Austria and Ireland, is presented today (Tuesday) at the European Respiratory Society (ERS) Congress in Barcelona, Spain.
Researchers say their findings suggest that nicotine addiction remains a major health concern and that public health measures need to deter children and young people from all forms of nicotine, including vaping, cigarettes, shisha and nicotine pouches.
The first study is presented by Dr Charmaine Helk-Lim from the Ludwig Boltzmann Institute for Lung Health and Sigmund Freud Private University, Vienna, Austria [1]. It included 15,056 Austrian people aged between six and 82 years who were asked about their use of any tobacco products over the course of 12 years between 2012 and 2024.
Researchers found that, during that time, smoking fell from 24.2% to 16.3%. However, they found use of 'alternative' nicotine products, such as vaping, rose sharply over the same period from 0% to 17.2%. At the same time, the proportion of people using more than one tobacco or nicotine product, for example smoking and vaping, also increased from 5.2% to 18.3%. The average age when people started to smoke has gone down over the same period of time, from 20 years in people born in the 1930s to around 15 years in those born in the 2000s, and the proportion of under 18s who smoke has almost doubled from 2.6% to 5.0%.
Dr Helk-Lim said: "The decrease in smoking conceals a broader nicotine problem. The epidemic isn't shrinking; it's changing shape and reaching children younger than it used to. This appears to be a global pattern, not just an Austrian one, and it can create a false impression that today's youth are safer from nicotine than in the past, when in reality many are being exposed earlier and through different products.
"Our advice for families is to talk with children about all nicotine products – vapes and heated tobacco included, not just cigarettes – and to start that conversation before the teenage years, since our data show many young people begin using these products by age 15 or 16. Those who start using tobacco early face a greater risk of long-term addiction meaning that quitting becomes harder later in life."
Research by a second team, led by Professor Joan Hanafin, from the TobaccoFree Research Institute Ireland, was presented by Salome Sunday [2]. They examined smoking and vaping in 5,265 Irish 15- to 16-year-olds over three points in time: 2015, 2019 and 2024. This showed that the proportion of these children who smoke has gone from 13.9% in 2015 down to 11.7% in 2024, after a peak of 14.4% in 2019. The proportion who vape has gone from 10.1% in 2015 up to 15.7% in 2024, after a peak of 18.1% in 2019. This study also showed that a growing proportion of children said they had taken up vaping without prior use of cigarettes, increasing from 50.2% of vapers in 2015 to 76.2% in 2024.
Another study by the team from the TobaccoFree Research Institute Ireland, presented by Professor Luke Clancy, looked at smoking and vaping habits in a group of 3,380 young people, and how these changed as they grew older (from age 13 to 25) [3]. This showed that both smoking and vaping generally increased from adolescence into young adulthood, with current e-cigarette use at 38% by age 25 and current smoking at 25%. The people who were least likely to be smokers by the age of 25 were those who had never vaped.
Ms Sunday said: "Nicotine use among young people is changing rapidly. Although smoking in some age groups has declined over the long term, young people are increasingly using a wider range of nicotine products, leading to an overall increase in nicotine use and highlighting the need to monitor overall nicotine use rather than individual products alone.
"Our findings reinforce the need for prevention strategies and tobacco control policies that address both smoking and vaping, particularly given the growing number of adolescents who try nicotine first through vapes. The availability of new nicotine products will likely keep the prevalence of nicotine addiction at the current high levels or even higher."
Dr Filippos Filippidis, Chair of the European Respiratory Society's Tobacco Control Committee from Imperial College London, UK, who was not involved in the research said: "Nicotine is highly addictive and it has taken decades for research on the harms of cigarettes to translate into a long-term decline in smoking. E-cigarettes have only become widely available over the last ten to 15 years, but research has already shown that vaping is harmful to the lungs and cardiovascular health.
"These studies, looking at smoking and vaping in Austria and in Ireland, show how the gains we've made in terms of fewer people smoking could now be jeopardised by a rise in addiction that results from the use of e-cigarettes and other nicotine products, especially among children, teenagers and young adults. These studies also show a rise in 'dual use', which can complicate quitting efforts and implementation of tobacco control policies.
"If we want to protect the next generation from addiction and the potential harms of these products, we need policies and public health strategies that address all forms of nicotine."
