Young people & pregnancy

While vaping poses risks to all users, certain populations are particularly vulnerable to its adverse effects due to biological susceptibility or developmental stage.

A. Adolescents and Young Adults

The rapid uptake of vaping among youth globally has been widely described as a public health epidemic. While recent surveys in the U.S. indicate a decline from peak levels in 2019, millions of middle and high school students still report current vaping. Worryingly, a significant proportion of these young users vape frequently (e.g., 20 or more days per month, or daily), suggesting established nicotine dependence. Several factors make this age group uniquely vulnerable:

• Neurological Vulnerability: As detailed previously, the adolescent brain is undergoing critical development, making it highly sensitive to the disruptive effects of nicotine. Exposure during this window can lead to lasting impairments in cognitive functions like attention, learning, and memory, as well as problems with impulse control and mood regulation.
• Heightened Addiction Susceptibility: Adolescents appear to be more sensitive to nicotine’s rewarding effects and can become dependent more quickly and potentially at lower levels of exposure compared to adults. Product characteristics like appealing flavors and the smooth delivery of high nicotine concentrations via nicotine salts significantly facilitate initiation and the rapid development of addiction in this group.
• Potential Gateway to Smoking: Multiple longitudinal studies have found that young people who initiate nicotine use with e-cigarettes are significantly more likely to subsequently start smoking traditional combustible cigarettes compared to their peers who do not vape. While the exact mechanisms are debated, this association raises concerns that vaping, rather than solely diverting youth from smoking, may also serve as an entryway to tobacco use for individuals who might otherwise have remained nicotine-free.
• Influence of Marketing and Flavors: The youth vaping epidemic has been strongly linked to the proliferation of kid-friendly flavors (such as fruit, candy, mint, and menthol) and targeted marketing strategies. Surveys consistently show that flavors are the primary reason young people try and continue to use e-cigarettes. Marketing often employs themes of youthfulness, rebellion, and social status, utilizing channels popular with adolescents, including social media platforms like TikTok and Instagram. Regulatory efforts to curb youth access and appeal have faced challenges. For instance, restrictions on flavored pod-based systems led to a rapid market shift towards flavored disposable e-cigarettes, which remained widely available and popular among teens. This dynamic illustrates the “flavor trap”: the industry’s ability to adapt and continue supplying appealing flavored products that attract and hook young users, despite known risks to their health and development. Loopholes, such as the legality of giving free samples in some jurisdictions and illicit markets often originating from overseas , further complicate prevention efforts. Addressing the youth vaping crisis effectively likely requires comprehensive regulations that eliminate all characterizing flavors attractive to minors.

B. Pregnant Individuals and Fetal Development

Vaping during pregnancy poses significant risks to both the pregnant individual and the developing fetus. Health authorities strongly advise against the use of any nicotine-containing products, including e-cigarettes, during pregnancy.

• Nicotine Toxicity to the Fetus: Nicotine readily crosses the placenta and is toxic to the developing fetus. It can adversely affect fetal brain development, potentially leading to cognitive and behavioral problems later in life, and can also impair lung development.
• Adverse Birth Outcomes: Studies have linked maternal e-cigarette use during pregnancy with negative birth outcomes, including low birth weight and pre-term delivery. One systematic review noted that while many side effects were similar to smoking, lower birth weight was specifically associated with ENDS exposure during pregnancy.
• Unknown Risks of Other Chemicals: Beyond nicotine, the potential effects of inhaling the various other chemicals present in e-cigarette aerosol (solvents, flavorings, metals, etc.) on fetal development are largely unknown but represent an additional layer of concern. Given the established harms of nicotine and the uncertainties surrounding other aerosol constituents, avoiding vaping during pregnancy is the safest course of action.