Vapes overtake cigarettes for teenagers in more than half of countries, global study finds

Vaping and other non-combustible nicotine products are now more popular than cigarettes among adolescents in more than half of the countries analysed in a major international study – with researchers warning that youth vaping prevalence is rising, particularly among boys.

The research, published in the Journal of Korean Medical Science, examined World Health Organisation (WHO) Global Youth Tobacco Survey data covering 173,658 adolescents aged 13–15 across 57 countries and territories between 2014 and 2021. It found non-combustible nicotine or tobacco product (NNTP) use was higher than combustible cigarette (CC) use in 31 countries, with the opposite pattern in 26.

Across all countries, overall prevalence was broadly similar – 8.75 per cent for NNTP use and 8.81 per cent for cigarette smoking – but the direction of travel differed. Global NNTP use increased over the period, with the steepest rise among male adolescents.

Researchers also attempted to forecast trends out to 2045 using a hierarchical Bayesian model. Their projections suggest NNTP use will remain relatively stable at around 10.61 per cent in 2044–2045, while cigarette use will fall sharply to 1.05 per cent over the same period.

Male teens and high-income countries show highest NNTP use

The paper highlights stark differences by sex, income and regulation. Male adolescents showed higher prevalence for both vaping and cigarette smoking: 10.78 per cent for NNTP use compared with 6.49 per cent for girls; and 10.36 per cent for cigarettes compared with 7.02 per cent for girls.

Adolescents in high-income countries recorded the highest prevalence levels – 11.29 per cent for NNTP use and 10.48 per cent for cigarette smoking.

The study also suggests regulation matters. Countries classed as having “less restrictive policies” on e-cigarettes reported some of the highest youth use rates: 11.18 per cent for NNTP use and 11.44 per cent for cigarette smoking.

Big disparities underline regulatory debate

On a country-by-country basis, Poland recorded the highest NNTP prevalence (22.39 per cent) and the highest combined prevalence for dual use of both cigarettes and NNTPs (10.46 per cent). Meanwhile, Papua New Guinea saw the highest cigarette prevalence at 22.92 per cent.

Some markets showed particularly wide gaps in favour of NNTPs, including Barbados, Trinidad and Tobago, and Belarus – all recording disparities of around 10 percentage points where vaping use exceeded cigarette use.

The authors argue that adolescent NNTP use has spread quickly through marketing that positions vaping as healthier than smoking and exploits peer influence – and call for stronger safeguards, including restricting advertising on platforms popular with young people.

Notably, their projections suggest a shift in gender patterns: NNTP use among female adolescents is predicted to surpass males around 2030–2031 (female 10.13 per cent vs male 9.18 per cent), underlining the need for sex-specific prevention approaches.