Electronic cigarettes (e-cigarettes) have rapidly emerged as a new frontier in the global nicotine epidemic, particularly targeting children, adolescents, and youth. Marketed as safer alternatives and cessation aids, e-cigarettes deliver highly addictive nicotine, often via protonated formulations that enhance absorption and dependency. This position paper by the International Pediatric Association (IPA) synthesizes global evidence on the use, risks, and regulatory gaps of e-cigarettes. It highlights increasing prevalence among youth, driven by misleading marketing, ease of access (especially via social media), appealing flavors, and stealth designs. E-cigarettes have not proven significantly effective through real-world studies for smoking cessation in youth or adults when used as consumer products. Instead, dual use (using e-cigarettes and cigarettes at the same time) and long-term nicotine dependence are common. E-cigarette use is associated with cardiovascular, metabolic, respiratory, oral diseases and cancer, with dual users facing greater health risks than cigarette smokers alone. Drawing on global data and recommendations from apex public health organizations, IPA calls for comprehensive bans or stringent regulation on the manufacture, marketing, sale, and use of e-cigarettes. Pediatricians and medical associations play a vital role in advocating, educating, and providing clinical support to combat industry-driven misinformation and safeguard the youth. IPA urges its member societies to adopt unified, evidence-based policies to restrict access and exposure and to ensure governments are guided by robust scientific evidence—not industry interests. E-cigarettes threaten to reverse decades of progress in tobacco control—an urgent, coordinated action is required to safeguard the health of future generations.
Arora et al. (2025) studied this question.