Vaping among people who never smoked: what the evidence shows on addiction, health and later smoking

E-cigarettes were introduced as a way for smokers to get nicotine without burning tobacco. In Britain they are now used by a large number of people who were never smokers at all. More than a million people who say they have never smoked are now vapers, latest data for 2025 reveals, up from around 940,000 in 2024, the BBC reported on October 6.

The figures come from the Office for National Statistics. They also show that for the second year in a row, more over-16s in Great Britain are using vapes or e-cigarettes than smoking cigarettes. The BBC put the number of vapers at 5.4 million and the number of smokers across the whole United Kingdom at 4.9 million.

Most public debate about vaping concerns smokers trying to quit. For someone who has never smoked the question is a different one, because there is no cigarette habit to replace. This explainer covers what is established about that group, what is uncertain and what is unknown.

Who the never-smokers taking up vaping are

The shift is recent. A team at University College London has surveyed adults in England every month since 2016, reaching 153,073 people. Among those who had never regularly smoked, vaping prevalence was relatively stable up to 2021, at an average of 0.5%. It then increased rapidly, reaching 3.5% in April, 2024.

This increase was largely driven by young adults, with 19.0% of 18-year-olds who had never regularly smoked reporting that they vaped, and by people who drank more alcohol.

These were not people trying a vape once. In 2023 to 2024, 55.6% of never-regular-smokers who vaped reported vaping daily, and 81.7% had been vaping for 6 months or more. Half were using disposable devices, and the most common e-liquids, the nicotine solutions that vapes heat into an aerosol, contained 20 milligrams of nicotine per milliliter or more.

The newest British figures suggest the user base is aging. Twenty-five to 34-year-olds are now more likely to use vapes than 16 to 24-year-olds. David Mais of the Office for National Statistics told the BBC this “may reflect existing users getting older, growing popularity among this age group, or a combination of both”.

What is established about vaping and health

The broadest synthesis of the health evidence was produced at the Australian National University for the Australian government and published in The Medical Journal of Australia in 2023. It combined eight earlier major reviews with a fresh search of the literature. In all, four hundred eligible publications were included.

The reviewers graded each claim by the strength of evidence behind it. Their summary can be laid out in three tiers.

Strength of evidence	What the review concluded
Conclusive	Poisoning, acute inhalation toxicity including seizures, lung injury, and burns from faulty devices
Substantial or strong	Nicotine dependence in non-smokers; young non-smokers who vape more likely to start smoking
Insufficient or unavailable	Cardiovascular disease, cancer, development, mental and reproductive health

The acute harms are the firmest. There is conclusive evidence linking e-cigarette use with poisoning, immediate inhalation toxicity (including seizures), and a severe lung injury that was traced largely, though not only, to liquids containing cannabis extracts and an additive. Poisoning and acute toxicity were reported particularly in children and adolescents.

Dependence is the harm most relevant to a never-smoker. There is substantial evidence that nicotine e-cigarettes can cause dependence or addiction in non-smokers. A person who has never used nicotine and starts vaping daily is acquiring a drug habit they did not have.

The review’s overall verdict was pointed at exactly this group. E-cigarettes can be harmful to health, particularly for non-smokers and children, adolescents, and young adults.

Whether vaping leads never-smokers to smoking

The most contested question is whether vaping acts as a route into smoking, sometimes called the gateway effect.

The association itself is not in doubt. The Australian review found strong evidence that young non-smokers who use e-cigarettes are more likely than non-users to initiate smoking and to become regular smokers. Pooling 25 studies that followed young people over time, it put the difference at about three times as likely.

Two independent pooled analyses found the same pattern and questioned what it means. Researchers at the University of Bristol pooled 17 studies of people up to age 30. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking, with odds about four and a half times higher. They then listed reasons for caution. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. A negative control is a check built into a study to detect a spurious link.

A team at the University of Queensland looked only at people who were under 18 and not smoking at the start. Across 11 studies, vapers had about three times the odds of smoking later. The team then examined how well those studies were done. Overall, the attrition rate was very high, with a median of 30% of participants lost before follow-up. Only two studies comprehensively adjusted for confounding. Confounding here means other differences between teenagers who vape and those who do not. Young people who are drawn to risk, or whose friends and parents smoke, are more likely to try both products regardless of which comes first.

The Queensland authors concluded that there is a longitudinal association between adolescent vaping and smoking initiation; however, the evidence is limited by publication bias, high sample attrition and inadequate adjustment for potential confounders. A longitudinal association is one seen when people are followed over time, and publication bias is the tendency for striking results to reach print more readily than null ones.

Population trends point the other way. Smoking has continued to fall in Britain during the years vaping rose, including among the young. Young adults aged 18 to 24 years have seen the largest drop in smoking among all age groups, the BBC noted. That is hard to square with vaping driving large numbers into smoking, though it does not rule out an effect on some individuals.

How vaping compares with smoking, and why that matters less for never-smokers

Against cigarettes, vaping comes out ahead. England’s most recent government-commissioned evidence review, published in 2022 and led by academics at King’s College London, concluded that in the short and medium term, vaping poses a small fraction of the risks of smoking. Measurements of toxic substances in the body are substantially lower in people who vape than in people who smoke.

The same review drew the line that matters here. It found that vaping is not risk-free, particularly for people who have never smoked. Compared with people who use no nicotine product, vapers have similar or higher exposure to harmful substances.

For smokers the trade is favorable, and trials back it. A Cochrane review, a systematic review prepared to a published protocol and updated in 2025, covers 104 completed studies (14 new to this update), representing 30,366 participants. There is high-certainty evidence that nicotine e-cigarettes increase quit rates compared with nicotine replacement products such as patches and gum, its authors concluded.

That benefit does not transfer. A never-smoker who vapes is not reducing a risk. The University College London researchers framed the population question carefully: the public health impact, they wrote, will depend on what these people would otherwise be doing. It is likely that some might have smoked if vaping were not an available option, exposing them to more harm, whereas others would have used neither product.

What is unknown about long-term vaping

The largest gap concerns diseases that take decades to appear. The Australian review found that evidence regarding effects on other clinical outcomes, including cardiovascular disease, cancer, development, and mental and reproductive health, is insufficient or unavailable. It reported some evidence of short-term effects on blood pressure, heart rate and lung function, without data on whether those translate into illness.

England’s review said the same in different words: evidence is mostly limited to short and medium term effects, and studies of vaping for more than 12 months are necessary.

Absence of evidence is the accurate description.

“Although we don’t know the long-term risks of vaping, evidence so far shows that legal vapes are less harmful than tobacco and an effective tool to stop smoking,” Kruti Shrotri of Cancer Research UK told the BBC.

What health bodies say about vaping for non-smokers

Official advice in Britain separates smokers from non-smokers. Vaping is less harmful than smoking, although the long-term effects are not yet clear, says the NHS, in the BBC’s summary. It says non-smokers and people aged 17 and under should never vape.

The Australian reviewers reached a more restrictive conclusion for their own country, noting that e-cigarettes are not approved smoking cessation aids there and that better evidence is needed on effective regulation.

Britain is also changing its tobacco law. Legislation due to take effect at the start of 2027 will permanently ban the legal sale of tobacco to anyone born on or after January 1, 2009. “Smoking has fallen enormously over recent decades, but it remains the biggest driver of preventable death in the UK,” said Hazel Cheeseman of the charity Action on Smoking and Health.

For a smoker weighing whether to switch, the choice of quitting method depends on their history and health, which is assessed by their doctor or stop-smoking service.

Where the evidence on vaping in never-smokers is weak

The Australian review rated the certainty of evidence for most disease outcomes as low or very low, citing small studies and weak designs. Its literature search ended in 2020, before disposable vapes and the surge among never-smokers.

The studies of later smoking are observational, rely on what young people report about themselves, and lose many participants. The reviewers who pooled them do not agree on whether the link is causal.

The British counts come from surveys. People may misreport their smoking history. The vaping figures cover Great Britain and people aged 16 and over, while the smoking figures cover the whole United Kingdom.

Products change faster than studies. Nicotine strength, device type and flavorings have all shifted since most of the research was done, and results from earlier devices may not apply to current ones.

For a person who has never smoked, vaping brings a well-supported risk of nicotine dependence and no offsetting benefit, while whether it leads to smoking remains unsettled and its long-term effects on disease are unknown.