International Pediatric Association publishes position paper concluding that “e-cigarettes are not an effective harm reduction strategy for adults and pose a serious risk to nicotine naïve youth”

On October 10, 2025, the International Pediatric Association (IPA) published a landmark position paper, “E-Cigarettes and the Nicotine Epidemic: Statement From the International Pediatric Association,” in Pediatrics, the international peer-reviewed journal published by the American Academy of Pediatrics. The paper concluded, “In contrast to early hopes and assumptions, e-cigarettes are not an effective harm reduction strategy for adults and pose a serious risk to nicotine-naive youth.” Echoing another conclusion from the report, IPA president Dr. Joseph Haddad said, “There are effective policies to counter this threat that have been and need to be increasingly implemented. There is an important role for pediatricians and their professional organizations in addressing this problem.”

This paper presents the latest global evidence on e-cigarette use and emphasizes how companies hook young customers with child-friendly flavors such as fruit, candy, and mint, sleek designs that mimic USB sticks, pens, or cosmetics, and aggressive promotion through online marketing and social media influencers. These marketing tactics normalize e-cigarette use by presenting them as trendy lifestyle items while perpetuating the false myth of reduced harm, threatening progress made in denormalizing tobacco use under the WHO Framework Convention on Tobacco Control.

With regard to smoking cessation and health effects, the paper concludes, “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.”

This paper was prepared by a committee of international experts who served on the IPA Program Area on Non-Communicable Diseases and Mental Health. The lead author of the paper, Prof. (Dr.) Monika Arora, from India, chaired the writing group and observed, “E-cigarettes are being deceptively marketed as harmless alternatives to smoking. In reality, they are addictive products causing long-term harm to our children’s lungs, hearts, and developing brains. Pediatricians must act now to protect young people from this threat.”

Dr. Stanton Glantz, retired Professor of Medicine from the University of California San Francisco and a member of the committee and writing group said, “The latest scientific evidence shows that, contrary to claims promoted by e-cigarette advocates, e-cigarettes as consumer products do not help smokers break their nicotine addiction and instead trap young users into long-term nicotine dependence.”

E-cigarettes, designed as sleek, technologically attractive devices, have become status symbols, often promoted globally by social media influencers. Another alarming trend noted in the paper is the invisibility of e-cigarettes in daily life. Many devices are disguised as pens, USBs, or makeup kits, producing odorless vapors that make them difficult for parents and teachers to detect. These innovative designs encourage hidden use in schools and homes, exposing children to nicotine without the knowledge of adults responsible for their care.

The paper further draws attention to how companies exploit weak laws and regulatory loopholes. Products are marketed under false claims of being “nicotine-free” or “non-tobacco,” often sold freely through online platforms without effective age checks, and distributed across borders through e-commerce channels that bypass regulation. These gaps make it dangerously easy for children to access e-cigarettes.

The IPA statement includes a strong call to action for pediatric societies and child health advocates across the globe. Dr. Naveen Thacker, IPA Executive Director and a member of the committee that compiled evidence on this publication, added, “Pediatricians must play a central role in warning families about the health harms of e-cigarettes, pushing for bans on flavors, youth-targeted advertising and packaging, advocating for stricter enforcement of existing laws, prohibiting influencers from promoting this deadly addiction through strict policy measures and integrating e-cigarette screening into routine pediatric visits. Awareness programs in schools and communities are also critical to protecting young people from the aggressive tactics of the e-cigarette/tobacco industry.”  Thacker continued, “Pediatricians must lead the fight against the rising threat of e-cigarettes. By uniting globally, advocating strongly, and educating families, we can counter industry-driven misinformation and safeguard the health and future of our youth.”

E-cigarette use among youth varies across countries. In the United States, e-cigarette use among middle and high school students declined from 7.7% in 2023 to 5.9% in 2024, though about 1.63 million students still reported use. Among them, 26.3% reported daily use and 87.6% used flavored products. Multi-country analyses estimate that adolescents globally used e-cigarettes at an average rate of 9.2%, while national prevalence ranges widely, from 23.3% in Bulgaria among 13- and 15-year-olds to 33.2% in Guam.

Regulatory responses for electronic nicotine delivery systems (ENDS) vary from country to country. As of 2024, 42 countries out of 133 ban e-cigarette sales, including India, Brazil, and Singapore, which have imposed complete bans on the sale, distribution, and use of ENDS in all indoor public places, workplaces, and public transport. Another 91 countries have enforced partial legislative measures, while 62 lack any regulations on ENDS.

The International Pediatric Association (IPA) exists to create a world where all children, regardless of age, location or family situation, can live healthy lives. For over 100 years, IPA has been one of the most prestigious global bodies representing the professional societies of pediatricians. IPA advocates globally, nationally and locally for high-quality, evidence-based and child-centered pediatric care. It partners with the World Health Organization and UNICEF and provides global leadership on emerging child health issues through work with leading global health players.

The paper is available here.

The members of the committee that prepared this report, which was endorsed by the IPA Executive Committee are:

1. Monika Arora, PhD; HRIDAY, New Delhi, India; Public Health Foundation of India, New Delhi, India
2. Muralidhar M Kulkarni, MD; Kasturba Medical College, Manipal, Karnataka, India
3. Shishirendu Ghosal, MPH; HRIDAY, New Delhi, India
4. Aishwarya Sathyan, MPH; International Pediatric Association, Geneva. Switzerland
5. Mansi Gupta, MOT; HRIDAY, New Delhi, India
6. Simran Verma, MPH; Public Health Foundation of India, New Delhi, India
7. Mychelle Farmer, MD; Advancing Synergy, Baltimore, MD, USA
8. Adamos Hadjipanayis, PhD; European University Cyprus, Nicosia, Cyprus; Larnaca Hospital, Larnaca, Cyprus
9. Jonathan D. Klein, MD, MPH; International Pediatric Association, Geneva, Switzerland; International Association for Adolescent Health, Montreal, Quebec, Canada; Stanford University, Stanford, CA, USA
10. Jonathan Winickoff, MD, MPH; Harvard Medical School, Boston, MA, USA
11. Naveen Thacker, MD; International Pediatric Association, Geneva, Switzerland
12. Stanton A. Glantz, PhD; University of California San Francisco (retired), San Francisco, CA, USA

Here is the abstract:

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.

The full citation is: Arora M, Kulkarni MK, Ghosal S, Sathyan A, Gupta M, Verma S, Farmer M, Hadjipanayis A, Klein JD, Winickoff J, Thacker N, Glantz SA. E-Cigarettes and the Nicotine Epidemic: Statement from the International Pediatric Association. Pediatrics 2025; 156(5): e2025072337. Published online: 10 Oct 2025 (doi: 10.1542/peds.2025-072337). The paper is available here.