Youth vaping: 38% of 25-year-olds use e-cigarettes, physical capacity may drop by 15%

Numbers are only the beginning; verification is the destination. When an Irish survey showed that nearly 38% of 25-year-olds currently use e-cigarettes while only 25% smoke conventional cigarettes, many might quickly conclude that vaping has replaced traditional smoking. But three independent studies presented at the European Respiratory Society (ERS) International Congress in Barcelona paint a more worrying picture: vaping is becoming the main gateway for nicotine among young people, and its impact on physical capacity, respiratory health and later smoking behaviour is far from negligible. These figures must be placed in context. The Irish research group followed 3,380 people from age 13 to 25, using a population-based sample rather than a hospital sample. By age 25, current e-cigarette use was 38%, substantially higher than the 25% smoking rate. People who had never vaped had the lowest probability of smoking cigarettes. This means vaping is not only a substitute; it also emerges before many young people ever try a cigarette. It is a reversal of the traditional model of nicotine addiction. The second study was a large-scale evidence synthesis conducted by the Royal College of Paediatrics and Child Health (RCPCH) in the UK. The team screened more than 14,000 articles and included 81 studies in the final analysis. The conclusion is clear: vaping in young people is associated with cough, wheeze, bronchitis, asthma attacks and nicotine dependence. More importantly, the pooled evidence shows that vaping increases the probability of starting conventional cigarette smoking. For a subgroup of young people, vaping is not the end point but a stepping stone. The third study focused on physiology. Published in ERJ Open Research, it compared young people who vape or smoke with never-users. The result: the vaping/smoking group had an average 15% reduction in exercise capacity. They retained oxygen less effectively, eliminated carbon dioxide less efficiently, became suddenly fatigued during exercise and had markers of vascular inflammation. Notably, these changes appeared even in young people with active lifestyles and regular training. In other words, someone who looks healthy at rest can still carry hidden internal damage. Methodologically, each study sits on a different level of the evidence hierarchy. The RCPCH synthesis is high because it aggregates many designs and checks consistency. The Irish cohort benefits from longitudinal follow-up and better control of confounders than typical cross-sectional surveys. The physiological study adds a plausible mechanism for how vaping may affect the cardiovascular and respiratory systems. What many news articles miss is that these studies are not simply measuring “smoking”; they are measuring total nicotine exposure. For a long time, public health used cigarette prevalence as a proxy for population-level nicotine harm. That proxy is no longer valid. If you only look at declining smoking rates, you might celebrate a victory. But when vaping enters through never-smokers, when the age of nicotine initiation moves earlier, and when many young people use multiple products simultaneously, the total nicotine burden may not be falling; it is shifting into a new channel that is less regulated. Defence is what people undervalue, until it wins you the cup. In the context of athletic health, the “defence” is the lungs and cardiovascular system. A young athlete might not notice a difference during light training. But in extra time, during repeated sprints, or when oxygen is needed to maintain intensity at the 90th minute, a 15% reduction in exercise capacity is enough to turn a “promising” player into someone who tires easily, loses concentration and has a higher injury risk. Vaping is a physical debt that young people pay with their own performance. A careful reader might ask: are these causal findings? The honest answer is no. The Irish cohort and the ERJ Open Research study are observational and show association, not causation. But the convergence among three different designs increases confidence in the trend. One study provides mechanism; one shows breadth; one shows temporal order. When three lines of evidence point in the same direction, health writers should treat it as a signal for action, not wait for a perfect randomized trial. I have spent years tracking sports data and the habits of young athletes. What I see in these studies is similar to what I see when analysing high training loads without recovery: basic indicators remain stable for a long time, but when real competition begins, the deficit appears very quickly. The human body has great compensatory capacity, but it cannot handle accumulated debt. Nicotine is a powerful addictive substance. When a 15-year-old uses vapes daily, the developing brain restructures itself towards dependence. The RCPCH research makes this clear. Looking at the situation among Vietnamese youth, I see a distinct reason to be concerned. E-cigarettes are sold widely through online channels, packaging is eye-catching, fruit flavours are appealing, and many adults still mistakenly believe that vaping is “less harmful” and therefore easy to tolerate. But the lessons from Ireland and the UK show that without early control, we may face a generation that is both nicotine-dependent and physically diminished. Every sport needs strong legs and clean lungs. Football is the king of sports, but players cannot perform without oxygen. The biggest blind spot in media coverage of vaping is the separation between “smoking” and “nicotine addiction”. Young people do not call themselves smokers because they do not smoke cigarettes. But pharmacologically, nicotine from vapes can create dependence just as quickly. Moreover, multi-product use – vapes, heated tobacco, nicotine pouches – is becoming common. Each product has a different nicotine pharmacokinetic profile, and those who rotate them may have a much higher total nicotine intake than any single product suggests. Current studies are still chasing the innovation of the nicotine industry. Crises do not ask if you are ready; they ask if you have seen it before. For public health and youth sports, “seen before” means studying what happened in countries that moved ahead. They saw a generation start with vaping and then transition to cigarettes. They saw more asthma, cough and bronchitis among vapers. They saw lower physical capacity measured by exercise tests. If Vietnam does not want to repeat that trajectory, vaping should be included in school health surveillance, and parents and coaches should be taught that vaping is not “safer” – it is a new kind of danger. An economy cannot be sustainable if its future workers and athletes have worse lung capacity than the previous generation. This story also poses a major question for policy-makers: the commercial interests of the new nicotine industry versus public health. In Western countries, advertising budgets of major vape manufacturers are large enough to create a media wave of their own. Many messages on social media say that vaping helps quitting smoking or that vaping does not create second-hand smoke. These messages are not entirely false, but they ignore the core question: does a 14-year-old who has never smoked need to quit? When products are sold in strawberry, gum and mint flavours and become common in high schools, the “harm reduction” strategy is distorted into an “early addiction” strategy. Data also have limits. We do not have figures on the health-care costs of vaping-related respiratory disease in Vietnam. We do not have reports on how tobacco control budgets address new products. We still lack long-term studies that capture cancer or chronic cardiovascular disease. Those gaps must be filled with practical monitoring and control systems, not merely with generic warning articles. Looking at the overall picture, I want to say to coaches, parents and young people who exercise: treat vaping as a performance variable, not just a preventive health issue. A young athlete who vapes can undergo regular lung function tests and still appear normal at rest. But when training intensity increases, the difference appears. For football and high-performance sports to develop sustainably, Vietnam needs players who are not only technically skilled but also have strong hearts, clean lungs and durable physical foundations. Vaping threatens exactly that goal. History does not repeat itself, but precedents always knock at the door during a crisis. Ireland saw its youth smoking rate decline, and many viewed that as a victory. Then vapes appeared and reversed the balance. The United Kingdom once expected vapes to be a harm-reduction tool for adult smokers, but young people used them as a starting point. Do not let Vietnam pay the price with a generation of athletes who forever remain just “promising” because of flavoured chemical clouds rising from the locker room. It is time to look at vaping through the pragmatic eyes of an analyst: check, verify, and act before every indicator falls below the alarm line.