While traditional cigarette smoking has dropped, overall nicotine exposure is shifting toward alternative products such as e-cigarettes, with youth starting at earlier ages.
RT’s Three Key Takeaways:
- Changing Nicotine Patterns: While traditional cigarette smoking has dropped, overall nicotine exposure is shifting toward alternative products such as e-cigarettes, with youth starting at earlier ages.
- Direct Entry via Vaping: In an Irish study of adolescents, the proportion of teenagers who began vaping without ever smoking conventional cigarettes climbed from 50.2% in 2015 to 76.2% in 2024.
- Rise in Dual Product Use: Long-term Austrian data found dual use of cigarettes and alternative nicotine products surged from 5.2% to 18.3%, presenting new challenges for respiratory clinicians and tobacco cessation efforts.
Although cigarette smoking rates have declined in recent years, young people are initiating nicotine use at earlier ages, and e-cigarette use has risen sharply, according to data from three large studies presented at ERS 2026.
The findings indicate that while public healthcare campaigns have reduced conventional cigarette smoking, nicotine addiction continues to spread through alternative delivery methods, including vapes, heated tobacco products, shisha, and nicotine pouches.
Austria: Earlier Initiation and Rising Dual Use
In the first study, researchers evaluated tobacco and nicotine habits among 15,056 Austrian individuals aged six to 82 years between 2012 and 2024, according to findings presented by Dr Charmaine Helk-Lim from the Ludwig Boltzmann Institute for Lung Health and Sigmund Freud Private University in Vienna, Austria.
Over the 12-year study period, cigarette smoking declined from 24.2% to 16.3%. However, use of alternative nicotine products increased from 0% to 17.2%, and concurrent use of multiple products grew from 5.2% to 18.3%. The data also revealed that the average age of smoking initiation dropped from 20 years among participants born in the 1930s to approximately 15 years for those born in the 2000s, while smoking among individuals younger than 18 years nearly doubled from 2.6% to 5.0%.
“The decrease in smoking conceals a broader nicotine problem. The epidemic isn’t shrinking; it’s changing shape and reaching children younger than it used to,” said Dr Charmaine Helk-Lim, researcher at the Ludwig Boltzmann Institute for Lung Health and Sigmund Freud Private University. “This appears to be a global pattern, not just an Austrian one, and it can create a false impression that today’s youth are safer from nicotine than in the past, when in reality many are being exposed earlier and through different products.”
Helk-Lim emphasized that early initiation makes cessation far more difficult later in life, urging healthcare professionals and families to address all nicotine products before adolescence.
Ireland: Vaping Becomes Primary Nicotine Gateway
A second investigation, led by professor Joan Hanafin of the TobaccoFree Research Institute Ireland and presented by Salome Sunday, evaluated 5,265 Irish adolescents aged 15 to 16 years across 2015, 2019, and 2024.
The researchers found that smoking prevalence among this cohort dropped from 13.9% in 2015 to 11.7% in 2024, following a peak of 14.4% in 2019. In contrast, vaping increased from 10.1% in 2015 to 15.7% in 2024, after peaking at 18.1% in 2019. Notably, the proportion of adolescent vapers who took up e-cigarettes without prior cigarette use increased from 50.2% in 2015 to 76.2% in 2024.
“Nicotine use among young people is changing rapidly. Although smoking in some age groups has declined over the long term, young people are increasingly using a wider range of nicotine products, leading to an overall increase in nicotine use and highlighting the need to monitor overall nicotine use rather than individual products alone,” said Salome Sunday, researcher at the TobaccoFree Research Institute Ireland.
A related longitudinal study presented by professor Luke Clancy followed 3,380 individuals from age 13 to 25. The analysis showed that both smoking and vaping increased into early adulthood, reaching 38% for e-cigarette use and 25% for smoking by age 25. Participants who had never vaped were the least likely to smoke cigarettes at age 25.
Implications for Respiratory Care and Prevention
The transition toward alternative nicotine delivery systems creates significant concerns for long-term cardiopulmonary outcomes, according to respiratory specialists.
“Nicotine is highly addictive and it has taken decades for research on the harms of cigarettes to translate into a long-term decline in smoking. E-cigarettes have only become widely available over the last ten to 15 years, but research has already shown that vaping is harmful to the lungs and cardiovascular health,” said Dr Filippos Filippidis, chair of the European Respiratory Society’s Tobacco Control Committee from Imperial College London.
Filippidis noted that rising dual use complicates quitting efforts and could jeopardize decades of public healthcare progress, underscoring the need for clinical interventions and regulatory measures that target all nicotine products simultaneously.
