New HRB evidence shows e-cigarettes are associated with adolescents starting to smoke tobacco cigarettes

A Health Research Board (HRB) review into e-cigarette use has found that e-cigarettes are associated with adolescents starting to smoke tobacco cigarettes, which could potentially lead to serious harm.

It shows that those adolescents who had ever used an e-cigarette were between three and five times more likely to start smoking compared to those who never used e-cigarettes.

Key findings reported by the HRB include:

  • E-cigarettes are no more effective than approved and regulated nicotine replacement therapies (NRTs) to help people stop smoking. However, e-cigarettes as a smoking cessation device are not regulated or approved and their safety beyond 12 months is not yet known
  • Adolescents who use e-cigarettes are three to five times more likely to start smoking tobacco cigarettes compared to those who never used e-cigarettes
  • E-cigarettes acute effects include poisonings, burns, blast injuries, lung injury and asthmatic attacks. Some of the chemicals in e-cigarettes are thought to cause tissue and cell damage and some are agents that may cause cancer in the long-term. The long-term health effects beyond 24 months are not researched
  • Dual use of both e-cigarettes and conventional tobacco cigarettes wasn’t less harmful than smoking tobacco cigarettes alone, which raises questions about the smoking reduction benefit of e-cigarettes.

The HRB conducted this review to help inform the Department of Health’s policy position in relation to e-cigarettes; in particular with regard to e-cigarettes as part of a harm reduction strategy in relation to tobacco.

Dr Jean Long, Head of the Evidence Centre at the Health Research Board said;

“HRB evidence shows e-cigarettes are no more effective than approved and regulated nicotine replacement therapy to help people stop smoking. They can cause harms including burns, poisonings and lung injuries. Our findings also highlight that e-cigarettes have the potential to negatively impact on the health of adolescents, leaving them more likely to initiate tobacco smoking. These factors would have to be considered as part of any smoking harm reduction strategy.”

“Our findings highlight that it is important more is done to promote NRT and protect the health of adolescents and vulnerable groups before considering the role of unregulated e-cigarettes as a harm reduction approach.”

Chief Executive of the Health Research Board, Dr Mairéad O’Driscoll, said;

“Independent and credible evidence is vital to help inform policy decisions. This HRB review is already informing forthcoming HSE good practice guidelines to help people stop smoking and these will take into consideration the place of the e-cigarette when trying to stop smoking. The Department of Health have also prepared legislation which will look at licensing of retail outlets and banning e-cigarettes for young people under 18 years of age.” 


Dr Jean Long, Head of the HRB Evidence Centre and Joan Quigley, Research Officer at the HRB Evidence Centre are available for interview in relation to the E-cigarettes evidence review.

For further information please contact Aileen Gaskin / 087 7724 717 or Robyn Keleghan / 085 8001 275. 

Editors Notes 

The three reports which were used to inform this overall evidence review of E-cigarettes are available on request. 

What is an e-cigarette? 

  • An e-cigarette is an umbrella term for an electronic device that delivers nicotine and other products including flavourings
  • E-cigarettes are battery-operated devices with an element and a tank for e-liquid that is heated to allow people to inhale an aerosol
  • The aerosol arising from the carrier solvents (humectants) typically (although not always) contains nicotine, flavourings, and other chemicals (metals and volatile organic compounds)
  • Other terms used to identify e-cigarettes include e-vaporisers, or electronic nicotine delivery systems (ENDS), e-hookahs, hookah pens, vapers, vape pens, and mods (short for modifiable devices)
  • Mods are customisable e-cigarettes and contain more powerful vaporisers than earlier e-cigarette models
  • Although there are variations in the appearance of e-cigarettes, the National Institute on Drug Abuse has reported that regardless of their design and appearance, the devices generally operate in a similar manner and are made of similar components.

How many people use e-cigarettes in Ireland? 

The Health Ireland survey* for 2019 shows that:

  • 5% of the population use e-cigarettes and a further 12% have tried them at some point
  • Use is higher in more deprived areas (7%), than in more affluent areas (4%)
  • 10% of current smokers use e-cigarettes, with 13% of ex-smokers using them
  • 38% of those who made an attempt to quit smoking used e-cigarettes during this attempt
  • 25% of those aged between 25 and 34 have tried e-cigarettes, with 8% currently using them
  • 20% of men have tried e-cigarettes compared to 14% of women
  • 5% of men and 3% of women currently use e-cigarettes.

A Health Behaviour in School Children survey found that e-cigarette use is about twice as common as tobacco smoking:

  • More than one in five of 12 to 17 year-old children report that they have ever used e-cigarettes
  • Boys (one-in four or 26%) are more likely than girls (under one-in-five or 18%) to report that they have ever used e-cigarettes. 

How many people use e-cigarettes in Europe and the USA? 

  • A study based on Eurobarometer surveys reported that 63 million (or 14.6%) of people living in European Union member states aged 15 or older had ever used e-cigarettes by 2017 and 7.6 million (or 1.8%) were regular e-cigarette users
  • Never smokers were less likely to be regular e-cigarette users than current and former smokers
  • In the USA, the self-reported prevalence of current e-cigarette use among adults was 3.2% in 2018
  • For young adults aged 18-24 years in the USA, the prevalence of current e-cigarette use was more than double at 7.6%. 

Tobacco smoking in Ireland: people aged 15 years and over  

The results for 2019 Healthy Ireland survey* show that:

  • Smoking has declined from 23% in 2015 to 17% in 2019
  • 17% of respondents are current smokers. 14% smoke daily and 3% smoke occasionally
  • Men are more likely to smoke than women. 19% of men are current smokers, compared to 16% of women
  • Smoking rates are highest among those aged 25 to 34. 26% of this age group are current smokers
  • Smoking rates are higher in more disadvantaged areas (24%) than in more affluent areas (14%)
  • Smoking rates are also higher for those who are unemployed (40%) and those with no third level education (20%), than they are for those in employment (18%) and those with degree level education (11%)
  • 28% of respondents are ex-smokers.

*The 2019 Healthy Ireland survey involved 7,413 interviews conducted with a representative sample of the population aged 15 and older living in Ireland.

About the Health Research Board 

The HRB is the lead funding agency for health research in Ireland. It oversees a €50 million investment in health research activity each year and manages a funding portfolio of more than €200 million. The organisation produces evidence reviews for the Department of Health to inform health policy making and manages four national health information systems as well as the HRB National Drug Library.

We want the research that we fund and the evidence we generate to:

  • deliver real benefits for people's health
  • transform the way healthcare is delivered
  • provide information and evidence that informs decisions about health care
  • advance health research and data infrastructure
  • generate economic returns through healthcare innovation and economic development