E-cigarettes and Smoke-Free Nicotine, and Later Mental Illness, Tobacco Smoking, or Other Substance Use

Human and animal data show that youth nicotine exposure causes permanent brain changes and raises mental illness risk, including addiction to nicotine and other drugs. E-cigarettes (EC) and nicotine pouches (NP) are associated with subsequent tobacco smoking, and vice versa, but whether these links are mainly causal or due to common liability remains debated. Use of EC and NP is negatively correlated with tobacco use. Some studies suggest EC and NP add harm; others suggest they reduce harm. This review finds that misinterpreting data can lead to regulations that fail to improve public health.