Recent studies highlight how selective reporting and omitted context can distort evidence, fueling misinformation that undermines life saving harm reduction strategies.
A recent study published in PLOS Mental Health has reignited discussions about youth tobacco use and mental health. It reported that teens who use any form of tobacco (the accurate term here would have been nicotine) including vapes, traditional cigarettes, and so forth—are significantly more likely to report symptoms of depression and anxiety than those who don’t use these products. The research team concluded that the risk was highest among adolescents who used both traditional tobacco and vapes (dual users).
The research, based on over 60,000 responses from the 2021–2023 U.S. National Youth Tobacco Survey, revealed that around 21% of students reported using some form of tobacco. Of these, nearly 10% used only e-cigarettes, about 4% used only conventional tobacco, and nearly 8% were dual users. Over a quarter of all respondents reported depressive symptoms, and close to 30% reported anxiety.
When science misleads
Yet, while the alleged findings are concerning, the fact that the resarchers are implying a causation where highly likely there is none, is highly damaging. The findings do not prove that nicotine use causes mental health issues. In fact, it is highly plausible that teens already suffering from depression or anxiety may be turning to nicotine in an attempt to self-medicate. In fact, this has been shown in previous studies but was noticeably absent from the PLOS paper’s discussion—an omission that contributes to a growing trend of skewed narratives surrounding vaping.
Unfortunately, this isn’t the only recent example of how scientific findings can be interpreted in ways that reinforce public fear, rather than offer clarity. A systematic review just published in npj Primary Care Respiratory Medicine claimed a link between vaping and an increased risk of COPD (chronic obstructive pulmonary disease). This meta-analysis pulled data from over 4.3 million adults across 17 studies and concluded that people who currently or formerly used vapes had a 48% to 84% greater chance of having COPD, compared to those who never used them.
However, this conclusion falls apart under closer inspection. The vast majority of the studies in the analysis relied on self-reported COPD diagnoses rather than objective clinical tests like spirometry. When only the two studies that used spirometry were considered, the link between vaping and COPD was no longer statistically significant. To add insult to injury, most participants had a history of smoking—an established cause of COPD—which likely confounded the results, making it clear that the existance of COPD was likely caused by any previous smoking.
How misinterpretation fuels the vaping debate
This kind of fear-based interpretation is a perfect example of what fuels the ongoing misinformation about vaping, and echoes previous misleading omissions around the 2019–2020 outbreak of EVALI (E-cigarette or Vaping Associated Lung Injury). Though initially attributed to vaping in general, the U.S. Centers for Disease Control and Prevention (CDC) later confirmed that the condition was caused by vitamin E acetate found in illicit THC vaping cartridges—not regulated nicotine products. Yet, years later, some studies still misattribute EVALI to general vaping.
A 2022 case report about a 25-year-old male who suffered from EVALI made no mention that his condition was linked to THC vaping, misleading readers to believe that regular nicotine vapes were to blame. The study’s conclusion even suggested discouraging all adolescent vaping, regardless of the substance involved—an approach that risks further entrenching misconceptions.
Tobacco harm reduction experts have repeatedly emphasized that regulated nicotine vapes were never linked to EVALI. In a study published in Drug and Alcohol Review, Australian smoking cessation expert Dr. Colin Mendelsohn had stated that no verified cases of EVALI had ever been tied to legal nicotine vaping products. These findings are supported by additional research showing that states with legal cannabis markets had lower EVALI rates—likely due to reduced black-market purchases of contaminated products.
The real evidence
So why does this matter for harm reduction? Because when fear clouds facts, smokers lose access to tools that could save their lives. For example, new research from the University of Catania’s CoEHAR (Center of Excellence for the Acceleration of Harm Reduction) found that smokers who switched to either e-cigarettes or heated tobacco products (HTPs) experienced measurable improvements in aerobic capacity within just four weeks.
Participants in the study, published in Scientific Reports, were tested for VO₂ max—a key indicator of cardiovascular fitness. Those who reduced or completely switched from smoking saw a 3% to 6% improvement in oxygen use during exercise. These benefits are thought to result from reduced exposure to harmful combustion byproducts like carbon monoxide.
Importantly, these gains were not exclusive to e-cigarette users; HTP users saw similar improvements. This supports the idea that the real harm lies in combustion, not nicotine. For younger adults and fitness-conscious smokers, these fast, tangible health improvements may serve as a powerful motivator to quit smoking using safer alternatives.
Separating data from distortion
As the science evolves, one message remains clear: nicotine products are not all created equal. Combustible cigarettes are far more harmful than modern alternatives like vapes and HTPs. Yet misleading headlines, incomplete research reporting, and fear-driven policies continue to muddy the waters—making it harder for adult smokers to access less harmful options while doing little to protect youth.
There is broad consensus in the harm reduction community that adolescents should not use any nicotine products. But that doesn’t justify restricting adult access to tools that can dramatically reduce smoking-related harm. Instead, what’s needed is clear, evidence-based communication that distinguishes between youth prevention and adult harm reduction.
It’s time to stop letting incomplete data and outdated fears drive public health decisions. Adults deserve access to safer alternatives, and teens deserve honest education—not alarmist rhetoric. Only with a balanced, science-based approach can we truly reduce the burden of smoking-related disease.