"Permanent Scars on Children's Bodies"? Confronting the Hidden Threats of E-Cigarettes — Doctors Concerned About the Impact of E-Cigarettes on the "Brain and Heart"

Prologue: Beyond the White Steam

School toilets and school routes. The sweet scent and white steam are no longer an unusual sight.Electronic cigarettes (VAPE) have spread as a sophisticated gadget that is too refined for minors to handle, under the understanding that they are "safer than traditional cigarettes." However, “safe” does not apply to minors—such a strong warning was sounded at the European Society of Cardiology (ESC) Annual Congress held in Madrid on September 1, 2025. According to a report by The Guardian, cardiologists and researchers expressed concern about the long-term effects on the hearts and brains of young people, using terms like "irreversible harm."The Guardian

What's the Problem: The "Incomplete Organs" of the Brain and Heart

There are two main points of concern. First is the exposure to high-concentration nicotine. Adolescence is a time when neural circuits are pruned and rewired, and nicotine, which strongly stimulates the reward system, can leave long-term distortions in dependency formation and attention/emotional regulation. Second is the acute and chronic stress on the cardiovascular system. Specialists report that VAPE use can lead to increased heart rate, blood vessel constriction, and progression of arterial stiffness, potentially raising the risk of high blood pressure, arrhythmia, and stroke. Furthermore, harmful chemicals such as formaldehyde and acetaldehyde are released from the liquid heated at high temperatures, damaging the vascular endothelium and driving inflammation. Although long-term data is limited, doctors advocate for the application of the precautionary principle.The Guardian

Current State of Evidence: What is Known and What is Uncertain

Research accumulation is progressing. An analysis in NEJM Evidence shows that there are a considerable number of epidemiological studies indicating higher odds of stroke and cardiovascular disease among e-cigarette users, although the strength of causation varies. Many areas, centered on observational studies, cannot completely eliminate the influence of confounding factors. In other words, it is certain that "it is not completely safe," but the work of quantifying "how dangerous it is" based on age, usage frequency, and product characteristics is ongoing. For minors, due to their stage of brain development, there is medical rationality in applying preventively stricter standards than for adults.Evidence

Policy Movements: Ban on Disposable VAPE and "Smoke-Free Generation"

The UK has completely banned the sale of disposable VAPE from June 1, 2025. In addition to environmental impact, the high appeal of flavors and convenience to young people was targeted. In parallel, the Tobacco and Vapes Bill is progressing as a large-scale bill including further strengthening of sales and advertising regulations, and a lifetime ban on tobacco sales to those born after 2009 (the so-called "smoke-free generation"). In countries including Japan, restrictions on flavors, labeling, advertising, and stricter age verification will likely become points of contention in the future.

Reality: VAPE "Too Close" to Young People

According to a youth survey compiled by the UK's **ASH (Action on Smoking and Health)**, 20% of 11 to 17-year-olds have tried VAPE at least once, and **current use is about 7% (estimated 400,000 people)**.Regular use is also at a significant scale, with motivations including the appeal of flavors and design, ease of acquisition, and stress management. The WHO warns that many countries are still lagging in regulatory and legal frameworks for purchase age, making it difficult to protect minors due to international discrepancies.

Recent Research Topic: "Leap" from VAPE to Smoking

A large-scale review reported in late August showed a consistent association that young VAPE users have about three times the odds of transitioning to cigarette smoking. Although there are limitations to observational studies, it strongly suggests the possibility that minors' use deviating from "smoking cessation aid" is linked to future smoking and respiratory symptoms. The realistic line is to **"limit VAPE to support adult smokers' cessation and zero tolerance for minors."**

SNS Reactions: Polarization into Support, Skepticism, and Realism

The Guardian's report spread on SNS as well. Starting with a post by the article's journalist (Andrew Gregory), it was shared by public health organizations like ASH and educational accounts, spreading voices in favor of strengthening regulations. On the other hand, from the perspective of harm reduction, there were notable counterarguments that it is "a narrative that incites fear." On the bulletin board Reddit, the top comments were realistic arguments such as "We should not deny the effectiveness of adult smoking cessation support" and "First, block minors' access." Social consensus is still halfway there. Reddit

Misunderstandings and Pitfalls: Avoiding a Binary Opposition

Falling into a binary choice of "more harmful or harmless than cigarettes" will lead to failure in measures for minors. What is important is,

• positioning as smoking cessation support for adult smokers (accompaniment by medical professionals, management of products, concentrations, and duration) and,

• complete exclusion of minors (control of sales, advertising, flavors, and online distribution)
  through simultaneous policy design. The US CDC also clearly states that **"there are no tobacco products safe for young people."**

Five Actions to Take Now (For Parents, Schools, and Municipalities)

1. Know the Actual Products: Understand the "clues" such as devices, pods, smells, and chargers. Also observe entry and exit patterns and unusual toilet use within the school.

2. Start a Dialogue: Instead of starting with complete denial, listen to the background of stress management and peer pressure. Do not overlook signs of dependency (irritability, difficulty concentrating, sleep disorders).

3. Update School Regulations: Establish VAPE-specific provisions (prohibition of possession, use, solicitation, and support protocols for violations) and clarify collaboration routes between the health room, local medical care, and parents.

4. Block Sales Channels: Conduct local retail audits, on-site inspections of online age verification, and request corrections for flavor labeling. Refer to the effectiveness of supply-side measures like the UK's ban on disposables.

5. Dependency Support: Introduce school-based nicotine cessation programs, behavioral therapy, and stress coping, and refer to specialized medical care as needed.

Conclusion: What Children Need is "Clean Air"

Electronic cigarettes have room to be useful in the limited context of supporting adult smoking cessation. However, there is zero benefit for minors, and the potential risks are not small. The warning from doctors in Madrid highlights the reality that "the health lost while waiting for long-term data cannot be regained." It is time for families, schools, healthcare, administration, and platforms to take concrete actions in their respective roles.The Guardian

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