Reacción a "Vaping among young people is associated with higher subsequent consumption of tobacco, marijuana or alcohol"

The article presents solid and rigorous work, befitting publication in a high-impact journal such as Tobacco Control. Its umbrella review format, including 56 systematic reviews and meta-analyses, gives it great methodological strength in synthesising a large body of evidence. Although it is acknowledged that many of the primary studies are observational and that many of the reviews included are of low quality according to AMSTAR-2, the consistency of the findings and the relevance of the topic to global public health reinforce the validity and relevance of the work. Overall, this is a high-quality scientific article with a direct impact on the current debate on youth vaping regulation.

The study confirms and expands the existing evidence on the risks of vaping in young people. Although partial reviews had already been published, this is the first umbrella review focused exclusively on young people and a wide range of outcomes (physical and mental), representing a novel and necessary contribution. The findings are consistent with previous theories such as the ‘gateway’ effect to smoking and other substances, and add relevant data on mental health (risk of depression, suicidal ideation and behaviour), fertility, oral health and injuries.

In terms of implications, the results strongly support the need to strengthen regulatory policies: limiting the sale and advertising of e-cigarettes to minors, controlling designs that are attractive to adolescents, and increasing prevention and counter-marketing campaigns against industry strategies. The fact that the findings are published in a leading journal gives them even more weight for consideration in the formulation of international public health policies.

[Regarding possible limitations], the article itself acknowledges several:

• The methodological quality of the included reviews is mostly low or critically low, which limits the robustness of the conclusions.
• The predominance of observational studies makes it difficult to establish definitive causality, although the consistency of the associations suggests a probable link.
• There is heterogeneity in populations, exposure measures and outcomes, which may influence the reported effect sizes.
• Some areas (such as cardiovascular effects, addiction, neurodevelopment or fertility) still have little evidence and require further longitudinal research.

Even so, these limitations do not invalidate the central message: vaping among young people is clearly associated with multiple risks, and health authorities must act accordingly.