Nicotine vaping among UK adolescents: A systematic review and meta-analysis

Adolescent nicotine vaping has escalated in the UK despite its regulatory positioning for adult harm reduction. This review synthesizes evidence on prevalence, inequalities, initiation, and gateway dynamics among UK adolescents ≤18 years. Following PRISMA 2020, we searched seven databases (2015-2025) and grey literature. Two reviewers screened 2,847 records, identifying 42 studies (n=18,196). Quantitative synthesis used random-effects meta-analysis; qualitative data underwent thematic synthesis mapped to the Theoretical Domains Framework. GRADE assessed evidence certainty. Pooled ever-use among 11-17 year-olds was 17.4% (95% CI: 15.2-19.8%; Wales 22.1%, Scotland 19.8%, England 14.2%). Current use was 7.6%, regular use 5.8%, and 8.9% of never-smokers had experimented. Prevalence peaked in 2023 (20.8%) before declining. Socioeconomic inequalities were marked (most vs. least deprived OR=3.7; maternal smoking OR=12.4). Thematic synthesis identified social influences (42.1%) and disposable accessibility (27.8%) as primary initiation drivers. Disposable device use among English youth vapers surged from 8.6% (2017) to 83.2% (2023). Among never-smokers, the vaping-to-smoking transition showed a pooled HR of 2.8 (95% CI: 1.9-4.1). GRADE certainty was moderate for prevalence/inequalities and low for gateway effects. UK adolescent vaping shows stabilized but elevated prevalence with profound socioeconomic gradients and plausible gateway effects. The rapid disposable device transition highlights commercial innovation outpacing regulation. Findings underscore the need for post-ban surveillance, targeted interventions for disadvantaged communities, and validated cessation support.