Introduction
Worldwide, the COVID-19 pandemic reshaped adolescent health and risky behaviors, including tobacco use. Lockdowns, remote schooling, and social distancing altered peer influence, access to products, and stress levels—factors likely to affect smoking initiation, cessation, and nicotine dependence among youths. This article summarizes a scoping review that maps what is known about how the pandemic influenced adolescent smoking, including conventional cigarettes and vaping, across different settings and populations.
Methods
The scoping review synthesized observational surveys, administrative data, and qualitative studies from multiple countries that reported on adolescent smoking or nicotine use during the pandemic. We looked for outcomes related to initiation, cessation, quit attempts, and patterns of use, and we noted study quality and context to explain divergent results.
Key findings
Smoking initiation during COVID-19
Evidence is mixed. In some contexts, reduced in-person social interactions and school closures limited opportunities to experiment with smoking, contributing to lower initiation in certain school-based samples. In other regions, pandemic-related stress, parental smoking at home, and increased exposure to online marketing or digital peer groups appeared to be associated with higher initiation or experimentation. The overall signal depends on policy environment, local tobacco control measures, and the timing of lockdowns.
Cessation and quit attempts
Several cohorts reported increased quit attempts or temporary cessation during waves of the pandemic, driven by heightened health risk awareness and parental oversight. However, pandemic stress, mood disorders, and reduced access to in-person cessation services sometimes hindered sustained quitting. Digital cessation supports, telehealth, and school-based outreach helped some youths maintain cessation, though access disparities remained a barrier for disadvantaged groups.
Vaping and dual use
Adolescent nicotine use patterns often shifted toward vaping or dual use with cigarettes in some settings, while others observed declines. The relative affordability, perceived lower health risk, and targeted online marketing could sustain vaping uptake during periods of social isolation. Differences across countries reflected regulatory environments and youth-targeted marketing restrictions.
Access to resources and health services
The pandemic accelerated the adoption of telehealth and online resources for quit support, but school closures and service disruptions limited face-to-face counseling. Digital divides, privacy concerns at home, and confidentiality challenges affected adolescents’ willingness to seek help. Public health systems responded with hotlines, mobile apps, and remote counseling in many regions, with variable reach.
Disparities and determinants
Socioeconomic status, gender, race/ethnicity, geography, and family dynamics shaped how adolescents experienced tobacco use during the pandemic. Youths with higher exposure to stress, lower access to health care, or living in households with tobacco exposure faced greater risk for initiation or relapse. Conversely, some groups benefited from stronger family support and targeted public health messaging. The evidence underscores the need for equity-focused prevention and cessation strategies.
Policy implications and prevention strategies
To address evolving tobacco use among adolescents in a post-pandemic world, policymakers should invest in youth-friendly cessation services (including confidential digital options), integrate mental health support with tobacco prevention, and sustain school- and community-based programs. Equitable access to telemedicine, data monitoring, and culturally tailored messaging will help reduce initiation and support cessation across diverse populations.
Gaps and future research
Many studies rely on cross-sectional designs with short follow-up. Longitudinal data, standardized measures of smoking and vaping, and cross-country comparisons are needed to understand lasting effects and to identify which interventions are most effective during and after public health crises.
Conclusion
The COVID-19 pandemic has produced a complex, context-dependent pattern of changes in adolescent smoking and nicotine use. A scoping review reveals mixed signals: some youths reduced or paused smoking, others started or persisted with vaping or dual use. Ongoing surveillance, equitable access to cessation support, and targeted prevention are essential to mitigate future harms and inform resilient public health responses.
