Introduction
The COVID-19 pandemic brought sweeping changes to daily life, schooling, family dynamics, and stress levels for adolescents worldwide. These disruptions intersected with tobacco and nicotine use in complex ways, potentially affecting smoking initiation, cessation, and addiction trajectories. This article synthesizes evidence from a scoping review that maps what is known about how the pandemic environment—lockdowns, remote schooling, social isolation, and shifts in health services—has influenced adolescent smoking and vaping behaviors. Understanding these patterns is crucial for designing timely prevention and cessation interventions that address both behavioral and mental health needs in youth.
Methods
This article draws on a scoping review of studies examining smoking and nicotine use among adolescents during the COVID-19 era. The included literature encompasses cross‑sectional surveys, longitudinal cohorts, qualitative studies, and policy analyses published from 2020 onward. Key outcomes include smoking initiation, cessation, relapse, and the use of electronic cigarettes or vaping devices. Studies from diverse geographic regions were considered to capture variations in pandemic responses, lockdown severity, school reopening, and product regulation. As a scoping review, the goal is to map existing evidence, identify gaps, and highlight factors that may moderate pandemic effects on youth tobacco use rather than perform a meta‑analysis of effect sizes.
Key findings
Initiation of smoking among adolescents
Evidence on new smoking initiation during the pandemic is mixed. In some regions, reduced social contact and school-based exposure appeared to lower traditional cigarette initiation among early adolescents, as peer influence and routine in-person activities waned. Conversely, elevated stress, anxiety, and increased time spent online were linked to higher uptake of nicotine products in other contexts, particularly vaping. The rise of online marketing and easy access to e-cigarettes in certain markets may have offset declines in conventional cigarette exposure, contributing to initiation through alternative nicotine pathways.
Cessation and relapse
Several studies noted that the pandemic disrupted cessation efforts. For some youths, remote health services, telemedicine, and family support facilitated quit attempts, especially when motivation aligned with concerns about respiratory health during COVID‑19. However, ongoing mental health burdens—depression, loneliness, and stress—created relapses or sustained nicotine use for others. Accessibility to cessation resources varied by country and region, with disparities evident across socioeconomic groups and urban–rural divides.
Nicotine use patterns and access
Patterns of nicotine use shifted during the pandemic. Vaping surged in certain cohorts, potentially fueled by greater online availability, perceived lower health risks, and a lack of structured school-day monitoring. In contrast, some adolescents reported decreased use of combustible cigarettes due to reduced peer gatherings and limited social incentives. Access to products fluctuated with lockdowns: some regions restricted in-person sales, while others maintained or expanded online channels. Economic stress and family smoking environments also influenced adolescent exposure and usage, underscoring the role of home context in shaping nicotine trajectories.
Policy and environmental factors
Public health policies during the pandemic—such as school closures, stay-at-home orders, and restrictions on point-of-sale tobacco venues—created a changing risk environment for youths. The degree of impact depended on local enforcement, product regulations (including vaping devices), and the availability of youth-targeted cessation programs. Messages about respiratory health may have raised awareness of smoking risks, yet inconsistent messaging and variable access to services likely contributed to heterogeneous outcomes across populations.
Gaps and limitations
Many studies relied on self-reported data collected during short time frames, limiting causal inferences about the pandemic’s impact. Heterogeneity in age ranges, definitions of smoking and vaping, and study designs complicates synthesis. Longitudinal data capturing post-pandemic trends are needed to understand persistence or reversal of early pandemic effects on adolescent tobacco use. There is also a need for more research in lower-resource settings and among marginalized youth to address equity concerns.
Implications for public health
Findings suggest targeted, youth-centered prevention and cessation strategies are essential as societies recover from the pandemic. Integrating mental health support with tobacco cessation, expanding telehealth access, and maintaining robust school-based prevention programs can help deter initiation and support quitting. Regulatory actions to limit youth access to vaping products, combined with clear public health messaging about respiratory risks, may further reduce adolescent nicotine use in the wake of COVID‑19.
Conclusion
The COVID-19 pandemic produced nuanced and sometimes competing effects on adolescent smoking and vaping. While some youths avoided new initiation through reduced social contact, others faced heightened risk through stress and online exposure. Ongoing, equitable surveillance and tailored interventions are essential to safeguard adolescent health and prevent a lasting rise in nicotine dependence as the world moves beyond the pandemic.
