Vaping appears to act as a gateway to cigarette smoking among young people, a new evidence review says.

E-cigarettes also were significantly linked to risk of asthma and substance use, researchers reported Aug. 19 in the journal Tobacco Control.

“The consistency in the evidence is striking,” said lead researcher Su Golder, an associate professor in health science at the University of York in the U.K. 

“Across multiple studies, young people who use e-cigarettes are more likely to smoke in the future,” she said in a news release. “These findings support stronger public health measures to protect teens from the risks associated with vaping.”

For the new paper, researchers pooled data from 56 prior reviews of research regarding vaping.

The results show that vaping increases risk of taking up smoking, with risk estimates ranging from 50% to 26-fold higher, researchers said.

Most reviews found that young people who vape are about three times more likely to start smoking, compared to those who don’t vape, the paper says.

The new analysis also linked vaping to substance use, including:

• Nearly triple to sixfold greater odds of marijuana use.

• 4.5 to more than sixfold increased risk of drinking.

• 4.5 to nearly sevenfold increased risk of binge drinking.

Vapers also had a 20% to 36% increased risk of asthma, with a 44% higher risk of worsening asthma symptoms, researchers reported.

“Our review provides the most comprehensive picture to date on the range of risks vaping poses to young people,” researcher Greg Hartwell said in a news release. He’s a clinical assistant professor at the London School of Hygiene & Tropical Medicine.

“In particular, we found consistent evidence around transitions to smoking which of course, in turn, opens the door to the multitude of harms that conventional cigarettes bring,” Hartwell added.

The results support measures to restrict the sales and marketing of e-cigarettes to young people, researchers concluded.

“Such efforts may form part of a wider set of measures to restrict harms, including raising the public’s and young people’s awareness of these harms, and counter-marketing to raise public and policy awareness of the marketing and strategies that e-cigarette companies have targeted at children and young people,” researchers wrote.