A Thailand-based study found that young adults who used e-cigarettes were significantly more likely to be at risk of cognitive decline, adding new concern to the debate over whether vaping is really a safer alternative.
Study: The effect of e-cigarette use on cognition, emotional intelligence and risk of dementia in adolescents and young adults. Image credit: Hazem.m.kamal / Shutterstock
In a recent study published in the journal Scientific Reportsa group of researchers evaluated the relationship between e-cigarette use and cognitive impairment, emotional intelligence, and attention-deficit/hyperactivity disorder (ADHD) trend of symptoms in young adults.
Neurocognitive concerns surrounding vaping in young adults
What if a habit considered “safer than smoking” is quietly affecting the way the brain thinks, feels and remembers? The growing popularity of electronic cigarettes, also known as electronic nicotine delivery systems (IT’S OVER), in youth and adolescent populations has caused worldwide concern.
Nicotine exposure during critical developmental years can affect brain maturation, affecting attention, emotional regulation, and long-term cognitive health.
Conditions like ADHD and the risk of early cognitive decline are particularly important in this age group. Currently, there is limited and inconsistent research on the relationship between IT’S OVER and these neurocognitive outcomes.
Further research is needed to clarify these relationships and inform public health policies.
Thai e-cigarette study design
A cross-sectional analytic study was conducted between August 2023 and July 2024 in Lat Krabang district, Bangkok, Thailand. In the study, 232 participants, aged 18-25, were equally divided into e-cigarette users and non-smokers (n = 116 each). Systematic random sampling was used to select participants based on predefined inclusion and exclusion criteria to ensure comparability between groups.
Structured questionnaires and validated instruments were used to collect data from participants. The Adult ADHD Self-Report Scale (ASRS) version 1.1 was used for determination ADHD trend of symptoms.
Emotional intelligence was measured with a standardized Emotional Quotient test that assessed self-regulation, empathy, motivation, and interpersonal skills. The Montreal Cognitive Assessment (MoCA), a well-validated screening instrument to detect early cognitive decline, was used to assess cognitive function and risk of cognitive decline.
Demographic data, substance use, and e-cigarette use were also recorded for this study. All statistical analyzes were performed using IBM SPSS version 29 and group differences were assessed using Pearson’s Chi-square test.
Binary logistic regression analysis was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for dementia risk predictor variables and statistically significant results were set at p < 0.05. Ethical approval and informed consent was obtained before data collection began.
ADHD, Emotional Intelligence and Cognitive Findings
The study included 232 young adults with an average age of about 22. Most participants were college students (53.9% female), among whom alcohol use was common but drug use was low. Almost half reported having a family member who smoked, indicating possible environmental exposure to nicotine-related behaviors.
The majority of e-cigarette users reported moderate use, meaning most smoked one or fewer e-cigarette devices per day. Most began in late adolescence, often motivated by curiosity, perceived reduced harm, and social influences. Social and contextual influences played a role, with many participants using e-cigarettes on nights out or in social settings, highlighting the importance of peer environments in perpetuating patterns of use.
Analysis of ADHD symptom trend showed that approximately 10-11% of participants experienced symptoms according to ADHD. It was observed that e-cigarette users and non-smokers showed no significant difference in attention-related symptoms and this suggests that, in this group, vaping is not strongly associated with attention-related issues.
Levels of emotional intelligence were generally within the normal range, but both groups showed lower than expected levels of empathy, decision-making, interpersonal relationships and emotional well-being.
Comparisons between e-cigarette users and non-smokers revealed no statistically significant correlations between the ‘Good’, ‘Able’ and ‘Well-being’ dimensions of emotional intelligence. Although small differences were observed, these patterns likely reflect social or contextual influences rather than direct effects of e-cigarette use.
E-cigarette use and risk of cognitive impairment
The risk of developing dementia was significantly increased for those who used e-cigarettes. A significantly higher proportion of e-cigarette users (39.7%) were classified as at risk for cognitive impairment compared to non-smokers (0.9%) (p < 0.001).
A series of additional analyzes confirmed these findings, including a logistic regression analysis that showed that people who did not plan to quit using e-cigarettes in the next month were six times more likely to experience cognitive decline.OR = 6.04).
Those not planning to stop using e-cigarettes in the next six months were four times more likely to experience cognitive impairment (OR = 4.15).
Vaping prevention and implications for research
This study shows that e-cigarette use is significantly associated with an increased risk of dementia in young adults, even though there are no strong links with ADHD symptoms or emotional intelligence. Regular vaping, especially without trying to quit, is associated with greater cognitive vulnerability, even in young people.
These findings are critical, as early changes in cognition could affect brain health, work productivity, and quality of life. Although many believe that e-cigarettes provide an alternative means of safely consuming nicotine, the long-term effects of e-cigarettes may have neurocognitive effects, although this study cannot prove causality.
Strategies designed to change public perception should focus on raising awareness of early intervention and prevention measures intended to help people who currently use e-cigarettes. There is also a need for longitudinal research to elucidate this association and the mechanisms that may underlie it.
The findings should also be interpreted with caution because the study was cross-sectional, used MoCA as a screening tool rather than a diagnostic test, and was conducted in a single urban area in Thailand.
