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All paediatricians are aware of the impact e-cigarettes and nicotine addiction have had on children, adolescents and youth. These devices deliver nicotine in formulations that enhance absorption and drive addiction and dependency. This is a major crisis for the health of nations. The International Pediatric Association (IPA) has published global evidence on the use, risks and regulatory gaps of e-cigarettes. It is an important update. Arora M et al (Pediatrics 2025;156(5):e2025072337) highlight the startling increase in prevalence among youth of the use of e-cigarettes. Misleading marketing, ease of access via social media, interesting flavours and creative designs all drive this increase in use among the young. The data are interesting. Many smokers use e-cigarettes and cigarettes, and the real-world studies show they have not been that effective for smoking cessation. Many young people have started e-cigarettes and not taken up cigarettes. It is a disaster. We now know that e-cigarette use does increase cardiovascular, metabolic, respiratory and oral diseases and cancer, and dual users have greater health risks than cigarette smokers alone. This paper draws on global data and recommendations from public health organisations, and the IPA calls for comprehensive bans or stringent regulation on the manufacture, marketing, sale and use of e-cigarettes. E-cigarettes appear to be reversing the progress in tobacco control. This paper demands urgent, coordinated action to safeguard the health of future generations. There is a section on the devices and nicotine receptors. The epidemiology of e-cigarette use in young adults is interesting: a reduction in cigarette smoking with a peak of e-cigarette use in 2019 that was higher than that of cigarette smoking in 2006. Between 2011 and 2019, the global current prevalence of youth e-cigarette use was 4.8%, and the cumulative prevalence was 16.8%. There is a detailed section on the reasons for this increased use in this age group. They highlight the rapid growth of India’s illicit e-cigarette market and heavy industry marketing focussing on and targeting youths with aspirational imagery and peer endorsements on youth-centric social media platforms glamorising e-cigarettes as symbols of independence and modernity. This marketing on social media is particularly concerning. There are misleading cessation claims, and there is now clear evidence that young children who start with e-cigarettes do go on to smoke real cigarettes and indeed develop a dual smoking habit. There is then a detailed assessment of nicotine addiction and the harm that e-cigarettes inflict. It is now obvious that e-cigarette users and smokers show similar risks for cardiovascular disease (CVD), stroke, metabolic dysfunction and oral disease. Dual use, which is now very common, increases the risk of developing CVD, stroke, metabolic dysfunction, asthma, chronic obstructive pulmonary disease and oral diseases by 20%–40% compared with smoking alone. Randomised controlled studies do show cigarette smoking cessation is associated with e-cigarette substitution, but the real-world studies, which are large observational population-based studies, show little or no link. These are important data to share with your patients and families when vaping is discussed. Vaping is not safe.