Ever since modern e-cigarettes first hit the market in the mid-2000s, it's been marketed as being safer than regular cigarettes — and a potential way to quit tobacco.¹ ²
The slim, battery-powered devices work by heating up an internal e-liquid to form vapours (hence the term 'vaping') which the user inhales.
Depending on the retailer, e-liquids can come in both nicotine and non-nicotine versions.
They're known to be less harmful than tobacco cigarettes because of the chemicals contained in the solution. Regular smoking exposes users to around 7000 chemicals, and about 70 are known to be carcinogenic. E-cigarette solutions have far fewer chemicals and some experts estimate that they might be about 95% less harmful than cigarettes.
More specifically, it's eliminated tar and carbon monoxide which are the most toxic parts of tobacco smoking.³ ⁴ ⁵
Because of this perception that it's less harmful, vaping has seen a steady increase in consumer use over the years. In 2009, it was estimated that about 1.8% of the US population were e-cigarette users. And this has increased to 3.2% in 2018.
When the Centers for Disease Control and Prevention (CDC) analyzed e-cigarette use based on cigarette smoking status, it was clear that people who have ever vaped were more likely to be current or ex-smokers.⁶
This is most likely because many smokers see it as a way to stop smoking regular cigarettes. A separate research study found that 77.4% of current smokers said that they vaped to try and quit smoking. While 88.3% of ex-smokers used it to stay free from tobacco cigarettes.⁷
How exactly vaping helps people quit smoking is still being worked out by experts. But several agree that vaping fulfills many of the biological (nicotine cravings) and socio-behavioural (e.g. hand-to-mouth motion) aspects of tobacco smoking. So this makes it an ideal substitute to cigarettes that people are more likely to stick with without relapse.⁸ ⁹
In support of this, a recent review of 50 scientific papers involving 12,000+ participants found moderately-certain evidence that using e-cigarettes to quit smoking may be more effective than traditional nicotine replacement therapies like patches or gum.¹⁰
So if the evidence is indicating that vaping is a better alternative to smoking, why are there inconsistencies between the stance of different public health bodies on the topic? For example, countries like the UK and New Zealand are advocating for smokers to use vaping as a way to quit. On the other hand, other institutions like the Australian Department of Health and the CDC state that there is still insufficient evidence for them to recommend it as a smoking cessation tool.¹¹ ¹² ¹³ ¹⁴
It all comes down to the fact that e-cigarettes are a relatively new product, and several experts are still unsure about the long-term health effects. So erring on the side of caution is the move that some countries choose to take.
Others are also worried about how the "e-cigarettes are safer" message presented by vaping brands and public health institutions, can be easily misconstrued by the public as "they are safe". The distinction is important because while it may be the better of two evils when compared with tobacco cigarettes, it doesn't mean that there are no health risks to vaping.
The misconception that "e-cigarettes are safe" is likely why it has gained tremendous popularity amongst youths and young adults. And this has been further demonstrated in a survey that showed how young American adults are less likely than older people to say that vaping is "very harmful to health.¹⁵ ¹⁶
According to the CDC, 7.6% of 18-24-year-old young adults are current e-cigarette users, compared to 4.3% and 2.1% amongst those within the 25-44 and 45-64 age group respectively.⁶
However, what worries health authorities the most is how many teenagers are vaping despite age restrictions. Since 2014, e-cigarettes have been the most popular tobacco product amongst high schoolers in the US.
A 2020 survey by the CDC has also found that 19.6% of high schoolers reported using e-cigarettes within the past 30 days.
In contrast, normal cigarette use was significantly lower at 4.6%.¹⁷
It’s also not hard to see why vaping has such an appeal to youth. Firstly, it smells and tastes better than cigarettes — with the e-liquid often coming in seemingly benign flavours like “gummy bear” and “green apple”. This also means kids are able to cover up their vaping more easily without the lingering smell of regular tobacco smoke.
There are a host of other reasons why youths are flocking to vaping. It’s relatively cheaper and more easily attained than normal cigarettes. Plus, a big part of e-cigarette marketing is done through social media (where the vast majority of teens hang out). Influencers collaborate with vaping brands to produce glamorized vaping lifestyle content. And impressionable teens may start vaping to emulate these public figures without fully understanding its risks.¹⁸ ¹⁹
The most common issue that health experts have with the safety of vaping is that it's too new a product to fully understand how it impacts the body in the long term. And what worries several experts is how quickly others in the scientific community have concluded that it's a safer alternative.
"I have been concerned about how the scientific community could possibly know the full spectrum of their dangers. After all, it took decades for epidemiologists to discover that regularly inhaling the smoke from burning plant material, tobacco, caused lung cancer," writes Inhalation toxicologist, Ilona Jaspers from the University of North Carolina Chapel Hill, in an article for The Conversation. "Why would the scientific community be so quick to assume e-cigarettes would not have hidden dangers that might take years to manifest too?"¹⁵
She even adds that it might even be erroneous to compare the health effects of smoking and vaping as they can result in very different outcomes. "Considering that the compounds inhaled through cigarette smoke are very different from those inhaled through the vast number of different flavoured e-cigarettes and vaping devices, wouldn’t that be like comparing apples and oranges?" writes Jasper. "Nobody would consider it reasonable to compare health effects caused by smoking cigarettes to those induced by smoking crack."¹⁵
So what exactly are the health risks of vaping? Its most immediate effects can be seen on heart and lung health. According to experts, it can lead to emphysema, airway constriction, increased blood pressure, arterial stiffening and more.²⁰ ²¹
And like traditional cigarettes, e-cigarette vapour can impact oral health by increasing the risk of cavity and gum disease development.
For youths, these health risks are tremendously amplified as their bodies are still developing. The CDC has highlighted in particular that exposure to nicotine at a young age can have profound and long-lasting effects on brain development.²² According to experts nicotine triggers alterations within the reward centre of the brain so that more of it is needed after each session for the individual to feel the buzz. For teenage brains that are still in the process of maturing, this can have long-lasting effects in terms of memory, concentration, impulse control, and more.²³
Teenage brains also form new brain cell connections for learning and memory more rapidly than adults. So when you add nicotine (which is highly addictive) to the efficient learning pathways of young brains, they’re more likely to be addicted compared to adults. Furthermore, teens that vape are also at greater risk of taking up cigarettes later.²⁴ ²²
Young people should also not assume that non-nicotine e-liquids are any safer. One study examined 9 artificial flavourings alone (like cinnamon, strawberry, and mint) and found that inhalation of these chemicals through tobacco products was linked to blood vessel damage in the heart. This can ultimately lead to conditions like high blood pressure and heart disease.²⁵
Lung cancer risk is one of the main yardsticks by which the medical community assesses the harm caused by smoking. And current reviews suggest that there is not enough evidence at this point to conclude whether e-cigarette vapour results in cancer or not.
One reason for this is that cancer development can take decades to manifest and vaping has only been around for a decade or so. However, one animal study has demonstrated that e-cigarette vapours can cause DNA changes in rat models — which is the mechanism through which cancer develops.²⁶ ²⁷ ²⁸
And even though the main cancer-causing chemicals (like tar) of tobacco smoke are absent in e-cigarettes, many other carcinogenic particles are still present. This includes formaldehyde, toluene, and heavy metals.²⁹ Only time and more research will tell if there is a definitive link between vaping and lung cancer.
Another major issue with the e-cigarette industry is that it’s highly unregulated. What actually goes into the e-liquids can even include highly toxic contaminants and chemicals, as noted by a group of Australian researchers. They found that 60% of nicotine-free e-liquids which were purchased from “best-selling” retailers still contained nicotine. All of the brands also contained a chemical known to be in pesticides and disinfectants — 2-chlorophenol.³⁰
In the US, an outbreak of e-cigarettes or vaping use-associated lung injury (Evali) which resulted in several thousand hospitalizations (and deaths in some cases) caused a scare amongst the smoking community. The condition was eventually linked to the unregulated presence of Vitamin E acetate fillers in THC e-liquids (cannabis oil) which is harmful when inhaled.³¹ ³²
Most public health bodies agree that the best scenario is not to use any form of tobacco products or e-cigarettes — especially for vulnerable populations like kids and pregnant women.
But what about smokers who want a less harmful form of smoking or would like to use it to quit tobacco cigarettes? While the recommendations vary with each public health institution, most agree that there is some evidence showing it's less harmful than regular cigarettes. But be aware that the science behind its long-term health effects needs time to catch up with consumer recommendations.³
In terms of using vaping to quit smoking, some health bodies are already supporting it. The UK National Health Service (NHS) adds that for it to be optimally effective, you need to stop tobacco cigarettes completely and make the switch to vaping. A 2019 UK study also found that when this was done with professional in-person support, vaping to quit smoking had double the success rate of other smoking cessation tools like nicotine patches or gums. The ultimate goal is to also quit vaping, but only if you're certain that you revert to smoking.³³ ¹²
Selecting regulated e-cigarette brands is equally crucial, as contamination can lead to very serious health complications (like Evali). Within countries like the UK, this might be easier as sales of e-cigarettes are more regulated. The US is comparatively lagging behind in this area, but at least there has been some advancement with the FDA recently approving the first nicotine-flavoured e-cigarette.
The biggest takeaway is that it's not entirely safe to use e-cigarettes. So don't start if you're a non-smoker. But if you already smoke, vaping is most likely the better of two evils and might be a way to help you quit tobacco cigarettes.
Is vaping safer than smoking cigarettes? | National Center for Health Research
The wild history of vaping, from a 1927 'electric vaporizer' to today's mysterious lung injury crisis | Insider
About electronic cigarettes (e-cigarettes) | Centers for Disease Control and Prevention
How vaping helps even hardened smokers quit | EurekAlert
Vaping is 95% safer than smoking. Fact or factoid? | Australian Tobacco Harm Reduction Association
Electronic cigarette use among U.S. adults, 2018 | Centers for Disease Control and Prevention
Reasons for regular vaping and for its discontinuation among smokers and recent ex-smokers: findings from the 2016 ITC Four Country Smoking and Vaping Survey (2019)
Can vaping help you quit smoking? | ABC Everyday
How vaping helps even hardened smokers quit | EurekAlert
Our position on vaping | Vaping Facts
Adult smoking cessation—The use of e-cigarettes | Centers for Disease Control and Prevention
About e-cigarettes | Australian Government - Department of Health
Vaping likely has dangers that could take years for scientists to even know about | The Conversation
Before recent outbreak, vaping was on the rise in U.S., especially among young people | Pew Research Center
Youth and tobacco use | Centers for Disease Control and Prevention
The 3 main reasons youth use e-cigarettes | Truth Initiative
Vaping is glamourised on social media, putting youth in harm’s way | The Conversation
Health effects of vaping | Government of Western Australia - Department of Health
Effects of e-cigarettes and vaping devices on cardiac and pulmonary physiology (2020)
Quick facts on the risks of e-cigarettes for kids, teens, and young adults | Centers for Disease Control and Prevention
Know the risks | U.S. Surgeon General
Flavorings in tobacco products induce endothelial cell dysfunction (2018)
How close are we to definitively identifying the respiratory health effects of e-cigarettes? (2019)
Can vaping cause cancer? 10 faqs on key research, misleading headlines, and more | Healthline
E-cigarettes induce toxicological effects that can raise the cancer risk (2017)
Facts About Electronic Cigarettes | Johns Hopkins Medicine
Many e-cigarette vaping liquids contain toxic chemicals: new Australian research | The Conversation
E-cigarettes: misconceptions about their dangers may be preventing people from quitting smoking | The Conversation
Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products | Centers for Disease Control and Prevention
Vaping to quit smoking | Vaping Facts
The author, Dawn Teh, is a health writer and former psychologist who enjoys exploring topics about the mind, body, and what helps humans thrive.
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