Is electronic cigarette (e-cigarette) use safer than tobacco smoking?

From the Guidelines

Vaping is not a safer alternative to smoking, and both habits pose significant health risks, particularly in terms of morbidity, mortality, and quality of life. The most recent and highest quality study, published in 2025 in the journal Diabetes Care 1, emphasizes the importance of avoiding vaping and e-cigarettes, as they can contribute to nicotine dependence and pose health risks to the cardiovascular and respiratory systems. While vaping may expose users to fewer toxic chemicals than traditional cigarettes, it still delivers harmful substances, including nicotine, ultrafine particles, volatile organic compounds, and heavy metals.

Health Risks Associated with Vaping and Smoking

• Both vaping and smoking can lead to nicotine addiction, with vaping products containing nicotine in varying concentrations (typically 3-50 mg/ml) that can harm brain development in young people 1.
• The aerosol produced by e-cigarettes can cause lung inflammation and has been linked to serious lung injuries (EVALI) 1.
• Emerging research suggests potential cardiovascular and respiratory problems associated with long-term vaping 1.

Recommendations for Smoking Cessation

• The safest choice is to avoid both smoking and vaping entirely.
• If trying to quit smoking, consider FDA-approved cessation methods like nicotine replacement therapy (patches, gum), prescription medications (bupropion, varenicline), or behavioral counseling, which have proven safety and efficacy profiles 1.
• Healthcare professionals should continually encourage patients to quit smoking and other forms of tobacco use, using both pharmacological and behavioral-based strategies, alone or in combination, to increase smoking cessation rates 1.

From the Research

Comparison of Vaping and Smoking

• Vaping and smoking are two different methods of consuming nicotine, with distinct differences in terms of health risks and benefits 2.
• While smoking is a well-established cause of lung cancer and other health problems, the health effects of vaping are still being studied and debated 2.
• Some studies suggest that vaping may be a safer alternative to smoking, as it does not involve the combustion of tobacco and the release of harmful chemicals 3, 4.
• However, other studies have raised concerns about the potential health risks of vaping, including the presence of oncogens and other toxic substances in e-liquids and the potential for lung cancer and other health problems 2.

Effectiveness of Nicotine Replacement Therapy

• Nicotine replacement therapy (NRT) is a commonly used method for quitting smoking, and has been shown to be effective in increasing quit rates 3, 4, 5.
• NRT can be delivered in a variety of forms, including gum, patches, nasal sprays, and inhalers, and can be used in combination with other therapies to increase effectiveness 5, 6.
• Studies have shown that NRT can increase the odds of quitting by 1.5 to 2 times, regardless of the setting or intensity of additional support provided 5.

Vaping as a Quitting Aid

• Some studies have suggested that vaping may be a useful aid for quitting smoking, particularly for those who have tried other methods and failed 6.
• However, other studies have raised concerns about the potential health risks of vaping, and the lack of regulation and standardization in the industry 2.
• More research is needed to fully understand the potential benefits and risks of vaping as a quitting aid, and to determine whether it is a safe and effective method for quitting smoking 2.