What are the relative health risks of smoking cigarettes, chewing tobacco, and vaping?

Comparative Health Risks of Smoking, Chewing Tobacco, and Vaping

Smoking cigarettes poses the greatest health risk compared to chewing tobacco and vaping, with combustible tobacco products being clearly the most harmful to overall health and mortality. 1, 2

Smoking Cigarettes: Highest Risk

• Smoking combustible cigarettes negatively impacts nearly every organ system and reduces life expectancy by approximately 10 years compared to non-smokers 2
• Smoking is the leading preventable cause of disease, disability, and death worldwide 1, 2
• Smoking and secondhand smoke exposure are responsible for roughly 1 in 5 deaths attributed to coronary heart disease 2
• The relative risk of myocardial infarction in smokers under 50 years is five times higher than in non-smokers 2

Smokeless Tobacco (Chewing Tobacco): Intermediate Risk

• Smokeless tobacco products, such as dip and chew, pose an increased risk for cardiovascular disease 1
• Chewing tobacco is associated with increased risk of oral cancer 1
• While less harmful than smoking cigarettes, smokeless tobacco still contains nicotine and is addictive 3
• Smokeless tobacco use should be discouraged due to its negative health effects 1

Vaping/E-cigarettes: Lower But Significant Risk

• While combustible tobacco products are clearly the most harmful, electronic products should not be characterized as harmless 1
• E-cigarettes contain and emit numerous potentially toxic substances beyond just nicotine 2, 4
• Vaping affects both cardiovascular and respiratory systems 1, 5
• E-cigarettes may contribute to nicotine dependence, confirming there is no safe tobacco product 1, 5
• Vaping has been associated with acute lung injury (e-cigarette or vaping-associated lung injury) 6

Comparative Risks and Recommendations

• All forms of tobacco and nicotine products carry health risks, with combustible cigarettes posing the greatest threat 1, 2
• The American College of Cardiology advises healthcare providers to recommend that individuals avoid both smoking and vaping for optimal health outcomes 2
• The American Diabetes Association recommends advising all people with diabetes not to use cigarettes, other tobacco products, or e-cigarettes 1
• Individuals should be advised to avoid using both combustible and electronic cigarettes simultaneously 1, 2

Evidence-Based Cessation Approaches

• A combination of behavioral interventions plus pharmacotherapy is recommended to maximize quit rates for tobacco users 1
• Varenicline has been found to be the most efficacious pharmacotherapy for people with diabetes when compared with placebo 1
• Tobacco abstinence is recommended to reduce cardiovascular disease risk 1
• Evidence is limited regarding the efficacy of e-cigarettes as a smoking cessation aid 2
• The US Preventive Services Task Force recommends focusing on proven behavioral counseling and FDA-approved pharmacotherapy for smoking cessation rather than e-cigarettes 2, 4

Common Pitfalls and Misconceptions

• Many people incorrectly perceive e-cigarettes as harmless or significantly less harmful than traditional cigarettes 5
• E-cigarette use among youth is associated with increased risk of subsequent cigarette and marijuana use 7
• Weight gain after smoking cessation (average 3-5 kg) does not diminish the substantial cardiovascular benefit realized from quitting 1
• E-cigarettes are not approved as smoking cessation aids by regulatory agencies, unlike standard nicotine replacement therapies 4

In conclusion, while all three forms of nicotine delivery carry health risks, smoking cigarettes presents the highest risk to health and mortality, followed by chewing tobacco, with vaping likely posing the lowest risk of the three options - though still carrying significant health concerns that should not be minimized.