Is vaping more deadly than smoking tobacco?

Vaping vs. Smoking: Comparative Health Risks

While vaping is likely less harmful than smoking combustible cigarettes, it is not safe and poses significant health risks. Both should be avoided for optimal health outcomes.

Comparative Health Risks

• Smoking combustible cigarettes negatively impacts nearly every organ of the body and reduces life expectancy by approximately 10 years compared to non-smokers 1, 2
• Smoking is the leading cause of preventable mortality and morbidity worldwide, with smoking and secondhand smoke responsible for roughly 1 in 5 (21%) of all deaths attributed to coronary heart disease 3, 2
• E-cigarettes contain and emit numerous potentially toxic substances beyond just nicotine, though exposure varies based on product characteristics and usage patterns 2
• Growing evidence shows e-cigarettes and their constituents can have deleterious effects on the cardiovascular system, respiratory system, and brain 3, 2
• Recent biomarker studies suggest that vaping may be approximately one-third as harmful as smoking combustible cigarettes, though this should be considered an upper limit of risk 4

Specific Health Concerns with Vaping

• Electronic cigarettes and vaping are not harmless alternatives to traditional cigarettes and can adversely affect cholesterol metabolism and cardiovascular health 1, 5
• Nicotine, present in both cigarettes and most e-cigarettes, has significant cardiovascular effects and may contribute to the development of coronary artery disease, atherosclerosis, and aortic aneurysms 5
• The 2019 outbreak of e-cigarette or vaping product use-associated lung injury in the United States led to over 2,800 hospitalizations, highlighting potential acute risks 6
• E-cigarette products can contribute to nicotine dependence, confirming that there is no safe tobacco product 5

Concerns for Youth and Dual Use

• E-cigarette use among youth poses a clear threat to public health with dramatic increases in usage among young people in the United States 3, 2
• E-cigarette use is associated with increased odds of smoking combustible cigarettes among adolescents who had no previous intention of smoking conventional cigarettes 3, 2
• The introduction of high-nicotine delivery systems has transformed the e-cigarette landscape and increased addiction potential for young people 3, 2
• Many e-cigarette users also continue to smoke cigarettes, and dual use is not associated with higher quit rates 3

Smoking Cessation Considerations

• Evidence is limited regarding the efficacy of e-cigarettes as a smoking cessation aid 3, 2
• A 2020 Cochrane review found only moderate evidence that quit rates were higher among those using nicotine e-cigarettes compared with nicotine replacement therapy or non-nicotine e-cigarettes 2
• Pharmacotherapy plus counseling improves smoking cessation compared with either pharmacotherapy or counseling alone 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

Clinical Recommendations

• Healthcare providers should recommend that individuals avoid both smoking and vaping for optimal health outcomes 1, 2
• If people are using e-cigarettes to quit smoking, they should be advised to avoid using both combustible and electronic cigarettes simultaneously 2, 5
• Healthcare providers should develop a plan with patients using e-cigarettes to eventually quit them as well 2, 5
• Electronic cigarette use or vaping should be specifically discouraged in youth due to increased health risks 1, 2

Regulatory Considerations

• Many countries have introduced restrictions on the sale and use of electronic nicotine delivery devices, with some countries like Brazil, Norway, Singapore, and Indonesia banning them completely 3
• The Food and Drug Monitoring Agency of Indonesia has warned that electronic cigarettes could be more dangerous than combustible cigarettes 3
• The US FDA Center for Tobacco Products has proposed regulations requiring manufacturers to register with the FDA and provide detailed accounting of ingredients 3
• The World Health Organization Framework Convention on Tobacco Control has concluded that health and safety concerns about electronic nicotine delivery systems have not been resolved 3