Vaping vs. Smoking: Understanding the Risks

Smoke and aerosol are different exposures

Cigarettes burn tobacco. Vapes heat liquid to produce an aerosol. The absence of tobacco combustion is a major reason that nicotine vaping exposes users to fewer toxic substances than smoking cigarettes. The NHS describes nicotine vaping as less harmful than smoking, while noting that its long-term effects are not fully understood. [1]

The comparison has to name the alternative. “Less harmful than smoking” answers a question about two exposures. It does not mean that vaping is harmless compared with using neither.

What do measurements of exposure show?

A study using data from the US Population Assessment of Tobacco and Health study compared biomarkers in adults who used e-cigarettes, cigarettes, both products or neither. Exclusive e-cigarette users generally had lower concentrations of many measured toxicants than cigarette smokers, while some exposures remained above those of never-users. [2]

Biomarkers provide evidence about what enters the body. They are not the same as measuring lifetime disease risk. That distinction is especially important when a headline turns a reduction in a chemical into a precise percentage reduction in all health harms.

Complete switching and dual use

Using a vape while continuing to smoke is often called dual use. It preserves exposure to cigarette smoke. In the biomarker study, dual users did not show the same lower exposure pattern as people who used e-cigarettes exclusively. [2]

CDC cautions that dual use is not an effective way to protect health. [4] Counting fewer cigarettes is not enough to conclude that the combination is low-risk. For someone who smokes, stopping combustible tobacco entirely is the relevant goal when discussing a switch with a healthcare professional.

What about vaping as a way to stop smoking?

Cochrane's review of randomized trials finds that nicotine e-cigarettes can help more people stop smoking than nicotine replacement therapy. That conclusion concerns cigarette cessation in the studied populations; it is not evidence that vaping is harmless or that every person should start using it. [3]

It is also a different question from how to stop vaping. A trial whose outcome is “no longer smoking cigarettes” may include participants who still vape. Keep the outcome in view when reading claims about a successful quit attempt.

Your starting point matters

• You do not smoke or vape: starting introduces an exposure. NHS advice is that nonsmokers should not take up vaping. [1]
• You smoke cigarettes: discuss options for stopping with a healthcare professional. If vaping is used as a substitute, complete switching is distinct from using both products.
• You stopped smoking and now vape: plan any change with staying off cigarettes in mind. NHS guidance emphasizes avoiding a return to smoking while preparing to stop vaping. [5]

These are different situations. A single slogan cannot describe all three accurately. Read the health-effects overview for the wider picture, or the lung-health guide for respiratory evidence.

If you are ready to stop vaping

Consider both nicotine dependence and the routines associated with use. Write down your reasons for changing, who you can turn to for support and which situations are likely to be difficult. The guide to stopping vaping explains withdrawal and preparation.

For a description of the app's recording features, see the existing vape tracker guide. Health decisions depend on your circumstances; a record of sessions is one way to describe those circumstances.