Vaping vs. Smoking: Is One Really Safer Than the Other?

By Sarah MooreReviewed by Lily Ramsey, LLM

The vaping-smoking debate
Smoking and health
Rise of vaping
Vaping and respiratory health
Vaping vs smoking: A health comparison
Public health implications
Making healthier choices
References
Further reading

​​​​​​​The vaping-smoking debate

For decades, smoking has been a major public health concern, with medical experts across the globe warning against the serious health impacts of smoking and highlighting the threat it poses to public health.

In recent years, vaping has emerged as an increasingly popular alternative to smoking. While it is often seen as a less dangerous habit, it is highly addictive and its long-term impact is yet to be fully understood, due to the newness of vaping. Recent research has linked vaping with increased risk of lung disease, and cardiovascular disease.

There is also rising concern over the impact of vaping on children. Data indicates that vaping is more popular among children than smoking ever was. From 2022 to 2023 the proportion of children experimenting with vaping grew by 50%.

​​​​​​​Image Credit: ducu59us/Shutterstock.com

Smoking and health

According to the World Health Organization (WHO), tobacco kills 8 million people each year, including 1.3 million non-smokers who die from exposure to second-hand smoke. Of smokers who do not quit, one in three will die from their habit.

Smoking is the leading cause of preventable death across the globe and the number one cause of cancer. Roughly 90% of lung cancer cases in men and 70-80% of cases in women are attributed to cigarette smoking.

The Centers for Disease Control and Prevention (CDC) highlight that smoking is known to cause not only cancer, but also heart disease, stroke, diabetes, lung diseases, and chronic obstructive pulmonary disease (COPD). It is also associated with an increased risk of eye diseases, tuberculosis, and immune system illnesses.

Rise of vaping

The use of e-cigarettes, known as vaping, is different from the traditional smoking of tobacco. It involves a device that heats nicotine along with flavorings and other chemicals to produce an aerosol that is inhaled by the user.

Vaping is largely perceived as a safer alternative to smoking. While vaping does not expose users to tar or carbon monoxide, two of the most dangerous elements in tobacco smoke, vaping is far from safe and has its own health risks.

Vaping’s increase in popularity, particularly among young people, is a major cause for concern due to the real health risks associated with vaping. An astounding 2.55 million US middle school and high school students reported using e-cigarettes in 2022. While many experts agree that compared with smoking, vaping is less dangerous to health, it is not a safe alternative and should not be promoted as such.

Vaping and respiratory health

In 2019, reports of severe and sudden lung problems related to vaping emerged in the news. The condition that was termed e-cigarette or vaping use-associated lung injury (EVALI) resulted in the hospitalization of 2,800 patients, as of February 2020, 68 of which died. Sadly, most cases reported were among teens and young adults.

Since the outbreak of EVALI, researchers have begun to understand the mechanisms of the disease. So far, we know that the pathophysiologic mechanisms that underlie the disease most likely involve cytotoxicity and neutrophilic inflammation that is a result of inhaling the chemicals used in vapes.

E-cigarette use has also been linked with pre-symptomatic cardiovascular dysfunction. The vapor inhaled from e-cigarettes contains harmful substances including diacetyl, which is linked to lung disease; acrolein, which causes lung injury and COPD; and aldehydes, which are known to cause lung disease and heart disease. E-cigarette vapor also includes cancer-causing chemicals, heavy metals, and volatile organic compounds (VOCs), which are known to pose risks to health.

Finally, e-cigarettes also pose a second-hand smoke risk, like regular tobacco cigarettes. The devices do not just emit harmless water vapor, as some argue. The vapor emitted by e-cigarettes contains a cocktail of toxins that are known to cause cancer, nicotine, and ultrafine particles.

Vaping vs smoking: A health comparison

Vaping is relatively new, and therefore, we do not have data on its long-term health effects. The health risks of smoking, on the other hand, are very well understood. Therefore, it is not possible to make a thorough comparison between vaping and smoking at this point.

What we do know is that vaping is not a risk-free alternative to smoking and it has been associated with an increased risk of a number of diseases including lung illnesses, stroke, cancer, pneumonia, and even mental health issues such as depression and anxiety.

Public health implications

There is an urgent need to address the growing popularity of vaping among young people and children. E-cigarette companies have been accused of deliberately targeting young adults and adolescents via tactics such as leveraging social media, sponsorship of festivals and music events, and introduction of flavors that appeal to youth.

If strategies are not implemented to protect young people from vaping then the next generation may face a plethora of negative health impacts, the likes of which are not completely clear. What we do know is that vaping is detrimental to health, and children should be protected from picking up this habit. Equally, it should not be seen as a healthy alternative to smoking.

Making healthier choices

While experts generally agree that the health risks of vaping are less severe than those of smoking, vaping should still be discouraged by health organizations, and children should be protected from being introduced to it. There is an argument for using vaping as a method to assist those with a smoking habit in quitting tobacco products, however, the risks of vaping should be made clear to users.

Many strategies that have been used to target smoking may be applicable to vaping, such as adding appropriate warnings to vaping products and removing products from visible displays in shops.

Overall, there should be an effort not only to stop tobacco smoking but also to stop vaping.

References

• Dai, X. et al. (2022) ‘Health effects associated with smoking: A burden of proof study’, Nature Medicine, 28(10), pp. 2045–2055. doi:10.1038/s41591-022-01978-x.
• Groner, J. (2022) ‘Health effects of electronic cigarettes’, Current Problems in Pediatric and Adolescent Health Care, 52(6), p. 101202. doi:10.1016/j.cppeds.2022.101202.
• More than 2.5 Million Youth Reported E-Cigarette Use in 2022 [online]. CDC. Available at: https://www.cdc.gov/media/releases/2022/p1007-e-cigarette-use.html (Accessed October 2023)
• Outbreak of Lung Injury Associated with the use of E-Cigarette, or Vaping, Products [online]. CDC. Available at: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html (Accessed October 2023)
• Park, J.-A., Crotty Alexander, L.E. and Christiani, D.C. (2022) ‘Vaping and lung inflammation and injury’, Annual Review of Physiology, 84(1), pp. 611–629. doi:10.1146/annurev-physiol-061121-040014.
• Walser, T. et al. (2008) ‘Smoking and lung cancer: The role of inflammation’, Proceedings of the American Thoracic Society, 5(8), pp. 811–815. doi:10.1513/pats.200809-100th.

Further Reading

• Lung Health and Vaping
• Do E-Cigarettes Cause Cancer?
• Everything You Need to Know About Giving Up Cigarettes