While vaping is not risk-free, it is less harmful than tobacco
Answers to some of the most frequently asked questions about vaping and its effects.
A decade ago, most smokers thought vaping was less harmful than tobacco. But ten years on, the opposite is true: the majority say that vapes are just as or even more dangerous.1
You can see this shift in opinion in the chart below.2
It’s not surprising that sentiment towards vaping has become more negative — the public discourse has shifted substantially. Look at the news, and it’s easy to see why people would think that vaping is just as bad, if not worse.
Here are just three headlines published in popular newspapers (The Sun, The Telegraph, and Daily Mail) in the last few years:
The rising popularity of e-cigarettes may be another reason for the backlash against them.
In the United Kingdom today, almost as many people vape as smoke tobacco: around one-in-ten adults.4 But the trajectory of these products has been very different. Half of adults smoked cigarettes in the 1970s, and since then, rates have plummeted. Vapes, on the other hand, are a relatively recent addition. You can see this in the chart below.
Is this a positive development? Or are people just substituting one harmful habit with an equally harmful or even worse one?
In this article, I address some of the most frequently asked questions about vaping and its effects. Are British smokers right? Is vaping actually more harmful than tobacco? Is there evidence for its effectiveness as a tool to quit? Could it be a “gateway” to smoking among young people?
What are the health risks of vaping compared to cigarettes?
This is the crucial question. If vaping is just as bad as cigarettes, then substituting one for the other would not be positive for public health, or for individuals who smoke.
Research suggests that this is not the case. While we can’t say that vaping carries zero risk, the evidence clearly indicates that it is much less harmful than smoking.
Look at the news, and it’s easy to see why people would think that vaping is just as bad, if not worse.
This should not be surprising: tobacco is extremely bad for health. It not only increases the risk of lung cancer — American men who smoke are around 21 times more likely to die from lung cancer — but a range of other diseases too, including strokes, heart disease, and several other cancers.5 In the UK, smoking is the leading risk factor for early death, ahead of obesity, high blood pressure, cholesterol, and other behavioral and environmental factors. If you’re a smoker who wants to improve your health, quitting is probably the single best thing you can do.
To understand the comparative risks of tobacco and vaping, we need to understand what’s in each and what makes them harmful.
When you light a cigarette, you burn dry tobacco leaves. This burning generates thousands of chemicals, some of which are toxic or carcinogenic. These include nicotine (which makes them addictive), tar, carbon monoxide, benzene, cadmium, and polycyclic aromatic hydrocarbons (which are strong carcinogens), to name a few. Inhaling these substances is bad for the lungs, but as mentioned above, it can also damage other organs.
Vaping is different. E-cigarettes heat a liquid, which creates an aerosol. This vapor is inhaled, but since no burning occurs — the liquid is heated, but there is no combustion — fewer toxins are released compared to smoking.
That doesn’t mean vaping is completely harmless, though. Many vapes contain nicotine, which makes them addictive. While nicotine is relatively benign for most people and has little long-term health impact, it can have short-term impacts on blood pressure and heart rate.6 It’s also not recommended for pregnant women, since there is some evidence that it can cross the placenta and affect fetal development — I say more on this in the additional information section below.
Vapes also contain solvents and flavorings that can create harmful byproducts, and small amounts of metals can be released from the heating coil. Breathing in aerosols can irritate the lungs and exacerbate asthma or bronchitis. But overall, the health impacts are far lower than smoking tobacco.
People often note that we have less data on the long-term health impacts of vaping. This is certainly true compared to cigarettes. However, vapes’ earliest adopters have been using them for two decades — they were first commercialized in the early 2000s. If there were significant long-term health impacts, we’d expect to see signs of those by now, especially if they were anywhere close to those of tobacco. And while we don’t have very long-term epidemiological data, we do have a good understanding of the ingredients, the levels of exposure, and how these are likely to affect the human body.
Several additional health concerns are often raised; you might have seen them in media headlines. I review the evidence on these in the “detailed questions” section below.
For those who don’t want to read through all of the details in my detailed FAQ below, the summary is quite simple: many health bodies suggest that vaping is much less harmful than tobacco. While they advise against it for young people or non-smokers, they do recommend it as a “quitting tool” for smokers for the health benefits of switching.7
I don’t think I can put it more succinctly than this:
“The key points about vaping (e-cigarettes) can be easily summarised. If you smoke, vaping is much safer; if you don’t smoke, don’t vape.”
Just so that my position is clear for the rest of the article: I do not want to “promote” e-cigarettes, just as Chris Whitty would not recommend them to someone who has never smoked or vaped. However, based on the research, vaping does appear to be an effective tool that helps people quit cigarettes.
What motivated me to write this research overview was the finding in the opening chart — that most smokers think vaping is equally or even more harmful. That misconception robs some people of the best option they might have to quit. I hope, then, that this article helps to close the gap in understanding and supports more smokers who want to stop but have struggled to do so.
Frequently asked questions on the health impacts of vaping
Is vaping an effective tool to quit cigarettes?
The majority of smokers say that they would like to quit.16 Most have tried to, often several times.17 The problem is that letting go of an addictive habit is hard.
This is why I wrote this article: Research suggests that e-cigarettes are the most effective quitting tool.18
Periodically, researchers publish “Cochrane Reviews” on the effectiveness of vapes as a way to stop smoking.19 Cochrane Reviews are independent assessments that attempt to answer important medical questions by examining the scientific literature as a whole.
Their latest review — published in 2025 — found “high certainty evidence” that people who used vapes were more likely to stop smoking than those using other nicotine replacement therapies, like patches or gums.20 This confidence level is rare for these Cochrane assessments.
They also judged that there is moderate evidence that vapes that contained nicotine were more effective as a quitting tool than those without.
The changes in the last decade are consistent with this finding. If we look at success rates for stopping tobacco smoking in Britain, we see a gradual increase over the last decade or so, both among adults and young people.
There are several reasons why success rates have increased — for example, the COVID-19 pandemic may have played a role, as people spent less time around other smokers and more people set health goals — but this rise also coincides with the growing popularity of vaping. Before 2013, the most popular “quitting aids” were nicotine replacement therapies (patches or gums), but since then, e-cigarettes have become the most common by far.
“The key points about vaping can be easily summarised. If you smoke, vaping is much safer; if you don’t smoke, don’t vape.” — Chris Whitty, Chief Medical Officer for England
More than half of British smokers who quit in the last five years say they used e-cigarettes in their final, successful attempt. That amounts to 2.4 million people. 60% of those ex-smokers still use vapes, but 32% have since quit vaping too. E-cigarettes have not been the only factor in more people quitting, but they have likely played some role.
So far, we’ve talked about the use of vaping to quit cigarettes altogether: the potential benefits or risks of completely substituting one for the other. However, many people who vape continue to smoke. If they are vaping and still smoking the same number of cigarettes, then there are no health benefits to using e-cigarettes. Their overall consumption would have actually increased. However, some current smokers use vapes to smoke fewer cigarettes, even if they don’t cut them out completely. That reduction in cigarette use is still beneficial for their health.
What do current smokers think about the harms of vapes compared to cigarettes?
If vapes are an effective and less harmful tool that helps people quit cigarettes, then current smokers need to know this. Survey data suggests that they do not.
The chart below shows how different groups view the relative harms of vapes and cigarettes. This survey data comes from Action on Smoking and Health (ASH).
On the left, you can see that ex-smokers and current smokers who do vape are more likely to say that vaping is less harmful than cigarettes. That’s not surprising, and might be one of the reasons why they started vaping in the first place.
But, if you ask smokers who do not currently vape — they either used to, or have never used them — they say the opposite: that e-cigarettes are more harmful. This is shown in the two bars on the right.
E-cigarettes are the most effective quitting tool.
These differences might partly explain why smokers appear to be increasingly negative towards vapes, which we saw in the opening of this article. Those who smoked in 2015 and thought vapes would be effective ways to quit no longer smoke, and therefore weren’t surveyed as “current smokers” in 2025. That leaves those who have been more reluctant to use tools like vaping to quit.
This perception gap among current smokers matters. There is evidence that people’s perceptions of the health risks of vaping affect their willingness to switch.21 For example, in a study of young adult smokers, those who knew vaping was less harmful were more likely to have made the switch from cigarettes to e-cigarettes at a follow-up six years later.22
When smokers are asked why they haven’t tried e-cigarettes, around one-third either say it’s because they are concerned that they’re not safe enough or don’t want to substitute one addiction for another. See the chart below, which shows the main reason cigarette smokers give for not trying e-cigarettes.
An additional 13% are skeptical that vapes would help them quit or cut back on cigarettes. Indeed, e-cigarettes won’t work for anyone, but as we saw earlier, they are the most effective tool available.
That means around half of smokers who are unwilling to try e-cigarettes give reasons that are at odds with much of the scientific evidence and public health advice.
How common is vaping among people who have never smoked?
Tobacco smokers who switch to e-cigarettes might see large health benefits, but one concern is that many people who have never smoked take up vaping. If the health risks of vaping are not zero, then that could represent a public health problem.
Is it common for people who have never smoked to take up vaping?
As a reminder, just under 10% of British adults use vapes (we’ll discuss vaping among young people soon). That’s around 4.7 million people.
You can see this breakdown of vapers in the chart below, based on their smoking history.
The majority are either current or ex-smokers. There are around 300,000 people who vape who are “never smokers”, which is a relatively small share of the total.
This represents around 1% of people in Great Britain who have never smoked and now vape. 99% of “never smokers” do not vape, but this figure does appear to be growing quickly.

How common is vaping among young people, and how often is it a “gateway” to tobacco?
The biggest concern that most people raise about vaping is its impact on young people. This is for good reasons.
First, most people who become addicted to smoking start in their teenage years.23
Second, young people are more likely to vape than people in older age groups. The chart below plots the share of people in each age group who vape in the UK. Nearly 30% of those aged 16–24 vape (not necessarily daily, but at least occasionally), compared to 14% of those in their late thirties or 10% in their late fifties.
Let’s then go through the main concerns.
The first is that e-cigarettes are a “gateway” to tobacco. Teenagers start smoking vapes, then progress to cigarettes, which they get hooked on. Given the huge health risks of smoking, it would be extremely detrimental if vaping were a key driver.
It’s true that young people who vape are more likely to go on to smoke than young people who don’t vape. This is well-established within the scientific literature.24
What’s less clear is the causal link; it may not be that vaping is what caused them to start smoking. It could be that, for some underlying reason, young people who are more likely to start vaping are the same young people who are more likely to take up smoking. These young people who vape are possibly more prone to “risky” or addictive behaviors than those who don’t, and that likely makes them more open to smoking cigarettes, too.
Overall, the literature on this causal relationship is inconclusive. One recent study, published in Addiction, suggested with “very low certainty evidence” that, at the population level, an increase in vaping rates is associated with a decline in smoking rates.25 This study has received pushback from other researchers in the same journal, who argue that the available evidence — or lack of reliable evidence — does not support the conclusion that vaping actually helps to reduce future smoking among young people.26
Since very few reviews tackle this “causal” question and those that do attempt to, at best, find only “very low certainty evidence” of vapes displacing cigarettes (which is contested), it’s hard to know exactly how the rise of vaping has affected young people’s behaviors around cigarettes.
We can gain some insight into this question through population-level data on smoking rates. If vaping were a widespread reason for young people to start smoking tobacco, then we might expect to see more youngsters using cigarettes over time. Vaping rates have increased quite dramatically among young people, and with almost 20% of 15-year-olds regularly using them, have reached a level where we would expect to see an effect in the smoking data.
In England, we don’t see such an effect: smoking rates continue to fall (or hold constant at their lowest levels in decades). You can see this in the chart below. Only a few per cent of 15-year-olds smoke regularly, which is a huge drop from the 1980s, when it was over 20%. The share of pupils (aged 11 to 15) who have ever smoked has also fallen dramatically, from 50% to 12% since the 1990s. The same is true for other nations in Great Britain.
To be clear: this doesn’t mean vaping has been a driver of this decline in smoking. Smoking rates have fallen for a variety of reasons, and the initial drop predates e-cigarettes. What it does suggest is that any potential “gateway” effect has not yet been large enough to offset the decline in smoking.

These trends are reflected in the United States, where smoking rates among young people have continued to fall, reaching a low of 1.7% high school students in 2024. As Jamie Hartmann-Boyce, assistant professor of health policy and management at the University of Massachusetts Amherst, says:
“The smoking rates among kids have declined steeply, and whether or not that's due to vaping or something else is up in the air. But it's difficult to argue that—in the U.S. population—youth vaping is en masse causing kids to smoke. The data doesn't support that so far.”
Evidence from New Zealand is still contested, with some researchers suggesting that vaping is responsible for a slowdown in the decline of youth smoking rates.27 Others dispute this.28
To me, there is a clear argument to be made that e-cigarettes can positively impact many adults. In older populations, the majority of people who vape are ex- or current smokers; only a small percentage have never smoked. However, the net impact on teenagers is less clear. That’s because most of those who vape are teens who haven’t had time to become smokers. It’s hard, then, to know the counterfactual of how many would go on to smoke cigarettes if vapes didn’t exist.
That leads to another concern: that a large population of young people is becoming addicted to nicotine through vaping. Many are those who would never have smoked in the pre-vaping era. I think this is broadly true. The significance of this problem depends on how harmful we think nicotine is on its own. It is far less dangerous than many of the other ingredients in cigarettes, but most health experts would argue that it isn’t risk-free.
That’s why public health advice almost always tries to strike a balance between recommending e-cigarettes as an effective tool to quit tobacco without encouraging vaping use among young people and non-smokers. The challenge for public communication is that emphasizing the small health risks of vaping for non-smokers or young people can make it seem particularly “unsafe” — or even more harmful than cigarettes — which isn’t true.
Smoking is uniquely bad for human health, and almost anything that can help people quit will improve public health
I started this article with survey data; it showed that most British smokers think that vaping is more or equally harmful than cigarettes.
The evidence is clear that this is incorrect.
A smoker who replaces cigarettes with e-cigarettes will reduce their health risks and potentially live a longer and healthier life. The fact that many smokers believe the opposite means that many will not try e-cigarettes as a way to quit. That’s a shame because e-cigarettes are the most effective quitting tool available.
A smoker who replaces cigarettes with e-cigarettes will reduce their health risks and potentially live a longer and healthier life.
At the same time, given the current evidence we have about vaping rates among young people, policymakers have very valid concerns about how to best promote e-cigarettes as a safer cessation tool without actively encouraging millions of teens to start. Striking this balance is difficult, but crucial. The stakes are high.
Smoking is the leading risk factor for early death in many countries and kills more than six million people every year. The mistaken belief that vaping is just as harmful means fewer smokers make the switch that could save their lives. Closing this perception gap could save millions.
Update note
A previous version of this article referenced one study as being a Cochrane Review. While this study and its protocol were registered in the Cochrane Library, the final study was published in the journal Addiction (not in Cochrane). This has been corrected.
The section on vaping associations in young people has also been updated to reflect disagreements within the scientific literature on the causal impact of vaping on youth smoking rates.
Acknowledgments
Many thanks to Max Roser, Edouard Mathieu, Simon van Teutem, and Fiona Spooner for their valuable suggestions and feedback on this article, and to Marwa Boukarim for work on its visualizations.
Smoking: How large of a global problem is it? And how can we make progress against it?
Every year, around eight million people die prematurely as a result of smoking. But there are things we can do to prevent this.
Smoking
Tobacco smoking is one of the world’s largest health problems today.
How do researchers estimate the death toll caused by each risk factor, whether it’s smoking, obesity, or air pollution?
Risk factors are important to understand because they can help us identify how to save lives. How do researchers estimate their impact?
Endnotes
This additional study, based on more than 28,000 survey respondents in England, found the same. From 2014 to 2023, there was a substantial increase in the share that said vapes were more harmful. Most adult smokers in 2023 thought e-cigarettes were at least as harmful as cigarettes.
Jackson, S. E., Tattan-Birch, H., East, K., Cox, S., Shahab, L., & Brown, J. (2024). Trends in harm perceptions of E-cigarettes vs cigarettes among adults who smoke in England, 2014-2023. JAMA Network Open, 7(2), e240582-e240582.
As I’ll discuss later, part of this may be a selection effect: many of the smokers who thought vapes were less harmful in 2015 have perhaps stopped smoking since then. So the remaining smokers in 2025 include those who have been more reluctant or have struggled to quit. They might be less willing to try alternatives that could help them quit (and might possibly be trying to find justifications for why).
If you think that your teen vaping is better than them smoking – think again — The Telegraph
Recent data on e-cigarette use suggests that around 10% of adults in the UK use them, with just under 8% using them daily. Cigarette smoking is only slightly higher, at around 12%.
Oza, S., Thun, M. J., Henley, S. J., Lopez, A. D., & Ezzati, M. (2011). How many deaths are attributable to smoking in the United States? Comparison of methods for estimating smoking-attributable mortality when smoking prevalence changes. Preventive medicine, 52(6), 428-433.
Royal College of Physicians. E-cigarettes and harm reduction: An evidence review. RCP, 2024.
Here’s Public Health England: “Alternative nicotine delivery devices such as vaping products can play a vital role in reducing the huge health burden caused by cigarette smoking, which remains: (i) the largest single risk factor for death and years of life lived in ill-health globally, (ii) a leading cause of health inequalities in England, and (iii) the second most important risk factor for death and disability-adjusted life years globally.”
Here is the Royal College of Physicians: “E-cigarettes should be promoted as an effective means of helping people who smoke to quit smoking tobacco.”
Health Canada: “If you've tried approved methods to quit and are still smoking, switching completely to vaping nicotine is less harmful than continuing to smoke. Youth and people who don't smoke, shouldn't vape.”
Hukkanen, J., Jacob III, P., & Benowitz, N. L. (2005). Metabolism and disposition kinetics of nicotine. Pharmacological reviews.
As you can see from the graph on “E-liquid strength” in these surveys in England, many vapers use e-cigarettes with a nicotine content of 6mg, 7mg, or 12mg, which is lower than the 20mg standard we assumed above.
The Royal College of Physicians quotes 8 to 10 puffs over 8 or 9 minutes. Having spoken to smokers and looking at more online references, this seems conservative. That means the nicotine intake from cigarettes could be higher.
Ozekin, Y. H., Saal, M. L., Pineda, R. H., Moehn, K., Ordonez-Erives, M. A., Figueroa, M. F. D., ... & Vladar, E. K. (2023). Intrauterine exposure to nicotine through maternal vaping disrupts embryonic lung and skeletal development via the Kcnj2 potassium channel. Developmental biology.
Ussher, M., Fleming, J., & Brose, L. (2024). Vaping during pregnancy: a systematic review of health outcomes. BMC Pregnancy and Childbirth.
Cohn, A. M., Elmasry, H., Wild, R. C., Johnson, A. L., Abudayyeh, H., Kurti, A., & Coleman-Cowger, V. H. (2023). Birth outcomes associated with E-cigarette and non–E-Cigarette tobacco product use during pregnancy: an examination of PATH Data Waves 1–5. Nicotine and Tobacco Research.
Galbraith, D., & Weill, D. (2009). Popcorn lung and bronchiolitis obliterans: a critical appraisal. International archives of occupational and environmental health.
Logue, J. M., Sleiman, M., Montesinos, V. N., Russell, M. L., Litter, M. I., Benowitz, N. L., ... & Destaillats, H. (2017). Emissions from electronic cigarettes: assessing vapers’ intake of toxic compounds, secondhand exposures, and the associated health impacts. Environmental science & technology.
In the UK, around two-thirds of smokers say they want to quit. The same is true in the United States. And, in Australia.
In any given year, more than one-third of British smokers try to quit. Over years or even decades, more than half of smokers will likely have tried at least once.
Jackson, S. E., Brown, J., Buss, V., & Shahab, L. (2025). Prevalence of popular smoking cessation aids in England and associations with quit success. JAMA Network Open.
Jackson, S. E., Brown, J., Buss, V., & Shahab, L. (2025). Prevalence of popular smoking cessation aids in England and associations with quit success. JAMA Network Open.
Here is the latest review, and its predecessor, published in 2022.
Lindson, N., Butler, A. R., McRobbie, H., Bullen, C., Hajek, P., Wu, A. D., ... & Hartmann-Boyce, J. (2025). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews.
Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P (2022). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews.
Lindson, N., Butler, A. R., McRobbie, H., Bullen, C., Hajek, P., Wu, A. D., ... & Hartmann-Boyce, J. (2025). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews.
McNeill, A, Simonavičius, E, Brose, LS, Taylor, E, East, K, Zuikova, E, Calder, R and Robson, D (2022). Nicotine vaping in England: an evidence update including health risks and perceptions, September 2022. A report commissioned by the Office for Health Improvement and Disparities. London: Office for Health Improvement and Disparities.
East, Katherine, et al. (2025). Perceived Harm of Vaping Relative to Smoking and Associations With Subsequent Smoking and Vaping Behaviors Among Young Adults: Evidence From a UK Cohort Study. Nicotine and Tobacco Research.
The US Centers for Disease Control and Prevention (CDC) states that 9 out of 10 adults who smoke daily tried their first cigarette before the age of 18.
In England, two-thirds of smokers start before the age of 18, and 83% before the age of 20.
An umbrella review — which is bacially a review of reviews — found that most studies found a positive association between youth vaping and smoking. They found that young people who vape are around three times as likely to smoke cigarettes as those who don’t vape.
While they discuss a “causal relationship” in this paper, it’s difficult to demonstrate this causality since most of the underlying studies are observational, and often contain confounding factors. See more discussion on the merits and limitations of this umbrella review from experts.
Golder, S., Hartwell, G., Barnett, L. M., Nash, S. G., Petticrew, M., & Glover, R. E. (2025). Vaping and harm in young people: umbrella review. Tobacco Control.
A previous version of this article referenced this study as being a Cochrane Review. While this study and its protocol were registered in the Cochrane Library, the final study was published in the journal Addiction (not as a Cochrane Review).
Begh, R., Conde, M., Fanshawe, T. R., Kneale, D., Shahab, L., Zhu, S., ... & Hartmann‐Boyce, J. (2025). Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review. Addiction.
Egger, S., & McKee, M. (2025). Unreliable evidence from problematic risk of bias assessments: Comment on Begh et al.,‘Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review’. Addiction.
You can also read the original authors’ response to this critique.
Hartmann-Boyce, J., Begh, R., Conde, M., Shahab, L., Jackson, S. E., Pesko, M. F., ... & Lindson, N. (2025). Response to comment from Egger and McKee entitled'Unreliable evidence from problematic risk of bias assessments: Comment on Begh et al., 'Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review"'. Addiction.
Egger, S., David, M., McCool, J., Hardie, L., Weber, M. F., Luo, Q., & Freeman, B. (2025). Trends in smoking prevalence among 14–15-year-old adolescents before and after the emergence of vaping in New Zealand; an interrupted time series analysis of repeated cross-sectional data, 1999–2023. The Lancet Regional Health–Western Pacific.
Walker, N., Parag, V., Wong, S. F., Youdan, B., Broughton, B., Bullen, C., & Beaglehole, R. (2020). Use of e-cigarettes and smoked tobacco in youth aged 14–15 years in New Zealand: findings from repeated cross-sectional studies (2014–19). The Lancet Public Health.
Chan, G. C., Sun, T., Vu, G., & Hall, W. (2025). Caution is needed when interpreting interrupted time series findings on vaping and smoking. The Lancet Regional Health–Western Pacific.
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title = {While vaping is not risk-free, it is less harmful than tobacco},
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year = {2025},
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